(Progress in Brain Research 203) Stanley Finger, Dahlia W. Zaidel, François Boller and Julien Bogousslavsky (Eds.)-The Fine Arts, Neurology, And Neuroscience_ Neuro-Historical Dimensions-Academic Pres

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Bridget Marie Flaherty Professor of Neurology
Neurobiology, and Pharmacology;
Director, Center for Neuroscience &
Regeneration/Neurorehabilitation Research
Yale University School of Medicine
New Haven, Connecticut
USA
Donald G. Stein
Asa G. Candler Professor
Department of Emergency Medicine
Emory University
Atlanta, Georgia
USA
Dick F. Swaab
Professor of Neurobiology
Medical Faculty, University of Amsterdam;
Leader Research team Neuropsychiatric Disorders
Netherlands Institute for Neuroscience
Amsterdam
The Netherlands
Howard L. Fields
Professor of Neurology
Endowed Chair in Pharmacology of Addiction
Director, Wheeler Center for the Neurobiology of Addiction
University of California
San Francisco, California
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Contributors
Julien Bogousslavsky
Genolier Swiss Medical Network Neurocenter, Clinique Valmont, Montreux, and
Center for Brain and Nervous Disorders (Neurocentre), Genolier Swiss Medical
Network, Genolier, Switzerland
Francois Boller
Coordinator of Centres for Acquired Brain Injury Rehabilitation, Bethesda,
MD, USA
Valmantas Budrys
Clinics of Neurology and Neurosurgery, Faculty of Medicine, Vilnius University,
Vilnius, Lithuania
Javier DeFelipe
Laboratorio Cajal de Circuitos Corticales, Centro de Tecnologa Biomedica,
Universidad Politecnica de Madrid, and Instituto Cajal, Consejo Superior de
Investigaciones Cientficas, Madrid, Spain
Eugenio Frixione
Section of Methodology and Theory of Science, Department of Cell Biology,
Center for Research and Advanced Studies IPN (Cinvestav), Mexico City, Mexico
Christopher Gardner-Thorpe
MD, FRCP, FACP, Consultant Neurologist, and Course Director, Diploma Course
in Medical History, Society of Apothecaries, Blackfriars Lane, London, and
The Coach House, 1a College Road, Exeter, EX1 1TE, UK
Douglas J. Lanska
Veterans Affairs Medical Center, Tomah, WI, USA
John Robert Lanska
University of Wisconsin-Eau Claire, Eau Claire, WI, USA
J. Wayne Lazar
Neuropsychology, Garden City South, NY, USA
Rebecca Messbarger
Department of Romance Languages, Washington University, St. Louis, MO, USA
Julio Montes-Santiago
Service of Internal Medicine, Complejo Hospitalario Universitario, Vigo, Spain
Bartlomiej Piechowski-Jozwiak
Department of Neurology, Kings College Hospital, London, UK, and Department
of Neurology, The Medical University of Warsaw, Warsaw, Poland
Gul A. Russell
Department of Humanities in Medicine, Texas A&M Health Science Center,
Bryan, TX, USA
Preface
It is with pleasure that we are able to present two volumes on The Fine Arts,
Neurology, and Neuroscience. These books will be the first of a group of volumes
on the arts soon to appear in Progress in Brain Research. The remaining volumes,
which will come forth in 2014 and 2015, will deal with neurology and neuroscience
in literature and music, respectively.
The idea for such volumes on art, literature, and music stemmed from the rapidly
growing interests basic and applied neuroscientists have been showing in the arts,
broadly defined. This reflects a scientific and intellectual curiosity that goes beyond
just a busy practice or a laboratory stocked with the latest tests or recording or devices. It was further stimulated by how inquisitive minds in the humanities also have
been increasingly turning to neurology and the basic neurosciences to shed further
light on these subjects.
Bringing medicine, the laboratory neurosciences, and the arts together might, at
first glance, seem like a new development, especially given how narrow and compartmentalized teaching has become in many medical schools, in music and fine arts
departments, and even in science-oriented curriculums. But a closer look at todays
landscape will also reveal a growing belief that bringing scholars from different disciplines together will lead to new insights and discoveries.
Further, on closer inspection one will find that interdisciplinary interactions
between the biomedical sciences and the arts already have a lengthy and rather
colorful history, albeit one that merits more attention. Indeed, a journey back in time
will reveal that anatomists were working with artists to illustrate their books since the
Renaissance; that novelists have long had a fascination with neurological disorders,
especially epilepsy and stroke; and that more than a few famous musicians suffered
from syphilitic and tubercular tumors, as well as from various other neurological problems, which affected how they composed, played, and perceived their music. For these
and other reasons, the volumes in this series will present both current thoughts and
modern examples about how science, medicine, and the arts can intersect and interact,
while also looking back at famous case histories and selected works by the masters.
There are, of course, many ways of approaching just how the neurosciences and
the humanities have and still can converge. But rather than just selecting one approach and analyzing it in depth, we have opted to showcase several, hoping to
wet the palates of our readers for further readings and, even better, perhaps for even
initiating their own scholarly studies. This will become clear in our first two volumes, the ones on the fine arts.
We shall begin this odyssey by presenting a series of essays on how skilled artists,
some reasonably well known and others less so, helped to illustrate early anatomy
books and also worked on wax models that could be used for teaching anatomy
and medicine. In Part 1, we shall also examine how the demand for more informative
scientific and medical artwork increased steadily over time, until photography became the medium of choice.
vii
viii
Preface
Some anatomists were themselves quite skilled in the arts and/or art lovers, and
Part 2 of this volume will introduce a few of these talented individuals and examine
their artistic abilities or love of art in the context of their contributions to the neurosciences. One such person is John Bell, a surgeon and artist, and the somewhat forgotten brother of Charles Bell, who is, of course, the much better known Bell to
neurologists and neuroanatomists. Two others are Jean-Martin Charcot and Santiago
Ramon y Cajalboth having once contemplated careers as fine artists.
Given the fascination people have had, and still do have, with revered artists plagued by suspected neurological disorders, some selected case studies will be presented in Part 3 of this volume. Here, we shall look at the effects of lead
poisoning, an insidious and very real occupational danger for unknowing or adventurous artists, such as the great Spanish artist, Francisco Goya y Lucientes, who
stands out for using heavily lead-based paints on his canvases. We shall also examine
how strokes and other fairly common neurological diseases have affected some
equally famous artists.
In contrast to this sampling of historical material, the second volume on the fine
arts will focus on newer developments that also show how neurology, the basic neurosciences, and the fine arts can come together. Its authors will look at brain damage,
creativity, and the arts, as well as many other things, ranging from evolutionary approaches to the fine arts to what scientists today have been gleaning from their brain
imaging studies.
We very much hope that these two volumes on the fine arts (and indeed all of the
volumes in this series) will show our readers some of the many ways in which neurology, the basic neurosciences, and the fine arts can come together, and that they will also
stimulate new research spanning seemingly diverse fields. With these thoughts in
mind, let us now turn to the essays themselves, starting with those based in
historya collection that we, the editors, found both fascinating and informative,
and which we would like to present in memory of the late Frank Clifford Rose
(19262012), a man who had long been a pioneer in promoting the history of the neurosciences (basic and applied) as a promising path to understanding more about the
arts, and the arts as a fitting subject for those in his own discipline, neurology.
Stanley Finger
Dahlia W. Zaidel
Francois Boller
Julien Bogousslavsky
Recommended Additional Readings

Bogousslavsky, J., Boller, F., 2005. Neurological Disorders in Famous Artists. Karger, Basel.
Bogousslavsky, J., Hennerici, M.G., 2007. Neurological Disorders in Famous ArtistsPart 2.
Karger, Basel.
Bogousslavsky, J., Hennerici, M.G., Bazner, H., Bassetti, C., 2010. Neurological Disorders in
Famous ArtistsPart 3. Karger, Basel.
Rose, F.C. (Ed.), 2004. Neurology of the Arts. Imperial College Press, London.
CHAPTER
Vesalius and the emergence

of veridical representation in
Renaissance anatomy
Gul A. Russell1
Department of Humanities in Medicine, Texas A&M Health Science Center, Bryan, TX, USA
1
Corresponding author. Tel.: 1 979 436 0523, Fax.: +1 979 436 0083,
e-mail address: russell@medicine.tamhsc.edu
Abstract
The Renaissance marks the introduction of veridical representation of anatomical structure
into printed books. For centuries, anatomy that had relied solely on textual description and
the authority of the written word was transformed. An existing graphic tradition only visualized function within a humoral theory, schematically naming the parts or mapping the uses
of the parts for mnemonic purposes. In the sixteenth century, anatomists and artist began to
apply their knowledge and skills to present the fabric of the dissected human body with
increasing detail and accuracy, exemplified by the naturalistic illustrations of the brain in
Vesalius De humani corporis fabrica (Basel, 1543). How did this transformation occur?
Among the causal factors, the importance the humanist textual scholarship will be shown
not only in the recovery of the anatomical writings of Galen (129ca. 216), in particular,
but also in providing a model in establishing anatomical truth by a method of comparison.
It will be argued that Vesalius comparative approach in dissection, using both human and
animal preparations against Galens textual description, paved the way for cumulative observations of greater detail, which in turn required the representational skills of artists. An analysis of Vesalius views between 1538 and 1543 shows a shift in the use of illustrations from
serving as a visual record to compensate for limited access to cadavers in teaching, to becoming an indispensable tool to accurately convey detailed anatomical structure through the medium of printing. With the Fabrica, morphology became divorced from humoral function and
enduring paradigms established that dominated until the nineteenth century.
Keywords
Vesalius, brain dissection, Berengario da Carpi, Charles Estienne, Galen, anatomical illustration, rete mirabile, ventricular localization, Vigevano, Fabrica
Progress in Brain Research, Volume 203, ISSN 0079-6123, http://dx.doi.org/10.1016/B978-0-444-62730-8.00001-3

2013 Elsevier B.V. All rights reserved.
CHAPTER 1 Vesalius and the emergence of veridical representation
FIGURE 1
Title page. Andreas Vesalius, De humani corporis fabrica (Basel, 1543). 43 28.5 cm.
1 A new vision of anatomy
1 A NEW VISION OF ANATOMY

On August 1, 1542, Vesalius completed his monumental De humani corporis fabrica
libri septem, with over 700 pages. It also had 85 plates, containing almost 420 separate illustrations in an oversize format. It was followed shortly after by the Epitome,
intended as a brief introductory summary in 12 leaves of mainly illustrations.1 They
were cut in Venice on pear wood and then transported with great care to Basle to be
printed. The publication in 1543 was a unique masterpiece, elegantly printed and
superbly illustrated. It was revolutionary in significant ways and no less than in
the exploitation of graphic representation as an effective visual tool in conveying
detailed anatomical knowledge.
The title and the frontispieces left no doubt that this was not the kind of illustrated
anatomy book that had appeared in print since Johannes Kethams Fasciculus Medicinae (1491), including the more recent Berengario da Carpis Isagoge breves (1536).
Inserted into the usual anatomy of the human body was the word fabrica, a term from
architecture denoting construction,2 which was rarely applied specifically to anatomy.3 The new emphasis was on the title page, illustrating (Fig. 1) how the fabric
or construction of the human body was revealed. This was not presented in private,
but openly to general scrutiny as a public spectacle at the theater of anatomy. Most
significantly, the figure of focus in the scene was not the female cadaver on display,
which in and of itself was not novel at all.4 It was the anatomist, holding center stage in
the midst of a packed audience of awed spectators within a vast temple enclosure.5
The anatomist was also individually portrayed on the frontispiece. He is again
shown in the very act of practical dissection. This time, he is demonstrating the details in the fabric of the forearm, the specific construction of the tendon that
moves the fingers of the hand (Fig. 3). Interestingly, the books, the sources of a
learned anatomist (Fig. 5), from which he would have been reading during a demonstration are conspicuously absent (Fig. 2). Instead, they are replaced by a small
For the recently discovered annotated 1555 edition in Vesalius own hand in preparation for a possible
third edition, see Nutton (2012).
2
The term was used in the sense of a building, construction, or the action of making construction,
structure, workmanship (See the Oxford Latin Dictionary; the Oxford English Dictionary). In the
translation of Galens De usu partium, the usages include structure (OMalley, 1964), construction
(May, 1968), fabrica (Carlino, 1994; Lind, 1972; fabrica also in Estiennes De dissectione partium, 1545.
3
A previous use of fabrica occurs in the title of the Latin translation of a Greek medical work in 1537. It
was included in Guinters Institutions with which Vesalius was familiar (see Kusukawa, 2012, pp. 204,
285).
4
Park (2006), p. 9, argues that dissection was practiced on female bodies and not hindered by any religious prohibition, and criticizes the current historiography as having focused single-mindedly on
dissection as an institutional practice and performed by male masters employed by universities and
medical colleges, for the benefit of male students and practitioners, on mostly male bodies of condemned criminals.
5
There are numerous detailed descriptions of this plate (see Carlino, 1994, pp. 3953; OMalley, 1964,
pp. 141145).
FIGURE 2
Frontispiece. Johannes, Ketham, Fasciculus Medicinae (Venice, 1495 edition). An academic
dissection scene where the professor, seated at a distance in his high chair, reads the text, a
barber-surgeon carries out the dissection which is conducted by a demonstrator.
piece of paper on the table, which is hardly noticeable next to his instruments on display. The writing has been found to be from the opening lines of the relevant chapter,
thus tying the dissection directly to his own detailed textual description (OMalley,
1964). He has taken over the menial role of sector traditionally carried out by the
barber-surgeon or the occasional medical student, challenging the viewer with a direct
unflinching gaze, at least as shocking in its visual impact as Manets Dejeuner sur
lherbes (1863). Whereas Manet might have offended the nineteenth-century bourgeois sensibilities, Vesalius was challenging the established professional role of the
learned physician, the impact of which we can only fully appreciate with historical
hindsight.6 The change to the direct involvement of the anatomist had profound consequences for the study of the human body and its interior parts, such as the brain.
The extent to which the illustrations have attracted attention is not surprising. Their
style, variety, and nature throughout the Fabrica are staggering. Most of the major
ones take up a full page. The anatomists work behind the scenes is also revealed,
using the putti, seemingly at play, in miniaturized vignettes within the frame around
each initial letter for the opening paragraphs of the books and chapters (Fig. 4).
The message is unmistakable. The anatomist has closed the distance that traditionally separated the learned physician from directly exploring the proper subject
of anatomy, the fabric of the human body itself.
At the same time, the anatomy book has been transformed. In the Preface of the
1543 edition, which is dedicated to Charles V, Vesalius explains why it is essential to
teach anatomy properly, by encouraging students to undertake dissection with their
own hands, as well as how it should be taught by illustrations. He defends their use
against those who strongly condemn the presentation of anatomy to students, not
merely by words but also no matter how exquisitely executed, by pictorial delineation
of the parts of the human body. . .. (Vesalius, 1542 in OMalley, 1964, p. 322). His
aim has been to describe as completely as possible the [fabric] structure of the human
body which is formed not of ten or twelve partsas it may seem to the spectatorbut
of some thousands of different parts. . .. Here he gives his reasons why visual representation is important to anatomy, writing: How greatly pictures assist in the understanding of these matters and place them more exactly before the eyes than even the
most precise language, no student of geometry or other mathematical disciplines can
fail to understand. (Vesalius, 1542, Trans., OMalley, 1964, p. 323).
Thus, the anatomy book, a relentlessly verbal textual description for centuries,
has been transformed. The inclusion of pictures was not new, whether in manuscripts
or the subsequent printed books, such as the Fasciculus medicinae (1491, 1494). Pictures were also related to the text already with Berengario da Carpis Isagoge
breves. . . (1522). The hallmark of the new approach in the Fabrica is the remarkable
emphasis on the exactitude of the presentation of anatomical parts before the eyes,
and their exquisite execution in pictorial delineation.
For the continuity of the practice of dissection after Galen, and the extended religious authorization in
the Papal bull, for public dissections as in the case of Padua, see Carlino, 1994, pp. 183186.
FIGURE 3
Portrait of Vesalius, De humani corporis fabrica (Venice, 1543). Woodcut 19.7 14.5 cm.
Demonstrating his dissection of the forearm with the tendon of the first muscle moving the
fingers, and the underlying tendon of the second muscle. The paper on the table is the
opening line of chapter ii on the muscles in Book II of the Fabrica.
The initial success of the Fabrica, despite its revolutionary argument, has been
attributed to its illustrations, at times almost to the extent of ignoring the significance
of its textual content. In fact, it is aptly described as one of the most famous, visually
familiar, of all unread books (Nutton, 2012, p. 545). Historians of both art and anatomy have emphasized the magnificence of the plates, where the artists hand is
clearly visible, translating the reality of dissection into powerful illusions of aesthetic beauty, exemplified by the flayed muscles and skeletons in classical poses of
antique sculptures (Cazort et al., 1996; Kemp, 1970; Kemp and Wallace, 2000;
Laurenza, 2012). But who were the artists? Who created such compelling images?
Vesalius neither identifies nor acknowledges his exceptional artist(s) or his woodblock cutters. The absence of their identity has remained a subject of debate. Scholars
have been trying with limited success to name at least some of them from the memoirs of Vasari or Cellini, and the ateliers of artists in Venice and Rome.7
There is no doubt that the appearance of the Fabrica marks a turning point in
conveying anatomical knowledge by illustrations prepared for and transmitted
through the medium of printing. This has been viewed as the achievement of the
anatomists collaboration with the artist(s) (Cuir, 2009; Kemp, 1996; Nutton,
2012; Rifkin and Ackerman, 2006). How and why the apparent collaboration
emerged are questions to be explored. What were the grounds for its rise and success?
Was it perceived as necessary? If so, why? Any attempt to provide answers must
consider the historical context of how the use of visual illustrations was perceived.
In addition, the objectives of the anatomists and the artists should be clarified to identify their roles in working together. At the same time, it is also important to take a
critical approach to the illustrations to avoid taking at face value what may appear to
be a veridical record of observation based on dissection.
Finally, one fundamental feature in illustrations is the increasing accuracy of detail, exemplified by the representations of the structure of the brain in the Fabrica.
Scholars have paid more attention, however, to the dramatic ecorche muscle figures
(the so-called living cadavers) set against the background of the Umbrian landscape
than those of the unembellished brain (Cazort et al., 1996; Kemp, 1970, 1996;
Roberts and Tomlinson, 1992). Among the figures poised between the old and
the new, the superbly delineated Vesalian brains (Fig. 4) require attention on their
own. Their analysis can help answer the question of how the concern with accuracy
of anatomical detail emerged within a tradition of schematic figures depicting functional relationships.8 It will be argued that the representation of what was seen independently of function was not a straightforward process, but a gradual development
as a result of cumulative empirical experience, rather than a directed purposive
For the identity of the artists, see Kemp (1970); for a summary of the findings, see Kusukawa (2012),
Laurenza (2012), Simons and Kornell (2008), Saunders and OMalley (1952).
8
Singer, Ch. (1952, pp. 88124) in Vesalius on the Brain, reproduces the plates and drawings largely
from Book VII of the 1543 edition of the Fabrica with their captions in translation.
10
FIGURE 4
This woodcut presents for the first time a detailed delineation of the base of the brain and
cerebellum, exposing seven of the cranial nerves in accordance with Galen. Vesalius,
De humani corporis fabrica (1543), Book IV, i.
activity from the start. Its origins will be traced to the consequences of the Renaissance recovery of classical knowledge in art and in the humanist textual scholarship.
On the one hand, the objective in art of creating a copy, an exact likeness of the natural world, was matched by the skills of the artist to achieve it. On the other hand,
with the textual recovery process, the humanist scholarship produced an unexpected
concept and a method, which proved to be of fundamental importance in anatomy
and anatomical illustration. This was the concept of an original source, and a
new method of comparison.
2 REVIVAL OF CLASSICAL KNOWLEDGE: ART AND ANATOMY

The Renaissance was characterized by a conscious revival of classical knowledge in
art and anatomy. Only twice in this globe, in ancient Greece and in Renaissance
Europe, have artists striven systematically to approximate their images to the visible
world, and to achieve a likeness that might deceive the eye. (Gombrich, 1975, p.11).
2 Revival of classical knowledge: Art and anatomy
One could add that in a parallel development to that in ancient Alexandria, anatomists began again in Bologna and Padua, to explore the detailed fabric of the human body through systematic dissection. These two endeavors, however, came
together during the Renaissance alone, in particular in sixteenth-century Italy, where
the skills of both anatomists and artists were applied to record the dissected fabric of
the human cadaver.
Artists in the fifteenth century had turned to the only surviving treatise of the
Roman architect Vitruvius (c.d. 15 BCE), the extant texts of Euclid (d. 283 BCE),
and the optics of Alhazen (Ibn-al-Haytham, d. 1040). Scholararchitectengineers,
such as Alberti, had laid down the theoretical principles, and empirical tools for painters in De Pictura (Alberti, 1972). Architectsculptors, Ghiberti and Brunelleschi,
had posed and solved the problems of representing solid objects on a flat surface with
the rules of perspective. Ghiberti in his Commenterii (c.1453) had identified the wide
range of subjects with which the artist needed to become acquainted. These included
not only the visual science of space but also the medicine for the nature of man, and
anatomy for the understanding of human structure, motion, and proportions.
During the sixteenth century, Florence, Venice, and Rome had become centers of
great art. Artists such as Leonardo da Vinci, Michelangelo, and Raphael made dissections of the body. Although they are frequently regarded as artist-anatomists,
with the exception of Leonardo, there is no evidence that their dissections were more
than skin deep in preparation for their artwork. To create veridical representations,
they also became interested in measurement. Albrecht Durer, for example, made extensive studies to establish the exact proportions of the parts of the body and the face
(Kemp, 1990). Raphael, in his anatomical sketches, studied the static and dynamic
equilibrium of the body (Laurenza, 2012). Such artists had the skills to create the
illusion of exact likenesses.
The revival in anatomy came later in the early sixteenth century, especially with
the recovery of the writings of Hippocrates, Aristotle, and (most importantly) Galen.
The ensuing humanist scholarship bears directly on the subsequent artist and anatomist collaboration.
Access to original texts in print led to the discovery of how erroneous the Latin
translations were. The translators had frequently misinterpreted the content, as well
as creating a complex problem of muddled anatomical terminology in barbarous
Latin. The corrupt versions of classical, Arabic and Hebrew vocabulary were confusing and frequently incomprehensible. There was a need to redefine and clarify by
going back to the original texts.9 Although the vigorous polemics of the humanists
have been interpreted largely as attacks on the Arabic textual legacy, they were
aimed more against the medieval translators from both Greek and Arabic into Latin
For the importance of the discovery of Polluxs Onomasticon (2nd c.) in the revival of classical terminology, and for a detailed discussion of the Hebrew and Arabic medical terms, see Renaissance
Anatomical Vocabulary (Singer and Rabin, 1946), pp. lxv-lxxi.
11
FIGURE 5
Johannes Ketham, Fasciculus Medicinae (Venice, 1495 edition). Out of the 11 displayed
standard sources of a learned physician, only 4 are Graeco-Roman, the rest are Arabic texts in
Latin translation.
3 The concept of original source: A textual prelude to the human cadaver
than against Galen or Avicenna, as usually claimed10 (OMalley, 1964; Russell,

1997; Singer and Rabin, 1946; Siraisi, 1987).
What emerged was a recognition of the critical importance of using original
sources. The existing Latin versions were revised with full or partial retranslations,
to get closer to Greek and Arabic medical texts for a better understanding. A concern
with accuracy emerged as a consequence of the discovery of textual discrepancies
between the summaries, commentaries, translations, and the originals. The comparisons provided incontrovertible evidence of the unreliability of secondhand
knowledge.
Galens influence had been continuous in diluted versions through such medical texts as Mondino de Luzzis Anathomia (Pavia, 1476). The recovery of original
anatomy texts in print also stimulated a new interest in the ancient Greek physicians.
For example, Vesalius hoped that anatomy would be cultivated and taught as it was
once conducted in Alexandria in the age of Herophilus and Andreas Marinus and
other distinguished anatomists11 who became known through Galens writings.
The Fabrica was no longer arranged according to Mondinos medieval order of dissection (Wickersheimer, 1926). It followed Galens Anatomical Procedures that became available, in part, through Guinter Andernachs translation of 1531, and part of
which Vesalius revised for the Guinta edition of Galens work (OMalley, 1964;
Singer and Rabin, 1946).
3 THE CONCEPT OF ORIGINAL SOURCE:

A TEXTUAL PRELUDE TO THE HUMAN CADAVER
The recovery and publication in 1529 and 1531 of Galens De anatomicis administrationibus (On Anatomical Procedures), as well as his De usu partium created a new
emphasis in anatomy (Galen, 1956, 1968). They revealed how much importance
Galen placed on firsthand experience and direct observation through dissection
(Carlino, 1994; Lind, 1975; Singer, 1952). The zeitgeist had been created. Under
Galens influence, Vesalius teacher in Paris, Jacobus Sylvius (Jacques Dubois)
who was immersed in classical scholarship, was not alone in upholding the view that
it is much better to learn the manner of cutting by eye and touch than by reading
and listening. For reading alone never taught anyone how to sail a ship or lead an
army, nor to compound a medicine.
Cazort et al. (1996); Kellett (1961).
The direct study of the human body was through dissection because the original
source of the anatomist was the cadaver itself, and not secondhand descriptions.
10
Otherwise, why would Vesalius revise the Latin translation of Rhazes in a paraphrase along with
Galen, or work with a Jewish physician on the Hebrew translation of Avicenna (See OMalley,
1964; Singer and Rabin, 1946; Siraisi, 1987).
11
This is quoted in OMalley, p. 146.
13
14
Thus, as reinforced by Galen, the concern with original sources that had emerged
out of textual scholarship became transferred to anatomy.
With the approval of public use and availability of the human cadaver, what had
previously been recognized could now be put into practice. Neither the emphasis on
the need for dissection, nor the practice itself, was new to the Renaissance physicians
(Carlino, 1994; Park, 2006). The initial objective of verifying anatomical detail in
Galens text by direct examination of the cadaver had unexpected consequences.
Despite the approval of public dissections, two problems remained in the practice
and teaching of anatomy. Access to human cadavers was limited in number and frequency. At medical schools like Bologna or Padua, a student might get to see one
dissection during the term of his training.12 It was also of short duration, due to quick
deterioration without preservatives or fixatives. Although human demonstrations
were supplemented by fresh animal preparations (Heseler, 1540; Vesalius, 1543),
the question remained. How could one have a lasting record of the observations
for teaching in the absence of the cadaver itself?
Verbal descriptions could not substitute for direct experience or observation.
Graphic representation, however, might help clarify the anatomical structures obscured by confused textual nomenclature, or the lack of clearly defined terms with
which to describe features in detail. We know, for example, that Vesalius incorporated drawings into his lectures for purposes of clarification. In the Letter of
Dedication of the Tabulae anatomicae sex of 1538, he states that his delineations
were found to be so useful that both the professors and medical students pressed
him to continue to provide them, and as part of my professional duties, I could
not disappoint them, especially since I knew that delineations of the kind would bring
no mean help to those who attended my dissections (Vesalius, 1538, p. iv in Singer
and Rabin, 1946).
Furthermore, in the process of parallel dissection, the purpose of using animals
gradually shifted from serving to demonstrate what was in the human body, as described by divine Galen, to showing the actual similarities and differences as observed in the course of dissection. This could (and in time did) bring out
discrepancies with Galens transposition from animal structures to the human.
The case of the rete mirabile exemplifies the explanatory role of visual representation in this shift.
4 SEEING AND RECORDING THE INVISIBLE: RETE MIRABILE

In the history of illustrations of the brain, the rete mirabile or the marvelous net
has an impressive record of longevity and influence. It exemplifies the complexity
of seeing and the continuity of theoretical conceptions in anatomical perceptions.
12
For the details of availability of cadavers, private and public dissections, see Carlino, 1999.
4 Seeing and recording the invisible: Rete mirabile
An elaborate network of fine vessels into which the carotid artery divides at the
base of the brain, the rete exists only in ungulates. Yet, it was transposed
from Galens dissections of the ox onto the human brain, as a critical part of
the humoral theory (Rocca, 2003). Its existence in humans remained unquestioned until the sixteenth century (Clarke and Dewhurst, 1972; Clarke and
OMalley, 1968).
In his Tabula III (1538), Vesalius initially gives the accepted description of a
reticular plexus at the base of the brain, the rete mirabile (Fig. 6), wherein the vital
is elaborated into the animal spirit. He depicts the rete as the circle, surrounding the
funnel (infundulum) from which two pear-shaped processes pass into the brain
(Fig. 6), which are the chorioform plexuses formed from arteries and veins in the
cerebral ventricles (Singer and Rabin, 1946, p. xliv; Vesalius, 1538). By the time
of the publication of the Fabrica, however, Vesalius had come to the conclusion that
it does not exist in man. It has taken him 5 years to gain insight into his error in
Tabula III, which had been published in 1538.
We also have an eyewitness account by a medical student, who attended
Vesalius public demonstration in Bologna, of the rete in the head of a sheep. Heseler
was present during a detailed dissection of the brain and nerves on the morning of
Jan. 28 1540. He observed that the rete in the sheep was
situated high up in the middle of the cranium, near where the arteries ascend, and
forming the plexus in which the spiritus animales are produced out of the spiritus
vitales transferred there. And it was reddish, fine, netlike web of arteries lying
above the bones, which I afterwards touched with my hands, as I did with the
whole head.
Heseler (1540), Trans. Almqvist and Wiksells, 1959, pp. 289291.
How Vesalius perceived demonstrations initially and how he then changed his view
after repeated comparative dissections are clearly shown by means of a series of five
small drawings, with detailed captions. Starting with a complex structure, he progressively illustrates its smaller and smaller constituent parts (Fig. 7). His descriptions, including I have here depicted and At the sides, I have indicated. . .as they
have appeared to me in dissecting. . . leave no doubt that they are drawn by Vesalius
himself, and based on direct observation (Singer, 1952, p. 116; Vesalius, 1543,
p. 621).
His methodology is of interest. He starts with a drawing (Fig. 7) of the rete mirabile, stating in the caption, I represent the plexus falsely, but in accord with Galens
description in the De usu partium (Vesalius, Fig, 17a, p. 621). Then, in the next
figure (17b), Vesalius identifies its real presence, writing:
we see it in the heads of the sheep and oxen. I have here set them out lest any think
that I do not know the difference between those animals and man.
Singer (1952), p. 117; Vesalius (1543), p. 621.
15
16
FIGURE 6
In this figure of the arteries from the third plate of the Tabulae anatomicae sex (1538),
Vesalius depicts the choroid plexus of the lateral ventricles (A), as well as the rete mirabile (B)
that is formed by the carotid arteries (EE). It clearly shows that he accepted the existence
of the rete mirabile in the human brain. In 1543, however, Vesalius will come to reject it
(see Fig. 7).
4 Seeing and recording the invisible: Rete mirabile
FIGURE 7
These small drawings were made by Vesalius. In the top figure, he has sketched the
reticular plexus [rete] as it ought to be to agree with Galens description. . .in De usu partium.
In the second figure, Vesalius delineates his own dissection of the rete in the sheep brain. He
used these two drawings to show that it exists only in the cattle and sheep, and not in
the human brain. What he had initially accepted by taking Galen on trust, he now rejects as a
result of his own discovery due to comparative dissections. In admitting his stupidity, he
is at the same time proclaiming that Galen makes mistakes (De humani corporis fabrica
(1543), IV, i).
Thus what was taken for granted in the human body in the earlier Tabula is now being
presented correctly in the Fabrica. Furthermore, Vesalius not only recognizes the
error on his part but in his unequivocal admission explains the underlying reason
for it:
I cannot sufficiently marvel at my own stupidity; I who have so labored in my love
for Galen that I have never demonstrated the human head without that of a lamb or
ox, to show in the latter what I could not see in the former, lest forsooth I should
fail that universally familiar plexus. For in no way the carotics form a plexus reticularis [in man] as Galen alleges.
Vesalius (1543), p. 642, Trans. and insertion of [man] in Singer and Rabin, 1946, p. lxiv.
Through repeated comparative dissections, the emphasis has shifted. The purpose of
using animals is no longer a paradigm for the human brain, modeled on Galen, who
dissected ox brains because he could not use human brains. His Anatomical procedures was predicated on How best to observe the things that become manifest within
the brain through dissection in the dead as well as in the living animal. (Galen, Book
II, 70 7K; Rocca, 1997, 2003). Vesalius, in applying Galen, compares the actual differences and similarities that he further confirms in the Fabrica where he presents his
detailed dissection procedure:
If only you do not deny your own eyes in the name of Galen, for here you will observe beautifully how it was in the past that everyone described the reticular
17
18
plexus in man [which professors of dissection have fabricated] if only you compare the brain of a sheep or an ox in your dissection.
Vesalius (1543), Book 7, Ch. 8, p. 654, Trans. OMalley, 1964.
Vesalius exemplifies how accuracy of observation in anatomy was achieved

by cumulative and comparative empirical experience. This was not the result of
a directed purposive search from the start that is usually assumed and
attributed to anatomists (Roberts and Tomlinson, 1992). As Vesalius at least started
off as an uncritical Galenic anatomist, his intermittent corrections constitute further evidence of progressive empirical experiences underlying the evolution of his
thinking.
It should also be noted that before Vesalius, Berengario da Carpi, a surgeon
anatomist, had already questioned the existence of the rete mirabile, also through
repeated dissections. In anatomy, neither the spoken nor the written word could
be believedwhat is required is seeing and touching the cadaver (Berengario,
1521, Commentaria, fols. VIv and VIIr, in Carlino, 1994; Carpi, 1990). It is of interest
that in his Isagoge breves, the illustrations of the brain (Fig. 8) show anatomical
details for the first time, such as lateral and third ventricles, choroid plexus (vermis),
and the infundibulum/pituitary stalk (embotum) (De Carpi, 1523; Lind, 1975;
Singer, 1952).
5 VENTRICLES: FROM FUNCTION TO STRUCTURE:

CIRCLES TO CAVITIES
A second example of the outcome of Vesalius comparative approach using Galens text,
animal, and human dissections is the depiction of the ventricles. Similar to the
rete mirabile, the emphasis on the ventricles, or the cavities alone in the Renaissance
illustrations of the brain, represents continuity with an inherited theoretical, as well as a
graphic tradition in anatomy. Their schematic representations as circles within the cranium were precursor models for the brain, but not as Galens anatomical ventricles.
The earliest representation of the ventricles occurs in Rhazes (861922) simply
ab al-Mansur, Trans.
as four tiny circles, almost lost within the lines of the text (Kit
De Koning, 1903). Whether they were transmitted in the Latin version of his work is
unclear, but the ventricles continued to be depicted as circles within the cranial outline of the head in manuscripts and subsequently in printed texts (Fig. 9) until the
early sixteenth century. They were illustrations of the ventricular localization of cognitive function according to Avicennas (d. 1039) theory with minor variations,
which is also called the medieval cell doctrine (Clarke and Dewhurst, 1972;
Russell, 2009). What was being represented was a conceptual theory, schematically
mapped within the head, and not a failed attempt at naturalistic portrayal of anatomical structure. To dismiss them as crude in a progressive development does not explain the reason for their longevity. As with the rete mirabile, they exerted a powerful
influence on the illustrations of the Renaissance anatomists even when they were
based on dissection.
5 Ventricles: From function to structure: Circles to cavities
FIGURE 8
This woodcut is from Berengario da Carpis second edition of Isagoge breves (1523). The
brain is shown from above with one ventricle exposed (top), then with both ventricles
exposed (bottom). The structures are labeled, rather than using lettering as a key. He has
provided such figures of the brain as he could so that some of the matters previously discussed
can be better understood, as you see [them]. (Trans. Lind, 1975; Saunders and OMalley, p. 52).
This is a pioneering work in recognizing how illustrations can be used to enhance
understanding of verbal descriptions in anatomy. The figures, however, lack the precision of
detail and the quality of execution to achieve it. (For comparison, see Vesalius figs. 1317.)
With the advent of medical publishing of manuscripts, artists were employed by

printers to incorporate illustrations as woodcut engravings into the texts. The external appearance of the figures, whether as portraits or full-sized bodies, is reproduced
with the skill of a Bellini or a Mantegna (Laurenza, 2012). The depiction of the
19
20
FIGURE 9
This figure, from Dryanders (Johann Eichmann, 15001560) Anatomiae hoc est corporis
humani (Dryander, 1537) is copied from an earlier one by Magnus Hundt (14701519). The
cells or ventricles have become slightly modified from circles, but the labels remain: sensus
communis, imaginativa, cogitativa, and memorabilis. Interestingly, Dryanders Anatomia
capitis (Marburg, 1536/1537) illustrates the stages of his progressive dissections of the head
and brain, which is regarded as an important transitional pre-Vesalian anatomical text
(Choulant, 1926, Trans. Frank, 1946; Clarke and Dewhurst, 1972). He exemplifies both the
conceptual schematic illustration of the ventricular localization theory and the longevity of its
influence.
interior content still remained schematic and unchanged, dictated by the anatomists
conceptual view. The artists role is only seen in the aesthetic consideration of the
placement of circles within the cranium or outside, balanced symmetrically, two
on either side along with the labels (sensus communis, cellula ymaginative,
estimativa) (Clarke and Dewhurst, 1972).
FIGURE 10
From Lorenz Phryes/Fries, Spiegel derArtzny (Fries, 1518), the six small illustrations around
the cadaver represent the stages of brain dissection. It was directly copied (see also von
Gersdorff, 1517), from an earlier popular broadside in 1517, which illustrated the
dissections of Dr. Wendelin Hock von Brackenau. Intended for physicians and surgeons, the
title of Contrafact or Counterfeit anatomy on the broadside appears to be a form of
validation that the illustrations represent the actual dissections of the physician named.
Although the execution lacks anatomical detail, the direct experience of dissection is
conveyed. The woodcuts are attributed to Waechtlin, a pupil of the elder Holbein.
22
Nor is the obstacle simply the lack of dissection as usually proposed. Even when a
drawing is claimed to be faithful to direct observation in dissection, as in Guido Vigevanos unique series of schematic figures included in his anatomy (1345;
Wickersheimer, 1926), what is revealed of the exposed brain is still only the tiny
circular cavities as the ventricles. Interestingly, Galens experimental evidence
for the importance of the ventricles did not localize brain function. The exposure of
the ventricles caused loss of sensation and voluntary motion due to the escape of the
psychic pneuma. He did not, however, specify the ventricles as the site of the
rational psyche responsible for the sensation and voluntary motion, but left it
ambiguous as somewhere in the substance of the brain (Clarke and Jacyna, 1987;
Rocca, 2003; Russell, 2009).
Berengario da Carpi (14601530), an outstanding anatomist in the tradition
of Galen, exemplifies that the shift from circles depicting functional
relationships to the ventricles themselves was not a sudden break, or progress
from primitive schema to naturalistic representation. The evolution of his views
can be traced by comparing his illustrations between 1518 and 1523. Initially he
reproduces a traditional representation of the cells in a woodcut of the head
(from the Bologna anatomist, Achillini) on the title page of his work on head
injuries (1518; Lind, 1990). In his Isagoge breves (1522), he states I have accommodated such figures of the brain as I was able, in which some of the matters previously described can be understood, as you see. (Berengario, 1522, F, 55R in
Clarke and Dewhurst, 1972). In the second edition of the Isagoge (1523), his
figures show details of the ventricles in the left and then in both hemispheres viewed
from above (Fig. 8), where he provides anatomical labels of the individual
structures.13
In the depictions of brain by Renaissance anatomists, the influence of the theory
is reflected in their emphasis on the ventricles alone, in contrast to the surrounding
convolutions, the gyri, that are either ignored or presented in a stylized cursory
manner.
Charles Estienne (15031564), in his De dissectione, which was prepared in
1530s, prior to the Fabrica, but published in 1545, includes a series of plates of
the horizontal section of the brain. Again the ventricles are carefully displayed,
but the surrounding area is simply covered by dots (Figs. 11 and 12). They are also
proportionally far too small to show any details (Clarke and Dewhurst, 1972; Rath,
1964; Singer and Rabin, 1946).
The illustrations indicate that the cell theory was not rejected outright. Vesalius
became doubtful of the ventricular localization of function. It became gradually
modified as discrepancies are noted through piecemeal discoveries in dissection
of the brain (Fig. 10), and as anatomical structures are identified through their meticulously detailed depictions.
13
For anatomical details of the structures, see Clark and Dewhurst, 1972, p. 52.
FIGURE 11
FIGURE 12
Figures 11 and 12: Charles Estiennes De dissectione partium corporis humani libri tres (Paris, 1545) is extensively illustrated with 62 plates. Those of the
brain have features in common. The brain and the ventricles are presented within the head of full-sized muscle figures in extraordinary poses and
settings. The top of the cranium is horizontally sliced off, and displayed nearby on a bench, or hanging from the branch of tree as in Fig. 12. The dissected
parts of the brain, which are far too small, are listed on tablets held by the figures. For example, Fig. 11 shows the fornix (A), vermis [choroid plexus]
(B), pineal (C), cerebellum (D), and aqueduct of Sylvius (E). The drawings for woodcuts were made by a surgeon, Estienne de la Rivie`re, whose
legal fight for recognition delayed the publication of the work by 6 years. When it finally appeared in 1545, Charles Estienne had received full authorship,
but lost the priority to Vesalius Fabrica (1543). Nonetheless, Estienne de la Rivie`res assistance with both the dissections and the illustrations was
acknowledged on the title page of De dissectione. The disproportionately small area given to anatomy in the full-page figures is puzzling, as the tiny size of
the representations of the brain makes them useless for any didactic or practical purposes. They seem, however, to have been superimposed onto
existing figures that may have been used for other purposes (Kellett, 1964). The borders of the rectangular woodblock insertions are visible in both plates.
24
FIGURE 13
The ventricles that are displayed within the head of full-sized figures are separately presented
here, in a large size, to show details. A series of 14 plates provide greater and greater detail of
brain structure in a progressive order of horizontal dissections. In the accompanying text,
Vesalius describes his impressively systematic procedure: We have removed in the
sequence of dissection the right and left portions of the brain so that the cerebral ventricles
now begin to come into view. And then we placed here, the left part of the brain to
show to some extent the upper aspect of the left ventricle, while the corpus callosum still
remains in the head. (Fabrica, 1543, VIII, fig. 4. Trans. Saunders and OMalley, 1950,
p. 190). All four ventricles are similarly demonstrated. Small figures also represent additional
details by isolating a specific structure, such as the brain stem. Each structure, indicated by
the lettering, is identified and carefully described by him in the legend.
Vesalius provides an impressive series of illustrations of the brain with increasingly detailed depictions of the lateral ventricles (Fig. 13). They are viewed not only
from above within the head but also separately with a part cut from the same cerebral
hemisphere showing the roof of its lateral ventricles. In his concern with structure, he
did not pay a great deal of attention to the convolutions of the brain in the illustrations
either. He presents, however, the base of the brain for the first time (Clarke and
Dewhurst, 1972; Singer, 1952). Here, we have an example of a remarkable anatomist
and an exceptional artist coming together to display a structure in a way that begins to
closely approximate its original source. Ultimately, Vesalius became doubtful of the
ventricular localization of brain function.
With the repeated comparison of Galens textual descriptions against visually
recorded, detailed observations in animal and human dissections, humoral function
became gradually divorced from morphology.
7 The need for illustration: Vesalius
6 THE ROLE OF ILLUSTRATIONS

6.1 Before the renaissance: Visualizing humoral function
Schematic drawings were used as a teaching tool in medieval Latin manuscripts,
from the twelfth and thirteenth centuries, as exemplified by the five-picture series.
Originally labeled as the funfbilderserie by Karl Sudhoff who discovered them,
they depict bones, muscles, veins, and arteries, as well as the nerves. There were,
in fact, nine figures, corresponding to Galens introductory treatises on anatomy with
more figures added over time.14 They have the distinctive features of a schematic
outline of the human figure in squatting, frog-like positions. In some of the figures,
superimposed onto the cranial outline, a crude drawing of the rete mirabile has
been noted (Clarke and Dewhurst, 1972). Although judged as crude, their schematic representations of Galenic anatomical systems (bones, muscles, veins, arteries,
and nerves) as distinct from individual parts (organs) provided a paradigm for their
subsequent depiction in five full-sized figures, as in Vesalius and others.
Earlier images were concerned largely with the naming of the parts for their
uses. They provide a schematic arrangement or mapping of functional relationships (as with the eye and the optic nerve) and general location of parts within
the body. The depiction of anatomical form or detail was not essential for the application of a humoral theory. They served as visual aids to memorizing the written text.
During the Renaissance, however, a change in the perceived use of illustrations began to emerge in the pioneering works of specific individuals, such as Berengario da
Carpi and Charles Estienne with Estienne de la Rivie`re. We find its fullest expression, justification, and ingenious exploitation in Vesalius Fabrica.
7 THE NEED FOR ILLUSTRATION: VESALIUS

In the sixteenth century, the need for graphic representation of observations in dissection was acknowledged, defended, but not accepted by all physicians. Pictures
were no substitute for the direct experience that Galen advocated. In the Preface
of the Fabrica (1543), Vesalius makes a strong case for the importance of pictures,
aimed at those (possibly including his former teacher Dubois) who totally rejected
pictures. His general objectives had remained constant: to teach, as well as to enhance understanding of the anatomy books of the divine Galen. Whether he faithfully followed or criticized him, Galen was the embodiment of anatomy for Vesalius.
From very early on, Vesalius had become aware of the value of pictures and how
they could be used in anatomy. We know from both his own statements, as well as
eye-witness accounts of medical students, who were then present, that Vesalius had
14
They have been extensively studied (see ONeill, 1969; for the Arabic transmission, French, 1999;
Russell, 1997, 2009). They also appear in histories of medical illustrations (see Choulant, 1926;
Herrlinger, 1970.)
25
26
started using them in his lectures and dissections (Heseler, 1540; OMalley, 1964).
He also saw the need for artists who obviously had the skills to represent the original
in a likeness that could deceive the eye. They would provide a visual record of
observations in dissections that would be accessible when cadavers were not readily
available to meet student demands at medical schools. He went further, however, to
recognize, as Leonardo da Vinci had before him, the explanatory power of illustrations. With the increasing awareness of anatomical discrepancies through repeated
dissections, between text and observation, animal and human parts, graphic representation would help to clarify and correctly identify structures that may be difficult to
see in actual dissections.
In 1539, Vesalius is already promising to undertake more figures of the nerves,
muscles, and bones if the opportunity of the bodies offers, and Johannes Stephanus,
the distinguished artist of our age, does not refuse his services, I shall by no means
evade that labor. (Vesalius, 1539, 1948). In this statement, he identifies the two key
problems: the availability of bodies for dissection and the services of the artist
for the figures. Vesalius may produce simple diagrams for didactic or explanatory
purposes. To successfully delineate the veridical appearance, identity, and location
of parts and organs, whether complete or in part, artists were needed. His reference to
the distinguished artist of our age reveals Vesalius exacting standards and high
expectations. He will seek out, not any artist, but the services of one who could,
to use Albertis phrase, make the absent present. (Alberti, 1435/1972, Trans. Grayson, 1972, p. 60). Interestingly, this is a rare occasion when Vesalius names an artist.
Stephan Calcar, the Flemish painter from the studio of Titian whose name also occurs
in connection with the Tabulae anatomicae sex (1538), appears to be the most likely
candidate for some of the figures, such as those of the muscles, in the Fabrica (Kemp,
1996; Singer and Rabin, 1946).
What Vesalius called that labor turned out to be the Fabrica, which required the
additional skills for the woodblocks in the printed book. His concern with precision
and exactitude characterized not only his choice of artists but also his dealings with
draughtsmen to ensure correction of errors. This is clear in his letter to his publisher,
Johannes Oporinus, Professor of Greek letters, instructing him to take the greatest
care that the printed illustrations shall correspond with the proofs, which accompany
the wood block. Every detail must be distinctly visible, so that each cut shall have the
effect of a picture. (Saunders & OMalley, 1990, p. 22).
When we compare his earlier views on the role of illustrations with those
expressed in the Fabrica, there is a marked shift between 1538, when he started
lecturing in Padua, and 1543. In the earlier Letter of Dedication of 1538, he
states:
I believe that it is not only difficult but also entirely futile and impossible, had I
wished to obtain knowledge of the parts of the body or of the use of simples from
pictures or formulas alone; but no one will deny that they assist greatly in confirming memory in such matters.
Vesalius (1538); Trans. Singer and Rabin (1946), p. iv.
FIGURE 14
FIGURE 15
FIGURE 16
FIGURE 17
Figures 1417: The head, neatly severed from the neck and the lower jaw, is positioned with
side and top views to display the brain in thirteen dissection sequences. The first stage
(Fig. 14) reveals the dura mater (A and B), with intersutural fibers (G, H, I), spreading on the
surface to form the pericranium; the sinuses, superior sagittal (C) and frontal (L); the middle
(D) and anterior (E) meningeal vessels as veins; arachnoid granulation (K). The second stage,
exposes the thin membrane (pia mater, E) that envelops the brain, by separating the dural
membrane (H), reflected downward. The third stage shows both membranes removed (O and
H), the process (falx cerebri) [D] of the dural membrane separating the right portion of the
brain from the left which is still preserved in position. . .. The two hemispheres have been
separated from each other manually so that the superior aspect of the corpus callosum
presents itself for inspection. (Vesalius, De humani corporis fabrica (1543), Book I, fig. 7;
Book VII, figs. 13. Trans. Saunders and OMalley, 1950, pp. 186, 188). Vesalius own
descriptions enable us to follow the detailed, elegant procedure of the anatomist and its exact
visual representation beautifully executed by the artist(s). Word and picture, incorporated into
the text, have become mutually indispensible in conveying anatomical structure.
28
FIGURE 18
In the Epitome, the brain is displayed within the head of a series of four full-sized superbly
executed figures. The fourth figure, here, viewed from behind, is holding a head in each
hand that shows parts of the brain that follow one another in the order of dissection. Vesalius
gives precise instructions as to how they should be viewed: Of these, the first, constituting
the head of the complete man, follows on from the left side of the head of the second
plate, but that here contained in the right hand comes after the first; while that grasped in the
left hand occupies last place. (Epitome, fig. 4, Trans. Saunders and OMalley, 1950, p. 208;
Vesalius, Trans. Lind, 1969). The emphasis is still on the ventricles (i.e., cavities), where the
convolutions are cursorily treated in sharp contrast to the detailed execution in the rest of the
figure. Nonetheless, here art and anatomy, text and illustration are in perfect balance.
8 Conclusions
What is expressed here is the accepted expectation from illustrations in teaching

anatomy. You cannot learn from pictures. They only confirm memory; they cannot
replace direct experience or substitute for the cadaver.15 In the Fabrica, however,
Vesalius view of the role of illustration has now broadened to encompass understanding of complex structures.
How greatly pictures assist in the understanding of these matters and place them
more exactly before the eyes than even the most precise language, no student of
geometry or other mathematical disciplines can fail to understand.
Vesalius (1543), Trans. OMalley, 1964, p. 323.
This can only be achieved if the illustrations can show the fine details of verifiable
anatomical structures (Figs. 1418). As he states,
I have done my best to this single end, to aid as many as possible in a very recondite as well as laborious matter, and truly and completely to describe the [fabric]
structure of the human body which is formed not of ten or twelve partsas it may
seem to the spectatorbut of some thousands of different parts.
Vesalius (1542), Trans. OMalley, 1964, pp. 322323.
They no longer merely assist in confirming memory. They now greatly assist in
the understanding of the detailed structures of the complex fabric of the body. The
illustrations need to be very correct, so that they are placed before the eyes with
mathematical exactitude. Such a demanding project, however, could not have been
done except with the services of both artists and printers. The collaboration underlying its achievement was not without problems as revealed by Vesalius qualification that the pictures had to be very correct and not spoiled by the printers in the
text. Although we do not know their identities, we gain an impression of Vesalius
relationship with his artists from further statements. They were clearly difficult and
at times even exasperating. We know that errors occurred which he had to correct.
After the completion of the Fabrica, he writes [No longer] shall I have to put up
with the bad temper of artists and sculptors [woodblock cutters] who made me more
miserable than did the bodies I was dissecting. (Vesalius, 1543, Trans. OMalley,
1964, pp. 124130).
8 CONCLUSIONS
The Renaissance marks a turning point in attempts to accurately describe and record
the form or structure of the brain as directly observed in the human body. Initiated
as a revival of classical knowledge in both art and anatomy, this has not been a
straightforward process. The explanations emphasized the collaboration of the
15
A representative view is expressed by Vesalius teacher in Paris, Sylvious (Jacques Dubois) in his
criticism of Berengario da Carpis pictures. See Kusukawa (2012), 184; for memory and representation, see Nutton (2001).
29
30
anatomist with the artist in developing a visual language that was enhanced with the
production of printed books. The artists, however, have no voice in this endeavor.
They were commissioned for their services. There is no question that it is the anatomist who has the authoritative and the innovative voice in the Fabrica. The artists
have, however, left, in the case of Vesaliuss Fabrica, a magnificent testimony to
their mimetic visual skills.
Two concepts and a method conjoined to create this apparent need for collaboration between the artist(s) and the anatomists. They both emerged out of the humanist textual tradition and were applied to anatomy in particular. The discovery of
discrepancies between translations of Galenic texts resulted in the recognition of
the necessity to use original source material. In anatomy, this also encouraged the
belief that the study of the human cadaver through dissection provided the ultimate
evidence of brain morphology. The opportunity to have empirical experience of dissection of the human body, combined with fresh animal preparations, opened the
door for detailed and comparative observation of similarities and differences with
the human anatomy. The limited access to human cadavers created a new need to
have a permanent record in addition to the anatomists quick sketches.
In response to that increasing need, anatomists commissioned artists to make
veridical anatomical portraits, which were then transferred into woodblock or
engraved illustrations for the printed record. In this endeavor, the collaboration
between the anatomist and artist was not one of equals. It was the anatomist who
brought his cumulative empirical experience and scientific knowledge to
direct the artist to create a detailed and accurate visual record of the brain
structure that provided a paradigm for subsequent studies. Where artistic concerns
dominated, the result was failure as an anatomy text for the purposes of teaching
or use in medical practice. Vesalius was a major figure (although not alone) in this
crucial change in Renaissance anatomical science, which was an essential precursor
for the much later emergence of the beginnings of neuroscience in the nineteenth
century.
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pp. 193200.
Carpi, J.B., 1990. Berengario da Carpi on Fracture of the Skull or Cranium (L.R. Lind, Trans.).
Transactions of the American Philosophical Society, Philadelphia, 80 (4).
Cazort, M., Kornell, M., Roberts, K.B., 1996. The Ingenious Machine of Nature: Four
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Choulant, L., 1926. History and Bibliography of Anatomic Illustration. (M. Frank, Trans.
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Clarke, E., Dewhurst, K., 1972. An Illustrated History of Brain Function: Imaging the Brain
from Antiquity to the Present. Norman Publishing, San Francisco, CA, p. 27, 5166.
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Cuir, R., 2009. The Development of the Study of Anatomy from the Renaissance to Cartesianism: da Carpi, Vesalius, Estienne, Bidloo. Edwin Mellen Press, Lewiston, NY,
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Vesalius, A., 1538. Tabulae anatomicae sex. Venice: B. Vitalis for J. S. Calcar.
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Vesalius, A., 1948. The Bloodletting Letter of 1539: An Annotated Translation and Study of
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Wickersheimer, E. (Ed.), 1926. Anatomies de Mondino dei Luzzi et de Guido de Vigevano. E.
Droz, Paris, 92 pp.
CHAPTER
Medieval and Renaissance

anatomists: The printing and
unauthorized copying of
illustrations, and the
dissemination of ideas
Douglas J. Lanska*,1, John Robert Lanska{,1

*
Veterans Affairs Medical Center, Tomah, WI, USA

University of Wisconsin-Eau Claire, Eau Claire, WI, USA
1
Corresponding authors. e-mail address: douglas.lanska@gmail.com; johnlanska@gmail.com
{
Abstract
The vanguard that began to question Galenic anatomical dogma originated in northern Italy in
the latter half of the thirteenth century, and not coincidentally this was where human dissection
was introduced, which in turn eventually fostered the origins of realistic anatomical illustration
in the late fifteenth century. With the advent of the printing press and moveable type at this
time, printed books began to supersede hand-copied medieval manuscripts, and laborintensive techniques were soon developed to integrate text and illustrations on the printed
page. The same technology was used to pirate the illustrations of prior authors with varying
fidelity. Specific medieval and Renaissance anatomical illustrations can often be traced from
their inceptions through different stages of development to the final printed images, and then
through subsequent pirated versions in various abridgements or other compendia. The most
important milestone in the development of anatomy and anatomical illustration was the publication in 1543 by Andreas Vesalii of De humani corporis fabrica (On the Fabric of the Human Body), commonly referred to simply as the Fabrica. With this work, Vesalii succeeded in
coordinating a publication production team (author, artists, block cutters, publisher, and typesetters) to achieve an unprecedented integration of scientific discourse, medical illustration,
and typography. However, despite Vesaliis valiant efforts to prevent unauthorized duplication, the illustrations from the Fabrica were extensively plagiarized. Although Vesalii found
such piracy frustrating and annoying, the long-term effect was to make Vesaliis ideas known
to a wider readership and to help solidify his own revolutionary contributions to anatomy.

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CHAPTER 2 Printing and copying anatomical illustrations
Keywords
anatomical illustration, anatomy, history of medicine, human dissection, intaglio, medieval,
plagiarism, printing, Renaissance, wood cut
1 ORIGINS OF ANATOMICAL ILLUSTRATION

During the Middle Ages, the limited available anatomic illustrations were not based
on direct observations from human bodies, but were instead stylized representations
of writings in the GalenicArabic canon. Because classical Greek medical lore had
been preserved in Arabic writings, illustrations were necessarily absent in the Arabic
sources because dissection and pictorial representation of the human figure were prohibited by Islamic law (Choulant, 1920).
The vanguard that began to question Galen anatomical dogma originated in northern Italy in the latter half of the thirteenth century, and not coincidentally this was
where human dissection was introduced, which in turn eventually fostered the development of realistic anatomical illustration. The initial postmortem dissections in the
latter half of the thirteenth century were conducted in Bologna solely as a forensic process to gather evidence in legal cases. Subsequently, the first public or semipublic dissection occurred at the venerable medical school in Bologna around 1300 where an
organized medical faculty had existed for approximately 150 years (Singer, 1957).
Nevertheless, even after dissection of human bodies became possible, anatomic illustrations were rarely used, and were hardly even considered necessary given that the
scholasticism of academics in medieval European universities served primarily to articulate and defend Galenic dogma. Until the middle of the sixteenth century, anatomy
remained firmly a scholastic discipline based entirely on the reading of Latin translations from Arabic, rather than a science based on direct observation (Figs. 1 and 2).
Any debates served simply and solely as an opportunity to practice the art of arguing.
Anatomic discrepancies between anatomical dogma and a dissected body, when present and if noticed at all, were considered to be defects in the body at hand rather than a
reflection of inaccuracies in Galenic teaching.
1.1 Theodoric Borgognoni

The surgical school in Bologna was founded by Hugh of Lucca (ca. 11701240; also
known as Ugo of Lucca and Hugo Borgognoni) and his pupil (and possibly son), the
surgeon and cleric Theodoric Borgognoni (12051298; also known as Teodorico
deBorgognoni, and Theodoric of Lucca). Borgognoni the younger became the surgeon of Pope Innocent IV (11951254), and subsequently practiced surgery in addition to his religious duties as Bishop of Cervia, a Roman Catholic diocese in
Emilia-Romagna, located in northern Italy. Borgognonis medical contributions included his four-volume Cyrurgia, or Chirurgia (Surgery, mid-thirteenth century), in
which he broke with many of the tenets of surgical practice handed down from the
FIGURE 1
Late-fifteenth-century dissection scene showing a robed professor (top) reading a Galenic
text from his chair. Below him, a menial barber surgeon dissects under the direction
of the ostensor (exhibitor), whose responsibility was to point out the specific parts of the body
corresponding to the professors reading. Students in academic garb observe but do not
otherwise participate directly in the dissection.
Image from Johannes de Kethams Fasciculus medicinae (15001501) (de Ketham, 15001501).
Courtesy of the U.S. National Library of Medicine.
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FIGURE 2
Early-sixteenth-century dissection scene showing a robed professor (right) reading a
Galenic text from his chair. To the left, the barber surgeon dissects under the direction of the
wand-wielding ostensor. Students in academic garb observe but do not otherwise participate
directly in the dissection.
From Anatomia (1535) by Italian physiciansurgeon and anatomist Jacopo Berengario da Carpi.
Courtesy of Wikimedia Commons.
Roman physician Galen (131 C.E.201 C.E.) and from later Arabic surgeons. In particular, Borgognoni argued against the practice of encouraging the development of
pus in wounds, which he correctly recognized as a complication that impeded healing, rather than a necessary stage of the healing process as was then the prevailing
view; instead, he advocated antiseptic practice, including the cleansing of wounds
and the use of clean, wine-soaked dressings. Borgognonis unillustrated anatomy,
however, closely followed the Arabic translations of Galen and showed no evidence
of original observations based on dissection (Singer, 1957).
1.2 Henri de Mondeville

Shortly thereafter, Thaddeus of Florence (12231303), who also taught at Bologna,
encouraged direct Latin translations from Greek medical sources (rather than from
Graeco-Arabic sources) and gave hints of postmortem examination in his works
(Singer, 1957). Furthermore, all of the first generation of writers who refer to human
dissection had been his pupils (Singer, 1957). Among these pupils was the Norman
physiciansurgeon Henri de Mondeville (ca. 12601320) whose name was variously
written as Hermondaville, Hermondavilla, Hermundavilla, Emondeville, Esmondeville, Amondeville, Mandeville, and Mandevilla (Bonnichon, 2005; Bos, 1897;
1 Origins of anatomical illustration
Cherau, 1892; Cohen, 1995; Pagel, 1892; Pilcher, 1895; Vidal, 1985; Vrebos, 2011).
Accounts conflict as to whether Mondeville also studied under Borgognoni (Clarke,
1931; Singer, 1957); in any case, Mondeville adopted and promoted Borgognonis
progressive antiseptic surgical practices, even if they were unfortunately soon abandoned until they were ultimately revitalized and developed in the late nineteenth
century.
Mondeville, as a direct or indirect disciple of Borgognoni, was also one who
openly questioned aspects of Galenic doctrine. As he acerbically wrote,
God did not exhaust his creative power in making Galen . . . It would be an
absurdity and almost a heresy to believe that God had accorded to Galen a
sublime genius, on the condition that no mortal after him should discover
anything new. . . . Has not God given to each of us, as to Galen, a natural
genius? Miserable would be our spirit if we could know only that which had been
discovered before us!
Clarke (1931, pp. 472473)
Mondeville subsequently conducted classes in anatomy and surgery, possibly in

Montpellier, and certainly in Paris (Fig. 3), where by 1306 he was a member of
the Academy of Paris (Choulant, 1920; Clarke, 1931). Mondeville, who taught using
full-length anatomic illustrations of his own creation, was among the first to regularly
use illustrations for medical instruction (Clarke, 1931). Based on his descriptions,
Mondevilles drawings are thought to have contained considerable detail that is only
hinted at by the rather crude miniatures in an extant French manuscript that was apparently a resume of Mondevilles course given in 1304 (Clarke, 1931). Some of these
illustrations, including the skeleton figures, follow the symbolic intent of medieval
drawings of death, although he eliminated existing constraints in posture of his figures
and also added several entirely novel anatomic representations (Choulant, 1920). One
illustration of a muscle man, in particular, had no precedent and appears to have
served as an influence for later medical illustrations by others in the sixteenth century
(Fig. 4). As noted by medical historian Mortimer Frank (18741919) in his translation
of German physician and medical historian Johann Ludwig Choulants (17911861)
bibliographic study of anatomical illustration from 1852 (Choulant, 1920):
Entirely free from tradition is [Mondevilles] muscle manikin, carrying his skin on a
stick over his shoulder, which does not show any copyist tendencies, but is already
fully representative of the type of later artistic anatomy; i.e., exposure of the superficial muscles by removal of the skin, de Mondeville has priority in this picture. . .
Choulant (1920, p. 59)
As noted by Frank, Mondevilles drawings represent an important milestone that

influenced later Renaissance anatomists:
In the composition of the postures of his figures, de Mondeville seems not to have
been without influence on posterity. That the many pictures of dissections, before
and after de Mondeville, showed the cadaver on its back on a table,
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FIGURE 3
Medieval surgeon and teacher Henri de Mondeville lecturing.
Source: Nicaise (1893).
[German medical historian Karl] Sudhoff [18531938] argues, is proof of the fact
that it was not an unconditional requirement of the Middle Ages to draw anatomic
scenes in a standing or squatting position. De Mondeville deliberately had his dissected figures drawn in a standing position, and in this respect, precedes all others
entirely. . . . De Mondevilles drawing must be regarded as an original accomplishment and his illustrative achievement as very remarkable.
Choulant (1920, p. 59)
By 1301, Mondeville became surgeon to King Philip IV of France (12681314; also

known as Philippe le Bel or King Philip the Fair), who was infamous for his
FIGURE 4
A miniature (number 4 of 14) drawn from charts used by Mondeville in teaching anatomy.
The illustration (ca. 1314) shows a skinned man, that is, a crudely drawn muscle man
carrying his own flayed skin draped across a stick. This was a precursor of the muscle men
by Renaissance anatomists, particularly those by Andreas Vesalii and Juan Valverde
de Hamusco.
From a manuscript in La Bibliothe`que nationale de France in Paris. Source: Sudhoff (1908).
eradication of the Knights Templar, and subsequently Mondeville was surgeon to Phillipes successor, Louis X (12891316). Despite his prominence at the time,
Mondevilles medical legacy was limited by his premature death, apparently from tuberculosis (Clarke, 1931). Although he began the first medieval treatise on surgery, and
although manuscript copies of this work are extant, the work remained unfinished at his
death and was never printed until 1889 (Clarke, 1931). This work was later eclipsed by
Inventarium sive chirurgia magna (Inventory of Major Surgery, 1363), written by Mondevilles pupil, the French physiciansurgeon Guy de Chauliac (ca. 12981368; also
known as Guigonis de Caulhaco), the personal physician of Pope Clement VI
(12911352). Both Mondeville and Chauliac followed a typical medieval scholastic
order of presentation of anatomy, progressing from head to foot, as did the Arabic physicians that preceded them (Larkey, 1933). However, of the two, Chauliacs work was
more traditional in its adherence to Galenic doctrine.
1.3 Johannes de Ketham and Hans von Gersdorff

The advances in anatomy in northern Italy also ultimately spread to Germany.
Johannes de Ketham was a German physician living in Italy at the end of the fifteenth
century, and is thought possibly to be the Johannes von Kirchheim who had been
practicing medicine in Vienna in 1460. Kethams Fasciculus medicinae (1491)
was an edited collection of short medical treatises and was notably the first printed
book to contain anatomical illustrations (de Ketham, 15001501). Subsequently,
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German surgeon Hans von Gersdorff (ca. 14551529) published Feldbuch der
Wundartzney (1517, Fieldbook of Wound Doctoring), a manual for the military surgeon based largely on the writings of Chauliac (Gersdorff, 1528). Gersdorffs book
became a standard surgical text in Europe. It includes four woodcut anatomical images by Johann Ulrich Wechtlin, including a viscera-manikin showing internal organs, a wound man showing various wounds a soldier might incur (Fig. 5), a
skeletal figure, and a bloodletting figure, in addition to images of various surgical
procedures such as amputations and trephining. Gersdorffs book was recognized
particularly for its discussion of limb amputation, but his traditional treatment approach using cauterization was eventually superseded by use of ligatures as successfully developed by French surgeon Ambroise Pare (15101590).
Woodcut printing as used in these and later works is a form of relief printing that
had been invented in China around the ninth century. To make a woodcut, an image is
carved into the surface of a wood blockat this time, pear wood was typically used
with the printing portion remaining level with the surface, while the nonprinting parts
are removed with gouges and similar tools. To make a woodcut print, the protruding
portions of the surface face of the block are inked while the recessed areas remain ink
free. Printing the image is then a relatively simple matter of inking the block face and
bringing it into firm contact with the paper. Unlike intaglio printing, which was developed later, a high-pressure printing press is not necessary to make a woodcut print, as
the back of the paper can be rubbed or pressed by hand with a simple tool such as a
hard pad, a flat piece of wood, a burnisher, or a leather frotton (Hind, 1935, p. 5). In
Europe, artists traditionally designed the woodcuts and left the block carving to specialist craftsmen known as block cutters. Several methods were employed to transfer
the artists design to a block, including drawing directly on a whitened block, drawing
on a piece of paper, which was then glued to the block, and freehand copying.
1.4 Jacopo Berengario da Carpi

Italian physiciansurgeon and anatomist Jacopo Berengario da Carpi (1460ca.
1530; also known as Jacobus Berengarius Carpensis, Jacopo Barigazzi, or Carpus)
was born to a surgeon father in Carpi, Italy. He studied under humanistic scholar and
printer Aldus Pius Manutius (14491515; also known as Aldo Manuzio) and subsequently attended medical school in Bologna, graduating in 1489. He then taught
anatomy and surgery in Pavia, and from 1502 to 1527 he was on the faculty at
Bologna, but at different times he also practiced in Ferrara and Rome. In anatomy,
Berengario was a follower of Mondino dei Luzzi (ca. 12701326; also known as
Mundinus), who had relied heavily on Arabic texts based on Galen, with supplemental observations from a few dissections. Both Berengario da Carpi and Mondino dei
Luzzi adopted an order of presentation of anatomy that mirrored the stages of
dissection, that is, an order designed to minimize putrefaction of the body, with
the abdomen dissected first, followed by the chest, the brain, the muscles, and finally
the bones (Berengario da Carpi, 1523, 1535; Larkey, 1933). In contrast to Mondino,
who had relatively little experience with dissection, Berengario reported that he had
dissected at least 100 cadavers, and was among the first to teach that anatomy must
FIGURE 5
Wound man woodcut image from Johannes de Kethams Fasciculus medicinae.
The image is from Fasiculo de medicina (1494), a translation into Italian by Sebastiano Manilio of Kethams
Fasciculus medicinae (1491). From de Ketham (1494). Courtesy of the U.S. National Library of Medicine.
41
FIGURE 6
Muscle man illustration from Isagogae breues (1523) by Italian physiciansurgeon and
anatomist Jacopo Berengario da Carpi. This composite image shows the internal and external
oblique muscles on the subjects right, the vertically oriented rectus abdominus, and the
horizontally oriented transversus abdominis muscles on the subjects left. The subject is
pictured so as to suggest that he is demonstrating the internal anatomy to the viewer, an
artistic and pedagogical device that became commonplace in the sixteenth century.
FIGURE 7
Brain dissection images from Isagogae breues (1523) by Italian physiciansurgeon and
anatomist Jacopo Berengario da Carpi. The images are crude by comparison with those of
Vesalii two decades later.
be studied by observation of human bodies rather than learned solely from books
(Merlini et al., 2003). Moreover, Berengario is considered to be the author of the first
human anatomical illustrations made from nature. His first illustrated work was
Commentaria cum amplissimis additionibus super anatomiam Mundini (1521), a
commentary on Mondinos Anatomia corporis humani (1493). This was followed
by a shorter version, Isagogae breves, with editions in 1522 and 1523 (Berengario
da Carpi, 1523; Merlini et al., 2003). The later edition included additional illustrations of the heart and two of the brain. The artist responsible for the illustrations is
unknown, with some contending that Berengario drew them himself, while others
suggest that the woodcuts were by the artist Hugo da Carpi (14551523). Regardless
of their origin, the later illustrations in Berengarios works are among the most sophisticated and realistic prior to those of Vesalii (Figs. 6 and 7). Many are of partially
dissected bodies in life-like poses and may have served as an inspiration or point of
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departure for the later works of Vesalii, although all of the images, and especially the
osteological and brain dissection images, are comparatively crudely executed
(Merlini et al., 2003). Despite his devotion to anatomy, at the time of his death,
Berengario was most famous for his promulgation of mercury in the treatment of
syphilis (Merlini et al., 2003).
2 ANDREAS VESALII
Flemish-born anatomist and physician Andreas Vesalii (15141564) was instrumental in reestablishing anatomy as an observational science after more than a millennium of stagnation under the teachings of Galen dating from the second century A.D.
(Fig. 8) (Fulton, 1950; Lanska and Lanska, 2013; OMalley, 1964; Osler, 1921;
Saunders and OMalley, 1950). As Vesalii complained,
And so, with their teeth set, the principal followers of Galen put their trust in some
kind of talking [scholastic argument], and relying upon the inertia of others in
FIGURE 8
Portrait of Vesalii from the Fabrica (1543).
2 Andreas Vesalii
dissecting, they shamelessly abridge Galen into elaborate compendia. They do not
depart from him a hairs breadth while they are following his sense; but to the
front of their books they add writings of their own, stitched together completely
from the opinions of Galen. . . The whole lot of them have placed their faith in
him, with the result that you can not find a doctor who has thought that even
the slightest slip has ever been detected in the anatomical volumes of Galen, much
less could be found. . . . [It] now becomes obvious to us from the reborn art of
dissection, from diligent reading of the books of Galen, and from impeccable
restoration in numerous places of [the text of] these books, that he himself
never dissected the body of a man who had recently died. . . . he was misled by
his [dissections of] apes.
Translation in Vesalii (1960, pp. 135136)
Early in his career, Vesalii had been trained as a Galenist and had edited some of
Galens texts. However, he had become frustrated with the teaching of anatomy
while a medical student in Paris from 1533 to 1536, and subsequently in Louvain
from 1536 to 1537. Indeed, he reported that anatomical teaching he received consisted merely of the casual and superficial demonstration of a few organs presented
to me and to my fellow students in one or two public dissections by unskilled barbers (translation in OMalley, 1964, p. 60). He nevertheless gained experience in
animal dissections, and in osteology as a result of the bones he stole from the Cimetie`re des Saints-Innocents (Saints-Innocents Cemetery, the oldest and largest cemetery in Paris, which was often used as a site for mass graves), the infamous Gibet de
Montfaucon (gibbet of Montfaucon, northeast of Paris, the main gallows of the kings
of France since the thirteenth century, where criminals executed by hanging were left
to rot as a warning to other would-be criminals), and subsequently from the gibbet
outside of Louvain. Vesalii recorded that he had been gravely imperiled by the
many savage dogs during his search for body parts at Montfaucon (translation in
OMalley, 1964, p. 59). His scavenging and diligent study paid off, though, and eventually he and a friend dared at times to wager with our companions that even blindfolded we could . . . identify by touch any bone offered to us. Those of us who wished
to learn had to study all the more zealously since there was virtually no help to be had
from our teachers in this part of medicine (translation in OMalley, 1964, p. 60).
In December 1537, Vesalii was examined for his medical doctorate in Padua and
the following day he was appointed to a lectureship in surgery and anatomy in Padua.
Within a week, he had dissected his first cadaver, breaking fully with tradition by
serving simultaneously as lecturer, ostensor (demonstrator), and dissector (Fig. 9).
He soon introduced anatomical drawings and later detailed printed sheets as pedagogic aids to support his teaching. In 1538, he published the Tabulae Anatomicae
Sex (Six Anatomical Tables), which were so-called fugitive sheets or broadsides
for his students. Three of these (diagrams of the portal, caval, and arterial systems)
were drawn by Vesalii himself, while the others (illustrations of anterior, lateral, and
posterior views of a skeleton standing in life-like poses on the ground) were drawn by
the Flemish artist Jan Stephan van Calcar (ca. 14991546, also known as Giovanni da
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46
FIGURE 9
Lithograph (1848) of Andreas Vesalii standing before a dissecting table with a cadaver. A skull
and instruments are on the side table.
By Edouard Hamman (18191888). Courtesy of the U.S. National Library of Medicine.
Calcar in Italian, or Johannes Stephanus Calcarensis in Latin), from a skeleton of the

human body that Vesalii had constructed (Saunders and OMalley, 1950). These
were soon plagiarized by printers in Germany (Augsburg, Cologne, Frankfurt, and
Marburg) and France (Strasbourg and Paris). Vesaliis innovative Tabulae Anatomicae and the rapid plagiarism of these fugitive sheets presaged later events with his
more ambitious books.
In 1543, Vesalii published his magnum opus, the magnificent De humani corporis
fabrica (On the Fabric of the Human Body), a folio volume comprised of seven
books (chapters), now typically referred to simply as the Fabrica (Fulton, 1950;
Lanska and Lanska, 2013; OMalley, 1964; Osler, 1921; Saunders and OMalley,
1950; Vesalii, 1543, 1555, 1960). Although controversial among avowed Galenists,
the Fabrica was revolutionary in accelerating the reexamination of Galenic anatomical dogma, and in its coordination of a publication production team (author, artists,
block cutters, publisher, and typesetters) to achieve an unprecedented integration of
scientific discourse, medical illustration, and typography (i.e., the art and technique of printing with moveable type) (Fulton, 1950; Lanska and Lanska, 2013;
Nutton, 2012; OMalley, 1964; Osler, 1921; Saunders and OMalley, 1950).
The same year Vesalii also published a short abstract of the Fabrica for students,
Andrea Vesalii suorum de humani corporis fabrica librorum epitome (1543), or simply
the Epitome (Vesalii, 1616, 1949).
2 Andreas Vesalii
The first edition of the Fabrica (1543), written when Vesalii was just 28, brought
him international recognition and established him as the father of modern human anatomy. A second folio edition was published in 1555 and incorporated stylistic and factual changes to the text, along with changes to the figures; it was also printed on thicker
paper and set in larger type with more widely spaced lines (Packard, 1922). The initial
print runs of these two editions are estimated to be at most 1000 each (Joffe, 2009). A
census of the 1543 edition identified only 145 surviving copies, and a recently completed census of the 1555 edition identified only 113 surviving copies around the world
(Horowitz and Collins, 1984; Joffe, 2009). Recently, Canadian pathologist Gerard
Vogrincic discovered that a third edition was planned but never published; Vogrincic
discovered a copy of the 1555 edition extensively annotated in Vesalii hand, with corrections, deletions, and additions throughout the book, along with detailed instructions
to the publisher and the block cuttersa discovery since verified by medical historian
and classics scholar Vivian Nutton (Nutton, 2012).
Vesalii adopted a novel order of presentation of anatomy in the Fabrica, one that
followed neither the scholastic head-to-foot order used by Mondeville and Chauliac
nor the dissection order used by Mondino dei Luizzi and Berengario da Carpi
(Larkey, 1933; Vesalii, 1543, 1555). Instead, of these traditional orders of presentation, Vesalii adopted a more conceptual system-based approach as if he were virtually building or constructing a body, beginning with the scaffolding (the bones) and
progressing to the muscles, the vascular system, the nervous system, the alimentary
system, the thorax, and then finally the brain (Larkey, 1933; Vesalii, 1543, 1555).
This approach, although more systematic (despite the inconsistencies, such as separation of the brain dissection in Book 7 from the discussion of the nervous system in
Book 4), was much less practical for anatomists, as it did not follow sequentially the
stages of dissection necessary to minimize putrefaction.
The Fabrica was extensively illustrated with hundreds of exquisitely detailed anatomical drawings based on Vesalii own human dissections. There were apparently
multiple artists involved in creating the drawings and in executing more than 250
woodcuts in the Fabrica under the close supervision of Vesalii, but the identity of
the artists has been controversial, with much ink spent on speculations and pronouncements, but all based on relatively little hard evidence (Saunders and
OMalley, 1950; OMalley, 1964). Among those proposed and championed as participating the illustrations in the Fabrica are the Italian painter Tiziano Vecelli(o)
(ca. 1488/14901576, known as Titian in English), his student Jan Stephan van Calcar, Italian painter and printmaker Domenico Campagnola (ca. 15001564), who
may also have been a student of Titian, and even Vesalii himself (Fulton, 1950;
Jelly, 1987; Kemp, 1970; OMalley, 1964; Petrucelli, 1971; Rudakewich, 1988;
Saunders and OMalley, 1950; Singer, 1961).
In 1546, 3 years after publication of the first edition of the Fabrica, Vesalii
expressed frustration at the plurality of artists he had supervised: [No longer] shall
I have to put up with the bad temper of artists and sculptors [wood-block cutters] who
made me more miserable than did the bodies I was dissecting (translation in
OMalley, 1964, p. 124). Regardless of Vesaliis frustrations with the artists,
the beauty, accuracy, and utility of these woodcuts led to frequent plagiarism, despite
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Vesaliis attempts to protect his work with the various privileges that were listed at
the foot of the title page.
In both editions, the striking and dramatic title-page illustration shows Vesalii
conducting a public dissection of a female cadaver in an open-air amphitheater, surrounded by a dense crowd of more than 70 students and onlookers on a temporary
wooden viewing platform, in front of a colonnaded building with Corinthian columns
in the style of ancient Greece (Figs. 10 and 11). Unlike prior and contemporary anatomy professors, Vesalii is performing the dissection himself, while the barber surgeon and ostensor are removed from direct involvement and are instead shown
quarrelling on the floor in front of the dissection table. Some of the spectators are
focused intently on either Vesalii or the cadaver being dissected. Others present have
turned away from the central action, including the bearded man standing in classical
raiments (sandals and robes) staring at a dog in the lower right corner of the picture,
indicating presumably a Galenist who was observing an animal upon which Galenic
human anatomy was based. Vesalii is not addressing the assembled crowd, but is
instead looking out toward the reader of his work. At the center of the plate is a skeleton, to which Vesalii frequently referred during his public dissections, because it
was the scaffolding upon which was draped the fabric of the body. At the top is a
shield with the crest of Vesaliithree weasels running across a dark field (a play
on the vernacular of his name, i.e., Wessels)that is supported by two putti (plump
naked little boys typically shown performing some purposeful activity in Renaissance artworks). This is a remarkable illustration, both artistically and technically,
with intense activity in dramatic depth and perspective, as well as incredible detail
and finely cross-hatched shading; craftsmen of unparalleled skill were required to
execute this work as a relief cut from a wood block.
Several of the preparatory drawings for the Vesalian plates are still extant, and
these begin to hint at the immense amount of labor involved in preparing each illustration (Saunders and OMalley, 1950; Kemp, 1970). For the frontispiece, an initial
rough line-and-wash sketch was made, which included preliminary but identifiable
features of the many faces present in the final version, along with several corrections,
but missing the skeleton that is hanging in the center of the final image (Saunders and
OMalley, 1950). For the next stage, as shown in a sketch preserved in the Hunterian
Collection of the University of Glasgowhaving been purchased by English surgeon and anatomist William Hunter (17181783) in 1775the skeleton was added
and the drawing was reversed in preparation for engraving (Saunders and OMalley,
1950). A third, and probably final, pen drawing in sepia ink was then created, which
was similarly reversed from the original sketch, but with meticulous detail added that
reproduces almost exactly the details in the finished woodcut, including for the first
time the architectural elements in the background (Saunders and OMalley, 1950).
Missing, though, are the cartouche and the coat of arms that occupy much of the upper central portion of the finished woodcut, as well as the scroll carrying the privileges located at the bottom of the finished woodcut (Saunders and OMalley, 1950).
In addition to the extant preparatory drawings for the frontispiece, a single preparatory study for one of the Vesalian muscle men has survived (corresponding to
2 Andreas Vesalii
FIGURE 10
Frontispiece of the Fabrica (1543).
Courtesy of the Becker Medical Library at Washington University in St. Louis, Missouri, USA.
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50
FIGURE 11
Detail of the right lower portion of the frontispiece of the Fabrica (1543).
Courtesy of the Becker Medical Library at Washington University in St. Louis, Missouri, USA.
a reversed image of the print on page 174 of the first edition of the Fabrica) (Kemp,
1970). This anatomical study, executed in red chalk, shows a side view of a muscle
man drawn with considerable anatomic detail, but missing from the drawing in any
aspect of the background (e.g., shrubbery, Roman arches, or distant buildings) present in the final woodcut.
Book 2 of the Fabrica contains Vesaliis quintessential sequence of 14 full-page
plates of muscle men in naturalistic poses and progressive stages of dissection. As
one progresses through the various stages, the more superficial muscles are either
resected or sectioned near the origins and allowed to fall away, though still anchored
at their insertions, in a process of continual revelation. In this way, Vesalii was able
to illustrate the anatomic relationships of the parts to a degree never before
attempted, and only hinted at by Berengario da Carpi. Vesalii reported that these illustrations were drawn by the artist directly from the dissected cadavers that Vesalii
kept upright using ropes and pulleys. To add to the naturalism of the images, the
muscle men are presented in an idyllic outdoor setting, rather than shown on a dissecting table.
2 Andreas Vesalii
At least since the beginning of the twentieth century, it has been known that the
various muscle men scattered throughout Book 2 can be combined in a sequence
against a continuous landscape (Cavanagh, 1983; Cushing, 1943; Jackschath, 1904).
As the dissection proceeds to deeper anatomical levels or stages, the muscle men
assume a range of naturalistic postures, each carefully choreographed to appear as a
seemingly natural continuation of the preceding one, until at the end the muscle
men appear no longer able to support their own weight but are instead supported
by a rope strung through the zygomatic arches, or presented essentially as a residual
skeleton propped against a wall (Cavanagh, 1983; Cushing, 1943; Kemp, 1970). The
progression of dissection is not strictly linear, though, as Vesalii adjusted the order in
places to avoid unnecessary redundancy (Kemp, 1970). The panoramic landscape
backdrops to this dance of the muscle men were likely in the form of two long
drawings that were cut into plate-size pieces and allocated to each succeeded dissection stageone of the lateral and frontal views and one of the posterior views
(Cavanagh, 1983). Stylistic considerations indicate that the background was created
by a different artist than the artist or artists responsible for the muscle men themselves, and such considerations suggest further that the background was crafted in the
tradition of Italian painter and printmaker Domenico Campagnola (ca. 15001564)
(Kemp, 1970; Saunders and OMalley, 1950).
Curiously, when the muscle men were originally combined so as to form a continuous background panorama, the order of the plates was found to be reversed from
that in the Fabrica, and also reversed from the expected natural progression from
least- to most-dissected stage (Cushing, 1943). These apparent inconsistencies were
resolved only relatively recently. The separate artistic elements (anatomic figure and
background) were brought together for the first time on the wood blocks, with the
background panoramas divided onto multiple separate blocks with one anatomic figure per block. After a woodcut block is inked, it is effectively flipped over as it is
applied to a sheet of paper for printing, forming a mirror image print of the plate.
Because the anatomic figures were copied from the preparatory figures onto the
wood blocks, the final published prints are consequently mirror images of the original preparatory drawings (Cavanagh, 1983; Kemp, 1970). When the prints are
rejoined to again form a continuous background, the resulting sequence of dissection
stages is opposite to what is expected by the order of dissection, just as they would be
if multiple muscle men were copied from the original drawings onto a single wide
block with an uninterrupted panoramic background and then printed from this multifigure block. To recreate the natural progression present in the original drawings of
the muscle men and the original background drawing, it is necessary to first create
mirror images of the prints and then reconnect these reversed prints (Fig. 12)
(Cavanagh, 1983).
Book 7 of the Fabrica includes a systematic dissection of the brain, illustrated
with woodcut prints through 12 sequential stages. As demonstrated in these prints,
Vesalii was the first to accurately depict numerous brain structures, including the
corpus callosum, thalamus, basal ganglia, and cerebral peduncles (Lanska and
Lanska, 2013; Singer, 1952). By comparison, previous illustrations of brain
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FIGURE 12
Three of the muscle men from Vesaliis Fabrica. These represent the pinnacle of sixteenth century artistic achievement using woodcuts for anatomical
illustrations. The three images of progressive stages of dissection show the muscle men in naturalistic poses against a background that flows clearly and
continuously from one image to the next. Note that the sequence is reversed from the progression of dissection with the least-dissected figure on the right. Each
anatomical stage had been copied onto a separate wood block. When the final woodcuts were printed, the individual images and the entire sequence were
necessarily a mirror image of the original artwork.
Individual images courtesy of the U.S. National Library of Medicine.
2 Andreas Vesalii
dissections are extremely crude and often show little or no correspondence to human
neuroanatomy (Berengario da Carpi, 1523, 1535; Olry, 1997; Singer, 1956). Despite
his many advances, though, Vesalii provided only a rudimentary representation of
the cerebral convolutions (which he likened to windings of the intestines), continued the Hippocratic belief that the pituitary served as a reservoir for pituita or phlegm
draining from the brain, and continued to follow Galen in classifying the cranial
nerves into seven pairs (with errors in grouping and distribution) (Lanska and
Lanska, 2013).
In 1910, historian James Moores Ball (18621929) commented that:
[The Fabrica has been the] fountain from which many anatomical writers have
derived practically all their illustrations and much of their text. . . . [For] a period
of two centuries, nearly all treatises on anatomy contained illustrations which
were taken from the writings on Vesalii. With few exceptions, these reproductions
were little better than caricatures of the original figures.
Ball (1910, pp. 126, 128)
Vesalii was well aware of the likelihood of unauthorized duplication, because his
earlier work Tabulae Anatomicae Sex was widely copied after publication in 1538
(Ball, 1910; Clark, 1981; Fulton, 1950; Lanska and Lanska, 2013; Saunders and
OMalley, 1950): For what the decrees of princes are worth among booksellers
and the printers who are now so densely planted on every corner can be seen abundantly in the fate of my Tabulae anatomicae, . . . [which was] hideously plagiarized
everywhere even while it was being dressed up in more pretentious titles, issued miserably depraved throughout (translation in Saunders and OMalley, 1950, p. 47).
Nevertheless, Vesalii tried to stave off such unauthorized reproduction of his
Fabrica: I shall attempt in every way in my power to hinder any inept person from
reproducing the plates, made with so much labor for the general use of students, so
that regardless of whatever turgid title is prefixed to them, they may not come into
human hands as if they has been issued carelessly by me (translation in Saunders
and OMalley, 1950, p. 48). Vesalii similarly noted in the dedicatory letter of his
own abridged edition for students, Andrea Vesalii suorum de humani corporis fabrica
librorum epitome (Vesalii, 1543), While I strive to be useful to [physicians and surgeons] yet at the same time I am anxious to snatch opportunity from the hands of certain rascally printers who may later seize in possession upon the labors of another
to reduce them ineptly into small space and publish them under their own names
(creatures born for the destruction of letters!) (translation in Fulton, 1950, p. 19).
Vesalii wrote several letters to the humanist printer Johannes Oporinus (1507
1568; original German name Johannes Herbster or Herbst) in Basel in which he
praised the printers virtues and honesty and explained steps he had already taken
to prevent unauthorized duplication. Vesalii had obtained a letter from the Venetian
senate forbidding the reprinting of Vesalii work without his consent, and noted an
existing license from Holy Roman Emperor Charles V (15001558), and through the
Bishop of Montpellier a copyright from King Francis I of France (14941547).
Nevertheless, Vesalii understood clearly that such privileges would not prevent
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unscrupulous printers from pirating his work for their own profit, so it was necessary
to retain as much secrecy as possible until publication and then to ensure rapid
distribution. To accomplish this, Vesalii arranged to have the manuscript and the
pear-wood blocks shipped by merchants over the Gotthard pass on muleback to
Baselan arduous 5-week journey of more than 250 miles; Basels location on
the Rhine River allowed rapid distribution of the Fabrica to critical northern European markets. To ensure the quality of the work and minimize the potential for
unauthorized reproductions, Vesalii himself went to Basel and provided direct oversight to at least a portion of the printmaking.
After publication of the Fabrica and the Epitome, Vesalii headed north with presentation copies for Holy Roman Emperor Charles V (15001558). Charles immediately enlisted Vesalii in his service as a royal physician, and over the next decade,
Vesalii spent most of his time as a military physician in a succession of campaigns
with the emperor. With the emperors abdication in 1556, Vesalii entered the service
of his son Philip II (15271598), who became King of Spain, while Charless brother
Ferdinand I (15031564) became Holy Roman Emperor.
3 VESALIAN COMPENDIA: PLAGIARISTS, IMITATORS, AND

DISSEMINATORS
Despite Vesaliis efforts, the Fabrica and the Epitome were extensively plagiarized,
particularly in abridgements or other compendia. In succeeding decades, some anatomists made their reputations not so much by their own discoveries as by making
Vesaliis work more accessible to others, particularly students, anatomists undertaking human dissections, and many practicing physicians and surgeons. Although
Vesalii found such piracy frustrating and annoying, the long-term effect was to make
Vesaliis ideas known to a wider readership, and to help solidify his own revolutionary contributions to anatomy.
3.1 Thomas Geminus (aka Thomas Lambrit)

Just 2 years after publication of the Fabrica, an abridgement of the Fabrica entitled
Compeniosa totius Anatomie delineatio was published in England in 1545 by
Flemish refugee Thomas Geminus, a pseudonym for engraver and printer Thomas
Lambrit (died 1562), who might have also functioned at times as a physician or
surgeon, including possibly as a surgeon to King Edward VI (Ball, 1910; Carlino,
1999; Donaldson, 2010; Geminus, 1545; Hind, 1923; Keynes, 1959; Larkey,
1933; OMalley, 1959; Singer, 1961). This book contained 40 of Vesalii prints, engraved on copperplate, often as montages of the original woodcuts in the Fabrica
(Fig. 13). It was the first book issued in England in which the roller printing process
was employed, and the first in which copperplate engravings were executed and
printed in England. The first edition (1545) was in Latin, but the subsequent editions
were in English and were translated by English schoolmaster and playwright
FIGURE 13
A bone man image from Andreas Vesaliis De humani corporis fabrica (1543, left), as copied in Geminuss Compeniosa totius anatomie delineation,
aere exarata (1545, center), and Ambroise Pares The Workes of the Famous Chirurgion Ambrose Parey (1649, right).
56
Nicholas Udall (15041556). The sequential editions were dedicated to Henry the
Eighth (1545), Edward the Sixth (1553), and Queen Elizabeth (1559).
Instead of the traditional relief printing process utilized by Vesalii for the illustrations in the Fabrica (in which the image is transferred from the high points
of a wood block that stand in relief once the nonprinting areas are cut away),
Geminus utilized the newer intaglio printing process in which the image is transferred from recesses incised into a metal plate. The intaglio process had been
invented in Germany by the 1430s and developed to an art form by 1550. In intaglio printing, the image is incised into a metal surface, known as a plate, using a
hardened steel tool called a burin. Until the early-nineteenth century, copper plates
were typically used for such engraving as the soft metal was easy to carve or incise. To print an intaglio plate, ink is applied to the incised copper surface by wiping or dabbing. The plate is then rubbed with a cloth to remove most of the excess
ink from the surface, followed by a final smooth wipe, leaving ink only in the
grooves. A damp piece of paper is then placed on top of the plate, and with
the high pressure of a printing press, the damp paper is forced into the plates
grooves and the ink in the recesses is transferred to the paper. As a result, the paper is printed with a mirror image of the plates artwork, as it would be also with
relief printing.
As noted by medical historian Sandford Larkey (1933, p. 369), Geminus presented a blatant plagiarism of Vesalii. In his dedication to Henry VIII (1491
1547) in the first (Latin) edition (1545), Geminus acknowledged his source:
In my delineation of the entire body according to its parts, I have followed
D. Andreas Vesalii of Brussels, who is by far the most skilled man of our age
in this art. I have followed him, and completely kept pace with him (unless I
am deceived): but by a transverse course. For whatever he produced very diffusely
in many prolix books, I, in accordance with my ability, have put into a compendium, so to speak; besides, I have made copper plates about the common practice
of our studies. And, granted that it is a volume that is not entirely comparable with
the great wealth of his, nevertheless it contains as much in regard to the principal
parts of anatomy as that profuse book of his does.
Translation in Larkey (1933, pp. 369370)
For his first edition, Geminus used the text of Vesalii Epitome (1543) with selected
plates from the Epitome and the Fabrica, omitting the Fabricas frontispiece, the
portrait of Vesalii, and small drawings of bones. The Geminus images are remarkably close to those in Vesalii works, though the large inserted plates of the Fabrica
are reduced in this edition. However, the brain dissection images in Geminus are of
virtually identical size to those of Vesalii, even if arranged differently and in groupings, whereas the Vesalii images are generally presented individually. As noted by
medical historian Sandford Larkey (1933, p. 370), The Geminus engravings compare favourably with [the Vesalii] woodcuts, both as to accuracy and as to artistic
merit, as they would be, of course, given that they were meticulously copied. In
addition, in only a few instances are Geminus copperplate engravings reversed from
the original woodcuts in the works of Vesalii (Crummer, 1926; Geminus, 1545;
3 Vesalian compendia: Plagiarists, imitators, and disseminators
Larkey, 1933; Vesalii, 1543). Because they were engraved as copies of Vesalian
prints, it would have been easier for the artist to engrave them in reverse. The most
straightforward approach would have been to paste the Vesalian prints onto the copper plates and then make the engraving along the original lines of the Vesalian print.
Instead, the artist had to use an intermediate image or a transfer process to create the
reversed image from the Vesalian prints, so that the final copperplate prints were not
mirror images of the Vesalian woodcut prints.
As might be expected, Vesalii reacted angrily to the Geminus plagiarism. In his
treatise on The China Root (1546), Vesalii writes:
But who, I ask, can feel the faintest inclination to publish the results of his nightlong studies, when there are people everywhere guilefully plotting to destroy the
works of others? A case in point exists at present in England, where the figures of
Epitome have been copied very poorly and without skill in drawing although not
without expense to whoever has to pay for them. And indeed, I should be ashamed
to have any one think that I had published these illustrations in such a form . . . I
would rather suffer the total loss of my private property, than to have my works so
disgracefully spoilt: in spite of the fact that everybody seems to think the new editions will be much improved by having very bombastic titles, and being published
as the work of a great many authors in collaboration. But, as the gods favour me, I
will spare no effort to discomfort these imitators who are accustomed to steal
other peoples efforts, since they cannot filch anything new from each other.
Translation in Larkey (1933, pp. 372373)
Geminus had clearly recognized the potential for a short practical work on anatomy,
and further the potential for a volume in the English vernacular rather than in Latin.
Therefore, for the second edition, Geminus used the figures copied from Vesalii but
substituted another anatomical treatise, which was likely copied from A Profitable
Treatise of the Anatomie of Mans Body (1547) by English physiciansurgeon and
anatomist Thomas Vicary (ca. 14901561) (Larkey, 1933). While the 1547 edition
of Vicarys text is no longer extant, the 1577 edition is almost identical to the text
used in Geminus in 1553, which largely follows the earlier work of Mondeville
(Larkey, 1933). Thus, for the second edition, Geminus had combined somewhat simplified versions of Vesaliis major figures with text based on an earlier medieval text
to generate in effect the first English dissecting manual (Larkey, 1933).
In the dedication to his 1553 English edition, Geminus wrote:
And now of late by the information of sondrye frends and also of diverse surgeons I
have ben borne in hande, that the same worke beeying set foorth in the English
tounge might greatly availe to ye knowlage of the unlatined surgeons. & by means
of them, should be muche more beneficiall, then in latin it is to an infinite nombre
of people in thys your Majesties Royalme of Englande. Wherefore mynding to
renre unto this Countrey, in which by your graces protection and bounteous liberalities I live, as much fruite as my poor industrie and continuall travaille maye
possibly bee hable to yelde, I have earnestly applied my selfe to make common and
familiar to all Englishe people, that which in the latin hath been found profitable
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amonge so many foren nacions. Wherunto forasmuch as I am not my selfe so perfect and expert in the Englishe touge that I dare warrant or trust myne owne
dooynges, I have used the studious peines of Nicholas Udall and certain other
learned med whose exercise in translacions and penying in this tounge hath been
(as I understand) not without some fruite to the common weale. . . [sic]
Larkey (1933, p. 375)
Despite the blatant plagiarism from Vesaliis Fabrica and Epitome, Geminus original Latin edition in 1545 and his later English-language edition of 1553 did more to
make Vesalii work known throughout Europe than did Vesalii larger, more expensive, and less accessible writings (De Freyer, 1914; Larkey, 1933).
3.2 Juan Valverde de Hamusco

Spanish anatomist Juan Valverde de Hamusco (ca. 1525 ca. 1587) (Fig. 14) also produced unauthorized abridgements of Vesalii Fabrica (Ball, 1910; Eycleshymer
and Schoemaker, 1917; Lanska and Lanska, 2013; Martn Araguz et al., 2001;
Roberts and Tomlinson, 1992; Valverde, 1556, 1560; Valverdo, 1589). Valverde
was born in the town of Hamusco (today Amusco, a small town in the province of
Palencia, Spain), and later studied anatomy in Padua under anatomist and surgeon
Realdo Columbo (ca. 15161559), who had himself been a student at the University
of Padua and later returned to take Vesaliis position when Vesalii left to oversee production of his Fabrica. Valverde also studied in Rome under anatomist Bartolomeo
Eustachi (ca. 15131574). In 1556, Valverde published Historia de la composicion
del cuerpo humano in the Spanish language in Rome (Roberts and Tomlinson,
1992; Valverde, 1556). It contains 42 copper plates and an engraved title page, of
which all but four plates were derived from Vesalii Fabrica. One of the figures that
was not copied from the Fabrica was a muscle man holding up his own flayed skin
(Fig. 15). The engravings are thought to have been made by Nicolas Beatrizet (ca.
1507 ca. 1570), whose initials NB appear on several plates. This work achieved
considerable popularity, going through multiple editions and ultimately being translated into Italian, Latin, and Dutch (Valverde, 1560, 1608).
Vesalii bitterly complained about Valverdes unauthorized abridgement of his
work: Valverde who never put his hand to a dissection and is ignorant of medicine
as well as of the primary disciplines, undertook to expound our art in the Spanish language only for the sake of shameful profit (translation in OMalley, 1964, p. 294).
Although much of Valverdes work was derivative, Valverde did make several corrections to the images (e.g., anatomy of the extraocular muscles), described the intracranial course of the carotid arteries, and made the first drawing of the stapes (Martn
Araguz et al., 2001). In addition, Valverde acknowledged using illustrations from
Vesalii because his illustrations are so well done it would look like envy or malignity
not to take advantage of them (translation in Roberts and Tomlinson, 1992, p. 211).
Craftsmen under the direction of Valverde copied the woodcut prints of Vesaliis
12-stage brain dissection in the Fabrica in close but approximate form by freehand
engraving onto copper plates (Lanska and Lanska, 2013). Valverdes illustrations are
FIGURE 14
Portrait of Juan Valverde de Hamusco from Historia de la composicion del cuerpo humano
(1560) and abridgement of Vesaliis Fabrica (1543).
fairly close copies of those in the Fabrica, except that Valverdes illustrations are
approximately half the size and are mirror images of those in the Fabrica. Valverdes
illustrations show the same dissection stages, identical transverse brain levels and
structures, and similar (but not identical) branching patterns of the middle meningeal
artery, but lack shadowing and show minor variations in perspective and fine details
(e.g., characteristics of the mustaches on many of the figures) from those in the Fabrica (Fig. 16) (Lanska and Lanska, 2013). Differences in the sizes of the images, and
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FIGURE 15
Valverdes muscle man holding his own flayed skin. This was one of only four figures in
Valverdes Anatomia del corpo humano (1560, 1608) that had not been copied from Vesaliis
Fabrica (1543), although it was possibly inspired by a medieval illustration from Henri de
Mondeville (ca. 1341). Two versions of this illustration are shown from the 1560 (left) and
1608 (right) editions. The illustration in the later edition is an approximate mirror image of the
earlier print, demonstrating that it is from a new engraving that was made as a close copy of an
earlier print. Numerous minor variations are evident upon careful review, including changes
in the guard on the knife, and changes in the shadows, ground, rocks, and blades of grass.
Courtesy of the U.S. National Library of Medicine (left) and the Becker Library of Washington
University in St. Louis, Missouri, USA (right).
in perspective and fine detail, preclude direct tracing of images as the means of copying. Because such copperplate images are in effect flipped over to make further
prints, prints made from Valverdes copperplate engravings from the first edition
are mirror images of those in Vesalii Fabrica.
3.3 Ambroise Pare

French military and royal surgeon Ambroise Pare (15101590) was a pioneer in the
development of surgical techniques, the treatment of battlefield injuries, and forensic
pathology (Fig. 17) (Packard, 1921; Paget, 1897). In 1552, Pare was accepted into
FIGURE 16
Comparison of details from a single stage of the 12-stage brain dissection by Vesalii in the
Fabrica (1543) as subsequently copied by Valverde in Historia de la composicion del cuerpo
humano (1556). The dissection level and most of the major details are identical. Because
workmen under the direction of Valverde copied the print from the Fabrica onto a
copperplate, the prints made from this copperplate are necessarily mirror images of those in
the Fabrica. For comparison purposes, the Vesalii print (left) is shown with a mirror image of
the Valverde print (right). In addition, the original prints in Valverdes Historia de la
composicion del cuerpo humano (1556) are about half the size of those in the Fabrica
(as measured by D.J.L. at the Becker Medical Library at Washington University in St. Louis,
Missouri, USA). Notice that the shadow of the head on the table that was illustrated in the
Vesalii print has been omitted in the Valverde print. There are also differences in other details,
including omission of a portion of the graywhite junction (upper right) in the medial occipital
lobe (beneath the portion of the corpus callosum that has been separated anteriorly and then
reflected posteriorly), distortions of the pattern of the graywhite junction in the frontoparietal
areas (lower right), a different appearance to the mustache (lower left), and an entirely
different pattern of lines used to convey shading (particularly lower left). Differences in size
and fine detail preclude tracing or a similar method of directly copying the print from the
Fabrica onto a copperplate. Instead, freehand copying was likely employed.
The original images are courtesy of the U.S. National Library of Medicine.
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62
FIGURE 17
Ambroise Pare, posthumous engraving by English portrait-and-figure engraver William Holl
the Younger (18071871).
royal service of the Valois Dynasty under Henri II (15191559). He stayed in the
service of the kings of France for the remainder of his life, serving not only Henri
II (15191559) but also Francis II (15441560), Charles IX (15501574), and Henri
III (15511589). In 1554, undoubtedly because of his prominence at court and despite his lack of university training in medicine and philosophy, Pare was invited to
become a member of the College de Saint-Come, a centuries-old association or guild
of master surgeons in Paris. He was thus recognized then as a master surgeon, or
surgeon of the long robe, rather than one of the lower class of barber surgeons
or surgeons of the short robe (Fig. 18) (Baas and Handerson, 1889).
Of those who copied illustrations from Vesalii, Pare is the only one known to
have met Vesalii, when both attended the dying King Henri II of France (1519
1559). On 30 June 1559, Henri was fatally wounded in a joust during lavish festivities in Paris celebrating the marriage by proxy of the kings 14-year-old daughter
Princess Elisabeth of Valois (15451568) to King Phillip II of Spain (Elze and
Wagenseil, 1963; Faria, 1992; Martin, 2001; Norwich, 1991; OMalley, 1964;
Wagenseil, 1962). This arrangement was one of the terms of the Peace Treaty of
Cateau-Cambresis that had been signed on April 2 between France and Spain. Henri
had already participated in three prior jousts and appeared exhausted after the last of
FIGURE 18
Etching of Ambroise Pare in the robes of a master surgeon and member of the College de
Saint-Come.
these, which had been with Gabriel de Lorges (15301574), Comte (count) de Mongonmery, who was captain of the Garde Ecossaise (i.e., the Scots Guard, an elite
Scottish military unit that had served for over a century as personal bodyguards to
the French monarchy). Despite admonitions from the queen and his advisors to forgo
further jousting, the king apparently was unsatisfied with his earlier showing against
the count, in which he had been badly shaken and nearly unhorsed. The king therefore ordered an additional joust. Unfortunately, on the second joust with the count,
the counts lance penetrated the kings helmet, sending splinters into the kings right
orbit.
According to Pares account (using the original spellings from the 1649
translation),
[King Henry] having set in order the affaires of France, desirous to honour the
marriages of his daughter, and sister, with the famous and noble exercise of
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64
Tilting [jousting], and he himself running in the Tilt-yard, with a blunt lance received so great a stroak upon his brest, that with the violence of the blow, the
visour of his helmet flew up, and the trunchion of the broken Lance hit him above
the left eye-brow, and the musculous skin of the forehead was torn even to the
lesser corner of the left eye, many splinters of the same trunchion being struck
into the substance of the fore mentioned eye, the bones being not touched or broken . . .
Pare and Johnson (1649, p. 273)
As subsequently recounted by Vesalii (based upon second-hand reports of witnesses

because Vesalii was not present at the joust):
Upon receiving the wound, the King appeared about to fall first from one side and
then from the other, but eventually, by his own effort, he managed to keep his saddle. After he had dismounted and was surrounded by spectators running forward
from the crowd he showed loss of consciousness, although he later ascended the
steps to his chamber with hardly a totter.
Translation in OMalley (1964, p. 396)
After splinters were removed from the wound by hand, the king vomited and subsequently became lethargic. Although Pare and the court physicians considered trephination, the procedure was ultimately deemed futile and was not attempted. Upon
learning of the kings injury on July 2, his new son-in-law, King Phillip II of Spain,
sent Vesalii from Brussels to assist in the management of the kings injury. Vesalii
arrived for consultation with Pare and the court physicians on July 3 and, although he
was a foreigner, Vesalii was effectively placed in charge of the case (Fig. 19). To
help understand the nature of the kings injury, Pare had already experimented with
the broken lance, thrusting it into the orbits of four criminals who were decapitated
on order of the Queen (Martin, 2001; OMalley, 1964). When he arrived, Vesalii repeated this procedure on the head of a murdered man, but these gruesome investigations failed to greatly enlighten the therapeutic and prognostic deliberations.
By that point, the king was febrile and delirious and showed signs of meningeal
irritation as Vesalii determined with a crude neck-flexion maneuver. On this basis,
Vesalii opined that the king would not recover from his injury. Vesalii also noted that
the kings left eye was immensely swollen [but nevertheless] retained full vision,
indicating that there had not been a breakdown of the nervous force (translation
in OMalley, 1964, p. 397). Subsequently, the king developed sequentially a left
hemiparesis, violent convulsions involving the right side of his body, and labored
respirations, before he ultimately died on July 10, the 11th day after his injury.
Vesalii and Pare both apparently participated in the autopsy and gave complementary accounts of the findings. According to Pares account of the autopsy:
His skull being opened after his death, there was a great deal of blood found between the Dura and the Pia Mater, poured fourth in the part opposite to the blow,
at the middle of the suture of the hind part of the head; & there appeared signs by
the native colour turned yellow, that the substance of the brain was corrupted,
[over an area] as much as one might cover with ones thumb. Which things caused
FIGURE 19
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Woodcut print (ca. 1559) of the deathbed of Henry II of France in 1559 (entitled Obitus Regis Henrici ii huius nominis, Parisiis ad Turriculas die x.
Iulii, 1559). Vesalii and Pare are in consultation (standing behind the table with Vesalii to the left). A cardinal, the kings constable, and the queen
consort, Catherine deMedici (15191589), who is noted to be crying, are standing (from far left to the right) behind the bed. The kings guard is at
the far right of the woodcut. Through the window are messengers on horseback sent from Flanders, together with doctors and surgeons including
Vesalii, by the King of Spain (The National Library of Medicine image description states incorrectly that the view shown through the window is of the
continuing joust).
66
the death of the most Christian King, and not only the wounding of the eye, as
many have falsly thought. For we have seen many others, who have not dyed
of farre more grievous wounds of the eye.
Translation in Pare and Johnson (1649, p. 273)
Vesalii similarly noted that the dural membrane appeared everywhere uninjured,
but there was a subdural hemorrhage and probable associated cerebritis or abscess as
well as evidence of a traumatic injury to the brain near the vertex (a lesion interpreted
by later authors as a contrecoup injury) (translation in OMalley, 1964, p. 397). As
Vesalii explained, the putrid condition gave proof that the brain had collided with
the skull and had been concussed and shocked by it, and not that the condition had
been caused by an injury to the skull [i.e., a depressed skull fracture] (translation in
OMalley, 1964, p. 397).
Sixteen years later, a collection of Pares works, based on his experiences treating
soldiers on the battlefield, was published at Paris in 1575. Later editions also appeared
in French, German, Dutch, and English (Pare, 1585, 1649, 1664). These volumes include multiple figures copied from works by other authors. Many are copied from
Vesaliis works, although many of the engravings were relatively crude by comparison
to those in Vesalii Fabrica (Fig. 20). Others were copied, for example, from Valverde
(Fig. 21) and Gersdorff (Fig. 22). Valverdes skinned man and Gersdorffs wound
man are among the illustrations copied in editions of Pares works.
The skinned man illustration was only present in the English edition of Pares
works, which was published after Pares death. The version of the skinned man
illustration in Pares works was itself directly taken from Microcosmographia: A
Description of the Body of Man (1615, 1631) by English physician Helkiah Crooke
(15761635), or a pocket-sized abridgement of that work entitled Somatographia
Anthropine, or a Description of the Body of Man by Alexander Read (1580
1641) (Anson, 1949; Crooke, 1615, 1631; Crooke and Read, 1616, 1634). Crooke
had in turn copied the general idea of the figure and many details from Valverde,
although there are obvious stylistic differences (Figs. 15 and 21). Crooke also copied
numerous other images from Vesalii.
It appears that the same plate was used for skinned man illustrations in the
editions and abridgements of Crookes Microcosmographia and the later English
edition of Pares works, because the skinned man illustrations are virtually identical,
and because the printers of these various works were closely related to each other.
The early editions of Crookes work (Crooke, 1615; Crooke and Read, 1616) were
published by London printer William Jaggard (ca. 15681623), who was the official
Printer to the City of London and is best known for his connection to the works of
William Shakespeare (15641616). Jaggard was eventually assisted by his son Isaac
(died 1627), but within a 4-year period both the father and the son had died; so, in
1627, the sons widow assigned the business and all of the copyrights to the brothers
Thomas Cotes (died 1641) and Richard Cotes (died 1653) (Plomer, 1900, 1907). The
1631 edition of Microcosmographia was published by the Cotes brothers together,
the abridgement of Crooks work from 1634 was published by Thomas Cotes, and the
FIGURE 20
Representations of the cranial nerves from Andreas Vesaliis De humani corporis fabrica
(1543, left) and from Ambroise Pares Les oeuvres dAmbroise Pare (1585, center) and The
Workes of the Famous Chirurgion Ambrose Parey (1649, right). Numerous gross errors are
apparent in the image from Vesalii, including representation of the origin of the sympathetic
trunk from the vagus nerve (Saunders and OMalley, 1950). The errors in the Vesalii woodcut
were continued in the copy woodcuts used in Pares later works. Because of right-to-left
asymmetries in anatomy (e.g., the more caudal origin of the recurrent laryngeal nerve on the
left than the right), the artisans copying the image from Vesalii had to make an intermediate
copy and then reverse it for the final woodcut so that the final print had the correct orientation.
The image from Pares (1585) edition corresponded to only part of Vesaliis original image.
The expanded image for Pares later 1649 edition had to be reengraved from Vesalii (1543) or
more likely from a later abridgement of Vesalii, and specifically from an intervening work by
Helkiah Crooke.
Images from Vesalii (1543) and Pare (1585) are courtesy of the U.S. National Library of Medicine, and the image
from Pare (1649) is courtesy of Wikisource.
1649 edition of Pares works was published by Richard Cotes (because Thomas had
died by this point). Thus, there is a clear printing lineage from the first edition of
Crookes Microcosmographia (1615) to the posthumous English edition of Pares
works (1649).
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68
FIGURE 21
A muscle man holding his own flayed skin from Ambroise Pares The Workes of the Famous
Chirurgion Ambrose Parey (1649), a posthumous edition. This was copied from one of
Juan Valverde de Amuscos (or de Hamusco) few original plates in Valverdes Historia de la
composicion del cuerpo humano (1556). The vast majority of the other images in
Valverdes work had been copied from Andreas Vesaliis De humani corporis fabrica (1543).
The image in Pares Workes is much more crudely engraved than the original in Valverdes
work. This illustration was not present in the earlier French edition (1585). It was likely
taken from an intervening work by Helkiah Crooke.
Image from Valverde is courtesy of the U.S. National Library of Medicine. Image from Pare is courtesy of
Wikisource.
4 Conclusion
FIGURE 22
Wound man images from German surgeon Hans von Gersdorffs Feldbuch der
Wundartzney (1517, left) and from Ambroise Pares The Workes of the Famous Chirurgion
Ambrose Parey (1649, right). The image from Pare is an approximate mirror-image copy
of that from Gersdorffs monograph with apparent stylistic modifications and some
omissions of injuries in the later image (e.g., the compound fracture of the right radius,
lacerations of the left biceps and left tibialis anterior muscles in the Gersdorff print). This
strongly suggests that the later woodcut copy print used in Pares monograph was done
freehand using a Gersdorff print as the model. When the copy woodcut was then printed, the
result was an approximate mirror image of the original print. This image was not present in the
earlier French edition (1585).
Images are courtesy of the U.S. National Library of Medicine.
4 CONCLUSION
From the late thirteenth century, anatomists began to question Galenic anatomical
dogma and to perform human dissections, initially as part of forensic investigations.
This eventually fostered the origins of realistic anatomical illustration in the late fifteenth century. As authors began to utilize the power of the printing press at this time,
printed books began to supersede hand-copied medieval manuscripts, and laborintensive techniques were soon developed to integrate text and illustrations on the
printed page.
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70
The same technology was used to pirate the images of prior authors with varying
degrees of fidelity. Specific medieval and Renaissance anatomical illustrations can
often be traced from their inceptions through different stages of development to the
final printed images, and then through subsequent pirated versions in various
abridgements or other compendia of the original works. The sequential modifications of the images typically provide clues to the methods used to create and develop
the printed illustrations in the original books and also the methods used to copy and
reprint these images in derivative works.
While the piracy of published illustrations was frustrating and annoying to the
authors of the copied works, and often reduced the profitability of the original publications, the resulting abridgements and other compendia were sometimes directed
at different audiences from the original works, helped to disseminate the ideas of the
original authors and artists more widely (though in only some cases were the original
authors credited as the source of the printed material), and also served to affirm the
importance and influence of the original works.
The ability of the original artists to make realistic drawings, and the ability of
block cutters and engravers to accurately transfer these images to wood blocks or
copper plates (whether authorized or not), rapidly accelerated knowledge of the human body and helped to make this knowledge widely available to students, practicing
physicians and surgeons, artists, anatomists, and scholars. This proliferation and profusion of knowledge undermined and eventually overthrew the scholastic reliance on
Galenic dogma and was entirely in keeping with cultural changes occurring more
broadly during the Renaissance. In this case, a picture was worth more than a thousand words.
Acknowledgment
This work was supported in part by an H. Richard Tyler Fellowship from the
American Academy of Neurology to D.J.L. in November 2012.
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Singer, C., 1952. Vesalii on the Human Brain. Publications of the Wellcome Historical Medical Museum. Oxford University Press, London.
Singer, C., 1956. Brain dissection before Vesalii. J. Hist. Med. Allied Sci. 11, 261274.
Singer, C., 1957. A Short History of Anatomy & Physiology from the Greeks to Harvey. Dover
Publications, New York.
Singer, C., 1961. Eighteen years of Vesalian studies. Med. Hist. 5, 210220.
Sudhoff, K., 1908. Abbildungen zur Anatomie des Maitre Henri de Mondeville (ca. 1260 bis
ca. 1320). In: Ein Beitrag zur Geschichte der Anatomie im Mittelalter speziell der anatomischen Graphik nach handschriften des 9. bis 15. Jahrhunderts. Studien zur Geschichte
der Medizin, vol. 4. Johann Ambrosius Barth, Leipzig, pp. 8289 (Tafel XXIV).
Valverde de Amusco, J., 1556. Historia de la composicion del cuerpo humano. Antonio Salamanca and Antonio Lafreri, Roma (Rome).
Valverde de Amusco, G., 1608. Anotomia del corpo humano. Giunti, Vinetia (Venice).
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Valverde di Hamusco, G., 1560. Anatomia del corpo humano. Antonio Salamanca and Antonio Lafreri, Roma (Rome).
Valverdo, J., 1589. Anatome corporis humani. Studio et industria luntarum, Venetiis (Venice).
Vesalii, A., 1543. de Humani corporis fabrica Libri Septem. J. Oporini, Basil.
Vesalii, A., 1555. de Humani corporis fabrica Libri Septem. J. Oporinum, Basil.
Vesalii, A., 1616. Epitome Anatomica. P. Pauw.
Vesalii, A., 1949. Epitome of Andreas Vesalii. MIT Press, Cambridge, MA (Translated from
the Latin with preface and introduction by L.R. Lind; with anatomical notes by C.W.
Asling).
Vesalii, A., 1960. Preface: To the divine Charles the fifth, greatest and most invincible emperor. The preface of Andrew Vesalii to his books on the fabric of the human body. In:
Clendening, L. (Ed.), Source Book of Medical History. Dover Publications, New York,
pp. 128141.
Vidal, F., 1985. Un grand nom de la chirurgie du moyen age: Henri de Mondeville (1260
1320). Revue dOdonto-stomatologie (Paris) 14, 213218.
Vrebos, J., 2011. Thoughts on a neglected French medieval surgeon: Henri de Mondeville
(/1260-1320). Acta Chir. Belg. 111, 107115.
Wagenseil, F., 1962. Vesal beim Tode Henrichs II von Frankreich. Sudhoffs Arch. Gesch.
Med. Naturwiss. 46, 333349.
CHAPTER
Anna Morandis Wax

Self-Portrait with Brain
Rebecca Messbarger1
Department of Romance Languages, Washington University, St. Louis, MO, USA
1
Corresponding author: Tel.: 1-314-935-5478; Fax: 1-314-726-3494,
e-mail address: rmessbar@wustl.edu
Abstract
In her self-portrait in wax, eighteenth-century Bolognese anatomist and anatomical modeler
Anna Morandi Manzolini (17141774) represented herself in sumptuous aristocratic dress
while dissecting a human brain. This essay explores the scientific and symbolic meaning of
the vivid self-portrayal in terms of Anna Morandis lifework at the intersection of art and
anatomical science and within the remarkable cultural context of Enlightenment Bologna that
fostered her rise to international acclaim.
Keywords
Anna Morandi, Pope Benedict XIV Lambertini, Giovanni Manzolini, anatomy, anatomical
wax figures, Enlightenment, eighteenth-century Bologna, neuroscience, cognition, Albrecht
von Haller, irritability, sensory perception
1 THE CONTEXT
We can deduce by all that has been said that the fantasy or the imagination is in itself
nothing other than that wondrous book of the human brain in which are imprinted
both intellectual notions as well as images of sensible objects collected by the sense
and transmitted by means of the animal spirits through those most subtle channels
of the nerves that carry them all the way to the market place of the brain.
POPE BENEDICT XIV LAMBERTINI, De servorum Dei beatificatione et beatorum
canonizatione (1738, p. 463; trans. Stefano Gulizia and Rebecca Messbarger)1
My thanks to Stefano Gulizia for his translation of this chapter on Miracles in Benedicts work from
Latin to Italian, from which I composed the translation into English. Unless otherwise indicated, all
future translations from the Italian are mine.

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CHAPTER 3 Anna Morandis Wax Self-Portrait with Brain
In 1738, the academic and religious elite of Bologna, Italy, celebrated the local
publication of the fourth and final volume of the monumental work of Church legal
doctrine, translated from the Latin as, On the Beatification of the Servants of God,
and the Canonization of the Blessed. Its author, Bolognas native son and current
archbishop Prospero Lambertini (16751758), would ascend the throne of Saint
Peter 2 years later as Pope Benedict XIV. The 484-page Part I of this volume, dedicated to the critical role of miracles in the processes of beatification and canonization, drew in its distinction between natural and miraculous cures directly from
Bolognas wealth of resources as a historic center of medical science (dalla Torre,
1991; Veraja, 1992). In preparing the section on miracles, the archbishop had
consulted doctors of medicine at the ancient university, as well as the universitys
rich holdings of scientific literature, in order to establish firm boundaries between
the natural functions of the body and supernatural intervention, of utmost importance
for assessing claims to miracles (Saccenti, 2011).
Archbishop Lambertini was, however, no novice in medical science. During his
20-year tenure (17081731) as Promoter of the Faith, better known as the Devils Advocate, Lambertini had applied a rigorous forensic methodology to dispute hundreds of
claims to sainthood and miracles, principally by means of modern medical literature
and his own direct knowledge of contemporary medical theories and practices
(Dacome, 2009; Duffin, 2009: 1231). Lambertinis training in medical science had
taken place under the tutelage of Roman physicians, above all Giovanni Maria Lancisi
(16541720), the chief physician to three popes, whose medical theories were based on
case studies and observed physical evidence obtained mainly during dissection (Donato,
2010: 148158). Pope Benedict XIV Lambertinis treatise on beatification and canonization, which still guides the procedures today, is testament to his erudition in canon law
and his experience on the ground, so to speak, as the Churchs defender of truth in sanctity. Further, the extended section on miracles reflects his deep knowledge and endorsement of experimental medicine (Donato, 2010; Vidal, 2007). This endorsement played
out in Bologna in explicit and transformative ways for the cultural life of the city.
From the moment of Lambertinis return home as archbishop through his 18-year
papacy, he viewed the development of medical science as a prime means for restoring Bolognas former standing as a leading European academic center. While archbishop, he regularly attended the annual Public Anatomy in the university anatomical
theater. In a published notification, he directed Bolognas priests to persuade their
parishioners to give up their dead kin for the publicly useful purpose of dissection.
From Rome, he appointed the noted physician Pier Paolo Molinelli to the first chair
of surgery in Bologna for the necessary instruction of new surgeons in human
dissection. He established the first chair of obstetrics and the use of obstetrical
models for the training of midwives and surgeons in female reproductive anatomy
and modern techniques in child delivery. He commissioned the first museum of anatomy in Italy, which displayed spectacular life-size wax models of the anatomized
body in Bolognas prestigious Istituto delle Scienze, a center of modern scientific
practice that he also helped to develop (Messbarger, 2010: 2051).
1 The context
In all of these endeavors, he was keenly interested in advancing understanding

of the structures and functions of the parts of the human body, from the muscles
to the bones, the sensory organs to the nervous system and the brain. Indeed, as
evidenced in his doctrine on miracles, in which he cites a whos who of recent
theorists on the anatomy and physiology of the brain, including Thomas Willis,
Marcello Malpighi, Rene Descartes, Daniel Sennert, and Thomas Fienus, Lambertini
was in fact engaged in the early stages of what Charles T. Wolfe has expressively
described as eighteenth-century neuromania (Wolfe, forthcoming: 9).2 In his analysis of the corporeal origins and natural and possibly supernatural effects of imagination, for example, Lambertini begins by summarizing current thinking on the
anatomy of perception and cognition. He discusses the nerves and spinal cord that
represent an extension of the brain, or a product flowing in the eyes, the ears, to the
nostrils, to the tongue, to the hands, where the sense of touch is found. On the origin
of ideas, he writes that insensible and spiritual things, by means of sensible things,
are impressed on the human brain or, so to speak, in the substance of its wrinkles, its
pits and folds, and its notes, in such a way that virtually all of the characteristics that
mark objects, both material and immaterial that form ideas, are stored for the future
(Benedict XIV, 1738: 462463). As Fernando Vidal has observed, Lambertini
participated in the nascent remaking of the sciences of the soul into sciences of
the mind (Vidal, 2013: 17).3
More than any other figure, Pope Benedict XIV Lambertini influenced medical
culture in Bologna in the first half of the eighteenth century. His dynamic engagement with contemporary medical theories and advocacy of modern scientific
methods shaped what and how medicine was done in Bologna for 30 years. The
leitmotifs of his master juridical tract concerning anatomy and medicine, including
neuroanatomy and science, were known and espoused by many Bolognese academicians and medical practitioners at the time.4 And it was in this resurgent milieu for
medical science that anatomist and anatomical modeler Anna Morandi would develop her art and science of the human body.
My thanks to professor Wolfe for sharing this and other relevant forthcoming articles.
Vidal explains the difference as a change from a focus on the physiological connection of soul and
body in the early modern scientia de anima to an emphasis expressed in Lambertinis analysis of
miracles on the intangible powers of the imagination that exceed causal explanation. Basing his
judgment only on observed corporeal events, Lambertini concludes that it is not possible to determine
if the imagination produces miracles (p. 17). I am grateful to professor Vidal for sharing this forthcoming work.
4
Not only was the treatise immediately reviewed in major literary journals like Osservazioni letterarie
with circulation across the peninsula, Lambertinis unedited correspondence with numerous members
of the scientific community in Bologna, held in the Biblioteca Universitaria di Bologna, manifest the
involvement in the project by the local academic class. My sincere thanks to Maria Teresa Fattori for
indicating these documents.
3
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2 THE ANATOMIST
With a virile soul, oblivious to the cadavers stench, and heedless of the feeble
weakness of her own sex, she decided to give (her husband) aid in that thankless
and difficult work (of dissection). The illustrious Signora learned to create in wax
not only the major parts, but she was the first to dare to form in wax and other
materials those most subtle and diaphanous parts of the body that would escape
our very sight. And all this she dared with such ability, with such realism, and such
happy results as I have already described.
Luigi Galvani, De Manzoliniana Supellegtili Oratio (1776, reprint 1988, p. 102)
The actors in Anna Morandis wax anatomical theater are the dynamic parts and
structures of the living human body. All of Morandis hundreds of naturalistic
models of organs, bodily systems, even the bony infrastructure uncovered at the
end of each series as in dissection, express the body in life and often in motion. Skeletal forearms flex, reach, and grip (Fig. 1); anatomized eyeballs playfully gape in all
directions beyond their wooden display (Fig. 2); a pair of intact hands that lead the
series on the anatomy of touch articulate the opposite sensations of pain and pleasure;
the right pricked by a woody spine (now lost) tensely recoils while the left languorously fingers a silk cushion (Fig. 3). All of Morandis figures are animate, that is,
except two.
In her self-portrait, the filmy yellowed brain within an open skull under the command of her doppelgangers scalpel and forceps is one of only two examples of dead
flesh in her vast oeuvre (Figs. 4 and 5). A dramatic prop and critical focal point in this
singular dissection scene, whose unconventional protagonist is the lavishly dressed
and ornamented woman anatomist, the brain is both graphically real in its representation and densely symbolic. Morandi shows herself disclosing with her surgical
tools (a forceps and scalpel now lost) the coverings and superficial structures of
the brain, the loftiest organ of the body. Acting as three-dimensional title page to
her plastic atlas of human anatomy, the self-portrait epitomizes and sublimates
her contribution to the science: the exquisite explication in colored wax of vital,
interrelated structures and functions of the experiential body, particularly the
anatomy of sensory perception, a foremost theme of her work, for which the brain
is font and final repository (Dacome, 2005, 2007; Focaccia, 2008; Messbarger,
2001, 2003, 2010).
Her bust was part of a diptych, bound to the wax portrait she created of her
late husband, the Bolognese artist and anatomical sculptor, Giovanni Manzolini
(17001755) (Medici, 1857; Messbarger, 2010). The uncanny likeness almost certainly modeled on his cadaver shows him in the act of dissecting a rust-colored heart
he palms familiarly with his left hand (Fig. 6). The dissected human heart together
with the anatomized brain exemplified the couples modern empirical method, their
hands-on exploration of the dead body. The rest of the collection instead served to
illustrate the living interior of the body for the instruction of medical students and the
use and appreciation by medical practitioners and connoisseurs.
2 The anatomist
FIGURE 1
Anna Morandi and Giovanni Manzolini, forearm and deep musculature, wax and bone.
Courtesy of Museo di Palazzo Poggi, Universita` di Bologna.
Professionally trained as artists, Anna Morandi and Giovanni Manzolini had first
met in the prominent local studios of Giuseppe Pedretti (16941778) and Francesco
Monti (16851768); they married in 1740. Their collaboration in anatomical wax
modeling began in earnest 6 years later, following Giovanni Manzolinis angry departure as chief assistant on the first Anatomy Museum in Italy, which Pope Benedict
XIV Lambertini commissioned for Bolognas Istituto delle Scienze (Messbarger,
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80
FIGURE 2
Anna Morandi, eyes, wax.
FIGURE 3
Anna Morandi, feeling hands, wax.
2 The anatomist
FIGURE 4
Anna Morandi, self-portrait, wax.
FIGURE 5
Anna Morandi, detail of self-portrait.
Courtesy of Museo di Palazzo Poggi, Universita` di Bologna. My thanks to Dr. Fulvio Simoni for taking this photo.
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FIGURE 6
Anna Morandi, portrait of her husband Giovanni Manzolini, wax.
2010). Having accused the project director, sculptor Ercole Lelli, of stealing credit
for his work modeling life-size figures in wax of the complete myology of the human
body (Fig. 7), Giovanni Manzolini opened a rival modeling studio and school of
anatomy with his wife in their home (Crespi, 1769; Fantuzzi, 1786; Ferretti, 1979;
Oretti, n.d.). The couple created wax anatomical models for medical professionals,
avid amateurs, science academies, and courts across Europe, and Anna Morandis
anatomical demonstrations in their home studio quickly became a mandatory stop
for European travelers on the Grand Tour (Bianchi, 17401792; Cusatelli, 1986;
Terlinden, 1755). The set of portraits thus commemorates the couples remarkable
professional alliance and contributions to the science and art of anatomy.
Equally significant, through their juxtaposition and their subversion of traditional
gender associations, the portraits serve to amplify the exceptional status of Anna
Morandi in the sphere of anatomical science. While improbably arrayed in taffeta,
lace, and pearls, the woman anatomists surgical study of the brain, seat of the rational soul and traditionally viewed province of male supremacy, is all the more provocative when compared to Manzolinis hands-on prosection of the heart, the seat of
feeling. Her husbands unfocused gaze, melancholic mien, and anatomical subject
reinforce Anna Morandis distinction among master anatomists and her command,
both physical and scientific, over the brain (Perini, 1988). As I will discuss in greater
depth later in this essay, the brainheart dichotomy at play in these portraits not only
3 Brain power
FIGURE 7
Ercole Lelli, ecorche of superficial muscles, wax.
serves to capture the couples professional partnership and Anna Morandis unique
standing in the science but also points to their role in dominant epistemological
debates taking place in Bologna and across Enlightenment Europe at the time. At
first reading, however, the symbolism of the brain in Morandis self-portrait
advances the mise en sce`ne of her scientific mastery.
3 BRAIN POWER
When the external sensors of individual senses are struck and moved by fitting
objects, they transmit the received impression to the brain through the continuous
track of the nerve and by means of an animal mechanism.
POPE BENEDICT XIV, De servorum Dei Beatifatione et Beatorum Canonizatione, Book IV
(1738, p. 462; trans. Stefano Gulizia and Rebecca Messbarger)
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All of the identified nerves extend to the summit and apex of the fingers and here
they multiply themselves in most copious and minute ramifications, more than in
any other part, and for this reason therefore and because of the proliferation of
nerves operated by Nature, the sensation is rendered more acute and delicate than
anywhere else.
ANNA MORANDI Anatomy of the Hand, Anatomical Notebook (ca. 1755,
fol. 52 v; trans. Rebecca Messbarger)
By the time Anna Morandi created her self-portrait and the companion wax effigy of
her husband, she had risen from working-class roots and obscure standing as a local
artist to international acclaim for her vibrant and meticulous anatomical waxworks.
She had recently buried her husband Giovanni Manzolini, dead from dropsy of the
chest and corrosion of the liver, in the floor of Bolognas main Cathedral (Crespi,
1769). For more than 10 years prior to his death and her takeover of their home
studio, she had been the face of the household anatomical practice, conducting on
her own expert anatomy demonstrations that drew medical practitioners and Grand
Tourists from across Europe. Giovanni Manzolini was, in fact, never mentioned in
any of the numerous published accounts of visits to their studio. According to several
of their Bolognese contemporaries, he suffered from a severely morose and acrimonious disposition and, for that reason presumably, remained out of public view. By
contrast, many of these same contemporaries underscored the extraordinary virile
strength of Anna Morandi in her dissections of putrefying cadavers, as well as her
proficiency and eloquence in the anatomy demonstrations she gave before captivated
listeners (Crespi, 1769; Fantuzzi, 1786; Zanotti, 17311791). On a highly personal
level, therefore, the organs she and her husband are shown anatomizing in her
portraits of them allude to the defining temperament and character of each: she,
the analyzing intellect, and, he, the melancholic heart.
At the same time, however, Anna Morandis hands-on dissection of a true-todeath brain and Giovannis Manzolinis examination of a naturalistic severed heart
epitomize their modern empirical method of anatomical discovery even as their
incongruous aristocratic dress symbolizes their prestige in the science. Over the
course of their 12-year partnership, Morandi and her husband achieved international
recognition, creating models of the sensory organs for the Royal Society of London
and the Procurator of Venice; wax replicas of the female reproductive system and
gravid uterus for Bolognas first school and museum of obstetrics founded by physician Giovan Antonio Galli, and anatomical models for Bolognas first Chair of
Surgery, Pier Paolo Molinelli, appointed by Pope Benedict XIV. The couple received
commissions from sovereigns across Italy and Europe, including King Charles
Emanuel II of Sardinia, King Charles of Naples, and King Augustus III of Poland.
After her husbands death in 1755, Morandi won formal recognition in Bologna
for her internationally celebrated work. The Senate of Bologna, in obedience to Pope
Benedict XIVs directive, named her Public Modeler and Demonstrator of Anatomy
at the University of Bologna (although she was allowed to continue to work from her
home), and awarded her a modest 300 lire annual honorarium provided she did not
3 Brain power
move her famous anatomy practice from Bologna. Two weeks after the popes
declaration of support for her, on December 3, 1755, the Clementina Academy of
Art within Bolognas Istituto delle Scienze inducted her into its honorary ranks
(Messbarger, 2010: 108118).
Morandis fame derived not merely from the beauty and exactitude of her wax
models but also from the currency of the anatomical studies she undertook with her
husband and on her own, based on extensive empirical investigations. Indeed, after
her husbands death, it was precisely because of the threat that she might move her
pioneering scientific practice to another, more obliging city that Pope Benedict
XIV publicly intervened to keep her in Bologna. He well understood the value and
originality of her three-dimensional images of the anatomical body, which recreated
the science in literal terms. The tracts that Giovanni Manzolini and Anna Morandi
wrote together and, to a greater extent, Anna Morandis 250-page anatomical notebook
that was a companion piece to her collection of wax models, most clearly manifest
their influence on the development of contemporary anatomical studies (Manzolini,
1751; Morandi, n.d.). As Morandis self-portrayal with brain aims to manifest, this
includes brain science. Although Morandi did not write explicitly in her notes about
the anatomy of the brain, as will be seen, she alone and together with her husband
produced extensive written and visual analyses of anatomical structures essential to
contemporary neuroscience, especially sensory perception and nervous sensation.
In 1751, Bolognese professor anatomist Domenico Maria Gusmano Galeazzi
conducted the annual 14-day Public Anatomy, more popularly known as the Carnival
Dissection, in the universitys Archiginnasio Anatomical Theater. Giovanni
Manzolini was one of the many attendees at the event and afterward procured from
Galeazzi, the severed head of one of the subjects used during the lessons. The
35-year-old male subject had been deaf and mute for life and Manzolini and Anna
Morandi sought to do further anatomical analysis to determine if, as they theorized,
the mans muteness was the indirect result of his deafness.
After dissecting the head and examining the muscles, nerves, and component parts
of the speaking apparatus, they found it without defect. On meticulous inspection of the
temporal bones and the anatomical parts of the ear, they discovered instead that the
auditory apparatuses of both ears were extensively malformed. Among other problems, the bones of the middle ear were fused, and the apex and spirals of the cochlea
were missing. The result of their research was an influential tract read in March of the
same year before Bolognas Accademia delle Scienze establishing that the subject did
not speak precisely because he was unable to hear. The mutilation of the auditory
apparatus that blocked transmission of sound and its interpretation by the brain also
prevented development of his speech (Focaccia, 2008).5
5
Manzolini concludes, One sees that while this subject did not have any mutation (vizio) in the speech
apparatus, he did have many defects in the auditory organ, such that these impeded its proper effects.
Therefore it can be said that he was necessarily mute because he was born deaf, in Focaccia (2008),
trans. Messbarger, pp. 256257.
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86
On her own after her husbands death, Anna Morandi continued to research the
anatomy of hearing, producing more precise descriptions and wax models of the
structures of the ear and improving significantly on the corrections the couple had
made together to Anton Maria Valsalvas foremost study on the subject, De aure
humana tractatus (Valsalva, 1704). She dedicated herself to demonstrating in
the most accurate hybrid terms, through image and word, the anatomy and physiology of all the sensory organs, with a special focus on the physical stimulus and on its
nervous and motor effect. Among the sense organs, she privileged the hand and the
eye, the real means and familiar emblems of perception and cognitionknowledge
derived from experience, decoded by the brain, and stockpiled as memory. The
hand and eye were, of course, the corporeal instruments most crucial to her own
science and art of human anatomy. Her demonstration of these organs not only
reached a consummate level of detail, including the identification of new anatomical
structures but also practically engaged crucial leitmotifs of eighteenth-century
sensism.6
Anna Morandis influential protectors were in fact academicians working at the
intersection of anatomy, chemistry, and physics, and at the center of heated debates
in Bologna over sensibility, vitalism, mechanism, irritability, and electrical physiology. The couple collaborated, as we have seen, on anatomical cases with Gusmano
Galeazzi, anatomist, experimental physicist, convert to Hallerian irritability, and
father-in-law to famed electrophysiologist Luigi Galvani (Messbarger, 2010).7
Jacopo Bartolomeo Beccari, professor of anatomy and chemistry also worked
directly with the couple, defended the excellence of their work in anatomy and,
as president of the Accademia delle Scienze in the Istituto delle Scienze, presented
their studies on the anatomy of the ear and their tract on the link between deafness
and muteness.8
Marco Antonio Leopoldo Caldani, the most vocal and controversial proponent in
Bologna of Albrecht von Hallers theories of inherent irritability (Lombardi, 1828:
130133), was among Anna Morandis strongest defenders after her husbands death
and served as her liaison on commissions she received from academies and universities. Luigi Galvani, destined to become a leading promoter of bioelectricity through
his famous experiments on the leg muscles of frogs,9 gave the effusive public eulogy
for Morandi, with whom he had collaborated, at the installation of her collection of
wax models in the Istituto in 1776, 2 years after her death.
A philosophical doctrine that holds that sense experience or perception is the essential font of
knowledge.
7
On a particularly dramatic case that also involved the noted Bolognese physicians Tommaso Laghi,
Giovan Antonio Galli, and Pier Paolo Molinelli, see Messbarger, The Lady Anatomist, pp. 9598.
8
Notably, Beccari also had strong ties to Gianbattista Beccaria, the leading proponent in Italy of
Benjamin Franklins electrical theories.
9
On Galvanis complex role on the development of the theory of animal electricity, see Finger and
Piccolino (2011), pp. 307325.
4 The crankling brain
In the broadest sense, the crux of the debates that involved all of these academic
figures was the distinction between natural perception and higher-level sensibility.
Bolognese physicians and scientists for decades sought to uncover empirically and to
quantify the precise properties that made some life-matter (muscle fibers) react to
stimuli spontaneously by contractions without transmitting the impression to the
soul, and that prompted sensible matter and organs to transmit the impression of
objects by means of the nerves to the soul within the brain. Although there are no
records of the couples explicit involvement in the controversies over the properties
of animated anatomy and Giovanni Manzolini died the very year that Albrecht von
Hallers theories first gripped Bolognas academic class,10 Anna Morandis visualization at the height of this controversy of her husband dissecting a heart and herself
dissecting a brain must be read as testament to their decisive roles in the new anatomy
of knowledge. Their long time collaboration with the central actors in this debate and
the intensive focus of their written and wax analyses on the organs of sense, in
particular Morandis study of the anatomy of pleasure and pain, unmistakably links
them to this chief scientific polemic in Bologna at the timea link Morandi no doubt
sought to underscore by means of her two portraits.
The heart and the brain epitomized, respectively, the difference between irritable
and sensible life matter. At the moment that Morandi created her portraits, proponents
of Hallerian irritability were, in fact, zealously cutting the still pumping great muscle of
the body, the heart, from countless living cats and dogs in Bologna to demonstrate the
reflexive property stored in muscle tissue, the vis insita, which permitted contraction
literally without recourse of the nerves to the brain. The structure of the brain was
studied at the same time to uncover how it functioned as the origin and terminus of
sensibility and, in humans, as the seat of the rational soul (Bresadola, 2011;
Cavazza, 1997a,b; Focaccia and Simili, 2007; Heilbrun, 1991). Morandi thus aligns
her husband scientifically in her portrait of him with the motor reflex of the heart, just
as she ties him personally to the hearts passions. In contrast, she affiliates herself with
the study of conscious sensation, which begins and ends with the brain, even as she
joins her authority and character to the cognitive powers of this supreme organ.
4 THE CRANKLING BRAIN

The substance of the brain is seen to be plowed, or laid as it were with furrows;
out of which arise banks or ridges of broken crevices, not in a direct series but
cross-wise.
THOMAS WILLIS, The Anatomy of the Brain (1681, p. 59)
10
The influential Swiss physiologist Albrecht von Haller (17081777) advanced the theory of irritability or muscle reflexivity: I call that part of the human body irritable, which becomes shorter upon
being touched. He contrasted this property of muscle fibers with sensibility: I call that part of the
human body, which upon being touched transmits the impression of it (via the nerves) to the soul
(Haller, 1755, pp. 45).
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88
In their analysis of the predominant ways in which the brain was represented from the
Renaissance through the nineteenth century, historians of medicine Edwin Clarke
and Kenneth Dewhurst stress the primitivism of most illustrations. The artist of
Vesaliuss Fabrica, they assert, seems to have gone out of his way to make the
cerebral convolutions look like small intestines, while the same gyri captured by
Charles Estienne and Estienne de la Rivie`re in De dissection resemble instead a
plate of macaroni. Eustachis gyri are intestine-like, Johann Veslings resemble
clouds, and Giulio Casserios look like coils of the small gut (Clarke and
Dewhurst, 1996: 6770). They find, in fact, no truly accurate depictions of the brain
until the nineteenth century.
Notably, however, the Early Modern masters of anatomy themselves resorted to
some of these same comparisons to describe the brain. Thomas Willis saw the exterior
surface of the cerebrum as uneven and broken, with turnings and winding and rollings
about almost like those of the intestines (Willis, 1681: 59). Vesalius described the
convolutions of the cerebellum as wormlike and their slanting pathways similar to
the way snakes and eels crawl (Vesalius, 2007: 208). These analogies and others like
them in Early Modern anatomical illustration are not idle or illiterate, of course, but
reflect shared notions of the consonant processes that take place in parts of the body
that appeared similar in form. Whether for the conversion of food in the channels of the
digestive tract into refined blood and spirit, the long uphill extraction of animal spirit
from blood as it rises through the vertebral and carotid arteries to the head and is sent
through the press of the brain, or the distillation and perfection of semen during its
intricate route through the canals of the epididymis and vas deferens, the intestines,
the male sex, and the brain and its vessels are, in Williss words, distillatory organs.
They are alembics for critical iatrochemical processes of the body. Dominant cultural
refrains and metaphorical inclinations imbue these descriptions of the anatomical
body, as they pervade scientific classifications generally.
So how does the Bolognese woman anatomist depict the brain she is dissecting in
her self-portrait? In adherence to the tenets of eighteenth-century empirical anatomy,
her replica is a naturalistic, depersonalized archetype devoid of moralizing visual
rhetoric. Although the anatomical subject is unmistakably lifeless, it does not overstep the boundary of symbolism and provoke the unease of a Baroque memento mori
(Gombrich, 1977: 60). Hers is an empirical, truth-to-nature rendering of the human
brain at once universal, particularized, and extremely precise for the time (Daston
and Galison, 2007: 1727).
Through her partial representation of the brain in wax within a triangular opening
of an actual human skull,11 Morandi depicts the various coverings that enclose and
protect the brain: the scalp with tussock of actual human hair, the real cranium, in
wax the meningeal layers or membranes including the dura mater or outer meningeal
lining the skull, and in wax the arachnoid matter, the middle of the three coverings of
the surface of the brain. The filmy texture of the arachnoid matter is particularly
11
Not infrequently, Morandi formed her anatomical figures by applying wax directly to actual bones.
4 The crankling brain
FIGURE 8
Identification of structures in model of brain by Morandi in self-portrait by Associate
Professor of Anatomy and Neurobiology, Krikor Dikranian and Thomas Woolsey, George H.
and Ethel R. Bishop Scholar in Neuroscience, Professor, Anatomy and Neurobiology,
Washington University Medical School.
well depicted. At the point where the dura matter is shown cut or separated from the
cerebrum at the interhemispheric fissure, the superior sagittal sinus can be seen
(Fig. 8). Although the gyri, the rounded convolutions at the surface of the cerebral
hemispheres, are accurately formed, their placement and extension are incorrectly
shown. Most obviously, the central sulcus is arrested far too low. The regular patterns
of the gyri, the central sulcus with the pre- and postcentral convolutions and insula,
would not be recognized and correctly represented until the end of the century.12
As has been noted, notwithstanding the precision of her depiction of the brain, unlike
the wax anatomical figures she created for use by medical practitioners, this organ is not
the subject of the work, but a crucial prop that, like her costume, serves to heighten the
noble drama of Morandis self-presentation. Moreover, from a conventional standpoint
in front of the portrait that is enclosed in a glass case, it is difficult for the viewer to see the
exact rendering of the brain. The viewer looks at the brain at eye level and sees it from
the side. To fully view the organ, the glass enclosure would have to be opened so that one
could to look down on it from above. The meticulousness of Morandis rendering of
the brain is thus all the more remarkable given the real circumstances of its viewing.
12
My sincere thanks for their identification of the structures and inaccuracies in Morandis wax brain to
Krikor Dikranian, M.D., Ph.D., Associate Professor of Anatomy and Neurobiology, and Thomas
Woolsey, George H. and Ethel R. Bishop Scholar in Neuroscience, Professor of Anatomy and Neurobiology, Cell Biology and Physiology, and Acting Director of the Center for the History of Medicine,
both at Washington University School of Medicine.
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5 CONCLUSION
Minerva was born from the Brain, Vulcan with his Instruments playing the
midwife; for either by this way, viz. by Wounds and Death by Anatomy and a
Caesarean Birth, Truth will be brought to light or forever lye hid.
Thomas Willis, The Anatomy of the Brain (1681, p. 4)
Anna Morandis self-portrait closely follows the iconographic rhetoric of title page
images and author portraits of revered anatomists, whose work she not only knew and
studied but also possessed in her sizable private archive. Like Andreas Vesalius, seen
in his author portrait in the act of dissecting a mans forearm and hand, an overt
symbol of self-knowledge, and her near contemporary and rival in anatomy Antonio
Maria Valsalva (Fig. 9), shown dissecting an ear, the subject on which he was leading
master, in her self-portrait Morandi also accentuates her role as modern anatomical
expositor of emblematic parts of the body. Yet, even as she remakes herself in
accordance with iconic signs of anatomical genius, by her audacious pairing of
FIGURE 9
Anton Maria Valsalva #Copyright 2004Archivio Storico, Universita` di Bologna, Tutti i diritti
riservati.
References
dissected brain and feminine dress, Morandi boldly claims an exclusive place as
female master of the site of the Soul in Chief.
She casts herself as the new Vesalius, the new Valsalva, by means of her selfrepresentation with brain. Yet, she may also be seen to assume the role of Bolognas
new Minerva, the goddess of wisdom born from Jupiters brain and, notably, a foremost symbol of the ancient university city. Through her art of anatomy, Morandi
gives birth to the brain in the dissection scene she dominates, and by means of which
she memorializes her scientific authority. Allusions to Minerva in the self-portrait
might also represent a subtle challenge to the official Bologna Minerva of her
day, the celebrated Newtonian philosopher Laura Bassi, who, with Archbishop
Lambertinis backing, became the first woman to receive a degree from the University of Bologna, and who was depicted in celebratory medals and portraits as the
laurel-crowned goddess (Cavazza, 1997a,b, 2009, Findlen, 1995; Franceschini
et al., 2011). In place of the austere Newtonian Minerva, Morandi assumes the role
of refined Minerva anatomist, whose wisdom and transmission of knowledge are
embodied by the brain itself (Algarotti, 1746: 339).13
Minerva, goddess of wisdom, was also the patroness of arts and crafts. Yet, absent
from Morandis portrait is any overt reference to her role as artist. She has repressed
the manual labor of her art in favor of the manual labor of her science. Needless to
say, she looked upon the human body simultaneously with dissecting and sculpting
eyes, and it was precisely her training in the fine arts that allowed her to synthesize
artistically, what she had taken to pieces scientifically. In her self-portrait, she transformed the disarray and incoherence of the exposed cerebrum, whose putrefaction
had begun even before she cut the skull open with her saw, into a comprehensible
form, at once true and universal, functional, and, yes, beautiful in its clarity and
exactitude.
References
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Eredi Hertz, Naples.
Benedict XIV, 1738. De servorum Dei beatificatione et beatorum canonizatione, Book IV.
Formis Longhi, Bologna.
Bianchi, G., 17401792. Lettera del Signor Dottor Giovanni Bianchi di Rimino scritta da
Bologna a un suo amico di Firenze, il 21 settembre, 1754. Novelle letterarie di Firenze
15, 708711.
Bresadola, M., 2011. Luigi Galvani: Devozione, scienza e rivoluzione, Compositori. Editrice
Compositori, Bologna.
Cavazza, M., 1997a. Dottricie Lettrici dellUniversita` di Bologna nel Settecento. Annali di
storia delle universita` italiane 1, 109126.
13
My thanks to Carl Craver for his constructive critique of this and other sections of this essay.
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Cavazza, M., 1997b. La recezione della teoria halleriana dellirritabilita` nellAccademia delle
Scienze di Bologna. Nuncius 12 (2), 359377.
Cavazza, M., 2009. Between modesty and spectacle: women and science in eighteenth-century
Italy. In: Findlen, P., Wassing Roworth, W., Sama, C. (Eds.), Italys Eighteenth Century:
Gender and Culture in the Age of the Grand Tour. Stanford University Press, Stanford,
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from Antiquity to the Present. Norman Publishing, San Francisco.
Crespi, L., 1769. Felsina Pittrice: Vite de pittori bolognesei, vol. 3. Marco Pagliarini 1980,
Rome, pp. 301312.
Cusatelli, G. (Ed.), 1986. In: Viaggi e viaggiatori del Settecento in Emilia e in Romagna, vol. 2.
Il Mulino, Bologna, pp. 596601.
Dacome, L., 2005. Un certo e quasi incredibile piacere: Cera e Anatomia nel Settecento.
Intersezioni: Rivista di storia delle idee 25, 415436.
Dacome, L., 2007. Women, wax and anatomy. Renaiss. Stud. 21 (4), 522550.
Dacome, L., 2009. The anatomy of the Pope. In: Kraye, J., Donato, M.P. (Eds.), Conflicting
Duties: Science, Medicine and Religion in Rome, 15501750, vol. 15. Warburg Institute
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Dalla Torre, G., 1991. Santita` ed economia processuale. Lesperienza giuridica da Urbano VIII
a Benedetto XIV. In: Zarri, G. (Ed.), Finzione e santita` tra medioevo ed eta` moderna.
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Daston, L., Galison, P., 2007. Objectivity. Zone Books, New York.
Donato, M.P., 2010. Morti improvise: Medicina e religione nel Settecento. Carocci, Rome.
Duffin, J., 2009. Medical Miracles: Doctors, Saints and Healing in the Modern World. Oxford
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Fantuzzi, G., 1786. Notizie degli scrittori bolognesi, vol. 5. Stamperia di Tommaso dAquino,
Bologna, pp. 5051, vol. 6, pp. 113116.
Ferretti, M., 1979. Il notomista e il canonico: Il significato della polemica sulle cere anatomiche di
Ercole Lelli. In: I Materiali dellIstituto delle Scienze. CLUEB, Bologna, pp. 100114.
Findlen, P., 1995. Translating the new science: women and the circulation of knowledge in
Enlightenment Italy. Configurations 3 (2), 167206.
Finger, S., Piccolino, M., 2011. The Shocking History of Electric Fishes: From Ancient
Epochs to the Birth of Modern Neurophysiology. Oxford University Press, Oxford.
Focaccia, M. (Ed.), 2008. Anna Morandi Manzolini: Una Donna fra Arte e Scienza: Immagini,
documenti, repertorio anatomico. Leo S Olschki, Florence.
Focaccia, M., Simili, R., 2007. Luigi Galvani, physician, surgeon, physicist: from animal electricity to electro-physiology. In: Whitaker, H., Smith, C.U.M., Finger, S. (Eds.), Brain, Mind and
Medicine: Essays in Eighteenth-Century Neuroscience. Springer, New York, pp. 145162.
Franceschini, M., et al., 2011. Laura Bassi Minerva Bolognese. Bononia University Press,
Bologna.
Galvani, L., 1776. De Manzoliniana Supellegtili Oratio (1988). In: Alma Mater Studiorum:
La Presenza Femminile dal XVIII al XX Secolo. CLUEB, Bologna, pp. 94103.
Gombrich, E.H., 1977. Art and Illusion: A Study in the Psychology of Pictorial Representation. Phaidon, London.
Haller, A.V., 1755. A Dissertation on the Sensible and Irritable Parts of Animals. J. Nourse,
London.
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Heilbrun, J., 1991. Contributions of Bologna to Galvanism. Hist. Stud. Phys. Biol. Sci. 22 (1),
5785.
Lombardi, A., 1828. Storia della letteratura italiana nel secolo XVIII, vol. 2. Tipografia
Camerale, Modena.
Manzolini, G., 1751. Osservazioni sopra le Orecchie, e le parti inservienti allarticolazione
della voce fatte in un cadavero che vivendo era Muto e Sordo a Nativatate. In:
Focaccia, M. (Ed.), Anna Morandi Manzolini. Una donna fra arte e scienze. Olschki,
Florence, 2008 pp. 255257 [Bologna, 3 March 1751].
Medici, M., 1857. Elogio di Giovanni Manzolini e di Anna Morandi, coniugi Manzolini. In:
Memorie della Accademia delle Scienze dellIstituto di Bologna, vol. 8. San Tommaso
dAquino, Bologna, pp. 323.
Messbarger, R., 2001. Waxing poetic: Anna Morandi Manzolinis anatomical sculptures. Configurations 9, 6597.
Messbarger, R., 2003. Re-membering a Body of Work: Anatomist and Anatomical Designer
Anna Morandi Manzolini. Stud. Eighteenth Cent. Cult. 32, 123154.
Messbarger, R., 2010. The Lady Anatomist: The Life and Work of Anna Morandi Manzolini.
The University of Chicago Press, Chicago.
Morandi, A., n.d. Catalogo delle preparazioni anatomiche in cera, Biblioteca Universitaria,
Bologna, MS 2193. The Modern publication of the notebook is found in Focaccia, Miriam
(Ed.), 2008, Anna Morandi Manzolini, Una donna fra arte e scienza. Olschki, Florence,
pp. 99236.
Oretti, M., n.d. Notizie de Professori, vol. 12. Biblioteca Comunale dellArchiginnasio,
Bologna, MS B 134, vol. 12, fols. 120123.
Perini, G., 1988. La Camera Anatomica dellIstituto delle Scienze. In: Calvina, A.O. (Ed.),
Palazzo Poggi da dimora aristocratica a sede delluniversita`. Nuova Alfa Editoriale,
Bologna, pp. 176188.
Saccenti, R., 2011. La lunga genesi dellopera sulle canonizzazioni. In: Fattori, M.T. (Ed.),
Le fatiche di Benedetto XIV: Storia e Letteratura. Edizioni di Storia e Letteratura, Rome,
pp. 421.
Terlinden, V.C., 1755. Journal de voyage dun medecin bruxellois de Munich a` Rome en 1944.
Valsalva, A.M., 1704. De aure humana tractatus. University of Lausanne, Lausanne,
Switzerland.
Veraja, F., 1992. Le Cause di Canonizzazione dei Santi. Libreria Editrice Vaticana, Vatican City.
Vesalius, A., 2007. (W.F. Richardson, Trans.). On the Fabric of the Human Body [1543],
vol. 7. Norman Publishing, Novato, California.
Vidal, F., 2007. Miracles, science and testimony in post-Tridentine saint making. Sci. Context
20 (3), 481508.
Vidal, F., 2013. Prospero Lambertinis On the Imagination and Its Powers. In: Fattori, M.T.
(Ed.), Storia, medicina e diritto nei trattati di Prospero Lambertini-Benedetto. Edizioni di
storia e letteratura, Rome.
Willis, T., 1681. The Anatomy of the Brain 1971. Classics of Medicine Library, London.
Wolfe, C.T., forthcoming. The brain is a book which reads itself: Cultured brains and reductive
materialism from Diderot to J.J.C. Smart. In: Groth, H., Danta, C. (Eds.), Mindful
Aesthetics: Literature and the Science of Mind. Continuum, London, pp. 131.
Zanotti, F.M., 17311791. De Bononiensi Scientiarum et Artium Instituto atque Academia
commentarii, vol. 3. Lelio della Volpe, Bologna, pp. 8789.
93
CHAPTER
David Ferrier: Brain

drawings and brain maps
J. Wayne Lazar1
Neuropsychology, Garden City South, NY, USA
Corresponding author. Tel. & fax: 1-516-292-0021, e-mail address: jwayne314@aol.com
Abstract
This chapter has two emphases, one is about the men who influenced the visual representations
that David Ferrier (18431928) used to illustrate his work on localization of brain functions
during the years 18731875, namely, Alexander Ecker, John C. Galton, and Ernest Waterlow,
and the other is about the nature of medical representations and of Ferriers illustrations in
particular. Medical illustrations are characterized either as pictures, line drawings, or brain
maps. Ferriers illustrations will be shown to be increasingly sophisticated brain maps that
contrast with early nineteenth-century standards of medical illustrations, as exemplified by
John Bell (17631829).
Keywords
brain map, diagram, figure, artist, draftsman, localization of brain functions, Ferrier, John
Galton, Waterlow
Several prominent men are associated with the early career of David Ferrier (1843
1928). Ferrier was inspired to study the localization of brain function by the experiments of Gustav Fritsch (18381927) and Eduard Hitzig (18381907), by the
clinical insights of John Hughlings Jackson (18351911), and by the intellectual
milieu and laboratory space provided by James Crichton-Browne (18401938)
(Ferrier, 1873b; Fritsch and Hitzig, 1870; Jackson, 1875; Young, 1970). Yet, there
were other men associated with Ferrier, less well-known men, who influenced his
work on localization during the early years of his forays into neurophysiology,
18731876. The focus of this chapter will be on Alexander Ecker (18161887), John
Galton (1839/401903), and Ernest Waterlow (18501919), their contributions to his
early work, and their assistance in providing engravings that illustrated two of Ferriers
early publications. Ferriers illustrations will be discussed in the context of nineteenthcentury medical illustrations. But first, some more general background is in order.
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CHAPTER 4 Brain maps
1 BACKGROUND
Sir David Ferrier, a Scotsman, was beginning his medical career at about the time
under consideration in this chapter. He was graduated with highest honors in
1863 from the University of Aberdeen where he studied logic and philosophy under
Alexander Bain (18181903). Afterward, he studied psychology for a short time at
the University of Heidelberg. His medical training was at the University of
Edinburgh where he earned first-class honors in the M.B. Examination in 1868
and the gold medal in the M.D. Examination in 1870.1 He was lecturer on physiology
at the Middlesex Hospital in London for a time in 1870. In the following year, he was
appointed demonstrator of physiology at Kings College Hospital and, in 1872, he
advanced to the chair of forensic medicine at the College (Anonymous, 2003;
Horner et al., 1928). He was well trained to take advantage of the opportunities at
the West Riding Pauper and Lunatic Asylum at Wakefield England (Finger, 1994;
Young, 1970).
James Crichton-Browne was a classmate of Ferrier at the University of
Edinburgh Medical School and later, from 1866, Superintendent of West Riding Pauper and Lunatic Asylum at Wakefield, England. Crichton-Browne held a series of
informal discussion groups in the early 1870s at his center (Millett, 1998) where
Ferrier and Jackson, among others, attended regularly to discuss topics in neurology
and the latest research. Discussed with considerable interest was the work of Fritsch
and Hitzig, which demonstrated elicitation of motor responses by electrical stimulation
of specific cerebral cortical areas of dogs. Ferrier had reviewed their paper in 1871 and
was well aware of their findings (Brunton and Ferrier, 1871); he also had the benefit of
fellow discussant Hughlings Jackson, who was better equipped to understand the implications of their work better than most, because he had predicted cortical motor areas
based on his clinical findings with epileptic cases (Jackson, 1873).
In early spring of 1873, Crichton-Browne gave Ferrier laboratory space in the
pathology laboratory at The West Riding Lunatic Asylum, which allowed Ferrier
access to a liberal supply of animals (Ferrier, 1873b, p. 30). Ferrier eventually
stimulated regions of brains of pigeons and several different mammals including
rabbit, cat, dog, and guinea pig. In the late spring, after completing his research at
Wakefield, Ferrier returned to his duties in London as Professor of Forensic Medicine at Kings College and continued his research at the Brown Animal Sanatory
Institute2 (Millett, 1998). With a grant from the Royal Society, Ferrier was able
to continue his cortical localization of function studies using stimulation and ablation
Ferriers M.D. thesis was on the corpus quadrigemina. At about this time, W.B. Carpenter supposed
the corpora quadrigemina to embody the sensorium; thus, it is through the medium of these ganglia the
mind becomes conscious of the impression made (Kirkes, 1869, p. 523).
2
The Institute, part of the University of London and founded in 1871, was a veterinary hospital and
research center. John Burdon-Sanders (18291905) was its first superintendent, Victor Horsley
(18571916) was its fourth, and Charles Sherrington (18571952) was its fifth.
1 Background
procedures on the brains of cats, dogs, and rabbits, and it was at the Brown Institute
that he was able to extend his work to include macaque monkeys.
Ferrier had an enormously productive year in 1873. He began his experiments in
the early spring of 1873 (Fishman, 1995; Young, 1970), published an abstract in
the British Medical Journal by April (Ferrier, 1873a), experimented with macaques
at the Brown Institute during the summer (Ferrier, 1875), published an extensive
paper in the West Riding Lunatic Asylum Reports sometime between June and
September3 (Ferrier, 1873b), delivered a paper about his experiments in September
to the British Association (Rutherford, 1874),4 and published another abstract in the
Journal of Anatomy and Physiology in November (Ferrier, 1873c). Over the winter
of 18731874, Ferrier wrote a 136-page manuscript (plus 16 figures), which was submitted to the Royal Society of London on February 20, 1874 (Ferrier, 1874a; Millett,
1998). Thus, in a short time, Ferrier was productive both in the laboratory and in
promoting his findings. How extensive could his initial laboratory work have been
in such a short time?
Millett detailed relevant aspects of Ferriers research methodology based on
information from Ferriers notebooks (Millett, 1998). Ferriers initial research, as
described by Millett, was not unusually simplistic according to contemporary standards, but it would be described as exploratory today. He made a few stimulations or
lesions in each experimental animal (pigeons, rabbits, guinea pigs cats, dogs, and
monkeys5), recorded their responses, and usually recorded the locations of his stimulations on sketches of their brains that he drew himself. Ferrier used alternating
current from an induction coil that was adjusted to be strong enough to elicit somewhat, but not completely, circumscribed responses, rather than the simple muscle
jerks that had been elicited by Fritsch and Hitzig with direct current. The brains
of the experimental animals were not preserved.
Ferriers West Riding article indicated an interesting way of recording experimental data. When working with cats, he had a hardened (preserved) brain of a
cat before him to mark the location of each stimulation site. Simultaneous comparisons of the locations on the exposed brain of the living cat with the locations on the
hardened brain provided an exact record according to Ferriers understatement of
the variability among animals (Ferrier, 1873b, p. 40).
Ferrier did not work in isolation. Several of his colleagues at West Riding, as well
as others who attended the discussion groups, such as William Benjamin Carpenter
(18131885), observed his experiments and even aided in recording data. Ferrier
received help with the illustrations of his work when it came time to publish. His
drawings were presumably too crude, so others provided drawings of animal brains
that could be used for subsequent engravings.
3
Footnote 2 on page 89 of Ferrier, 1873b suggests June.

The summary, by Rutherford, of Ferriers British Association for the Advancement of Science communication referred to the West Riding Lunatic Asylum Reports; therefore, it followed that publication.
5
The early experiments with macaques took place between June 14, 1873 and September 5, 1873 at the
Brown Institute.
4
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98
Millett (1998) chronicled the role of certain medical illustrations in Ferriers

early publications on localization of motor function in the cerebral cortex. He emphasized two illustrations used by Ferrier from a book by Alexander Ecker and
two sets of illustrations drawn under Ferriers guidance that implicated the services
of John Galton and Ernest Waterlow. The two drawings from Ecker (1869) were of
the left hemisphere and the dorsal view of the cerebral convolutions of the human
brain.6 In his West Riding article, Ferrier acknowledged Galton as the artist of the
drawings of the cerebral cortices of several animals (Ferrier, 1873b). Waterlow
was acknowledged to have contributed drawings of the cerebral cortices of the
macaque monkey and several other animals for Ferriers unpublished submission
to the Royal Society (Ferrier, 1874a). What follows are biographical sketches of
these three men and discussions of their contributions.
2 ALEXANDER ECKER
Alexander Ecker was a German comparative anatomist and an influential anthropologist. As a lecturer at Heidelberg, he was influenced by Friedrich Tiedemann (1781
1861) and Theodor Ludwig Wilhelm Bischoff (18071882). The importance of
Ecker for this chapter is his well-received monograph of 1869 titled, Die Hirnwindungen des menschen (The Cerebral Convolutions of the Human Brain). In it, he
published two figures that were adopted by Ferrier to illustrate the human brain,
namely Eckers illustrations of the left hemisphere and the dorsal view of both
hemispheres, which can be seen in Fig. 1. Not only were the figures subsequently
FIGURE 1
(A) The left hemisphere of the human brain from Ecker (1869). (B) A dorsal view of the
human brain from Ecker (1869).
Hitzig also used Eckers figure of the left hemisphere in his 1874 book, which was a compilation of his
work since 1870 (Anonymous, 1874d; Hitzig, 1874).
2 Alexander Ecker
reproduced by many authors, for example, Mills (1895), but Eckers book was translated into English.
Two independent translations of Eckers, 1869 book were published in 1873, a
critical time for Ferrier. One from London by John Galton was called The Cerebral
Convolutions of the Human Brain and the other from New York by Robert T. Edes
was titled The Cerebral Convolutions of Man (Ecker, 1873a,b). There are obvious
differences between the two translated editions. For example, Ecker (1869) had six
unique figures. Three of them were shown twice each; one of them was shown four
times; and two were shown once each. The London edition, translated by Galton,
reproduced all the figures including the duplications, printing the left hemisphere view
four times, the dorsal view two times, the ventral view two times, and the mesial view
of right hemisphere twice. The New York edition, translated by Edes, did not publish
all of Eckers figures and none of those published were duplicated. Of the four
duplicated figures of Ecker, Edes published only three. He did not publish the
dorsal view.
A second difference is that the literature section at the end of the American edition
is not the same or as extensive as the Bibliography at the head of the London edition.
A third difference is that the American edition did not include Ferriers 1873 West
Riding reference, whereas the London edition did. A fourth difference is that the
engravings were not identical copies of the same drawings from edition to edition.
The engravings in the London edition seem identical to those in Ecker (1869).
A fifth difference illustrates another type of medical illustration extant at the time: a
prospectus of wax models by Dr. Adolph Ziegler of Freiburg was appended to Galtons
translation, but not to Edes. Series I of the models was said to have 14 models illustrating different stages of fetal development. Series II was said to have two models that
illustrated aspects of Eckers book. Pictures of the models from Series I are available in
Archiv fur Anthropologie, volume 3, 1868, but there are no pictures for the models of
Series II.7 No information was found to indicate whether or not Ziegler was the artist
and/or engraver of the illustrations in Eckers book.
Beyond Eckers excellent reputation as an anatomist, he and Ferrier had common
beliefs that would have made Eckers book attractive to Ferrier. Eckers point of
view about brain functions is clearly quite compatible with what Ferrier will later
defend. In the very first sentence of the introduction to his monograph, he dogmatically states that the cortex of the cerebrum, the undoubted material substratum
of our mental operations, is not a single organ, which is brought into play as a
whole in the exercise of each and every psychical function, but consists rather of
a multitude of mental organs, each of which is subservient to certain intellectual
processes. . . (p. 1).8 Ecker went on to write that the furtherance of this idea was
7
See the advertisement for Dr. Zieglers models in the American Journal of Psychology for 1892,
volume 4, p. 131.
8
This point of view had been gaining currency since the work of Broca earlier in the decade (Broca,
1861/1960; Jacyna, 2000). It was contrary to the more dominant approach, which assumed that the
brain functioned as a whole (Flourens, 1846).
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100
sidetracked by phrenology and general naivete about the anatomy of the brain. The
latter is why he considered writing the monograph. Eckers plan for his book was to
elucidate the constant parts of the human convolutions through a fetal developmental
approach.
Convolutions of the brain had been considered folds without order or arrangement throughout much of the history of anatomy and too often drawn that way even
in the nineteenth century. Ecker lamented that draftsmen would represent the convolutions like a bowl of macaroni. A contemporary example of a depiction of cerebral convolutions resembling macaroni can be found in Fig. 2 from a book
published in 1870 (Cutter, 1870). Cutter, the author of this book, explains, probably
from a comparative point of view, that the higher the mental development, the more
unsymmetrical and complicated are the convolutions, and the deeper the depressions
or Sulci (p. 217).
It was only by degrees and over considerable time that certain gyri and sulci were
recognized as more constant than others (Ecker, 1873a, p. 3). Tracing the convolutions embryologically as Ecker did or comparatively as Culter described is challenging. Such ideas interested Galton and probably encouraged him to translate
Eckers book.
FIGURE 2
A drawing of the left hemisphere from Cutter (1870) illustrating the macaroni effect of
assuming brain gyri are without order or arrangement.
3 John Galton
3 JOHN GALTON
Galton, a surgeon and comparative anatomist, was at West Riding doing research of
his own on the tympanic membrane of the insane at the same time that Ferrier was
there. Galton was on leave in the midst of several years as a military surgeon in
Europe and had been a lecturer on comparative anatomy at Charing Cross Hospital
(Anonymous, 1903). Ferrier gave a special acknowledgment to Galton for the original sketches and subsequent drawings on wood that accompanied his contribution
to the West Riding Lunatic Asylum Medical Report of 1873 (Ferrier, 1873b, p. 96).
There were 11 figures in the West Riding paper, including drawings of brains of a
guinea pig, a cat, a dog, and a rabbit. All of them had a mark signifying that they
were drawn by the same draftsman. Figure 3 shows one of Galtons drawings with
his identifying mark at the lower right.
FIGURE 3
A dorsal view of the dog brain drawn by John Galton showing a brain map of the left
hemisphere and a line drawing of the right hemisphere from Ferrier (1873b).
101
102
Besides thanking Galton for drawing the figures in the West Riding article, Ferrier
also thanked Galton, among others, for much valuable and indispensable assistance
in observing and recording the results of experiments (Ferrier, 1873a, p. 96).9
Ferrier likely owed much more to Galton than he did to the others, because besides
assisting him by observing and recording and by drawing the illustrations for the
brains of cat, rabbit, dog, and guinea pig, Galton probably gave Ferrier valuable
advice about comparative anatomy. In his preface to Ecker (1873a), Galton acknowledged his interest in comparative anatomy, and the importance of identifying and
giving consistent names to homologous parts of brains of different species, especially
hoping to make them correspond to names of parts of human brains (Anonymous
Reviewer, 1874; Ecker, 1873a). The necessity for this was brought home to Galton
when he was witnessing the experiments of Dr. Ferrier, it being desired, on one
occasion, to give such names to the convolutions of the brain of a cat or dog as would
convey a definite meaning to anyone conversant with the more recent terminology
of the human cerebrum (p. x). This is exactly the kind of anatomical information
Ferrier needed to understand his experimental results and, later, to apply them to
human brain and pathology.
Furthermore, Galton could have made Ferrier aware of, or at least encouraged
Ferrier to use, the drawings of, the human brain from Ecker (1873a) that eventually
appeared in The Functions of the Brain in 1876 and afterward in a number of other
publications (Ferrier, 1876; for example, Ferrier, 1886, 1890; Mills, 1895). Clearly,
there was opportunity and availability. Galton published his translation of Eckers
work in 1873, and Galton and Ferrier worked together in 1873. We have Galtons
aforementioned comments in his preface of Eckers book. Galton mentioned
Ferriers 1873 West Riding article in the Bibliography of his translation, and Galtons
translation was mentioned in an advertisement in the back of the 1873 volume of the
West Riding Lunatic Asylum Reports. Furthermore, Smith and Elder published
Galtons translation of Eckers book, the West Riding Lunatic Asylum Reports,
and The Functions of the Brain. It is unlikely that Ferrier used the drawings from
Galtons translation of Ecker just because they were owned by Smith, Elder, and
Company. It certainly would not have been a last minute decision because he must
have spent considerable time placing circles in homologous locations. Ferrier
seemed to be oriented toward human application from the beginning. He made
his results of immediate interest to physicians by discussing their implications
for epilepsy, chorea, and hemiplegia (Anonymous, 1873, p. 375). The inclusion of
The others that Ferrier thanked were Dr. Crichton-Browne, who besides being the superintendent of
West Riding conducted research on epilepsy; Dr. Milner Fothergill (18411888), Senior Resident
Medical Officer to the Public Dispensary, Leeds, but at West Riding doing cardiac research; and
Dr. Thomas William McDowall (d. 1937), Assistant Physician, Inverness District Asylum and doing
research at West Riding on color perception. In addition, he thanked Dr. Lauder Brunton (18441914),
physician, researcher in heart disease, and lecture at St. Bartholomews Hospital at about this time, for
help in more recent experiments, which probably referred to his work at the Brown Institute in
London.
4 Ernest Waterlow
monkeys as experimental subjects was based on his interest in the human condition
even though their inclusion meant an increase in surgical difficulty.
The inclusion of macaques, made possible in part by grant money obtained from
the Royal Society of London, would also allow Ferrier to move beyond Fritsch and
Hitzigs initial findings. His macaque findings would become the first part of the
manuscript submitted to the Royal Society. This manuscript required a new set of
illustrations because of new experimental findings and, probably, because of the
need to give the drawings a homogeneity of style.
4 ERNEST WATERLOW
Ernest Waterlow agreed to make the new drawings. Waterlow was a young landscape painter at the beginning of a distinguished career when he assisted Ferrier.
He had already won a Gold medal at the Royal Academy Schools in 1873. Many
landscapes and much success later, he was elected Associate of the Royal Academy
in 1890 and to the Royal Watercolour Society in 1894, and became its president in
1894. He was knighted in 1902 (Baker, 1906).
Waterlow and Ferrier surely met by 1874, when in September of that year they
became brothers-in-law as a result of Ferriers marriage to Waterlows sister, Constance Eliza (Anonymous, 1874a). Although some of Waterlows drawings of the
macaque brain appeared in Ferrier (1875) 10 and Ferrier (1876), and were reproduced
many times afterward, he was only cited as draftsman in Ferriers, 1874, unpublished
Royal Society manuscript and not in subsequent publications (Ferrier, 1874a;
Millett, 1998).11 Figure 4 shows one of Waterlows drawing of the left hemisphere
of the macaque brain from the unpublished manuscript (Ferrier, 1874a, p. 23). His
initials can be seen on the lower left of the drawing.
Waterlows initials were not engraved on the published woodcuts and there is a
reasonable conjecture for this lack of credit. Millett (1998) is likely correct that pressure from vivisectionists contributed to withdrawing the citations. There were no
fewer than seven articles about vivisection in volume 9 of Nature, which spanned
from November 1873 to April 1874, and even then criticism from antivivisectionists
was not new. A sketch of the propriety of vivisection and its benefits to mankind
included Ferrier among such historical luminaries as Harvey, Hunter, Bell, Hall,
and Magendie (Anonymous, 1874b).
10
This is probably the first published article with Waterlows drawings. Ferrier used a diagram in his
talk to the British Medical Association in August of 1874. The diagram itself was not in the December
19th published version of the talk (Ferrier, 1874b). He did not specify what the diagram was or what
species it represented. Based on his discussion, it is likely to have been a diagram of a monkey brain.
11
The manuscript containing 16 drawings by Waterlow was not published due to various unresolved
reviewer questions (Millett, 1998).
103
104
FIGURE 4
The left hemisphere of the macaque brain drawn by Ernest Waterlow from Ferrier (1874a).
As early as 1870, the British Medical Association convened a committee to study

the subject of physiological experimenting. Their report gave guidelines for animal
experimentation, including the use of anesthetics and avoidance of unnecessary
experiments (Anonymous, 1874c). Such discussions increased in 1875 and culminated in the Vivisection Act of 1876 (Act for Amending the Law Relating to Cruelty
to Animals). The Act provided guidelines much like those of the committee of British
Medical Association and required experimenters with animals to obtain a license
before performing their studies. Such pressure would not go away. Even though
Ferrier obtained such a license, he was summoned under the Vivisection Act in
1881. The summons was dismissed in part because his collaborator, Gerald Yeo
(18451909), did the surgeries and Ferriers simple behavioral tests were not deemed
harmful to the animals.
Given this pressure, it would not have been worth the effort for Waterlow to get
credit for the drawings, because he did not need the notoriety or potential lawsuits.
Furthermore, the credit given for such drawings in art circles would have been
minimal anyway. His gold medal from the Royal Academy and exhibitions of his
landscapes were far more important. Artistic careers did not turn on illustrations
for medical works. Only illustrations for famous literary works seemed to be
remembered.12
12
Biographies of accomplish artists never seem to mention illustrations for medical books. For example, Waterlows obituary did not mention his contribution to Ferriers work. Such lack of citation is
common.
5 The nature of illustrations
5 THE NATURE OF ILLUSTRATIONS

For purposes of exposition, distinctions will be made among three types of medical
illustrations. These will be called pictures, line drawings, and brain maps. These distinctions are meant to capture relevant characteristics of all medical illustrations
and Ferriers illustrations in particular. They are based on dimensions of more and
less abstract, more and less ideal, and more and less actual. The term picture is
meant to capture the idea of real or actual, like a photograph or a realistic drawing.
A brain map is meant to capture the idea of an abstract representation of information. A brain map, for example, might be a picture or line drawing of a brain
coupled with information, for example, with the brains relevant parts or functions
labeled and identified. Eckers illustrations in Fig. 1 are examples of brain maps
line drawings with relevant parts labeled. Ecker identified each of those parts in the
text of his book.
A line drawing is a drawing of relevant characteristics of a brain decoupled from
added information. Figure 5 is an example of a line drawing of the right hemisphere
of a human brain. As noted, a line drawing can be transformed into a brain map by the
addition of information.
A line drawing usually does not stand alone, and it is not particularly useful. The
usefulness of a line drawing, actually, the usefulness of any illustration, depends on
its purpose and the information it conveys. For John Bell (17631829) at the beginning of the nineteenth century, the purpose of anatomical illustrations was to aid
in dissection and surgery. As a result, he argued for realistic drawings, faithful reproductions with all the blood vessels and fascia intact (Bell, 1810). Figure 6 is
an illustration from the pen of Charles Bell (17741842), who worked closely with
FIGURE 5
A line drawing of the right hemisphere of the human brain from Google images.
105
106
FIGURE 6
A realistic drawing by Charles Bell of the dorsal view of the human brain from Bell (1802).
The letters identify specific parts making it a simple brain map.
his elder brother John, also an accomplished artist, during this period (Bell, 1802;
Gardner-Thorpe, 2004). It is beautifully rendered, yet anatomically accurate.
Both Bells were for limiting the natural inclinations of artists, meaning people
who are trained to draw ideal figures. Artists certainly see anatomy differently than
trained anatomists and might even be repulsed by a morbid body or organ. Their
drawings, as a result of these inclinations, might be of little benefit to a physician,
surgeon, or medical student (Bell, 1810).
By the last quarter of the century, textbook writers of anatomy had interests beyond the teaching of dissection, but they still had to describe bodily structures. Their
illustrations did not need to be pictorial, but they still needed drawings with parts
identified by name to clarify their narratives. Thus, the typical illustration became
more like Eckers illustrations in Fig. 1.
During the same time, writers of cerebral physiology were becoming interested
in functional as well as anatomical labels. They needed brain maps with functions
superimposed on the line drawings of the brain or central nervous system. These
labels came in different forms depending on subject and sophistication. A relatively
unspecific brain map might have functions, such as HEAD AND EYES or
MOTOR written large across cortical regions, as opposed to a more specific
5 The nature of illustrations
FIGURE 7
A relatively specific brain map of the dorsal view of the dog brain with symbols representing
specific stimulation sites from Fritsch and Hitzig (1870).
illustration identifying a particular spot, as in Fritsch and Hitzigs classic illustration

of the dorsal view of a dogs cerebral hemispheres. Fritsch and Hitzig used symbols,
like, #, , and to label locations on the brain where electrical stimulation elicited
unique motor responses. These symbols can be seen in the upper left quadrant of
Fig. 7. As sophistication increased, more details were displayed.13 Ferriers brain
maps will now be shown to be more sophisticated than the brain map of Fritsch
and Hitzig.
13
More sophisticated brain maps might include networks of connected functions, such as the locations
and connections among Wernickes area, the angular gyrus, and Brocas area. Even more sophisticated
networks (arguably not neurophysiological functions, but neuropsychological functions) might show
interrelationships among multiple functions abstracted out of actual brain locations altogether.
107
108
6 THE NATURE OF FERRIERS ILLUSTRATIONS

Analyses of Ferriers illustrations demonstrate two things. First, they are quite
sophisticated for their time, and second, that they contrast with early nineteenthcentury illustrations in an instructive way.
Ferrier actually used two kinds of graphic elements to illustrate his findings. One
was the line drawing itself, which represented the convolutions of the cerebral hemispheres of nonprimates and macaque and human brains. The other was the circle that
he placed on the line drawing to represent his experimental findings. Both can be
understood as representations.
The line drawings of monkeys cerebral cortices, for example, are representational because they are meant to characterize all monkey brains, not necessarily
the specific ones that were stimulated. They are also representative because there
is no single monkey brain. The topography of brains differs somewhat from individual to individual, and even from hemisphere to hemisphere in the same individual.
Furthermore, homologous areas on the cerebral cortices of different species may
differ significantly from one another topographically.14
Ferrier simplified much of this complexity at this stage. In 1873, he made an
attempt to evaluate the symmetry between the hemispheres by stimulating homologous areas of each hemisphere. Although his results were acknowledged as tentative,
he apparently concluded that symmetry existed to the point of identity, and he
continued to express this thought for some years afterward.15 In his Croonian Lecture
of 1890, for example, he rendered the hemispheres mirror images of one another simply by flipping over Eckers drawing of the left hemisphere and calling it the right
hemisphere (Ferrier, 1890, p. 88).16
Differences between hemispheres are, therefore, expressed as if they are inconsequential. Inconsequential, because, whether drawing monkey brains or clouds, an
artist can only render what is typical or what is actual. They know they can never
capture true monkey brainness or cloudness. Their drawings are only representations
that differ from any specific one in what are thought to be inconsequential ways. This
is why many earlier drawings depicted the convolutions similar to that bowl of macaroni as mentioned earlier. Gyri were thought to be chaotically distributed and any
deviation would be inconsequential.
14
This identification is complicated by structurefunction relationships (Striedter, 2002). Remember

that Ecker (1869) used embryological development to identify lobes in the human brain.
15
Hitzig did not agree that Ferriers results warranted this conclusion (Anonymous, 1874e).
16
There are corresponding locations on either side, but the sides are not mirror images. Others, much
latter, made the same decision, for example, Starr (1903) also flipped his left hemisphere drawing. His
functional labels were identical in most cases. He did recognize differences. Notable differences were
the locations of visual speech, hearing, auditory speech, speech, smell, and taste. Netter did not use a
one-sided template for his drawings (Netter, 1977).
6 The nature of Ferriers illustrations
What is the importance of Ferriers circles? How do they compare with Fritsch
and Hitzigs symbols that marked point-locations? Initially, Ferriers circles did not
differ from Fritsch and Hitzigs symbols. Ferriers first and only publication
that used figures in 1873 was his West Riding article. Circles were placed on
Galtons line drawings at the region where responses were elicited, and were referred to as points throughout that publication. The circles were generally of uniform size, large enough to fit generously around numerals, which were used as
markers to identify the responses elicited at those points. Graphically, there was
an indication that at least some of the circles might mean more than a point-location
because, although usually of uniform size, some circles were larger than others and
some of his so-called circles were actually oblong shape, as can be seen in circles
marked 9 and 10, near the midline, on Fig. 3, which depicts the dorsal view of the
brain of a dog in Ferrier (1873b). However, an additional meaning was never
mentioned.
Soon afterward, Ferriers circles can be best understood as graphs embedded in
the line drawing and they no longer meant the same as Fritsch and Hitzigs symbols.
As far as publications go, this change occurred by April of 1875, and it merits
attention.
By 1875, Ferriers circles contrasted with Fritsch and Hitzigs symbols in that
the circles now provided much more information. Only the centers of Ferriers circles represented the same information as Fritsch and Hitzigs symbols, which
expressed none of the variability found in their actual stimulations or elicited movements. Ferriers circle represented regionsno more than one quarter of an inch in
diameterin which stimulations were followed by the same responses. The circles
do not represent the results of stimulation of any particular animal. It might
take multiple stimulations of the same and different animals to delimit a particular
region.
Ferrier assured that each region is capable of differentiation, yet he also wrote
that they cannot be exactly defined because the regions overlap somewhat as well.
They have more or less indefinite boundaries. His verbal description is of overlapping circles with common areas representing common functions. The centers of each
circle indicate more precisely the points of exact localization (all quotes from
Ferrier, 1875, p. 410). The circles, therefore, can be thought of as representing
two-dimensional ranges with medians at the centertherefore, themselves graphical
illustrations. Whether the strength of each function diminishes as it approaches the
boundary is not clear from Ferriers discussions.17
Ferrier did not actually wait the 2 years between the West Riding publication
and the 1875 Proceedings of the Royal Society paper to make these changes. They
17
If the probabilities of obtaining a response to electrical stimulation did decrease, modern graphing
would represent each functional area by a three-dimensional, probably normal distribution, with its
maximum at the center.
109
110
can be found in his unpublished manuscript submitted to the Royal Society in

February of 1874. It turns out that pages 553 from this handwritten manuscript were
published verbatim in Ferrier (1875). Therefore, Ferrier concluded quite soon
after his West Riding article that he had to specify his results in more detail than simply to imply, stimulate such and such a spot and get such and such a response. He was
an electrophysiologist at that point and he felt that he had to be more precise about his
methods.
Ferriers amendments changed the line drawings to brain maps. He probably realized that he could map the motor area of the cerebrum in 1873 when at West Riding. At
least Rutherford knew it when putting Ferriers work in perspective at the British Medical Association meeting of September of 1873. He stated that Ferrier mapped out
the various centers in the convolutions of the cerebrum (Rutherford, 1874, p. 392).
Ferrier seemed not to used the term mapped out in print, however, until February
of 1874, namely, . . . when once the brain has been accurately mapped out, the experimenter can predict with certainty the result of stimulation of a given region or centre
(Ferrier, 1874c, p. 229).
Ferrier could have read the term brain map in Ecker as early as 1869 and for
sure by 1873 (Ecker, 1869, 1873a,b), because the concept of brain map was in Ecker
(1869) as Die beigegebenen Abbildungen wollen weniger Bilder als vielmehr
Karten sein, durch die man in den Stand gesetzt wird, sich in dem Terrain leichter
zu orientiren (underline added, p. iv). Galton translated this sentence more awkwardly, perhaps more literally, than Edes did. As put by Galton: The accompanying
illustrations should be considered less in the light of pictures than of maps by the
aid of which the traveller [sic] be in a position the better to shape his course in
the district which he is exploring (Ecker, 1873a, p. viii). And in Edes: The accompanying figures are to be regarded not so much as pictures, as maps by which one
may be placed in a position to find his way more easily in this region (Ecker,
1873b, p. 4).
The brain map is analogous to the geographical map. It is used to orient the
viewer to locations in the brain. It is likely that Ferrier was already familiar with
the concept of brain map because the term map had been used in the contexts
of phrenology and anatomy long before 1869. For example, here are quotes from
authors at various points during the century: mapped out the head
(Blumenbach, 1828, p. 209), head map (Magendie, 1829, p. 555), craniographical
mapping (Marshall and Smith, 1868, p. 293), and the cranium was mapped out
(Dalton, 1871, p. 440). Further, in the context of anatomy, we have the map
of the brain (Mace, 1868, p. 238). Bell (1810) said it directly before any of these
examples were published. To quote: A book of anatomy without [illustrations]
seemed to me no better than a book of geography with out its maps; it was, in my
mind, like teaching mathematics without diagrams, or solving Euclids problems
without the help of figures or lines, by the mere force of imagination alone
(Bell, 1810, p. ii).
The basic idea of this concept of map is better understood by the word diagram,
in contrast to the words picture and even line drawing. The distinction between
Acknowledgments
line drawing and brain map is conveniently illustrated in Fig. 3, above, where the
right hemisphere of the brain is a line drawing and the left hemisphere is a map
(Ferrier, 1873b).
7 CONCLUDING REMARKS
The illustrations of Ferrier contrast with the illustrations of Bell, mentioned earlier,
and this contrast provides a glance at changes that took place in nineteenth-century
illustrations and, even, in nineteenth-century anatomy and physiology. There was a
shift from realistic illustrations to abstract representationsfrom pictures to diagrams. There was a shift of attention from structure to function and from superficial
aspects of the brain to the working specializations of its parts. For Bell, the purpose of
an illustration was to aid the medical student in dissection and the surgeon in surgery.
For Ferrier, the purpose was to aid the neurophysiologist, namely, to illustrate the
region associated with electrically elicited movements. Both required details, but
one required a simple map, a picture with labels identifying anatomical parts, while
the other was much more abstract and complex, requiring a line drawing (already an
abstraction of a picture) with added, sophisticated information.
Bell argued against an anatomically, unnatural illustration even to the extent of
explicitly arguing against what he called a poorly constructed plan,18 which was a
composite drawing concocted from fifty individual bodies of different sizes, of various forms, dying, some suddenly, and others slowly, some full and muscular, others
emaciated and poor, placed together on a standard skeleton to represent an anatomically correct body (Bell, 1810, p. v). It was not enough for Bell to have all body parts
present; they had to be represented true to nature.
We should think how much more a brain map from Ferrier resembles a plan
according to Bell than it resembles one of Bells drawings from nature; for Ferriers
brain maps were, in fact, concocted out of perhaps fifty stimulations, and their subsequent effects were all represented by a circle on a skeleton now known as a line
drawing. Bells realistic drawings were accepted at the beginning of the century.
Ferriers maps were accepted at the end of the century. They merit attention because
they reflect significant changes that took place in medical illustration and in anatomy
and physiology during the nineteenth century, changes that were accomplished by
Ferrier with the aid of some highly skilled artists.
Acknowledgments
I am obliged to Dr. Diakow of Adelphi University for her encouragement and for her
assistance in the organization of this chapter. I cannot refrain from acknowledging
Dr. Stanley Finger, one of the editors, for making this chapter more readable.
18
His idea of plan is probably best understood by the meaning of the word diagram.
111
112
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113
CHAPTER
Neura, nerves, nerve fibers,

neurofibrils, microtubules:
Multidimensional routes of
pain, pleasure, and voluntary
action in images across
the ages
Eugenio Frixione1
Section of Methodology and Theory of Science, Department of Cell Biology, Center for Research
and Advanced Studies IPN (Cinvestav), Mexico City, Mexico
1
Corresponding author. Tel.: 52-55-5747-3800, ext. 6774, Fax: 52-55-5747-3800, ext. 6782,
e-mail address: frixione@cinvestav.mx
Abstract
Available records indicate that the human body has always been conceived, in different periods and cultures, as spanned by multiple channels for internal communication and coherent
functioning as a unitmeridians in treatises of Chinese medicine, metu in Egyptian papyri,
srotas in Ayurvedic Indian texts, and neura in the Western scientific heritage from ancient
Greece. Unfortunately, the earliest extant figurative depictions of such pathways of general
control, complementary to the blood vessels, are late medieval copies of old crude sketches
that attempted to show the main anatomico-physiological systems. The scarcity of adequate
illustrations was more than compensated in the Renaissance, when the efforts of both artists
and anatomists for the first time produced basically correct renditions of the human nervous
system and many other bodily structures. As attention was next focused on microscopic
structure as a requisite to understand physiological mechanisms, during the Enlightenment
the nerves were revealed to consist of numerous thin tubes or fibers aligned in parallel.
Improved microscopy techniques in the nineteenth century led to discovering and delineating
still finer fibrils coursing along the cores of the nerve fibers themselves. Electron microscopy, developed throughout the twentieth century, recognized some of these fibrils within
nerve fibers as being also tubular. All the progressive stages in understanding nerve construction, at increasingly more detailed scales, have been accompanied by technological advances
and by debate about the structure and function relationship. And every step has been a source
of amazing imagery.

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Keywords
acupuncture, anatomical illustration, anatomy, history of medicine, microscopy, nervous
system, neuroanatomy, Renaissance art
1 OUR SUBJECT
This volume reveals that neuroscienceat bottom, the study of nerve cells and their
functional organization into systems capable of feeling, moving on purpose, and
even intelligent consciousnesshas offered some of the richest opportunities for
the intermingling of science and the fine arts. And few subjects in the field illustrate
such richness at as many dimensional levels as the relationship between structure and
function of the nerves themselves. This challenging issue has been a matter of inquiry
and debate throughout the centuries. How is it that the existence and role of the
nerves was realized in the first place? Then, just how might it be possible that soft
whitish cords like these could carry subtle sensations and precise motion commands
across the body, and do this at no time at all, instantly? What should be the actual
distribution of nerves throughout the organism in order to achieve such feats?
At some point, answering to these questions required consideration of the internal
structure of the nerves themselves. Are they indeed cords, as plain close inspection
shows, or rather tubes as their communication function suggests? Neither of these, it
turned out. Nerves revealed to be modular: every one of them was found to be a multitude of incredibly thinner pipes tightly aligned in parallel. Next, each of these pipes
was showed to contain in turn a number of still much finer threads, some of them later
found to be hollow ducts. So, which of these channels of vastly different calibers are
the true pathways for pain and pleasure, for action and reaction, and for thoughts and
dreams?
As discussed and illustrated in the following pages, attempts to solve the mysteries
posed by nerve function have involved not only thoughtful science but also a huge
amount of art in its broadest sense. This includes fine arts as well as technology from
the very etymology of the Greek word tekhne, translated into Latin as ars, from which
the modern term art in various European languages derives. A panoply of techniques
in graphic artistry, from woodcuts to drawings to engravings, all the way up to photomicrographs and electron micrographs, have been required at consecutive stages of
development in our growing knowledge of the nerve cells and fibers.
In this chapter, I review examples of the imagery that has accompanied our intellectual evolution and learning about the nervous system, understood as basically a
network of fibers where each of these is essentially a route of communication that
may itself enclose thinner conveying fibers, from the macroscopic scale down to
the subcellular level.
Starting from a late medieval woodcut representative of the various channels
found in age-old Eastern schools of medicine, upon which Western early medical science presumably nurtured itself, we shall next look at the scheme of neura inherited
2 In the beginning: Routes of life power across the body
from the ancient Greeks and tritely copied for over a thousand years across the Middle
Ages. Our survey will pick up again with the first essentially correct graphic representations of the human nervous system, as portrayed in the great drawings and engravings produced in the Renaissance, valuable not only for their fresh scientific
content but also by their exceptional artistic merit. We shall then see prints made
to illustrate both the imagined and the actual composite structure of single nerves,
a concept born in the Scientific Revolution and developed throughout the Enlightenment. Just before our last station, we recall the neurofibrils discovered within nerve
fibers in the nineteenth century, along with the dispute that followed the proposal of
their role as electrical conductors in the nervous system. We then conclude with
microtubules, that is, major elements of the neurocytoskeleton that currently remain
at the focus of a controversial theory about the persistent mystery of consciousness.
2 IN THE BEGINNING: ROUTES OF LIFE POWER

ACROSS THE BODY
Available evidence suggests that the human body, like those of animals that men cut
up into pieces for feeding themselves, has always been regarded as something more
than the obvious aggregate of different parts appearing to plain view. These components are invariably found not only arranged in a definite spatial order but also attached, linked, or otherwise interconnected to one another or to more distant parts
belonging to the same individual. And some of such connections course as seemingly
continuous tracts through various locations, thus associating several parts often
across relatively long distances. This pattern is obviously reminiscent of rivers
and streams that connect towns and peoples, bringing to them not only water, food,
and useful materials but also news about the world at large, which in turn may elicit
some local reaction to changing circumstances. Understandably, reference to internal
paths of communication within human bodies has been a common cultural trait of
many peoples from the oldest records, pointing to a prehistoric origin of such notions.
Charting those vital routes may have been judged as important as mapping roads and
watercourses.
A case in point is the meridians or jingluo` that from immemorial time have
played a central role in traditional Chinese medicine (Fig. 1A). The Nei Ching or
Yellow Emperors treatise of medicine, first composed more than 25 centuries
BCE (Before the Common Era), describes 12 main and 8 secondary pairs of channels through which the two major cosmic forces Yin and Yang move about the human body (Veith, 1966, pp. 34, 5965). Because these meridians are thought to have
major controlling functions, including the modulation of contents in other subsidiary
vessels that carry blood and air, an acupuncturist can theoretically treat diverse health
disorders by inserting special needles at certain key sites along their trajectories
(Fig. 1B).
These drawings intend to be guides for medical students to locate the acupoints
on life-size statuettes cast in bronze (Bronze men), long before trying their hand on
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2 In the beginning: Routes of life power across the body
FIGURE 1
Meridians or jingluo` along which the two major cosmic forces, Yin and Yang, move about
the human body according to traditional Chinese medicine. (A) Complete set of meridians
traced over a human silhouette in front view. (B) Key sites for acupuncture (acupoints)
indicated over some of the meridians, in back (left) and frontal (right) views of the body.
Panel (A): Print from a woodcut by Gao Wu, in Collected Gems of Acupuncture and Moxibustion, vol. I, 1537,
Library of the China Academy for Traditional Chinese Medicine; Wellcome Library, London, cat. L0037496.
Panel (B): Drawings on Chinese book, unspecified author and date; Asian Collection, Wellcome Library,
London, cat. L0020849.
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actual persons. The points were in fact drilled as narrow holes on the statuettes,
which were then coated with wax that both sealed the holes and concealed their
locations. In an exam, the student was requested by the professor to insert a needle
at a particular acupoint on a water-filled statuette, and only succeeded in the test
when drops appeared at the site punctured. The images reproduced here represent
millenarian concepts of Chinese medicine that remain in practice still today, and
which have greatly influenced therapy in other Far East countries, especially Japan.
Ancient Egyptian texts on medical matters, dated as from over 15 centuries BCE
but which claim to report teachings that were common already in a period twice as
old (i.e., about 5000 years ago), also mention diverse metu, plural of meta word
meaning something elongated like a shootpassing through various regions of
the human body (Nunn, 1996, pp. 4449; see also Finger, 1994, p. 8). Likewise, classic Ayurvedic texts of Indian medicine recognize several types of tubular connections or srotas coursing throughout the body, all of which distribute distinct
classes of vital fluids (Keswani, 1974, pp. 3439).
The broad similitude of these anatomical notions coming from otherwise quite
different civilizations, despite their geographical separation, unrelated linguistic
evolutions, and idiosyncratic historical developments, might still be a result of slow
but effective trans-cultural communication over the ages. It is therefore significant
that partly analogous accounts are found also among ancient Mesoamerican peoples,
with which such cross-influences are much less likely. The Aztecs and other Nahuatl
groups, at around the time when Columbus arrived on American shores, applied the
term tlalhuatl to any cord-like linkage as tendons or vessels (Lopez-Austin, 1996,
vol. 1, pp. 178). These structures were conceived as sites of concentration of life
force, apparently because they evidently undergo changes in tension under the skin
at will, or show palpitations (i.e., pulse) even when the body is in a relaxed state.
Accordingly, it is not too unsafe to conclude that after some thought any intelligent even if ignorant person, at any place and time, will come to realize that the bodies of living things are not only spatially arranged in their own particular forms but
also organized as systems of related parts in which some sort of coordination is required for them to work as coherent units. Furthermore, probably that same person
will also think that, regardless of where the souls headquarters may be located in the
body, some of those elongated and often winding liaisons seen between the internal
parts are the most likely routes to achieve such coordination.
Unfortunately, despite the copious legacies of beautiful iconography left by all of
the foregoing ancient cultures, no contemporary pictures or figurines showing the
jingluo`, metu, srotas, or tlalhuatl have survived to modern times. Most of the earliest
extant illustrations, like those shown in Fig. 1, date from a period corresponding to
the fifteenth to sixteenth centuries in Western chronology (for historical background
on anatomical illustration of the nervous system, see Clarke and Dewhurst, 1996,
esp. pp. 12 and 7578; for general background on Western anatomical illustration
up to the sixteenth century, see Herrlinger, 1970). The disappearance of ancient anatomical images is comparable to that of ancient maps, about which we know only
through references (Crone, 1953, chapter I). In both cases, the explanation is perhaps
3 Neura: Pathways of sensation and will
the same, at least for lettered societies. At those times, written descriptions were
probably more useful, and therefore preferred, than flat pictorial representations
of three-dimensional complexities for which the available graphic techniques, as
well as landscape or anatomical knowledge, were too limited. Scarcity, coupled
to fragility of papyri or silk sheets, and a far more difficult copying process than that
of simple texts, may have concurred to prevent the survival of such artworks.
As we shall see in the next section, no other were also the views and the fate of
illustrations produced by the ancient Greek peoples, who founded the progressive
kind of analytical thinking that eventually led to what we today know as Western
science.
3 NEURA: PATHWAYS OF SENSATION AND WILL

Starting in the early fifth century BCE for all we know, sage physicians and healers in
several cities of ancient Greece were also advancing opinions about processes occurring inside living animal bodies. Like in the much older Eastern cultures just mentioned, those so-called pre-Socratic philosophers attributed important control roles to
canals envisioned as carrying blood and air (see Smith et al., 2012, chapter 1). Thus,
for example, Alcmaeon of Croton reportedly concluded that sleep results from a temporary withdrawal of the blood (presumably dispersed throughout the body) into the
larger blood vessels (phlebes), whereas awakening takes place as the blood outpours
back, swamping again every part.
The key concept introduced by the Greeks, however, was that of neuron (neura in
plural), the root of our current word nerve. This is not the place to even summarize
the complex story of how the term, at first applied to tendons and other linking anatomical structures with an apparently sinewy texture, came to be associated with the
notion of internal ducts for the distribution of a special kind of air known as pneuma
among the Greeks (Frixione, 2013a; von Staden, 2000). Therefore, it will suffice just
to mention here a couple of points, both resulting from significant advances in anatomy and physiology achieved at the Museum of Alexandria in northern Egypt, the
great research institution where the famed Library was located. Two professors at the
school of medicine there, Herophilus of Chalcedon and Erasistratus of Ceos, realized
before anyone else the basic pattern of organization of the vertebrate nervous system.
The first point to emphasize here is that these anatomists discovered that two specific kinds of neura mediate sensory perception (neura aisthetika) and voluntary
movement (neura prohairetika or kinetica), and that both kinds are outgrowths of
either the encephalon or the spinal cord. The second point of interest here refers
to how exactly the sensory or motor messages were supposed to travel along their
respective neura. Opinions on this may have diverged but, as it happened, the notion
that a pneuma psychikona Greek expression later Latinized as spiritus animalis,
that is, the spirit of the anima or soulwas somehow channeled along hollow neura
prevailed. This idea would then be carried down throughout the Middle Ages and
beyond (see Clarke, 1968), with consequences to which we shall return below.
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Since none of the Alexandrian writings survived to modern or even medieval

times, the story has been tentatively reconstructed from what little we can gather
from brief quotes and subsequent commentaries upon them by later authors in classical antiquity. We know that detailed dissection of the human body, barred up to that
point due to beliefs and ethical considerations, flourished at Alexandria in a way that
would not be possible again for the following millennium and half. Unfortunately,
there is simply no art left for reviewing in relation to this crucial stage of development in medical science.
This is not to mean that the Greek professors made no use of pictures to help
themselves when describing anatomical organization. In fact they did, and this is
clearly mentioned in several passages. Thus, Aristotle (384322 BCE), a major
philosopher who lived just a few decades before the rise of Alexandria, wrote: From
the heart the blood-vessels extend throughout the body as in the anatomical diagrams
which are represented on the walls, elsewhere stating also that the veins have the
shape of the entire body, like a sketch of a mannikin (Generation of Animals, II, 6,
743a13, and History of Animals, III, 5, 515a34; see Aristotle, 1984, vol. 1, pp. 1153
and 818, respectively). Moreover, Aristotle refers to drawings labeled with letters in
order to explain dynamic relations between anatomical parts during motions of the
body (Movement of Animals, 9, 702b29703a3; ibid, p. 1094). And later on Galen of
Pergamon (second century CE), personal physician to several Roman emperors and
last great medical figure in antiquity, while stressing the importance of learning anatomy directly through dissection rather than from verbal accounts by himself or
others, occasionally made use of diagrams like those referred to when he described
certain muscles (Galen, 1956, I, 11; Trans. Singer, 1956, p. 28). It is too bad that none
of such graphics could be rescued from antiquity, although anyhow Aristotle and
Galen, like most other researchers at those times except the Alexandrian anatomists,
restricted their dissections to apes and other animals because social attitudes and
constraints opposed the inspection of human corpses. Hence, many of their conclusions were misled when applied to human anatomy.
Nevertheless, perhaps because of the evident interest in bringing and keeping together all kinds of scholarly writings and other documentation, as demonstrated by
its great Library, the Museum of Alexandria may have encouraged the practice of
complementing written descriptions with some illustrations. In any event, certain anatomical diagrams of five main general systems in the human bodyskeletal, muscular, nervous, venous, and arterialmay have been originated and routinely
produced first in Alexandria. The set of five charts, which is therefore known today
as the Alexandrian Series, was afterward copied multiple times all along the
Middle Ages, together with the texts in which those illustrations were generally
included. Such laborious copying, by hard-willing though not always equally gifted
hands, was inevitably affected also by the ethnicity of the Arabian and Western
medical schools that emerged from the Greek predecessors.
Some medieval anatomical pictures in the Alexandrian Series style have endured up to present time, including nerve men illustrating the nervous system
(Fig. 2). Examples of this type of illustrations show human silhouettes, often in a
FIGURE 2Contd
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FIGURE 2Contd
squatting position, with continuous lines coursing around the head and along the
limbs to indicate how major nerves reach even the farthest regions of the body.
The vertebral column and the spinal nerves, represented by numerous short lines radiating laterally from a segmented vertical post at the center, are also included
sometimes.
Another illustration of nerve connections typical of medieval centuries consist of
a head in which lines originating from the sense organs (eyes, nose, ears, and tongue)
appear linked to the first of three or five circles in a series contained within the cranium (Fig. 3), which represent internal chambers or cellae (cells) where various mental processes would take place in progressive order. Thus, according to this
mechanism, the first cell named sensus communis is in charge of receiving all
the different sensory inputs and passing its integrated contents into the imaginatio
compartment, which then relays its products to the estimatio and cogitatio cells
for proper intellectual elaboration, before the flow eventually reaches memoria
for storage at the end.
These crude cartoon-like depictions, which hardly do any justice to the significant theoretical and practical development attained by anatomical science in antiquity, remained as the only graphic representations of the human nervous system for
over a thousand years. They are different but still comparable to equivalent patterns
produced in the Eastern medical tradition (compare to Fig. 1). In both cases, we are
presented with vignettes that aim to provide a basic idea of a general disposition, like
our own current diagrams, not realistic renderings of structures too complex to simulate before the eyes with mere lines and eventually some added color. Moreover,
strict Islamic law specifically banned realistic representation of the human body,
and thus many figures appearing in Arabian sources were intentionally geometrized
or otherwise schematized (Fig. 2A).
At any rate, those pictures were appropriate to convey an approximate notion of
how the spirit of the anima (spiritus animalis) is channeled throughout the body so
the soul is able to care for every part. Such was the divine design that medieval clerics
writing about nature, including Albertus Magnus, had in mind when they discussed
the nervi and their roles (see, e.g., Magnus, 1999, I, 3rd. Tract, Ch. 1; and XII, 2nd.
Tract, Ch. 5; Trans. Kitchell and Resnick, 1999, pp. 242245 and 944945, respectively). It is clear therefore that, in both the Muslim (Fig. 2A) and the Christian
(Figs. 2B and 3) contexts, anatomy taught during most of the Middle Ages maintained the overall conception of linear connections to account for internal communication throughout the human body.
FIGURE 2Contd Nerve men, that is, diagrams of the human nervous system in different
medieval versions of the Alexandrian Series style. (A) Plate included in a 1632 copy of
the Canon of Medicine, written by the famous Muslim physician and author Ibn Sina
(9801037), better known to western scholars as Avicenna. (B) Ink-and-watercolor
vignette included in a 14201430 manuscript copy of St. Johns Apocalypse.
Panel (A): Wellcome Library, London, cat. L0013312. Panel (B): Wellcome Library, London, cat. L0000843.
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FIGURE 3
Pen drawing of a human head in which the medieval theory of sensory information processing
through a series of interconnected cellae or cells is schematized. Manuscript copy
dated 14721474.
Archives and Manuscripts, Wellcome Library, London, cat. L0005912.
4 PICTURING THINGS AS THEY REALLY ARE: NERVES IN THE

RENAISSANCE
Idealized images, either of people or animals or inanimate natural objects, ceased to
be satisfactory as Europeans realized that many of their apparently unmistakable
ideas about the worldsuch as the size of the Earth and its immutable central position in the cosmoswere suddenly and shockingly found uncertain or downright
wrong. Doubt and reservation about established teaching, as well as fresh curiosity
and interest on nearly everything, gradually spread throughout Western societies
from philosophers to physicians, from merchants to seamen. This concern involved
also standard ideas about how the human body operates, an anxiety fueled in part by
the total defenselessness of the population in front of devastating pandemics like the
4 Picturing things as they really are: Nerves in the Renaissance
Black Death plague that swept the continent and took over 100 million lives in the
mid-fourteenth century.
The reaction to this totally unexpected new reality was the Renaissance, promoted if not actually led by artists competing among themselves for profitable contracts from wealthy aristocrats and the Church. They all tried to achieve the most
realistic renderings in their works. Painters strived to turn their flat supporting surfaces into windows open to multicolor scenes full of characters in a whole variety of
attitudes, as accurate and convincing as in the real world itself. Sculptors succeeded
in turning hard marble into soft flesh before the eyes. It did not stop them that the road
to this excellence passed through long messy sessions fighting repugnance and fear,
while carefully flaying fresh corpses in order to find out just how muscles and bones
are actually arranged beneath the skin, and how this arrangement is modified upon
changes in posture. Never before had the interiors of men bodiesand those of some
common animalsbeen so minutely scrutinized in order to display their exteriors
with the ring of absolute truth. And the medical anatomists seized the opportunity.
Typical of this approach is, of course, that of Leonardo da Vinci (14521519)
who, though not a medical professional, produced hitherto unrivalled anatomical depictions. When it came to the nerves, however, he was still persuaded by the traditional teaching of hollow ducts:
The medulla is the source of the nerves which give voluntary motion to the members . . . . The substance of the medulla enters for some distance into the origins of
the nerves and then follows the hollow nerve as far as its terminal ramifications.
Through this perforation sensibility is carried into each muscle.
Leonardo (ca. 1490); Trans. OMalley and Saunders, 1983, plate 155, p. 356;
corresponding to plate 19040r in Kenneth Clarkes catalog.
Leonardos initial caution in not going against inherited knowledge is evident also in
his famous sketch of a medially split human head seen in profile (Fig. 4), where he
delineated the optic nerve projecting backward into a faint tandem of three bulbous
vesicles. These represent the intracranial chamber-like cavities (cellae or cells)
where, according to fancy medieval psychophysiology, the major faculties of perception, reasoning, and memory take place in series (see above). Here, we have a glaring
combination of jaded old theory with novel masterful command of realistic rendering
(compare to Fig. 3). A few years later, Leonardo would find out and illustrate, after
cleverly filling them with melted wax and later on removing the soft tissue around
the cold hardened cast, the true shapes of the mammalian cerebral ventricles. Our main
point of interest here, however, is that the optic nerve appears in this picture as a narrow
duct through which a fluid, for example, animal spirit, could flow as generally believed
since antiquity and as Leonardo himself admitted in the excerpt just quoted.
This belief was challenged in the following generation by the founder of modern
anatomy Andreas Vesalius (15141564), author of the landmark seven-book treatise
De humanis corporis fabrica (1543) or construction of the human body, often referred simply as the Fabrica. Vesalius clearly distinguished the nerves (Fig. 5), in
our current sense of the term, from ligaments and tendons that some experts in
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FIGURE 4
Sagittal section showing the medieval conception of the interior of a human head, as
interpreted in the late fifteenth century by Leonardo da Vinci. The optic nerve is delineated as
going from the eye to the first of three hypothetical cellae or cells, where all sensory
inputs were supposedly processed into perceptions, thoughts, and memories. In the lower
right corner of the page is a top-view sketch of a horizontal section of the same scheme.
Red-crayon drawing outlined with ink, corresponding to plate 12603r in Kenneth Clarkes catalog;
image in the public domain.
dissection in his time still called nerves. He described nerves as certain long,
rounded organs that have no perceptible cavity at their center and come forth from
the skull and the spinal vertebrae [and] convey animal spirit from the brain, fomenter
of the animal faculty, to the parts of the body. . .that need it for one of the senses or for
arbitrary movement. (Vesalius, 1543, pp. 315317; Trans. Richardson and Carman,
2002, pp. 159165). Furthermore, he emphasized that nerves are not homogeneous
inside, since we read:
Any nerve consists of three substances. The one in the very center corresponds to
the innermost marrow of trees; this is the one that undoubtedly takes origin from
the brain and resembles the substance of the brain. . . Of the two outer ones, we
have established that the one that is closer to the innermost substance comes from
the thin membrane and the other from the hard membrane [i.e., the meninges
enveloping the brain]. . . I am unable to differentiate nerves by the cavity within
FIGURE 5Contd
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FIGURE 5Contd
Distribution of the nerves in the body, as presented by Andreas Vesalius in his revolutionary
De humanis corporis fabrica, the first book of modern anatomy. (A) Spinal nerves and
their branchings. (B) Cranial nerves, presented as described below.
Prints of woodcuts, later on transferred to photolithographs; Vesalius (1543), IV, plates common to
several chapters at pages 332 and 319, respectively; Wellcome Library, London, cat. V0010424 and
V0010424, respectively.
them as I have never seen such a cavity or channel, even in the optic nerve. I do not
doubt, however, that the term vessels includes the nerves, no less than the veins
and arteries. . .
Apart from the discrepancy on the hollowness of the nerves, other notable differences between Leonardo and Vesalius are worth mentioning in this chapter.
One of them regards their background, training, and goals. Leonardo was a native
Florentine who earned his living as a painter in Milan when he became interested
on the underlying structure of human and animal bodies, initially just as a means
to master their naturalistic representation in artistic works. Vesalius, on the other
hand, was a Flemish physician and a professor who held the chair of Surgery and
Anatomy at the University of Padua, in the northeastern part of Italy, and was particularly interested on improving the teaching of a difficult and in his view largely
misunderstood subject. Both men thought of publishing the results of their anatomical work as printed books, which were rapidly becoming the main vehicle for the
diffusion of knowledge and ideas thanks to Johannes Gutenbergs (13951468) invention, scarcely a century earlier, of the movable-type printing press. Nevertheless,
while Leonardo merely entertained the possibility of such a project, and therefore
produced his anatomical drawings as single originals, Vesalius aimed from the
beginning at multiple copies of every illustration, to be included in a textbook
designed for wide distribution in numerous medical schools throughout Europe.
Printing multiple copies of an image involved first delineating a mirror-reversed
version of the figure on the smooth-ground flat face of a wooden block, followed by
carving the blank areas out from the block so as to avoid their touching the paper
when the resulting bas-relief was later inked and then stamped hard over the sheets
(see chapter by Lanska and Lanska in this volume for detailed technical explanations
of various plate printing methods current in the period). This procedure known as
woodcutting is, of course, much more laborious and therefore slower than simply
drawing on paper with charcoal bars, sanguine red crayons, or pen and ink. Thus,
while Leonardo traced all of his own anatomical drawings by himself, Vesalius asked
for professional artists to help in the job, apparently finding them among the members
of Titians studio in nearby Venice. The name of Vesalius countryman Jan Stephan
van Calcar, a student under Titian, is commonly associated in this connection
although some other hands may have collaborated as illustrators, including Vesalius
himself for certain plates.
Accordingly, whereas Leonardo had to agree only with himself about the most
convenient artistic approach to present a given anatomical fact, Vesalius was forced
to compromise with or, in his words, to put up with the bad temper of artists and
sculptors [wood cutters] who made me more miserable than did the bodies I was
dissecting (see OMalley, 1964, p. 124). We may wonder what his mostly Italian
artistic collaborators would have gossiped about this presumptuous Northerner
who, still in his twenties, bragged of correcting errors taught since antiquity by medical authorities that were highly respected in university circles. But, whatever the real
story behind graphic authorship and team internal struggles may be, both the mature
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Italian painter and the young Flemish professor succeeded in providing, independently and for the first time ever, naturalistic images showing essentially correct
anatomical relationships of the human body.
They were not the only ones active in the field, though. In fact, other authors were
already busy in projects undertaken to satisfying the demand in universities for illustrated textbooks of anatomy, all of them containing plates that represent the human
nervous system. Among the offerings for this market, we can mention here the
De dissectione partium corporis humani libri tres published in 1545 in Paris by
Charles Estienne (ca. 15041564; Fig. 6) and the Historia de la composicion del
cuerpo humano published in 1556 in Rome by the Spaniard Juan Valverde de
Amusco (spelled also as de Hamusco, ca. 15251588; Fig. 7), one of several competitors charged by Vesalius with plagiarism for including in their books plates or
ideas copied from the Fabrica (see Lanska and Lanska in this volume for additional
context about plagiarism in sixteenth century anatomy works). Also corresponding to
this period is a set of 46 anatomical engravings on copper plates by Bartholomeo
Eustachi (15201574), only eight of which he decided to publish in his lifetime
as Opuscula anatomica (1564), the complete collectionincluding those that concern the nervous system (Fig. 8)not appearing until 1714 with the title Tabulae
anatomicae.
Many of the anatomical artworks produced in the Renaissance reveal the
obsession with real-life naturalism characteristic of the period, especially in that
the figures are shown displaying postures or actions. But, though the authors
shared a common upbeat cultural context and pursued equivalent goals of learning
or teachingas well as profitingthey reveal profound differences of style and
approach. This is especially notable in the case of the nerves and the vessels, which
present peculiar difficulties for adequate graphic representation. All these structures
are individually thin in comparison with most bones, muscles, and other organs, and
therefore they are easily lost from sight in between other anatomical components. On
the other hand, however, nerves like vessels are profusely ramified and thus collectively luxuriant nearly everywhere in the body.
Vesalius answer in front of these complications was exposing exclusively the
nerves in the absence of everything else, just as it has always been done with bones
in skeletons. Thus, he presents the distribution of the spinal nerves with their main
branchings arranged in their natural positions, as they would presumably be seen in a
walking body if the rest of the whole figure (except for the vertebral column and a
few major vessels) were made transparent or invisible (Fig. 5A). He would even hide
some of the nerves behind the invisible figure in order to simplify the image, instructing the reader about how to use imagination in order to correctly interpret the resulting picture. This guidance we find, for example, in the legend for an illustration of the
cranial nerves (Fig. 5B), which explains:
This figure shows the right side of a complete cerebrum and cerebellum
and. . .shows laid bare the distribution on the right side only of the seven pairs
of cerebral nerves; but here and there we have depicted the distribution of certain
FIGURE 6
Distribution of the nerves in the body, as shown in De dissectione partium corporis humani
libri tres, published by Charles Estienne.
Woodcut print, Estienne (1545), I, p. 59; courtesy of the U.S. National Library of Medicine.
FIGURE 7
Distribution of the nerves in the body as presented in semi-diagrammatic display in an early
seventeenth century study after Juan Valverde de Amusco.
Ink drawing; Wellcome Library, London, cat. L0011862.
FIGURE 8Contd
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FIGURE 8Contd
Distribution of the nerves in the body as devised by Bartholomeo Eustachi in 1552, though the
figures were not published until 1714 under the title Tabulae anatomicae. (A) Plate XXI
illustrating the peripheral nerves in their natural positions, as they would be seen in a flayed
living body in front view. (B) Plate XVIII showing nerves of the sympathetic nervous
system in diagrammatic view.
Prints of intaglio engravings on copperplates, reproduced here from a unique hand-colored set published
in 1783; courtesy of the U.S. National Library of Medicine.
nerves of the left side as required. If a body were drawn around this figure,
its bladder would be at the bottom of the figure and you would see the front of
its thorax and abdomen, but its face would be turned away so that it was looking
toward the left shoulder and its right side was facing you.
Vesalius (1543), IV, plate at pp. 319320; Trans. Richardson and Carman, 2002, p. 169.
In a different approach, Estienne, more interested in identifying specific anatomical

parts for didactic purposes, strived to find the best possible solution toward that end
with assistance of his artistic collaborator Etienne de la Rivie`re (d. 1569) and woodcutter Jean Mercure Jollat (fl. 15301545). Estienne and his coworkers chose to
display the nerves mounted on an otherwise plain skeleton that, presented standing
in both front and rear views on separate plates, serves to provide approximate positional references (Fig. 6). Individual nerves appear at their corresponding locations,
all spread out of their normal orientations as curly lines fraying in the wind so they
could be each labeled on the plates, which are nevertheless decorated with surrounding scenery in an attempt to retain a sense of naturalness. As with Vesalius team,
tensions arose at some point between the anatomist and one or both of the artists,
though in this case erupting into a lawsuit that delayed by more than 5 years the publication of their joint work, which had been ready for the press already in 1539. Had it
been published as originally scheduled, Estiennes opus on human anatomy would
have preceded Vesalius Fabrica for about 4 years. This was peer pressure in science,
in mid-sixteenth century fashion and pace.
Such intent of increasing the comprehensibility of anatomical relationships by
separating individual structures on the figures themselves, even if at the cost of total
distortion, is still more evident in a congested document that describes the distribution of the nerves after Valverde (Fig. 7). Like Estienne, Valverde seems to have
worked in collaboration with just a couple of artists, generally believed to have been
Gaspar Becerra (15201568) for design and Nicolas Beatrizet (c.15201565) in
charge of the engravings.
Eustachi, for his part and with collaboration from intaglio artist Giulio de Musi
(fl. 15351553), solved the problem of cross-relating the figures with the text by means
of coordinates referred to rulers printed on the borders of each plate (Fig. 8A and B).
Diagrammatic representations of functional relationships were inserted also as instructional tools (Fig. 8B). As seen in these plates, intaglio or incision engraving with a hard
point on metal allows the tracing of very fine lines for a sharper and cleaner overall
effect of the artistic design, sometimes not obtainable with woodcuts.
In the end, none of the contending anatomists was as successful and memorable,
then and later, as Vesalius. Still, the number of publications attempting to graphically
explain human anatomy in the sixteenth century, even if partly plagiarized and often
inconsistent with one another, was clearly unprecedented. This abundance, along
with not a little of notoriety because of the quarreling among authors, plus a bit
of outrage at iconoclasm against ancient authorities, stirred the interest of the public
on the matter. As a result, the profuse distribution of the nerves throughout the body
became better known among anatomists, physicians, surgeons, and not a few artists.
It was indeed unfortunate that Leonardos anatomical masterworks, though much
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admired and talked about in his time, underwent a checkered fate until they were
finally collected and secured in the sixteenth century. Their first widespread publication, and this only in a partial edition, had to wait until 1898.
The pivotal importance of the Renaissance anatomists for the history of the neurosciences cannot be exaggerated. To begin with, the body-wide network of primordial channels of communication and vital force intuited by the authors of the earliest
medical treatises on record in several cultures, that is, that very system of internal
messaging and coordination that progressive research in Greek antiquity had
revealed in its basic organization, and which had been taught to physicians for countless generations ever since, was at last elevated from mere words to glorious realistic
pictures for everyone to watch at ease in a variety of different presentations to choose
from. To a part of the educated public, these pictures of the human machine interiors
in open view surely offered a source for mixed feelings of curiosity, awe, desacralization, and revulsion, equivalent to those described by visitors to present exhibitions
of posturing real bodies donated soon after death for immediately undergoing a process of plastination (see von Hagens and Whalley, 2002). Because millenary notions are hard to dispel, of course, some of the earlier cartoon-like figures would also
continue to appear for some time in parallel with late-Renaissance texts.
Once the power of fine visual arts for transmitting scientific knowledge was discovered, it would never be abandoned up to our own twenty-first century. The example
set by Vesalius and others, of taking advantage of art for the presentation of anatomy in
an appealing and therefore educationally favorable way, became itself a tradition with
a long list of authors and their works. They include, among many others and just in
neuroanatomy: Thomas Willis (Cerebri Anatome, 1664, with illustrations by the great
English architect Christopher Wren), Raymond de Vieussens (Neurographia
Universalis, 1685), Humphrey Ridley (The Anatomy of the Brain, 1695), Charles Bell
(A Series of Engravings Explaining the Course of the Nerves, 1803; see also GardnerThorpe in this volume), and more recently Frank H. Netter (Ciba Collection of Medical
Illustrations, Vol. I, Nervous System, 1953).
Still, the quest is not finished as yet, for the tracking of specific neural pathways
through successive loci across the central nervous system, at an ever more minute
level of detail by the use of labeled antibodies and other specific tracers, continues
to this day. In fact, completion of this work will undoubtedly be listed high in the
priorities of the Human Brain Project that is currently being launched internationally (http://www.humanbrainproject.eu/). In the now distant post-Renaissance period, however, one of the most pressing questions regarding the nerves was still
explaining the swift and effective transmission of messages through them, and this
required research at a much smaller scalemicroanatomy.
5 IMAGINING THE INVISIBLE: PIPES WITHIN NERVES

Whereas the mapping of the nerves, their sites of origin at various points in the encephalon or the spinal cord, and their main individual trajectories in the body seemed
nearly concluded, the enigma persisted of how could sensory information or motor
5 Imagining the invisible: Pipes within nerves
commands travel through those apparently solid cords at such high speeds, with specific directionalities and targeting. It was not enough to know that a few relatively
thick nerves issue from the spinal cord, passing out in between certain vertebrae just
below the neck, and then enter into the arm branching progressively as they extend
downward to the hand, with the terminal branchlets leading finally up to every fingertip. More information was needed to understand why can I move each finger up,
down, left or right, or bend it toward the palm if so desired. Or why can I tell what
side around a given finger is being pricked with a pin, or whether the object touching
my skin there is indeed a pin or a feather.
It took over a full century after Vesalius Fabrica appeared printed before an
imaginative proposal came out as a tentative solution to these problems, this time
posed neither by an artist nor by an anatomist, but by an early modern philosopher.
Rene Descartes (15961650), the French rationalist and systematic doubter, concluded that nerves should indeed contain separate passages with specific routes
for the animal spiritles esprits animaux, in his own pluralized French translation
of the Latin termonly too fine for being visible. In fact, he conceived the nerves
like tubes that enclose narrower tubes in a quiverarrows fashion, which, in turn, enclose thin filaments. Thus, for example (Fig. 9A),
FIGURE 9
Diagrams illustrating Rene Descartes conception of the nerves. (A) A nerve as a wide
pipe enclosing thinner tubes, each of these enclosing fine threads (Descartes, 1662, p. 19;
see text for correspondences of the labels). (B) Separate origins of these structures in
the brain (Descartes, 1664, p. 15). Descartes hypothesized this model in about 1637, but his
book on physiology (De homine) was published 12 years after his death in 1650.
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the nerve A of which the outer membrane is like a great pipe containing many
other, smaller pipes, b, c, k, l, etc., composed of a thinner outer membrane;
and these two membranes are continuous with the two, K, L, that envelop the
brain M, N, o. . . . Observe, too, that in each of these smaller pipes there is a kind
of marrow composed of many very fine threads [represented by tiny dots at the
centers of the cross-sectioned cylinders at the bottom] that come from the substance of the brain itself, N, of which [threads] the extremities terminate at
one end at the internal surface that faces the cavity, and at the other, at the membranes and fleshes against which the containing pipe terminates.
Descartes (1664), p. 15; Adam and Tannery (Eds.), 1986, pp. 132133; Trans. Clarke and
OMalley, 1968, p. 158.
These threads, he explained elsewhere, are quite free and so plentiful, so that the
least thing which moves the part of the body or extremity to which one of them is
attached, in the same way causes movement in the part of the brain from which it
comes; just as when one end of a cord is pulled the other end moves. (Descartes,
1649, p. 20; Adam and Tannery (Eds.), 1986, pp. 132133; Trans. Clarke and
OMalley, 1968, p. 158). This motion would activate little gates that allow the flux
of animal spirit from the brain into the muscles, which stretch or shrink according to
the quantity of animal spirits which flow in or out of them, and whose ramifications
are so arranged that the animal spirits flowing into them cause the whole body of the
muscle to swell and shorten, thus pulling [an eye or other body part] to which it is
attached toward it; on the other hand when the animal spirits flow out of the muscle it
shrinks and lengthens. (Descartes, 1664, LHomme, p. 16; Adam and Tannery
(Eds.), 1986, p. 134; Trans. Fulton and Wilson, 1966, p. 263).
The two prints included in Fig. 9 are a rare instance in our story, for they were
never seen by the author of the text that was intended to illustrate. Descartes wrote his
Traite de lhomme (Treatise on Man) in the 1630s but, afraid of an unfavorable
reaction of the Church, he abstained from publishing this and a few other works
in his lifetime. No arrangements were made either for the preparation of
professional illustrations upon his own admittedly crude sketches, which he considered absolutely essential to explain certain notions and which therefore appeared
mentioned as supporting material in the manuscript. The first edition, published
in Latin (De homine) 12 years after Descartes death in 1650, included suitable illustrations by the hand of the editor Florentius Schuyl, a professor of anatomy.
Two years later, the original French version appeared with figures drawn by Gerard
van Gutschoven and by Louis de la Forge, both former disciples of Descartes who
usually identified their artistic contributions to the book simply with their respective
initials G or F.
These two pictures are also good examples to show that efforts in using art to
illustrate science at those times did not always produce, neither do they today,
equally felicitous results. Whereas Fig. 9A by Schuyl, in showing what the text actually describes (a tube enclosing narrower tubes, each of the latter with a representative filament inside), indeed helps the reader to understand the authors idea,
5 Imagining the invisible: Pipes within nerves
Fig. 9B by de la Forge fails to convey in graphics two main points expressed with
words in the text: (1) continuity of the membrane L with the membranes forming
the narrow tubes and (2) the extremities of the fine threads coming off the substance
of the brain, N. The elliptical layer of closely spaced striations labeled as L, which
delimits a blank space that represents the brain, can hardly be said to be continuous
with the straight lines depicting narrow tubes enclosed within large ones that come
off at the bottom. (Compare L with the contour labeled as K, which at least is similar
in width to the straight outlines of the large tubes, as it fits to suggest identity as a
requisite for continuity.) Those striations might perhaps be intended to represent the
extremities of the fine threads that allegedly issue from the substance of the brain, but
no such threads are indicated here by dots as we do find in Fig. 9A, so any suggestion
of continuity is absent.
Anyhow, Descartes theoretical scheme, an adaptation of that coming down at
least from the Alexandrian anatomists (see above), could be only imagined and pictured from imagination. The small diameter of most nerves, in addition to their pulpy
consistency, precluded any useful inspection of the presence of internal pipes,
let alone of the fine threads allegedly contained within these pipes. Whenever such
inspection was attempted, even decades later, the vague conclusion about nerve
structure being porous and with passages could be communicated better with
words than with pictures. Here is what Thomas Willis (16211675), the abovementioned master anatomist of the nervous system in the Scientific Revolution
that followed the Renaissance, who counted with the collaboration of architect
Christopher Wren to produce the superb illustrations included in his milestone work
on the subject, had to say as he came to the peripheral nerves:
The passages of the Nerves are not bored through as the Veins and Arteries; for
the substance of those are not only impervious to any Bodkin, but no cavity can be
seen in them, no not by the help of Spectacles or a Microscope. . .. The Nerves
themselves (as may be discovered by the help of a Microcosm [microscope] or
Perspective-glass) are furnished throughout with pores and passages, as it were
so many little holes in a Honey-comb, thickly set, made hollow, and contiguous
one by another; so the Tube-like substance of them, like and Indian [sugar] Cane,
is everywhere porous and pervious. Within these little spaces the animal Spirits,
or very subtil little Bodies, and by their nature ever in a readiness for motion, do
gently flow . . . .
Willis (1681), XIX, p. 127; Trans. Pordage; for a modern translation,
see Clarke and OMalley, 1968, p. 160.
Nevertheless, Descartes vision of nerve structure would find partial support, as well
as an illustration obtained directly from nature instead of the mind, in the early eighteenth century. This next step was not taken by an artist, an anatomist, or a doubting
philosopher, but instead by a Dutch merchant in textiles who also happened to have
an inexhaustible curiosity for the natural world, as well as an exceptional ability to
build the instruments that he required for its close inspection.
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6 TURNING THE INVISIBLE INTO VISIBLE: NERVE FIBERS

Since Gutenbergs revolution in book printing (see above), the growing thirst for
reading materials expanded across Europe and fostered another technological revolution. Numerous readers found themselves not having sharp-enough sight for comfortably scanning along the many lines of printed characters. Therefore, grinding and
polishing pieces of clear glass in order to produce corrective spectacles and other
types of lenses became a profitable industry, as well as an interesting pastime. It
was soon found out that, by properly combining different lenses, tools could be made
up for inspecting either distant objects or small things and their parts in detail. When
in able hands, this last type of instrument, the microscope mentioned by Thomas
Willis above, was to be very helpful in understanding how the nerves are actually
constructed, as a requisite to understanding their mechanisms.
Antoni van Leeuwenhoek (16321723) was an enthusiast of the so-called fleaglasses, that is, single-lens microscopes as opposed to those made by combinations
of lenses (see Bradbury, 1967, pp. 6882), which helped him to evaluate the quality
of different fabrics and clothes. With such basic instruments, which he learned how
to build and improve just for himself, Leeuwenhoek had become familiar not only
with the anatomy of fleas like Robert Hooke and other contemporary microscopists
but also the discoverer of animalcules that were a thousand times smaller than the
eye of a Louse (van Leeuwenhoek, 1676). As regards the nerves, he had initially
come to conclusions equivalent to those of Willis and others:
I solicitously viewd three Optic Nerves of Cows, but I could find no hollowness in
them; I only took notice, that they were made up of many filamentous particles, of
a very soft substance, as if they only consisted of the corpuscles of the Brain joined
together, the threds [sic] were so very soft and loose. They were composed of conjoined globuls [sic], and wound about again with particles consisting of other
transparent globules.
van Leeuwenhoek (1674).
Four decades later, however, a well-seasoned Leeuwenhoek was able to discern that
those threads composing a nerve were in fact extremely narrow vessels, and
found an artist capable of producing an illustration of the same under his detailed
directions (Fig. 10). In his description, we read:
I have often, with great pleasure, observed the texture of the Nerves, which are
composed of very minute vessels of an incredible thinness, and which, running
along by the sides of each other, constitute a Nerve; the cavity of each of these
small vessels is about two thirds its diameter . . .And I not only saw the size or
circumference of these vessels, (some hundreds of which go to the composition
of a nerve no larger than a hair of a mans beard), but some of their cavities I
could as plainly distinguish, as if we were to pierce many holes in a paper with
a small needle, and hold them up against the sun.
van Leeuwenhoek (1717).
6 Turning the invisible into visible: Nerve fibers
FIGURE 10
Early hand-drawn micrograph showing how nerves are constituted by bundles of incredibly
thin vessels, as first illustrated in 1717 by Antoni van Leeuwenhoek. The tiny vessels
can be seen as quasi-parallel lines in the longitudinal section of a nerve labeled as Fig: 1
(top left), and in transverse view in the cross-section of aligned bundles labeled as Fig: 2
(bottom). Although only the bundle at the center of this last drawing is shown to be composed of
those very minute vessels of an incredible thinness, it should be understood that all the
equivalent bundles indicated with a G are similarly integrated by bundled fibers. The drawing
labeled as Fig: 3 (top right) represents a small piece of the spinal cord in longitudinal section,
where thin fibers aligned in roughly parallel arrangement also are evident.
The meticulous artwork seen in Fig. 10 may represent one of the few instances in
which artists were involved in transferring microscopic images to prints, because
productive communication between the collaborators may have been found rather
cumbersome and with good reason. It is one thing for an anatomist to discuss viewing
angles and design emphasis with an artist right in front of a dissected body that can be
variously illuminated, with its parts moved, turned, or otherwise manipulated in
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different ways; it is quite another thing for a microscopist to explain to someone else,
taking turns at the microscope eyepiece, where and what to look for in a dimly lit and
mostly static microscopic field, especially when optimum observation of the specimen requires careful focusing at several planes.
Consequently, from the seventeenth century and up to the advent of photomicrography (see below), it was not only expected but more efficient altogether that each
microscopist would develop enough artistic skill as for illustrating his own observations with reasonable clarity. Help in this task could be obtained from using a camera
oscura, that is, a system of mirrors attached to the microscope in order to project the
images on a paper by the side, so as to permit at least the tracing of correctly sized
main shapes in a darkened room. Fine detail and shading, however, depended on discriminative eyes and a steady hand. Projection on light-sensitive plates, like the daguerreotype method that preceded photography, was then just a dream decades away
of realization in practice.
As subsequent studies confirmed the bundle-like construction of the nerves, just as
Descartes had postulated and Leeuwenhoek had demonstrated, attention turned to their
constituent thin vessels. A new kind of player entered the scene hereneither physician nor anatomist, artist, philosopher, or merchant, but now a churchman, one of many
active in scientific research during the Enlightenment. The Italian Abbe Felice Fontana
(17201805), pushing the limits of empirical microscopy with lenses that allowed him
having magnification powers of up to 500 and 700 times, succeeded in more closely
inspecting the structure of nerves. This is how he summarizes his observations (Fig. 11):
The primitive construction of the nerves is as follows: a nerve is formed by a great
number of transparent, homogeneous, uniform, very simple cylinders. These cylinders seem composed of a very fine uniform tunic, filled, as far as the eye can
judge, with a transparent, gelatinous humor, not soluble in water. Each of these
cylinders receives a cover in the form of an external sheath, which is composed of
an immense number of winding threads. A very great number of transparent cylinders form together an almost invisible nerve, presenting the exterior appearance of white bands; and several of these nerves united, form the larger nerves
seen in animals.
Fontana, vol. 2; Trans. Skinner, 1787, pp. 313314.
Although produced still in the last decades of the Enlightenment, Fontanas drawings
are already representative of the excellent hand-drawn micrographs that were to
dominate biomedical research all along the nineteenth century. Microscopy of the
natural world had already a golden list of great predecessors including, apart from
Leeuwenhoek, the names of Robert Hooke, Marcello Malpighi, and Nehemiah Grew,
among others. Now, following the continued advance in optomechanical apparatuses and an ever more adequate handling of biological tissues, microanatomy had
reached a level of technical skill and artistic quality comparable to that acquired by
anatomy since the Renaissance. In the adventure of illustrating the microworld inside
living beings, however, scientists and artists were not partners anymore butlike
Leonardoone and the same person.
7 Lines for electricity: Neurofibrils
FIGURE 11
The primitive nerve cylinders (nerve fibers) that constitute the nerves, individually
illustrated for the first time by Fontana (1787), plate IV. The cylinders seemed to consist of a
thin tubular membrane enclosing a gelatinous fluid in which granules of various sizes could be
seen (clear dots in Fig. III). Most cylinders appeared covered with a sheath having
numerous irregularities (Fig. IV). Yet a few cylinders, like the one labeled om and for the
most part that labeled ne, looked devoid of a sheath.
By the time Fontana published this work, the world was at the threshold of a major revolution in neuroscience, in close parallel to the upheaval of the French Revolution, as a new subtle fluid entered the arena to dispute the role as the carrier of
nerve signals (see Finger and Piccolino, 2010, esp. pp. 307393; Smith et al.,
2012, esp. pp. 199249). Half a century later, the basic idea that the animal spirit
could be of electrical nature had been supported by a number of data, up to the point
of establishing that it consists of impulses traveling at speeds of tens of meters per
second. The actual conducting pathway for such electrical impulses along the nerve
fibers, however, was now wide open to controversy.
7 LINES FOR ELECTRICITY: NEUROFIBRILS

The above-mentioned realistic structure of nerve fibers as described by Fontana became the accepted picture, until the standards of microscopic technique were raised
again. Medical research in the mid-nineteenth century had already become mostly
microscope based, in the wake of Theodor Schwanns (18101882) and Matthias
Schleidens (18041881) bold but well-supported proposition that all living beings
seemed to be either cells or composites of cells, that is, tiny globules of organic materials containing even smaller corpuscles in their minuscule bodies. Consequently,
claimed Rudolph Virchow shortly after, diseases should necessarily result from
dysfunctional cells. Understanding cells, starting by their internal structure, was
therefore a top priority for biology as well as for medicine. Competition became
steep, both among researchers and among microscope makers.
Explaining the occurrence of fibers such as those found in nerve tissue and muscles presented something of a problem in this new thoroughly cellular world. This
puzzle was real even for Schwann himself. He concluded that a nerve or muscle fiber
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would likely originate from coalescence of precursor round primary cells aligned in
rows, which later on might (in muscle) or might not (in nerve) retain their native nuclei. A nerve fiber, therefore, would finally result in a continuous tube with a basically homogeneous content, after the nuclei of the constitutive cells had completely
dissolved. His description of such a mature nerve fiber is as follows (Fig. 12):
According to the foregoing explanation, therefore, each nervous fibre is, throughout its entire course, a secondary cell, developed by the coalescence of primary
cells. With respect to these [secondary] cells we remark. . . [that] the cell cavity
appears to be filled up by a firm substance, namely, the band discovered by
Remak.
Schwann (1839), pp. 175176; Trans. Smith, 1847, pp. 147148.
Indeed Robert Remak (18151865), the young author who Schwann mentions here,
had recently found a clear band running within primitive cylinders not unlike those
that, as Leeuwenhoek and Fontana had described, compose the peripheral nerves.
FIGURE 12
Nerve fibers drawn by Schwann (1839), plate IV, figure 9, who along with Matthias Schleiden
developed the theory that all living organisms are composed of cells. The set of drawings
is meant to illustrate a discussion about the membranes limiting the tubular nerve fibers,
supposedly formed by coalescence of round cells, rather than about their allegedly
structureless content.
But then, just a few years after Schwann published his provocative cell theory,
Remak himself discovered a bundle of extremely delicate fibers within the supposedly clear substance of that band at the center of the primitive cylinders.
Further, Remak also reported that the cylinders are usually connected to, or continuous with, some of the cells that so far had been considered as merely adjacent to or
situated in between the cylinders. In fact, he noted, the axial bundle of delicate fibers
appeared to link both elements into a single structure (Fig. 13):
Where, for instance, a finer tube (p), in which one can distinguish only a punctate
and non-fibre content, runs to a ganglion cell, one sometimes recognizes in this
cell (r) very delicate granular fibres which circulate around the nucleus to form
the substance of the cell. They collect at the site of transition from cell to tube to
form a continuation of the latters punctate content. This makes the assumption
more probable that finer lumens, too, have a fibrous content which, owing to their
greater fragility, disintegrate more easily into a granular substance.
Remak (1844), p. 469; Trans. Clarke and OMalley, 1968, pp. 4950.
FIGURE 13
Ganglion cell of the crayfish nerve cord showing neurofibrils, as first illustrated by Remak
(1844), figure 9. A bundle of delicate fibrils (thin lines) surrounds the nucleus of the cell
and continues into an offshoot fiber, the fibrils becoming granular as they apparently
disintegrate toward the site of section (see text for correspondences of the labels).
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It has remained virtually unrecognized that this finding completed the validation of
the model of nerve structure visualized in principle by Descartes 200 years earlier
(see above), even if certainly not his functional interpretation. Leeuwenhoek and
Fontana had confirmed that nerves are indeed composed of narrow pipes or cylinders, and now Remak found evidence that the latter may each enclose a bundle of
very fine threads. At the mid-nineteenth century, this last novelty became a contentious issue from its inception, in part because Remaks evidence was initially
obtained not from mammalian nerve tissue but from a distant lower animal, the river
crab or crayfish. Hence, before its acceptance as a common feature, the finding
needed confirmation in nerve tissues of other species. When this fact was gradually
presented for fish and other animals, however, the main adverse reaction was due to
some audacious inferences that were perhaps inevitable in a period when everyone
was amazed at the possibility of instantaneous messaging across whole countries,
thanks to that technological marvel of communication through a simple wirethe
telegraph. On physiological groundswrote the combative cell biologist Max
Schultze (18251874)I maintain the possibility of isolated conduction in these
constituent fibrils. . . (Schultze; Trans. Power, 1870, pp. 180182).
Clearly not everyone was ready to even consider this exciting suggestion, among
other reasons because opinions remained far from uniform as refers the internal
structure of the main nervous elementseither homogeneous, as Fontana and
Schwann among others had described, or delicately fibrillar as now Remak and
his supporters claimed. In the words of a promising young neuroscientist who soon
would launch his own revolutionary approach to the human nervous system, at least
for therapeutic purposes, Sigmund Freud (18561939):
One author thinks of the nerve cell as granulated, the other as fibrillose; one
thinks of the nerve fiber as a bunch of fibrils but another as a liquid column. Consequently, while one elevates the nerve cell to the basic source of nervous activity
another degrades it to a mere nucleus of the Schwann sheaths [the myelin layer
around nerve fibers in peripheral nerves].
Quoted in Jones (1953), p. 46.
Professor Ernst Brucke, his mentor at the Vienna University, suggested Freud to
tackle this problem as a doctoral thesis, using for starters the same animal in which
Remak first made his controversial observations. Freuds results (Fig. 14) were as
unambiguous as they were conciliatory:
The content of the nerve fibers in the crayfish, and indeed of both the fibers in the
central organs and also [those] in the peripheral nerves and the sympathetic
plexus, consists therefore of straight and isolated fibrils embedded in a homogeneous substance, with a very great though not everywhere uniform lability.
Freud, 1882a, pp. 2223; Trans. Frixione, 2003.
Upon these conclusions, Freud eventually became a partisan of the possibility maintained by Schultze and others:
FIGURE 14
Fibrils surround the nucleus of a nerve cell and continue into an emerging fiber in the crayfish
nerve cord, as drawn by Freud (1882a), plate 1, figure 2.
If we assume that the fibrils of the nerve have the significance of isolated paths of
conduction, then we should have to say that the pathways which in the nerve are
separate are confluent in the nerve cell: then the nerve cell becomes the beginning of all those nerve fibers anatomically connected with it.
Freud, 1882b/1883; emphasis as in the original.
Remak and Freud, like Fontana and many others, made the above observations on
fresh pieces of nerve tissue just excised from the experimental animals. This had
the advantage of looking at the biological samples in an unaltered, virtually still living
condition, but had also the drawback of unavoidable disruption caused by dissection,
which usually destroyed much of the natural spatial relationships. A further complication was that most animal tissues are quite transparent and almost colorless, turning
difficult the microscopic visualization. In response to these challenges, by the later
decades of the nineteenth century, technical advances already allowed producing very
thin slices of the intact biological piecesthat is, microtomy, which had been previously fixed by prolonged soaking in alcohol or other liquids, and even infiltrated
with paraffin to improve their mechanical consistency so as to resist deformation during the cutting process. Exposing these slices or sections to certain dyes, which selectively stain fats or protein or other organic compounds, offered the combined
benefits of chemical identification and increased contrast for an easier viewing.
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This leading-edge approach was applied to the problem of neurofibrils by the Hungarian microscopist Stephan von Apathy (18631922) and the younger German histologist Albrecht Bethe (18721954). Independently and using different methods of
specimen preparation, both succeeded in sharply staining numerous intracellular
threads (Fig. 15), for which they coined the term neurofibrils (Bethe, 1900; von
Apathy, 1897, 1899). The fibrils apparently coursed through successive cell units, suggesting they might constitute a virtually uninterrupted network. An enthusiastic Bethe
announced: We must stop looking at the neuron as an anatomical and physiological
unit; we must admit that the views which we have come along with up to now about
conduction in single parts of a neuron were premature and one-sided. (Bethe, 1898).
This declaration came as a cold shower for those in favor of the neuron doctrine.
Based upon mounting evidence that nerve cells and nerve fibers all belong to highly
branched configurations built of single units, this alternative view held the nervous
system to be composed of such unitsneuronsinstead of being a continuous network throughout the animal body. Particular responsibility for the future of this
model fell upon its undisputed experimenting champion and theoretical leader,
the Spaniard Santiago Ramon y Cajal (18521934). His initial reaction speaks for
itself. If Bethes views were true, wrote Cajal:
A panreticularism, a kind of ocean where nervous currents pour out and all channels become confused, comes to replace the luminous doctrine of neurons and of
connections by contact, sterilizing the great work of thirty years of precise observations. [. . .] At the door of this most new and bold histology, there should be written the epigraph over Dantes Hell: Lasciati ogni speranza [Abandon all hope].
Ye who, imbued with faith in the cognoscibility of nature, spend life peering
FIGURE 15
Numerous supposedly continuous and electrically conducting neurofibrils are shown as
merely switching courses and redistributing between dendrites in a motoneuron of the spinal
cord of a dog, as interpreted by Bethe (1898), plate IX, figure 9.
through the eyepiece of the microscope, know ye that ye pursue a chimera: the
nervous system is as impenetrable as Kants thing-in-itself.
Ramon y Cajal (1903a); Trans. Frixione, 2009, emphasis as in the original.
The hardest fight over the role of the neurofibrils extended for the next 5 years, a
period in which Cajal developed his own superior method for showing not only such
delicate threads (Fig. 16A) but also the complexity of the webs they constitute within
neurons from diverse animals. He and his group also studied the rearrangements of
these networks under stressful, pathological or otherwise abnormal states, and advanced hypotheses about the functional significance of the neurofibrils (see
Frixione, 2009).
Recognition of Cajals supreme mastery on this matter was granted even by a
distinguished Italian foe of the neuron doctrine with which the Spaniard shared
the Nobel Prize in Physiology and Medicine of 1907. At the tense official conference
in which they both accepted the honor, Camillo Golgi (18431926) displayed a
drawing taken from one of Cajals papers (Fig. 16B), stating:
FIGURE 16Contd
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FIGURE 16Contd
Neurofibrils forming intraprotoplasmic skeletons, as revealed by Cajals novel staining
method of reduced silver nitrate. (A) Large and small nerve cells and fibers from a rabbit
(Ramon y Cajal, 1903b, figure 2). (B) Pyramidal cells of the human brain visual cortex, in
which neurofibrils forming an intraprotoplasmic skeleton in each neuron (Ramon y Cajal,
1903b, figure 20; shown as figure 19 in Camillo Golgis Nobel Prize lecture to illustrate Cajals
mastery in the field).
I must hasten to say that in modern times new technological methods have opened
up new horizons in the study of detailed cell structure, and in first place are those
methods of Ramon y Cajal. [. . .] With Cajals method one can demonstrate fibrillar structure with such precision of detail that one can see how the fibrils behave
in the cell bodies as well as in the processes. . .
Golgi (1907).
As it turned out, electrical impulses are not conducted through the interior of a nerve
fiber but rather over the thin enveloping membrane at its surface, whereas the
neurofibrils were found to be part of an internal skeleton present in every cell. This
last outcome was foreseen by Cajal himself, who would often refer to the reticulum
of neurofibrils with expressions like intraprotoplasmic skeleton or neurofibrillar
skeleton, and neurofibrillar apparatus, a semisolid skeleton, years before the
terms cytosquelette and then cytoskeleton were introduced in the biological literature (see Frixione, 2000).
The pictures included in papers by Cajal and his contemporaries at the turn of the
twentieth century, such as those seen in Figs. 15 and 16, represented the last stage in
which microscopic images were illustrated with drawings executed by the researchers
hand (see chapter by DeFelipe in this volume for technical explanations and a beautiful
selection of this kind of artworks). Those elegant tracings, subjectively selective and
therefore artistic, and yet accurate, were soon to be substituted by plain photographs.
The mechanical objectivity of photomicrography, nevertheless, had several advantages for illustrating on paper the exact configuration of the microstructures
on view, including their disposition and relationships in three-dimensional space.
Once again Cajal pioneered these techniques and published some of the earliest
high-resolution stereomicrographs, which consist of two micrographs of the same
observation field taken from slightly different angles, like those showing networks
of neurofibrils within neurons in Fig. 17. When both micrographs are seen simultaneously by means of a stereoscope, so that each image is fed to the corresponding left
or right eye, the brain reconstructs the perception of depth as it normally does with
common binocular vision.
As a result of calculated design based on optical research, advanced engineering,
and improved manufacturing processes, from the late nineteenth century and onward
the best microscopes already offered the maximum resolution theoretically attainable with visible light. This technical success implied at the same time, however,
FIGURE 17
Dense networks of neurofibrils within neurons in the spinal cord of a cat in an early
stereomicrograph by Ramon y Cajal (1918), figure 18. See text for explanation.
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a unsurpassable limitation in terms of useful magnification power. Yet, a new chapter

in our story started soon upon initial observations of nerve tissue with a far more
powerful instrument, the electron microscope.
8 MICROTUBULES: THE SUBSTRATUM OF CONSCIOUSNESS?

Electrons, having much shorter wavelengths than photons, can discriminate much
smaller objects found in their paths. Hence, electron microscopes are capable of
much higher resolutions than optical microscopes. Therefore, as soon as physicists
triumphed in making electron microscopy a reality, biologists fought hard to
overcome the many technical problems associated with inspecting animal and plant
specimens under the high-vacuum conditions existing inside those impressive
instruments. In particular, new fixation and thin-sectioning procedures
ultramicrotomyhad to be developed from scratch in order to obtain useful images
at magnifications of thousands of times. Successful attempts with nervous tissue
started to be published in the 1950s (Gray, 1959; Palay and Palade, 1955).
The combination of light microscopy approaches with electron microscopy techniques led to the identification of neurofibrils as a particular group of a family of
cytoskeletal structures, present in many different cells, known generically as intermediate filaments and more specifically as neurofilaments in nervous tissue
(Gray and Guillery, 1961). Moreover, some of the changes induced experimentally
by Cajal and his coworkers in neurofibril arrangements were confirmed by electron
microscopy (Boycott et al., 1961).
At about the same time, apart from filaments, electron microscopy occasionally
showed a hitherto unknown type of long, 24-nm-wide hollow cylinders within neurons (Palay, 1956; Fig. 18). As these slender tubes started to be commonly found in
nerve and many other types of cells, they came to be known as microtubules
(Slautterback, 1963) and soon generated an abundant literature (Porter, 1966).
Microtubules have been characterized to play important mechanical roles in cells,
where they constitute major components of the cytoskeleton. They form a relatively
rigid framework that determines overall cell morphology, particularly in highly
asymmetric and branched cells like most neurons. At the same time, microtubules
constitute a supporting internal scaffold that keeps other organelles in their proper
places, acting also as guiding tracks for molecular motors to carry on intracellular
transport of different cytoplasmic components along precise trajectories (for reviews, see Frixione, 2000 and Frixione and Hernandez, 2011). The sturdiness of intracellular assemblies of microtubules has been demonstrated by inspection of partly
dismantled nerve cells with high-resolution scanning electron microscopy (Fig. 19),
which provides images where the topography of the objects can be appreciated.
Given their length and an exquisite supramolecular architecture, microtubules
have been hypothesized as devices with a potential for information processing
through switching conformational changes of the molecules constituting their cylindrical walls (reviewed in Hameroff et al., 2002). In a further development of this
idea, by the mid-1990s the microtubules within neurons were proposed as especially
8 Microtubules: The substratum of consciousness?
FIGURE 18
Early electron micrograph of certain more or less parallel, thin, canalicular elements (along
the broad central zone crossing upward from left to right) that later were called
microtubules. The microtubules shown here are located within a dendrite in the central
nervous system of the rat (Palay, 1956, figure 1).
Reproduced with permission of #1956 Rockefeller University Press. Originally published in Palay (1956).
well-suited candidates for the occurrence of quantum mechanics events believed to

mediate consciousness (Hameroff, 1994; Hameroff and Penrose, 1996; Penrose,
1994a,b). According to this view, most of the standard functions of the nervous system are mediated by electrical impulses leading to chemical communication between
nerve cells, in agreement with mainstream neurophysiology. Consciousness, however, is considered an altogether different phenomenon that depends upon periodical
reductions of quantum coherence which constantly builds up within microtubules as
a result of the traffic of electrical signals on the surfaces of the neurons. Despite being
highly controversial (see Frixione, 2013b), this theory has nevertheless received a
fair amount of attention and continues in place (Penrose and Hameroff, 2011).
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FIGURE 19
Microtubules forming an axial column in retinal cells of the crayfish. Scanning electron
micrograph of the bundle of microtubules (Mt), to which numerous granules, other
organelles, and filaments (F) remain attached after the cell membrane was stripped off by a
mild tissue-disrupting preparation procedure (Frixione, 1983, figure 4b).
Reproduced with permission of #1983 Rockefeller University Press. Originally published in Frixione (1983).
9 CONCLUDING WORDS
It has been a long way for humanity trying to fathom just how our bodies can function
as integrated units. We now know that much of the explanation is chemical. From the
genetic code that in expressing its content of information defines each of us in particular, to the hormones that tune up and keep on time every nook and cranny of our
References
whole organism, to the immune system in constant defense of our biological identity
everywhere, all are a frenzied dance of myriads of different molecules. Yet, none of
these marvelous automatons account for our most cherished capabilities
experiencing the world around us, reacting to it in multiple forms, and thus becoming
aware of our own existence, in just milliseconds.
From immemorial times, our ancestors intuitively believed that this miracle was
helped by an internal network of connections assisting communication of the body
parts among themselves, as well as with our inner self or soul if one wills so. Since
then, this role has been always assigned to channels that criss-cross the body in
many directions. Such conveying lines turned out to be composed of thin tubes
enclosing still smaller tubules, and all of them have been regarded as functional
in specific ways for some of the higher faculties in humans and animals, including
consciousness.
Graphic representation of many genres has been exploited to help oral and written
speech in transmitting this complex information. As with maps, both the technical
means and the visual quality of the final images have varied a great deal over time,
as artists did their best to understand the science they were requested to portray, and then
scientists have done their best to illustrate their findings in aesthetically appealing ways.
Innumerable hand drawings, prints, and photographs pave the road followed
toward having our current picture of how our nervous system is built. Scores of generations have both participated and benefited from this long-term saga. And despite
the assured confidence that always accompanies the professors at each stage of intellectual history, we really do not know whether this quest is close to its culmination
or if it still holds a trove of amazing new imagery in store for us.
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CHAPTER
John Bell (17631820):

Brother artist and anatomist
Christopher Gardner-Thorpe1
MD, FRCP, FACP, Consultant Neurologist, and Course Director, Diploma Course in Medical
History, Society of Apothecaries, Blackfriars Lane, London, UK
The Coach House, 1a College Road, Exeter, EX1 1TE, UK
1
Corresponding author. Tel.:44-1392-433-941, e-mail address: cgardnerthorpe@me.com
Abstract
John Bell, brother-surgeon of Charles Bell, was, like Charles, an outstanding surgeon and a
good artist. John was one of the few who illustrated his work with their own drawings in
the days before audiovisual aids were available and without the benefit of reliable drawing
aids, photography and computer-aided design. Charles, on the other hand, was the better artist
and illustrated much of the normal anatomy of the nervous system. Each brother undertook
extensive surgery of men who had been wounded in war; John Bell left us his engravings from
the textbooks, more numerous perhaps than Charles, but Charles left us a series of oil paintings
and watercolours in addition to the illustrations in his textbooks.
Keywords
John Bell, Charles Bell, anatomist, surgeon, Edinburgh, artist
1 INTRODUCTION
The brothers John and Charles (17741842) Bell were important doctors who
advanced the study of anatomy and clinical surgery in the eighteenth and early nineteenth centuries. They left copious works in text and illustration that formed a basis
upon which others could develop. Each described and illustrated the nervous system
and for this reason neuroscientists should remember the Bell brothers.
John Bell is less well known than his younger brother Charles, who he trained.
Both brothers were good artists and outstanding surgeons but Charles is the better
remembered since it was he who described much of the normal nervous system
(Bell, 1802, 1836) and also the variety of lower motor neurone facial palsy known
as Bells Palsy. Charles is also well known on account of his work on the spinal roots,
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CHAPTER 6 John Bell (17631820): Brother artist and anatomist
which has provoked dispute as to the priority of discovery; on the one hand is Alexander
Walker (17791852) who in 1808 and 1809 claimed that the anterior spinal roots
were sensory and the posterior motor and, on the other, is Francois Magendie
(17831855) who first published widely that the converse was the case, whereas
Charles had published this only in his privately printed work of just 100 copies.
Charles has also been the subject of more biographical publications (Gordon-Taylor
and Walls, 1958) than John but the contributions of each to anatomy and surgery is
worthy of very serious consideration (Gardner-Thorpe, 2004; Kaufman, 2005).
2 THE BELL FAMILY

John Bell was born on May 12, 1763, the second son of Reverend William Bell
(17041779) who came from a distinguished line of Scotsmen.
William Bell had been ordained into the Episcopal Church of Scotland and had
come with his own father, John Bell (16761708), grandfather of our John Bell, to
the Counties bordering the Forth. In 1702 grandfather John Bell had preached the
sermon in Edinburgh Cathedral on the death of King William III (16501702),
known as William of Orange, and is buried in an ornate tomb at Gladsmuir Church.
This John was the son of Sir John Bell of Hamilton (1640?), our Johns greatgrandfather, whose father was Patrick Bell and whose father in turn was another John
Bell (15801646), the son of James Bell of Kirkconnel and Blackett House.
John Bell was probably not quite such a good artist as his younger brother Charles
who produced more illustrations and also painted in oils in order to illustrate wounds
suffered in the Battle of Corunna in 1809, which may be seen at the Royal College of
Surgeons of Edinburgh. He also painted in watercolour to show the wounded
from the Battle of Waterloo in 1815, and these are held at the Wellcome Collection
in London, and various rural scenes in England and Rome. An exhibition catalogue
(Walls and Gardner, 1996) provides details as does a volume of colour images
(Crumplin and Starling, 2005).
Artistic ability ran in the family, for Johns and Charles mother, Margaret
Morice, granddaughter of Bishop Robert White who was Primus of Scotland from
1757 to 1761, was a good artist.
John had one elder brother, Robert (17571816), who became Professor of Conveyancing to The Society of Writers to The Signet. This organization is a professional
association for lawyers in Scotland and is one of the oldest professional organizations, still providing research facilities and other structured advice for lawyers
and now known as The Society of Her Majestys Writers to the Signet.
George Joseph (17701843) was the third son. He held the Chair of Scots Law in
Edinburgh University. In 1821 in Edinburgh, he published Commentaries on the Law
of Scotland and on the Principles of Mercantile Jurisprudence, an important book
dealing with the whole extent of the mercantile law of Scotland and a much
acclaimed publication by Archibald and Constable. Charles Bells correspondence
with his brother has been published (Anon, 1870) and the first words of the Preface
3 John Bell, the surgeon
read The discovery of the circulation of the blood by Harvey, and the discoveries of
Sir Charles Bell in the nervous system, were pronounced by Muller, the German
physiologist, the two grandest discoveries that have ever been made in physiological
science. The family lived in Fountainbridge, a straggling suburb of Edinburgh and
moved later to the upper part of a house in George Street in that city.
3 JOHN BELL, THE SURGEON

John Bell qualified as MD in Edinburgh in 1779 but he felt that anatomy teaching in
Edinburgh at that time lacked something. The study of anatomy in Edinburgh was
dominated by the three generations of the family of Monro, namely the father
(Primus), his son (Secundus) and the grandson (Tertius).
Alexander Monro Primus (16971767), founder of the Edinburgh Medical
School, published on the bones, nerves and heart (Monro, 1732). Alexander Monro
Secundus (17331817) was lecturing when John Bell was studying in Edinburgh.
Monro Secundus had learned from William Hunters (17181783) lectures in
London and then he went to study in Leyden, like so many at that time; he was young
when appointed lecturer at the age of 22. He published on the brain, eye and ear
(Monro, 1797), and the foramina of Monro, between the lateral ventricles and the
third ventricle of the brain, are named after him. He also published a comparative
work on fishes (Monro, 1785). Alexander Monro Tertius (17731859) wrote in
1811 (with a second edition in 1830) on the upper gastrointestinal tract (Monro,
1830) and in 1825 on general anatomy (Monro, 1825). Tertius dissected the resurrectionist Burke and discussed Burkes phrenology.
However, John Bell noted that neither Primus nor Secundus was a practising surgeon and he felt that, in order to have a practical purpose, anatomy needed to be studied
and taught in the light of surgical expertise and with relevance to clinical surgery.
He was appointed a Fellow of the Royal College of Surgeons of Edinburgh in
1786. He lectured at his home and accumulated a collection of specimens that Charles
later took to London to contribute to William Hunters (17181783) anatomical collection at The Great Windmill School of Anatomy near Leicester Square.
John Bell is regarded as the founder of surgical anatomy. He is reputed to be
the first to ligate the gluteal artery, the common carotid artery and the internal iliac
artery. An outstanding surgeon, he trained his younger brother Charles who was
apprenticed to him by Indenture from April 1792. He taught, among others, the ovariotomist Ephraim McDowell (17711830) of Kentucky.
3.1 The Anatomy of the Bones, Muscles, & Joints in 1793

In 1793 John published his The Anatomy of the Bones, Muscles, & Joints (Bell, 1793)
and the book carries an Advertisement that reads as follows:
As I proceeded in this work, I felt more and more at every step, the necessity of
giving plates to it. I have made them apart, that no one may be obliged to buy both
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books when perhaps he needs only one. I have quoted them on the margins here,
that this book may have the help of the plates, and the plates, in their turn, the
explanations of the book: but every reader will perceive with one glance, that they
are quite independent of each other; indeed the book is written, as it was at first
conceived, not needing the plates, yet not the worse for having a neat system of
drawings joined to it.
3.2 Engravings, Explaining the Anatomy of the Bones, Muscles

and Joints in 1794
In 1794 he published his book of illustrations Engravings, Explaining the Anatomy of
the Bones, Muscles and Joints (Bell, 1794) (Figs. 13). These anatomical illustrations were used to supplement teaching and to remind the student later of what
he had seen in the dissecting room in Edinburgh. Bell was one of the few artists
to illustrate his own books, as the common custom was for engravings for published
works to be provided by other artists.
3.3 Discourses on the Nature and Cure of Wounds in 1795

In 1795 John Bell published his book on surgery entitled Discourses on the Nature
and Cure of Wounds. The frontispiece (Bell, 1795a) labelled Plate 1 depicts a
dissection of the upper thigh (Fig. 4). He dedicated this book to Robert Allan
FIGURE 1
Muscles. Plate III from John Bells Engravings of 1794.
FIGURE 2
Muscles. Plate VIII from John Bells Engravings of 1794.
FIGURE 3
Muscles. Plate IX from John Bells Engravings of 1794.
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168
FIGURE 4
Frontispiece to John Bells Discourses on the Nature and Cure of Wounds. Third edition.
Edinburgh, 1812 (authors image).
(17781827), Surgeon-in-Ordinary, who had been Bells apprentice and became

senior operating surgeon to the Royal Infirmary, thus:
Dear Sir,
For many years of faithful, kind and skilful assistance in my Operations as well
as in the ordinary duties of Practice, I owe you much; and take a particular pleasure in dedicating to you, in token of lasting esteem, and as a just tribute to your
excellent professional talents, these my earliest ESSAYS; which I present to you as
a mark of respect and friendship, with fervent wishes for your happiness and
success.
I am,
DEAR SIR,
Your obedient Servant,
John Bell.
This work, as expected of that time, includes discourses on gunshot wounds and
wounds with a sword. However, of particular interest to neuroscientists is Discourse
V, On wounds of the head, which opens with the words While the bones in general
serve as a basis for the soft parts, and for supporting and directing the motions of the
body; certain bones have a higher use in containing those organs whose offices are the
most essential to life. The skull defends the brain; . . . and indeed it does; the section
Of secondary affections of the brain tells us why, inflammation is the most serious
but not alleviated by trepanning unless an abscess be present. Bell points out what
every neurologist knows, namely, that an abscess is a space-occupying lesion, sometimes overlain by a puffy tumorthis is the puffy tumour which Mr. [Percivall] Pott
[171488], and all modern surgeons, have so much noticed; . . . (Bell, 1795b).
Although barber surgeons were no longer the operators, Bell notes the history of
a young fellow, a servant to a horse courser, was thrown off his horse against some
of the bars in Smithfield, whereby . . . the skull was bared between two and three
inches in breadth; he was led to the next barber, who cut the piece off, and hanged
it up in his shop (Bell, 1795c).
Bell teaches a lesson that those who nowadays X-ray the skull in the hope of determining the degree of brain damage might heed, for Bell notes to believe that a
fractured skull is a chief cause, or even an absolute sign of danger, is a very mistaken
and vulgar notion; it is not the damage done to the skull, but the injury to the brain,
that is the cause of danger, and the fracture of the skull is but a faint uncertain mark of
the harm done to the brain (Bell, 1795d). Hence, the Royal College of Radiologists
guidelines for skull X-rays.
Bell writes of concussion, of compression of the brain and of intracranial haemorrhage. He concludes this section of his book with a warning about what we call
medical negligence when he quotes the German anatomist and surgeon Lorenz
Heister (16831758) For wounds become MORTAL by ACCIDENTS, either by
the ill conduct of the patient himself, or by the ignorance or neglect of the surgeon
(Bell, 1795e).
3.4 The Anatomy and Physiology of the Human Body in 1797

At the age of 34, in 1797 John Bell published The Anatomy and Physiology of the
Human Body and The Anatomy of the Human Body in four volumes (Bell, 1797a)
which was described by James Russell (17541836), Surgeon-in-Ordinary to the
Royal Infirmary and Professor of Clinical Surgery, as The first great textbook contributed by the British school to modern anatomy. James Russell presided over the
purchase in 1825 of the collection of Charles Bell, including Johns contributions,
from the Great Windmill School of Anatomy in London in 1825 for the sum of 3000.
In 1797 Bell published his work on anatomy in two volumes: The Anatomy of the
Human Body. Volume 1. Containing the Anatomy of the Bones, Muscles, and
Joints (Bell, 1797b) and The Anatomy of the Human Body. Volume 2. Containing
the Anatomy of the Heart and Arteries (Bell, 1797c).
The section on the skull occupies 69 pages and Bell considers the skull as a whole
and then each individual bone of the skull. He considers the sutures and notes as the
sutures continue open in a hydrocephalic child, they are said to open again in the few
instances where adults are seizures with the same disease (Bell, 1797d).
In describing the petrous part of the temporal bone, Bell notes there are two
nerves that enter the internal auditory meatus, the portio dura and the portio mollis
(the true nerve of hearing). The portio dura emerges on the cheek and surely is the
cranial nerve we call the fifth and he recognizes that it is no part of the organ of
hearing. Bell discusses the Eustachian tube, noting that
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170
when we have a sore throat, the pain extends up along this tube into the ear; when
we have a cold, both our voice and our hearing is hurt; the one by the stuffing of
the sinuses, the other by the stuffing of the Eustachian tube. When we shut the nose
and mouth, and blow strongly, we feel a crackling in the ear, as in the place of the
Eustachian tube; when we dive, we feel the same, by the condensation of the air . . .
(Bell, 1797e).
In describing the Vidian Hole, the pterygoid hole that transmits the retrograde branch
of the maxillary nerve that makes its way back into the skull, Bell provides a footnote
to remind us of Vidus Vidius [150869], a professor of Paris, and physician to
Francis the first [14941547]. A very popular surgery textbook, Bailey and Love,
enthused medical students in the 1960s by the footnotes that explained anatomical
and surgical terms in a similar manner.
Bell devotes 191 pages to the muscles, detailing each muscle. He is remembered
in anatomy for his description of the thickenings sometimes found in the sheet of the
muscle of the trigone of the bladder between the internal urethral orifice and the
openings of the ureters, bounding the trigone, and since then given the eponym
The Muscles of Bell.
4 WAR WOUNDS
John learned from those who had fought at the significant Battle of Camperdown in
1797; this battle between the British and the Dutch off Camperduin in Holland
resulted from the overrunning of Holland by the French in 1795. The Dutch Navy
was used to contribute to the French Revolutionary endeavour but was routed by
the British thereby using the North Sea Fleet from Great Yarmouth to prevent invasion of Britain by this new Batavian fleet. John Bell looked after the casualties at
Yarmouth. In 1798 he published Memoir of the Present State of Naval and Military
Surgery (Bell, 1798) and in 1800 Memorial Concerning the Present State of Military
and Naval Surgery (Bell, 1800a).
5 THE ROYAL INFIRMARY OF EDINBURGH

The Infirmary was established in 1729. James Gregory (17531821) held the Chair in
the Practice of Physic in the University of Edinburgh and was a Manager at the
Infirmary. Gregory felt strongly that equal opportunity should be given to younger
surgeons at the Royal Infirmary at Edinburgh rather than that the work should be
shared by rotation among the Fellows of the Royal College of Surgeons of Edinburgh
and who should not, therefore, keep all the work among themselves. In response to
these pamphlets, in his defence in 1800, Bell addressed his Letters on Professional
Character and Manners (Bell, 1800b) to James Gregory with a later publication on
6 John Bell the anatomist concentrates on clinical surgery
the same topic, Letters on Professional Character and Manners: on the Education of
a Surgeon, and the Duties and Qualification of a Physician (Bell, 1810).
6 FROM 1800 JOHN BELL THE ANATOMIST NOW

CONCENTRATES ON CLINICAL SURGERY AND ON HIS
WRITING
Bell therefore no longer worked at the Infirmary and ceased lecturing and instead
devoted himself almost exclusively to the practice of surgery and writing. In
1799 Bell discontinued the regular teaching of anatomy and concentrated on surgery,
becoming regarded as the leading surgeon in Edinburgh.
6.1 The Principles of Surgery in 1801

John Bell was now doing well and the portrait we have of him dates from around
1801, at the age of 38 (Fig. 5).
FIGURE 5
John Bell by an unknown artist but probably dated around 1801 when Bell would have been
aged about 38, held at the National Portrait Gallery, London, and published with permission in
Kaufman (2005).
171
172
In this same year, 1801, Bell published his work on surgery, The Principles of
Surgery, in two volumes (Bell, 1801) with a further edition in 1806 (Bell, 1806a,b).
A further, third volume appeared in 1808 (Bell, 1808). The first volume covered
some areas we would designate as plastic surgery and he knew of the work of the
surgeon Gasparo Tagliocozzi (15451599), born, trained and teacher in Bologna,
Italy, who pioneered The Italian Method using autologous flap grafts. The second
volume covered (in part 1) urethral diseases and bladder stones and (in part 2) the brain
and the skull.
6.2 Engravings of the Bones, Muscles and Joints in 1804

In 1804 John published his anatomy illustrations in Engravings of the Bones,
Muscles, and Joints, Illustrating the First Volume of the Anatomy of the Human Body
(Bell, 1804). In the same year his brother, the surgeon Charles Bell, left Edinburgh for
London. There, in 1812 he became proprietor of the Great Windmill School of anatomy and, from 1814 to 1836, he also held the appointment of Surgeon to the Middlesex Hospital. Charles was to paint and draw from his experiences in looking after
those injured at the Battle of Corunna in 1809 and the Battle of Waterloo in 1815.
6.3 The Principles of Surgery in 1815

In 1815 John Bell published The Principles of Surgery, as they relate to wounds,
ulcers, and fistulas; aneurism and wounded arteries; fractures of the limbs; and
the duties of the military and hospital surgeon. Also, a system of surgical operations
. . . and a series of cases (Bell, 1815) (Fig. 6).
John Bell also published his drawings of the nervous system but unlike those of his
brother Charles, whose work concerned predominantly the normal central and peripheral nervous system, Johns earlier work depicted mainly pathological lesions of the
scalp, skull (which he designated by the old spelling scull) and brain, studies that
we would designate as neurosurgical nowadays. The lesions resulted from trauma
and from infection. In his day, diagnosis was not usually possible at such early stages
of illness since it lacked the neuroradiology which could develop only after the description of X-ray diagnosis by William Conrad Roentgen (18451923) in 1895 and the
subsequent contrast studies by Walter Dandy (18861946) who developed air ventriculography, and intravascular sodium iodide by Egaz Moniz (18751955) in 1927.
Of the cases he illustrated, one of the most remarkable is the head of Thomas
Sharpe (Fig. 7) where he shows the large abscess above the ear which was discharging
pus, the overlying bone and scalp overlying being also infected. Another abscess is
demonstrated (Fig. 8) and the implements used for the postmortem opening of the
skull, a saw and mallet to drive the chisel, are included in the drawing.
The effect of trauma is depicted (Fig. 8) in the case of a young woman upon
whose head a smoothing iron fell. Such irons were heavy, being heated on a stove,
and the more metal in the iron the longer it would hold heat before needing refreshing. The skull was damaged extensively.
7 The final years
FIGURE 6
Pooll, Captain of the Wassenier, from John Bells The Principles of Surgery of 1815.
It may not always be wise to elevate depressions in the skull for fear of damage
(Fig. 9). Illustrations of fractures of the skull and the depression of the fractured segment that may become depressed below the plane of the surrounding bone are depicted
(Figs. 1012) in several drawings. The radiation of the fracture line is shown.
7 THE FINAL YEARS

In 1816 Bell fell from his horse. His final years were devoted to the surgical care of
some of the many expatriate British who spent time on the mainland of Europe.
John Bell died of dropsy, a term used to describe the swelling or oedema of the
dependent parts of the body, particularly the lower limbs and usually attributed to heart
failure (his brother Charles was also to die in due course of coronary artery insufficiency
and heart failure) in Rome on 15 April 1820 at the age of 53. He is buried there in the
Cimitero Acattolico, Il Cimitero Protestante, the Protestant Cemetery or the English
Cemetery, near Porta San Paolo, overshadowed by the Pyramid of Gaius Cestius
Gallus (?-67), dating from 12 BC and described by Thomas Hardy (18401928)
in his 1887 poem At the Pyramid of Cestius near the Graves of Shelley and Keats.
173
174
FIGURE 7
Description of Plate Page 358Vol. II. Head of Thomas Sharpe:
Fig. 1. Sketch of the scalp partially reunited.
A large abscess above the ear discharging a profusion of matter.
bb Extent of carious bone and dead scalp.
The probe passing from the opening c and d out by the opening e, and all round from the
vertex to the temple and ear, between the scalp and the bone.
Fig. 2. The integuments laid back, and the extent of carious bone exposed.
ff marking the extent of the caries.
Fig. 3. Drawing of the scull-cap sawed off and preserved.
g marking the centre of the caries.
bb the deep ulcerated furrow in the bone by which the carious part was circumscribed,
and which might have been mistaken for a deep fracture.
FIGURE 8
Drawing of the livid and gangrenous abscess of the brain; drawing of the scull of the young
woman hurt by the fall of a smoothing ironuniversally carious and unsuccessfully trepaned.
Page 447.
FIGURE 9
Elevation of depressions in the skull and the need to hold back from operating on occasions.
Page 749.
FIGURE 10
Plans and drawings of fractures and depressions of the skull. Sheet 1. Page 786.
176
FIGURE 11
The inscription on Bells original flat gravestone (Fig. 13) reads

MS
JOANNIS BELL CHIRURGI
EDINBURGENSIS
HAUD MELIUS SCRIPTII
QUAM EXIMIA ARTIS SUAE PERITIA
INSIGNIS
VIXIT ANNOS LIII
OB; ROMAE DIE XV APRILIS
MDCCCXX
John Bell Surgeon of Edinburgh
on all accounts best described
as excellent at his craft and skill
aged 53 years
died in Rome 15 April 1820
7 The final years
FIGURE 12
The marble cross (Fig. 14) erected at the head of the stone by The Royal College of
Surgeons of Edinburgh in 1891 bears this inscription (Fig. 15):
JOHANNI BELL
CHIRURGO EDINENSI CELEBERRIMO OPTIME DE ARTE
SUA MERITO HOC MONUMENTUM POSIUT COLLEGIUM
REGIUM CHIRURGORUM EDINENSE. A.D. 1891
NATUS, 1762. OBIT, 1820.
[John Bell
Surgeon of Edinburgh, most distinguished in his art,
to celebrate his achievements the Royal College of Surgeons of Edinburgh
erected this monument AD 1891
Born 1762, died 1820]
177
178
FIGURE 13
Original gravestone of John Bell in the Protestant Cemetery in Rome (authors photograph).
FIGURE 14
Memorial to John Bell in the Protestant Cemetery in Rome, behind that of John Keats and
close to the memorials to the family of Axel Munthe (authors photograph).
8 Charles Bell remembers his brother John
FIGURE 15
Inscription on the base of the memorial to John Bell in the Protestant Cemetery in Rome
(authors photograph).
The original memorial notes he died aged 53, on 25 April 1820 . However, his birthday has been accepted as on 12 May 1763 and so he would actually have been aged
56 years not 53 years; hence, the LIII should have read LVI, an error perhaps due to a
stonemasons misreading of a text provided to him.
The portrait commonly published is of unknown date but probably from around
1801 and by an artist unknown (Fig. 15). John Bells letter to James Law, dated
around 18121814, is held at the Royal College of Surgeons of Edinburgh and this
seems to be the only correspondence so held. It demonstrates Bells flowery
signature.
Johns widow was to publish posthumously his work in Italy (Bell, 1825, 1834).
8 CHARLES BELL REMEMBERS HIS BROTHER JOHN

Charles continued to publish and in 1829 he published in three volumes the seventh
edition of their combined work entitled The Anatomy and Physiology of the Human
Body by John and Charles Bell (Bell and Bell, 1829) (Fig. 16).
In 1840, during his month in Rome, Charles Bell visited the grave of his brother
John, situated close to the graves of two English poets, John Keats (17951821) who
had qualified in 1816 by Licence of the Society of Apothecaries but not practised
and soon died of tuberculosis and, a little further from it, the grave of Percy Bysshe
Shelley (17921822) whose heart alone lies there, and of the family of the writer
Axel Munthe (18571949).
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180
FIGURE 16
Title page of Volume 1 of John and Charles Bells 1829 book The Anatomy and Physiology of
the Human Body (authors image).
John Bell, the older of the two brother-surgeons, though less well known nowadays, was the teacher of his younger brother Charles and no doubt enthused Charles
and set him on the road for greater stardom. Charles was able to build upon the firm
foundation in anatomy and surgery that John developed and was able to remain a
good friend and pupil and eventually to outlive John and to advance even further
his, and therefore our, understanding of so many areas of anatomy and of clinical
medicine and surgery.
References
Acknowledgments
I am deeply indebted to Nigel Phillips, Antiquarian Bookseller in London (www.nig
elphillips.com) who has been so helpful with advice and in the provision of images
(Figs. 111) and whose catalogues are both a mine of information and an artwork in
themselves and should all be viewed by those interested in medical history.
References
Anon, 1870. Letters of Sir Charles Bell, KH, FRSL & E, Selected from His Correspondence
with His Brother George Joseph Bell. John Murray, London.
Bell, J., 1793. The Anatomy of the Bones, Muscles, & Joints. Edinburgh, Printed for G. Mudie,
Bridge Street.
Bell, J., 1794. Engravings, Explaining the Anatomy of the Bones, Muscles and Joints. Bell &
Bradfute & T. Duncan/J. Johnson & G.G.G. & J. Robinsons, Edinburgh/London.
Bell, J., 1795a. Discourses on the Nature and Cure of Wounds. Edinburgh, Bell & Bradfute;
London, T. Cadell Jun. & W. Davies. The second edition was published in 1800 and the
third edition in 1812.
Bell, J., 1795b. Discourses on the Nature and Cure of Wounds. Edinburgh, Bell & Bradfute;
third edition in 1812. Footnote page 387.
Bell, J., 1795c. Discourses on the Nature and Cure of Wounds. Edinburgh, Bell & Bradfute;
London, T. Cadell Jun. & W. Davies. The second edition was published in 1800 and
the third edition in 1812. Footnote pages 390 and 391.
Bell, J., 1795d. Discourses on the Nature and Cure of Wounds. Edinburgh, Bell & Bradfute;
third edition in 1812. Pages 391392.
Bell, J., 1795e. Discourses on the Nature and Cure of Wounds. Edinburgh, Bell & Bradfute;
third edition in 1812. Page 412.
Bell, J., 1797a. The Anatomy and Physiology of the Human Body and The Anatomy of
the Human Body. Cadell & Davies, Edinburgh In four volumes.
Bell, J., 1797b. The Anatomy of the Human Body. Volume 1. Containing the Anatomy of the
Bones, Muscles, and Joints. Printed for Cadell & Davies, Edinburgh.
Bell, J., 1797c. The Anatomy of the Human Body. Volume 2. Containing the Anatomy of the
Heart and Arteries. Printed for Cadell & Davies, Edinburgh.
Bell, J., 1798. Memoir of the Present State of Naval and Military Surgery. Addressed to the
Right Honourable Earl Spenser, First Lord of the Admiralty. Yarmouth, 20 January 1798.
Bell, J., 1800a. Memorial Concerning the Present State of Military and Naval Surgery.
Addressed Several Years Ago to the Right Honourable Earl Spencer, First Lord of the
Admiralty; and Now Submitted to the Public. Longman & Rees/Cadell & Davies,
Edinburgh/London.
Bell, J., 1800b. Answer for the Junior Members of the Royal College of Surgeons, of
Edinburgh, to the Memorial of Dr. J. Gregory, Professor of the Practice of Physic in
the University of EdinburghPhysician to the King for Scotlandand One of the
Managers of the Royal Infirmary of This City.
181
182
Bell, J., 1801. The Principles of Surgery, in Two Volumes: Volume First; of the Ordinary
Duties of the Surgeon,. . .: Volume Second; a System of Surgical Operations. . . Edinburgh,
T. Cadell Jun. & W. Davies; London, T.N. Longman, O. Rees & W. Creech, P. Hill &
Manners & Miller.
Bell, C., 1802. The Anatomy of the Brain, Explained in a Series of Engravings. C Whittingham, London.
Bell, J., 1804. Engravings of the Bones, Muscles, and Joints, Illustrating the First Volume of
the Anatomy of the Human Body, second ed. T.N. Longman & O. Rees, & T. Cadell & W.
Davies, London.
Bell, J., 1806a. The Principles of Surgery, Volume Second. Containing the Operations of Surgery. Part First, The Operation of Lithotomy and the Diseases of the Urethra. In Four Sections. T. Cadell, jun. & W. Davies; T.N. Longman, & O. Rees, & W. Creech, P. Hill, &
Manners & Miller, London.
Bell, J., 1806b. The Principles of Surgery Volume II, Part II, Containing the Anatomy, and
Pathology, of the Skull, & Brain, in the Form of Discourses. Longman, Hurst, Rees &
Orme, & Cadell & Davies, London.
Bell, J., 1808. The Principles of Surgery, Volume Third, Containing a Series of Cases, Calculated to Illustrate Chiefly the Doctrine of Tumors and Other Irregular Parts of Surgery,
and to Instruct the Young Surgeon How to Form His Prognostics and to Plan His Operations. Longman, Hurst, Rees & Orme, & T. Cadell & W. Davies, London.
Bell, J., 1810. Letters on Professional Character and Manners; on the Education of a Surgeon,
and the Duties and Qualification of a Physician. Addressed to James Gregory, M.D. John
Moir, Edinburgh.
Bell, J., 1815. The Principles of Surgery, As They Relate to Wounds, Ulcers, and Fistulas;
Aneurism and Wounded Arteries; Fractures of the Limbs; and the Duties of the Military
and Hospital Surgeon. Also, a System of Surgical Operations . . . and a Series of Cases.
Printed for Longman, London.
Bell, J., 1825. Observations on Italy by the Late John Bell. W. Blackwood/T. Cadell [dedicated to the
King . . . Rosine A. Bell]; Anon, Bell, John, Edinburgh/London, 168. Published by his widow.
Bell, J., 1834. Observations on Italy by the Late John Bell, second ed. Fibreno, Naples, In two
volumes.
Bell, C., 1836. The Nervous System of the Human Body: As Explained in a Series of Papers
Read Before the Royal Society of London. With an Appendix of Cases and Consultations
on Nervous Diseases, third ed. Adam and Charles Black, Edinburgh.
Bell, J., Bell, C., 1829. The Anatomy and Physiology of the Human Body by John and Charles
Bell. In three volumes. Printed for Longman, Rees, Orme, Brown, and Green, PaternosterRow; and T. Cadell, Strand, London.
Crumplin, M.K.H., Starling, P., 2005. A Surgical Artist at War. The Paintings and Sketches of
Sir Charles Bell 18091815. Royal College of Surgeons, Edinburgh.
Gardner-Thorpe, C., 2004. The Art of Sir Charles Bell Chapter 6 in Neurology and The Arts:
Painting, Music, Literature. In: Clifford Rose, F. (Ed.), Proceedings of The Mansell Symposium held at The Medical Society of London on 30 April and 1 May 2001. Imperial
College Press, pp. 99128, ISBN: 9 871860 368 3.
Gordon-Taylor, G., Walls, E.W., 1958. Sir Charles Bell; His Life and Times. Livingstone,
Edinburgh.
Kaufman, M., 2005. John Bell (17631820), the father of surgical anatomy. Journal of
Medical Biography 13, 7381.
Monro, W., 1732. The Anatomy of the Human Bones. To Which Are Added, an
Anatomical Treatise of the Nerves; an Account of the Reciprocal Motions of the Heart;
References
and, a Description of the Humane Lacteal Sac and Duct, second ed. Edinburgh for William
Monro.
Monro, A., 1785. The Structure and Physiology of Fishes Explained and Compared with Those
of Man and Other Animals, first ed. Edinburgh, for Charles Elliot and GGJ and J Robinson
(London).
Monro, A., 1797. Three Treatises. On the Brain, the Eye, and the Ear, for Bell & Bradfute,
Edinburgh, 1st and only edition.
Monro, A., 1825. Elements of the Anatomy of the Human Body in Its Sound State; with
Occasional Remarks on Physiology, Pathology, and Surgery. for Maclachlan & Stewart,
Edinburgh.
Monro, A., 1830. The Morbid Anatomy of the Gullet, Stomach, and Intestines, second ed.
1811. Edinburgh (& London), John Carfrae et al.
Walls, E.W., Gardner, D.L., 1996. Charles Bell 17741842, Surgeon, Physiologist, Artist and
Author. Exhibition Booklet, Royal College of Surgeons of Edinburgh.
183
CHAPTER
Jean-Martin Charcot and art:

Relationship of the founder
of neurology with various
aspects of art
Julien Bogousslavsky*,{,1, Francois Boller{

*
Genolier Swiss Medical Network Neurocenter, Clinique Valmont, Montreux, Switzerland

Center for Brain and Nervous Disorders (Neurocentre), Genolier Swiss Medical Network,
Genolier, Switzerland
{
Coordinator of Centres for Acquired Brain Injury Rehabilitation, Bethesda, MD, USA
1
Corresponding author. Tel.:41-21-9623701, e-mail address: jbogousslavsky@cliniquevalmont.ch
{
Abstract
Jean-Martin Charcot (18251893), the father of neurology in France and much beyond, was
also the man who established academic psychiatry in Paris, differentiating it from clinical
alienism. In his teaching, he used artistic representations from previous centuries to illustrate
the historical developments of hysteria, mainly with the help of his pupil Paul Richer. Charcot
liked to draw portraits (in particular, sketches of colleagues during boring faculty meetings and
students examinations), caricatures of himself and others, church sculptures, landscapes,
soldiers, etc. He also used this skill in his clinical and scientific work; he drew histological
or anatomic specimens, as well as patients features and demeanor. His most daring artistic
experiments were drawing under the influence of hashish. Charcots tastes in art were conservative; he displayed no affinity for the avant-gardes of his time, including impressionism,
or for contemporary musicians, such as Cesar Franck or Hector Berlioz. Leon Daudet, son
of Charcots former friend and famous writer Alphonse Daudet, described Charcots
home as a pseudo-gothic kitsch accumulation of heteroclite pieces of furniture and materials.
However, as Henry Meige wrote a few years after his mentors death, Charcot the artist
remains inseparable from Charcot the physician.
Keywords
history of neurology in France, Charcot, hysteria, nineteenth-century society, fine arts,
literature and music
Charcot the artist is inseparable from Charcot the physician. This statement was
written by Henry Meige (18661940), one of the last pupils of Jean-Martin Charcot,
in his monograph Charcot Artiste (Meige, 1925, p. 45). It is well known that Charcot
often skillfully drew sketches of histological slides and anatomical specimen, but it is
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CHAPTER 7 Jean-Martin Charcot and art
less known that during his entire life, he drew various subjects including scenes from
the world around him, caricatures of people he observed, including himself, portraits
of colleagues, and landscapes. Moreover, Charcots often-theatrical presentations of
patients, together with a spectacular way of examining them, have introduced a link
with art under the form of an artistry of neurological practice (Bogousslavsky,
2004). Coupled with his scientific and clinical achievements, Charcots artistic
features were critical in the genesis of the extraordinary fame which surrounded
him. This sort of personality cult reached a peak in his later years and continued
until his death in 1893. However it also led to criticisms and jealousy. That may be
the reason why, despite the large neurological school which he had established and
nurtured for over 30 years at La Salpetrie`re hospital, it turned out to be agonizingly
difficult to appoint a successor to his Chaire de clinique des maladies du syste`me
nerveux (Chair of diseases of nervous system clinics) after his death (Clarac and
Boller, 2010; Tatu and Bogousslavsky, 2011).
1 CHARCOTS NEUROLOGICAL CAREER

Jean-Martin Charcot (Fig. 1) was born on November 19, 1825, in Paris into a relatively modest family (his father was a carriage maker). For a while, before studying
medicine, he seriously contemplated becoming a full-fledged artist (Bonduelle et al.,
1996). In 1848, after a competition which was as difficult then as it is today, he
received the position of interne (roughly corresponding to what would be called
a Senior Resident in the United States) in the Paris hospitals system, along with
colleagues who also became great names of medicine: Alexandre Axenfeld
(18251876), Pierre Carl Potain (18251901), Ulysse Trelat the younger
(18281890), and above all Alfred Edme Felix Vulpian (18261887), who would
become Charcots life-long professional friend and colleague.
Charcot and Vulpian were internes together at La Pitie hospital, located next to
La Salpetrie`re hospital. They presented their doctoral theses (on gout, for Charcot)
just a few months apart in 1853. Charcot was appointed Medecin des hopitaux
(staff physician) in 1857, which allowed him to practice independently. He failed
at his first attempt to obtain the agregation (Professorship) but succeeded at his
second attempt in 1860 with a work on chronic pneumonia.
At the end of 1861, Charcot and Vulpian were both appointed Chefs de service
(Department Heads) at La Salpetrie`re hospital, where they both started work at the
beginning of 1862. For the following 5 years, they worked closely together, reorganizing their services and introducing modern diagnostic methods, including electrophysiology (partly influenced by Guillaume Duchenne de Boulogne), histological
specimens, and microscopic studies. Much of the clinical work was done by Charcot,
while Vulpian, who had received solid scientific training with Pierre Flourens
(17941867) (Bogousslavsky and Moulin, 2011), contributed mainly to the basic aspects of the studies. They were sometimes referred to as the Castor and Pollux of
experimental physiology and pathology (Editorial, 1872). Their main collaborative
1 Charcots neurological career
FIGURE 1
Jean-Martin Charcot (18251893).
works included pioneer papers on locomotor ataxia, a key symptom of tertiary syphilis,
on Parkinson disease, and to a lesser extent on multiple sclerosis (Bogousslavsky and
Moulin, 2011). Later, Vulpian was appointed to other positions and had an
exceptionally brilliant career ending up as Secretaire perpetuel (lifetime SecretaryGeneral) at the Academie des Sciences, the highest scientific academic body in France.
Charcot kept his neurological Service Cazalis department (named after Cazalis,
its first holder) for the next 31 years at La Salpetrie`re hospital, until his death in 1893.
This stable position allowed him to build the most impressive and influential school
of neurology in France. Indeed, this led to the creation of both the chair of Clinique
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des maladies mentales et de lencephale (i.e., psychiatry), first occupied at the

Faculty by his pupil Benjamin Ball (18331893) in 1875. Seven years later, Charcot
was able to obtain the Chaire de clinique des maladies du syste`me nerveux (Chair
of diseases of nervous system clinics). Until then, he had held the chair of pathology.
Nearly all of the most world-renown and respected French neurologists and psychiatrists of the time worked and studied under Charcot, including Pierre Marie
(18531940), Joseph Babinski (18571932), Gilbert Ballet (18531916), Alix
Joffroy (18441908), Georges Gilles de la Tourette (18571904), and from abroad,
Gaetano Rummo (18531917) who later translated his work into Italian, Sigmund
Freud (18561939), and Sergei Korsakov (18541900). Charcots school and prestige were partially built on his studies of hysteria, perhaps even more than on his
main neurological observations. Freud, for example, was greatly influenced by
Charcots demonstrations and teaching of this condition. Even though Charcots
fame among neurologists nowadays rests mainly on his neurological observations,
it was his work on hysteria that, at the time, had a major impact on Parisian society,
going much beyond medical circles (Bogousslavsky, 2011).
This development was also associated with what can be considered to be striking
artistic developments. Collaborators like Paul Richer (18491933) and Albert Londe
(18581917) produced drawings and photographs of the various conditions and
manifestations observed in the hysterical patients in Charcots medical practice.
These visual illustrations of disease reflected not only sophisticated techniques,
but also a form of influential art, which subsequently developed in many other fields
of medicine.
When Charcot died in August 1893, an impossible succession process ensued.
His pupil Edouard Brissaud (18521893) was asked to take the interim position of
Chair for a period of 1 year; subsequently, in a decision that satisfied no one, the
weak Fulgence Raymond (18441910) was appointed to the chair for the next
10 years (Tatu and Bogousslavsky, 2011). Charcots legacy was so immense that
it was still very evident in French neurology and psychiatry through the first quarter
of the twentieth century, when both the chair of neurology and the chair of psychiatry
were still held by his direct students (respectively, Pierre Marie and Gilbert Ballet).
2 CHARCOTS ARTISTIC SKILLS

In his youth, Charcot was already honing his skills in the fine arts. As mentioned
above, he considered becoming an artist, medicine being his second choice
(Meige, 1925). Interestingly, other French neurologists and scientists faced comparable dilemmas when making career choices, particularly Theophile Alajouanine
(18901980) (Boller, 2006). In addition, Claude Bernard (18131878) was a writer
before attending medical school, Charles Lase`gue (18161883) was a philosophy
teacher, and Pierre Marie had studied law. Charcots son Jean-Baptiste (18671936)
also followed a double career (see below).
2 Charcots artistic skills
This sort of artistic interest and real talent had run in his family. Charcots father,
it should be noted, liked to decorate the carriages he built with sophisticated designs.
But Jean-Martin Charcot especially liked to paint landscapes in the style of his contemporaries, at least in the 1840s. He was an autodidact and, without formal training,
studied the styles of several painters of that time.
Charcot also liked to make quick sketches and caricatures of family members and
colleagues and continued this practice throughout his life, especially at boring faculty meetings when he had become a professor. He was even known to have drawn
members of the council of the Faculty of Medicine with monkey faces (Meige, 1925),
and he liked to draw whatever came to his mind while candidates for positions in his
department presented lectures (Daudet, 1931). This did not imply a lack of respect,
but rather some sort of an inner need to produce sketches whenever he was listening
and observing others.
He continued to draw landscapes during his trips away from Paris, as well as
pieces of art and mythological figures that he saw in visits to museums and churches,
sometimes applying fantasy and acute wits, and sketched items of furniture, which he
subsequently tried to purchase in Paris for his own home (Meige, 1925) (Fig. 2).
He also sketched nudes, soldiers, dancers, and later anatomical and clinical figures,
including histological slides without a clear border between private amusement and
professional work. We know of a few self-portraits, often done with a lively sense of
humor, as when he represented himself as a parrot (Fig. 3). This often overlooked
aspect of self-mockery stands in contrast to the Napoleonic image of Charcot
so frequently emphasized by his rivals and detractors (Bonduelle et al., 1996).
FIGURE 2
Examples of drawings and sketches by Charcot.
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FIGURE 3
Self portraits including a self-mocking sketch as a parrot.
An even more poorly known feature of Charcots art is his drawing of devils and
dragons in hellish surroundings. They are said to have been produced under the influence of hashish, probably around 1850 (Meige, 1925) (Fig. 4). Experiments such
as these were common in intellectual circles at that time, including those attended by
physicians, as described in Baudelaires Les Paradis Artificiels, published in 1861.
For instance, Baudelaires philosophy teacher Charles Lase`gue, who, in addition to
his neurological work (he is famous for a sign that bears his name) would become one
of the most famous alienists in Paris, commonly participated in group sessions involving hashish, although apparently primarily as an observer (Dieguez and
Bogousslavsky, 2007). This kind of drawing illustrates Charcots fantasies, apart
from those tied to his scientific activities (Bonduelle et al., 1996).
3 CHARCOTS TASTE IN ART

Charcot was known for his exceptional visual memory (Meige, 1925); he could, in
fact, remember thousands of artistic works and drawings. However, he was also
known for a rather conventional artistic taste, miles away from the avant-garde of
3 Charcots taste in art
FIGURE 4
Drawing by Charcot presumably under the influence of hashish, according to Henry Meige.
his time. For instance, he never manifested interest in Impressionist or nineteenthcentury realist painters, whereas he did refer in some of his published works, but
above all during his lectures, to ancient masters, including Annibale Carracci
(15601609) and Carraccis pupil, Domenico Zampieri known as il Domenichino
(15811641), Breughel the Elder (15251569), Diego Velasquez (15991660),
and Jacob Jordaens (15931678). He even bought a Wedding at Canaa by
seventeenth-century Dutch artist Jan Steen (16261679). Yet only a few of the
painters working after Delacroix (17981863) early in the nineteenth century were
acceptable to him.
For a certain time, Charcot owned a painting by Jean-Baptiste Corot, the leading
painter of the Barbizon school (17961875). The painting Nymph Disarming Love
had been given to him by his godfather Jean-Martin Cathrein. However, Charcot
soon resold the painting to Alfred Chauchard (18211909), a businessman famous
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for the creation of one of Pariss main Department Stores, Les Grands Magasins du
Louvre, now an annex of the French Ministry of Culture. Chauchard was also an avid
art collector. Upon his death, the painting was bequeathed to the Louvre Museum,
and it now hangs at the Orsay Museum in Paris, part of the Chauchard collection.
Charcot tolerated Jean-Auguste Ingres (17801867), Francisco Goya
(17461828), and Jean-Louis Forain (18521931), but without enthusiasm. It
appears that his scientific eye always contributed to his evaluation of an artwork,
since he commonly criticized anatomical impossibilities, which, according to
him, ruined the esthetic value of a painting or a sculpture. A famous example is
the inaccurate representation of muscular tone of a demoniacally possessed boy in
the Transfiguration, a painting finished by Raphael in 1520 (Fig. 5), an error which
had already been pointed out by Charles Bell (17741842) in Edinburgh. This
FIGURE 5
Reproduction of Raphaels Transfiguration in Charcot & Richers book Les demoniaques
dans lart (The Possessed in Art) (1887).
comment appeared in Charcots 1887 book with Paul Richer Les Demoniaques dans
lArt (The Possessed in Art), which remains an excellent tool for understanding Charcots way of evaluating artworks (Charcot and Richer, 1887). Similarly, another of
his authored books Les Difforme et les Malades dans lArt (The Malformed Ones
in Art) (1889) reflects his knowledge of art and museums.
Similarly, Charcots preferences in literature and music were not in keeping with
modern taste. For example, he admired Beethoven but hated most contemporary
composers. Georges Bizet (18381875) was the only exception, although he
learned to like Richard Wagner (18131883) after first having despised him
(Bonduelle et al., 1996). Other famous musicians of his time, including Cesar Franck
(18221890) and Hector Berlioz (18031869), were apparently ignored. As for
political engagement, he is not known for having participated in one way or another
in the dramatic political events of 1870, including war with Prussia, the fall of
Napoleon III and La Commune. However, he was a freethinker and later on he
befriended several important political figures of the Third Republic, including some
controversial ones. For instance Alfred Naquet (18341916), a member of the
Radical-Socialist party who helped reestablish divorce in 1884, was among his
friends and is represented in the Andre Brouillet painting discussed below (Clarac
and Boller, 2010, p. 637).
He knew by heart long quotations by Aeschylus, Dante, and Shakespeare. He
was also familiar with the works of Rabelais, Racine, and Molie`re, but he is not
remembered to have quoted Honore de Balzac (17991850) or Gustave Flaubert
(18211880), who were closer to his time. Charles Baudelaire (18211867), and later
the Parnasse Contemporain poets (Contemporary Parnassum Group), including Paul
Verlaine (18441896) and Theodore de Banville (18231891), seemed to have
remained strangers to him.
Charcots taste, or lack of it, was apparent in his Parisian home at 217, Boulevard
Saint-Germain, in the former Hotel de Varangeville (Private home of the Varangeville noble family) built by the famous architect Gabriel in 1704 and now the cultural
center Maison de lAmerique Latine. However, his preferences were somehow
tempered by his wife, a true artist who seemed to have been more innovative than
her husband, and was most active in the decoration of their hotel particulier (private
mansion). In particular, she produced ceramic paintings, sculptures, and enameling,
and she interested their children in her artwork. Their son, Jean-Baptiste, was also
very gifted artistically and used to draw ships and sea landscapes, predating his future
career (Fig. 6). Actually, Jean-Baptiste, after first having followed his fathers
footsteps as a neurologist, became even more famous than his father, thanks to
his exploits as a navigator and explorer of the Antarctic where an island is named
after him. He died in 1936 when his ship, Pourquoi Pas? (Why Not?), sank in a storm
off the coast of Iceland.
Alphonse Daudet (18401897) had been Charcots friend, and he later became
his patient for progressive tabetic locomotor ataxia and pain, all complications of
a syphilitic infection he had contracted at age 17. However, this friendship later
ceased and Alphonses wife, Louisa, denounced Charcots suspension therapy,
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FIGURE 6
Drawing of ships by Jean-Martin Charcots son Jean-Baptiste.
which had produced severe discomfort with hemoptysis in her husband, calling it
exceedingly cruel (Bonduelle et al., 1996; Dieguez and Bogousslavsky, 2005).
At that time, his son Leon Daudet (18671942) had started his own medical
career, and Charcot was interested in him marrying his daughter, Jeanne. Leon
apparently was not fond of that idea, and it is said that Charcot was so displeased
that he made him fail at the concours dinternat (official contest for residency). Subsequently, Leon Daudet left medicine to embrace a journalism and writing career. He
went on to marry another Jeanne, the granddaughter of the writer Victor Hugo. However, the saga was not over, since the marriage was unhappy, with violent disputes.
His wife Jeanne finally divorced him to marry no other than Jean-Baptiste, Charcots
son! After having befriended the elite of the Third Republic, Leon Daudet veered
progressively toward the ultraright, bitterly attacking the Republic, the Dreyfusard
camp (i.e., the persons who were trying to reestablish the truth following the false
accusations against Alfred Dreyfus) and democracy in general. In later years, he
wrote a book criticizing Charcots despotic reign upon his service, staff, and patients
(Les Morticoles). Nevertheless, Leon Daudet praised Charcots immense erudition, and has given us a lively description of the interior of Charcots home, which
contained
FIGURE 7
Charcots living room in Paris.
By permission from the Charcot Library, Paris, Madame Marie-Veronique Leroux-Hugon, Curator.
furniture from the Middle Ages, colored stained glass windows, worked leathers,
obscure angles, or repaired tapestries, in the Louis XII, Louis XIII, and gothic
style. The ataxic and melancholic patients were restless on the baroque prayer
seats of the 13th century. The patients with muscular atrophy rested their meager
limbs on the griffons and gargouilles. Imagine the hell fires in a bric-a`-brac,
the hall of pathological miracles on a Victor Hugo stage (Daudet, 1931, p. 19).
Rather than art, this description suggests some sort of fantastic kitch, due to the
somewhat anarchic mixing up of ancient furniture and decorative items of different
epochs and styles as shown in Fig. 7.
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As further described by Henri Meige, there were:

Vast rooms, sumptuous, and dark, century-old fabrics of colors attenuated by the
years, furniture of discrete luxury, spent gold with impeccable style, paintings,
sculptures, and bibelots. The dominating style is that of the Renaissance. The
walls are covered with faded-colored tapestries; the wood panels face colonnades
covered with elegantly intertwined leaf-shaped decorations. The chandeliers display their discrete illumination through iron arabesques partly covered by gold.
The stained-glass windows are adorned by archaic characters or ancient coats of
arms and let through a pale light, a church-like lighting, somehow mysterious with
dark areas that encourage silence and meditation (Meige, 1925, p. 20).
FIGURE 8
Part of the same living room before remodeling.
Figure from Dangerous Liaisons: Fashion and Furniture in the Eighteenth Century, Metropolitan Museum of Art,
2006, by permission.
4 Art in charcots medical practice
The above quotations present a very realistic description of Charcots house, particularly its main drawing room. This is striking, especially if one considers what the
room actually looked like before the Charcot took possession of the building (Fig. 8).
This splendid eighteenth-century room was fortunately saved for posterity, and is
now on view at the Metropolitan Museum of Art in New York.
4 ART IN CHARCOTS MEDICAL PRACTICE

Charcots name is often associated with a theatrical approach to the medical conditions of his patients, his multimedia style of teaching during his Tuesday lessons,
and his case presentations of hysterics at La Salpetrie`re hospital. All these aspects of
Charcots demeanor and of the persons present at his lessons are summarized and
immortalized in the 1887 painting by Brouillet, A Lesson at La Salpetrie`re
(Bonduelle et al., 1996). However, Charcots theater was certainly less spectacular
and grandiloquent than the public grand shows of hypnosis put on by his rival on
hysteria, Hippolyte Bernheim (18401919), from Nancy. The same can be said regarding the often grotesque sessions involving mass ecstatic trances in hysterics,
which took place at La Pitie hospital in the service of Jules-Bernard Luys
(18281897), with his chef de Clinique (chief registrar), Gerard Encausse
(18651916), a Spanish-born physician, who transformed himself each evening into
Mage Papus for occult ceremonies in oriental robes, outside the hospital (Parent
and Parent, 2011).
Even though, as we have seen, he was not particularly interested in the avantgarde, Charcot personally knew and spent time with several writers and other artists.
In addition to Alphonse and Leon Daudet, he knew Edmond de Goncourt
(18221896), the Swedish writer Axel Munthe (18571949), who wrote about Charcot in his famous book The Story of San Michele, and Jules Claretie (18401913),
also represented in the Brouillet painting and who included Charcot as a character in
his novel Les Amours dun Interne (The Loves of an Intern) (Claretie, 1881). They
met both at the hospital and at Charcots home, where sculptors, architects, and painters of the time were often invited. These included Charles Garnier, the architect
of the Paris and Monte Carlo opera house (18251898), the sculptor Alexandre
Falguie`re (18311900), and others who all represented the official art establishment.
As mentioned, Charcots artistic approach to his medical practice inspired his
young assistants, Albert Londe to use photography and Paul Richer to use drawings
and sculptures to depict disorders, such as Parkinson disease, hysteria, and pesudobulbar palsy. Charcot himself often made drawings on a blackboard during his medical school lectures. Henry Meige remembered Charcots ability to perceive the
ensemble and to synthesize details into a global perspective (Meige, 1925). Artistic
quotations were permanent features of Charcots consultations. Leon Daudet emphasized his artistic and medical concordance, and remembered not only that he commonly quoted verses of Racine, Molie`re, Shakespeare, and Dante, but also reminded
his audience of paintings by Frans Hals (15821666) or Velasquez (Daudet, 1931).
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However, as pointed out by Goetz (1991), art also misguided Charcots career when
he relied heavily on artwork in his attempt to convince critics that disorders seen at
the Salpetrie`re Hospital were independent of his suggestive influence.
One of Charcots best applications of art to medical practice concerned hysteria.
Along with his pupil Paul Richer, he emphasized artistic representations of demoniac possessions in the previous centuries to illustrate what he called the external
manifestations of hysteria, underscoring that the main difference rested on the new
identification of these ecstatic or perverted states as medical conditions (Charcot
and Richer, 1887, 1889). In doing so, Charcot wanted to erase the close historical
association between hysteria and demonization with satanic trances. He used specific
pictorial examples of the Saint-Guy dance or the procession of Saint-Willibrod, including art by Breughel the Elder, pieces showing Saint-Medard fits, and works by
Rubens, Raphael, and others. Spectacular examples of the great demoniac variety
of hysterical attacks, with frightening contractures, contortions, and shouts, were
extracted by Charcot from ancient artistic representation. Moreover, he used these
representations in paintings and sculptures to point out that hysteria was a very ancient disease, and one not limited to women. Charcots goal was to improve the miserable fate of patients diagnosed with possession, which he now diagnosed as
hysteria. A noticeable contribution of Charcot in that domain is that he showed
the fallacy of the ancient remedy called grand secours (great help), where the possessed were hit by sticks until they did not show further signs of possession, that is,
they did not move anymore.
As concluded a few years ago by one of us (Julien Bogousslavsky), the artist and
the scientist are two unique facets of Charcot (Bogousslavsky, 2004), even though
his taste does not always correspond to what we might have expected. Charcot considered art as a pure representation of nature; he maintained that the repetition of
specific themes over the centuries reflected a proof of the constancy and inflexibility of a scientific law behind art production (Charcot and Richer, 1887), thereby
demonstrating an interesting mix of a conservative, old-fashioned opinion with
well-advanced views for his time. In addition, he considered and taught medicine
not only as a science but also as an art, a style that has unfortunately been almost
universally forgotten in our times.
References
Bogousslavsky, J., 2004. Charcot and art: from a hobby to science. Eur. Neurol. 51, 7883.
Bogousslavsky, J., 2011. Hysteria after Charcot: back to the future. In: Bogousslavsky, J.
(Ed.), Following Charcot: A Forgotten History of Neurology and Psychiatry. In: Bogousslavsky, J. (Ed.), Frontiers in Neurology and Neuroscience, vol. 29. Karger, Basel,
pp. 137161.
Bogousslavsky, J., Moulin, T., 2011. Alfred Vulpian and Jean-Martin Charcot in each others
shadow? From Castor and Pollux at La Salpetrie`re to neurology forever. Eur. Neurol. 65,
215222.
References
Boller, F., 2006. Modern neuropsychology in France: Theophile Alajouanine. Cortex 42, 34.
Bonduelle, M., Gelfand, T., Goetz, C.G., 1996. Charcot, un grand medecin dans son sie`cle.
Michalon, Paris.
Charcot, J.-M., Richer, P., 1887. Les demoniaques dans lart. Delahaye & Lecrosnier, Paris.
Charcot, J.-M., Richer, P., 1889. Les difformes et les malades dans lart. Babe & Lecrosnier,
Paris.
Clarac, F., Boller, F., 2010. History of neurology in France. In: Finger, S., Boller, F., Tyler, K.L.
(Eds.), History of Neurology (Chapter 40). In: Aminoff, M.J., Boller, F., Swaab, D.F. (Eds.),
Handbook of Clinical Neurology, 3rd series, vol. 95, Elsevier, Edinburgh, pp. 629656.
Claretie, J., 1881. Les amours dun interne. Dentu, Paris.
Daudet, L., 1931. Devant la douleur. Bernard Grasset, Paris.
Dieguez, S., Bogousslavsky, J., 2005: The one-man band of pain: Alphonse Daudet and his
painful experience of tabes dorsalis. In: Bogousslavsky, J., Boller, F. (Eds.), Neurological
Disorders in Famous Artists. In: Bogousslavsky, J. (Eds.), Frontiers in Neurology and Neuroscience, vol. 19. Karger, Basel, pp. 1745.
Dieguez, S., Bogousslavsky, J., 2007. Baudelaires aphasia: from poetry to cursing. In:
Bogousslavsky, J., Hennerici, M.G., Bogousslavsky, J. (Eds.), Frontiers in Neurology
and Neuroscience, vol. 22. Karger, Basel, pp. 121149.
Editorial, 1872. The Salpetrie`re. Br. Med. J. 567.
Goetz, C.G., 1991. Visual art in the neurological career of Jean-Martin Charcot. Arch. Neurol.
48, 421425.
Meige, H., 1925. Charcot artiste, second ed. Masson et Cie, Paris.
Parent, M., Parent, P., 2011. Jules Bernard Luys in Charcots penumbra. In: Bogousslavsky, J.
(Ed.), Following Charcot: A Forgotten History of Neurology and Psychiatry. In: Bogousslavsky, J. (Ed.), Frontiers in Neurology and Neuroscience, vol. 29. Karger, Basel,
pp. 1125136.
Tatu, L., Bogousslavsky, J., 2011. The impossible succession of Charcotthe quest for a suitable heir. Eur. Neurol. 65, 193197.
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CHAPTER
Cajal and the discovery of a

new artistic world: The
neuronal forest
Javier DeFelipe*,{,1
*
Laboratorio Cajal de Circuitos Corticales, Centro de Tecnologa Biomedica, Universidad

Politecnica de Madrid, Madrid, Spain
{
Instituto Cajal, Consejo Superior de Investigaciones Cientficas, Madrid, Spain
1
Corresponding author. Tel.: 34-91-336-4639; Fax: 34-91-585-4754,
e-mail address: defelipe@cajal.csic.es
Abstract
The introduction of the staining method of Camillo Golgi in 1873 represented a giant step
for neuroscience. Prior to this development, the visualization of neurons with the available
histological techniques had been incomplete; it was only feasible to observe the cell body
and the proximal portions of the dendrites and axon. However, with the Golgi method it
was possible to observe neurons and glia with all their parts (cell body, dendrites, and axon
in the case of neurons; cell body and processes in the case of glia). Due to the advantages
of this method, all of a sudden it was possible to begin studying one of the great mysteries
and critical issues of the organization of the nervous systemthe tracing of the connections
between neurons. Nevertheless, this method was not fully exploited until Santiago Ramon y
Cajal arrived on the scene in 1888. It should be noted that, in Cajals day, drawing was the most
common method of describing microscopic images in the absence of the highly developed
microphotography and other imaging techniques commonly available in todays laboratories.
As a consequence, most scientific figures presented by the early neuroanatomists were their
own drawings, providing an outlet for these scientists to express and develop their artistic
talent. In the hands of Cajal, the Golgi method represented not only the principal tool that
was to change the course of the history of neuroscience but also the discovery of a new artistic
world, the neuronal forest.
Keywords
cerebral cortex, Golgi technique, drawing of neural elements, connections of neurons, history
of neuroscience

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CHAPTER 8 The neuronal forest
1 INTRODUCTION
Throughout the nineteenth century and at the beginning of the twentieth century, the
study of the structure of the nervous system was marked by two milestones: the development of light microscopy and the discovery and improvement of anatomical
methods. During this period, scientists sought to develop appropriate methods to analyze different aspects of the structure and function of the nervous system. Some of
these methods were discovered by chance, whereas others were designed to resolve a
given problem. Nevertheless, a good lesson from these early days is that the development of science depends not only on the methods available but also on the way that
they are exploited. Often, methods were available to scientists but were not
always used to their full potential until a researcher made an important discovery
or an astute interpretation that generated new concepts. This was the case of the
method discovered by Camillo Golgi (18431926), the reazione nera (Golgi
method), which remained unexploited for many years until Santiago Ramon y Cajal
(18521934) appeared, changing the course of the history of neuroscience. This
period was important not only scientifically but also from an artistic point of view,
since the brain was revealed to be a truly neuronal forest, where the beauty of the
forms and groups of cells captivated both the scientific community and the general
public alike.
This chapter first addresses the discovery of the Golgi method, thereafter the
appearance of Cajal, and finally the artistic skills of the early neuroanatomists are
emphasized, using their own words to describe the artistic emotions that they experienced when visualizing the neural elements. In particular, it focuses on the intriguing story and discoveries of Cajal himself, who, as a boy, wanted to become an artist
through painting, but was prevented from doing so by his father until years later when
he discovered a new artistic world, the neuronal forest.
2 THE GOLGI METHOD

On February 16, 1873, a revolution began in the world of neuroscience with the discovery of a new method of staining of the nervous system, the reazione nera, by
the renowned Italian scientist Camillo Golgi (18431926). On this date, Golgi wrote
the following letter to his friend Niccolo` Manfredi (Mazzarello, 1999, p. 63):
I spend long hours at the microscope. I am delighted that I have found a new
reaction to demonstrate even to the blind the structure of the interstitial stroma
of the cerebral cortex. I let the silver nitrate react on pieces of brain hardened
in potassium dichromate. I have obtained magnificent results and hope to do even
better in the future.
This technique allowed neurons and glia to be visualized, labeling them black (hence
reazione nera) simply after prolonged immersion of the tissue, previously hardened
with potassium or ammonium dichromate, in a 0.50 or 1.0% solution of silver
2 The Golgi method
nitrate. The method was published in the Gazzetta Medica Italiana on August 2,
1873 (Golgi, 1873: Sulla struttura della sostanza grigia del cervello (On the structure of the gray substance of the cerebrum)) and later this method was named the
Golgi method in honor of its discoverer. For the first time, it was possible to observe
neurons and glia in a histological preparation with all their parts (cell body, dendrites,
and axon in the case of neurons; cell body and processes in the case of glia).
Although it was possible to completely visualize the morphology of a neuron before 1873 using the Deiters method of mechanical dissociation (1865), this technique
was very difficult to perform (Fig. 1). In the words of Cajal (1917, p. 71)1:
The procedure of mechanical dissociation . . ., applied to the analysis of the ganglia, of the retina, of the spinal cord or of the brain, the delicate operation of
detaching the cells from their matrix of cement and of unravelling and extending
their branched processes with needles, constituted a task for a Benedictine. What
a delight it was when, by dint of much patience, we could completely isolate a
neuroglial element, with its typical spider-like form, or a colossal motor neuron
from the spinal cord, free and well separated with its robust axis cylinder and dendrites! What a triumph to capture the bifurcation of the single process [axon] from
a dissociated spinal ganglia, or to clear a pyramidal cell from its neuroglial bramble thicket, that is, the noble and enigmatic cell of thought!
FIGURE 1
Drawings made by Otto Friedrich Karl Deiters (18341863) to illustrate nerve cells (spinal
cord of the ox). Method of mechanical dissociation. He distinguished a principal axon (a)
originated from the soma and several thin axons that arise from the dendrites (b, second
axonic system). According to Cajal, the erroneous interpretation of this second axonic plexus
was the germ of the reticular theory (see DeFelipe, 2010a). Taken from Deiters (1865).
The author of the present chapter has translated any passages that were originally only available in
Spanish.
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FIGURE 2
The first illustration by Golgi of a Golgi-impregnated preparation of the nervous system.
Semi-schematic drawing of a fragment of a vertical section of the olfactory bulb of a dog.
Taken from Golgi (1875).
3 Cajal arrives on the scene
Moreover, the advantage of the Golgi method was that it allowed the observation of
many cells at once in a given section and in situ, without any possible artifacts that
might be introduced by dissociation. Another important advantage of the Golgi
method was that only a small portion of the neurons in a given preparation were
stained, permitting individual neurons to be examined with the greatest morphological detail, allowing dendritic spines to be discovered. Thus, it was at last possible to
characterize and classify neurons, and to potentially study their connections (Fig. 2).
These characteristics of the Golgi method gave rise to another great advance,
namely that of tracing the first accurate circuit diagrams of the nervous system
(e.g., DeFelipe, 2002a,b).
An interesting aspect of these early days of the history of neuroscience is that for
a long time after the discovery of the Golgi method, the vast majority of the
scientific community failed to make the most of the opportunities it presented.
Indeed, this method was not commonly referred to in most of the contemporary texts
available at that time. Therefore, the slow progress in microanatomy was due not
only to the lack of appropriate methods but also to the inability to exploit the methods
available.
3 CAJAL ARRIVES ON THE SCENE

The Golgi method was not fully exploited until Santiago Ramon y Cajal (Fig. 3) arrived on the scene. He was born on May 1, 1852 in Petilla de Aragon, a small village
located in Navarre (North of Spain) and died in Madrid on October 17, 1934. He
studied medicine at the University of Zaragoza and was Professor of Anatomy
and Histology at the Universities of Valencia, Barcelona, and Madrid. In addition
to the many scientific articles and books he published, he also played a significant
role in the development of science and culture in Spain, as shown by the publication
of several nonscientific books (e.g., Cuentos de vacaciones [Vacation stories],
Fortanet, Madrid, 1905) and two scientific magazines: Revista trimestral de histologa normal y patologica, in 1888, and Revista trimestral micrografica, in 1896 (later
named Trabajos del laboratorio de investigaciones biologicas de la Universidad de
Madrid). He was also a pioneer in the development of color photography and his
book, La fotografa de los colores (The photography of colors) (Moya, Madrid,
1912), is a masterpiece on the subject.
Cajal became involved in the study of the nervous system using the Golgi
method after a meeting with Luis Simarro (18511921), a psychiatrist and neurologist who was also an enthusiast of histology. In 1887, Cajal visited the private
laboratory of Simarro, who showed him a Golgi-impregnated preparation. Cajal
was fascinated by this marvelous staining method and he immediately started using
it to analyze practically the entire nervous system of several species. In his autobiography Recuerdos de mi vida-Historia de mi labor cientfica (Recollections of
my lifeThe story of my scientific work) (1917, p. 76), Cajal wondered why the
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FIGURE 3
Cajal in his laboratory in Valencia (1885).
method of Golgi had not led to an explosion of excitement in the scientific

community:
I expressed in former paragraphs the surprise which I experienced upon seeing
with my own eyes the wonderful revelatory powers of the chrome-silver reaction
and the absence of any excitement aroused in the scientific world by its discovery.
How can one explain such strange indifference? Today, when I am better
acquainted with the psychology of scientific men, I find it very natural. . .. Out
of respect for the master, no pupil is wont to use methods of investigation which
he has not learned from him. As for the great investigators, they would consider
themselves dishonoured if they worked with the methods of others.
The historical moment when Cajal discovered the properties of the Golgi method
is beautifully described in several of his writings, especially in his classic book
Textura del sistema nervioso del hombre y de los vertebrados (Texture of the nervous system of man and the vertebrates) (Cajal 18991904) and in particular in
the French version Histologie du syste`me nerveux de lhomme et des vertebres
(Histology of the nervous system of man and vertebrates) (Cajal 19091911), which
represents an excellent example of his typical vivid writing style and enthusiasm
(DeFelipe, 2010a):
In summary, a method was necessary to selectively stain an element, or at most a
small number of elements, that would appear to be isolated among the remaining
invisible elements. Could the dream of such a technique truly become reality, in
which the microscope becomes a scalpel and histology a fine [tool for] anatomical
3 Cajal arrives on the scene
dissection? A piece of nervous tissue was left hardening for several days in
Mullers pure liquid [potassium dichromate] or in a mixture of this [fixative] with
osmic acid. Whether it was the distraction of the histologist or the curiosity of the
scientist, the tissue was then immersed in a bath of silver nitrate. The appearance
of gleaming needles with shimmering gold reflections soon attracted the attention.
The tissue was cut, and the sections were dehydrated, cleared, and then examined
[with the microscope]. What an unexpected spectacle! On the perfectly translucent yellow background sparse black filaments appeared that were smooth and
thin or thorny and thick, as well as black triangular, stellate or fusiform bodies!
One would have thought that they were designs in Chinese ink on transparent
Japanese paper. The eye was disconcerted, accustomed as it was to the inextricable network [observed] in the sections stained with carmine and hematoxylin
where the indecision of the mind has to be reinforced by its capacity to criticize
and interpret. Here everything was simple, clear and unconfused. It was no longer
necessary to interpret [microscopically] the findings to verify that the cell has
multiple branches covered with frost, embracing an amazingly large space with
their undulations. A slender fibre that originated from the cell elongated over
enormous distances and suddenly opened out in a spray of innumerable sprouting
fibres. A corpuscle confined to the surface of a ventricle where it sends out a shaft,
which is branched at the surface of the [brain], and other cells [appeared] like
comatulids or phalangidas.2 The amazed eye could not be torn away from this
contemplation. The technique that had been dreamed of is a reality! The metallic
impregnation has unexpectedly achieved this fine dissection. This is the Golgi
method! . . . whose clear and decisive images enable us to cast off the famous
net of Gerlach, the [dendritic] arms of Valentin and Wagner, as well as many another fanciful hypothesis.
During this period, Cajal brilliantly described the microorganization of almost every
region of the central nervous system, and the results were summarized in the Textura.
Furthermore, from the very onset of his studies with the Golgi method (Cajal, 1888;
Fig. 4), Cajal made important discoveries and formulated fundamental theories regarding the development of the nervous system. For example, he discovered and
named the axonal growth cone (cono de crecimiento) (Cajal, 1890) and also devised
the hypothesis of chemotaxis or chemotactism (Cajal, 1893), later to be called neurotropism. At present, these early contributions represent two of the most exciting
fields of research in neuronal development. Nevertheless, Cajal is better known
for his vivid discussions in support of the Neuron Doctrine, which represented a radical change in the understanding of how the nervous system is organized, a subject
that is discussed in Section 4.
Comatulids are marine crinoid invertebrates like sea lilies and feather stars. Phalangidas (or opiliones), also known as water harvestmen, are arachnids that superficially resemble true spiders, but
they have small, oval-shaped bodies and long legs. Cajal is probably referring to some neuroglial cells
that, when stained with the Golgi method, have a morphology which resembles these invertebrates.
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FIGURE 4
First illustration by Cajal of a Golgi-impregnated preparation of the nervous system
(Cajal, 1888), whose legend states: Vertical section of a cerebellar convolution of a hen.
Impregnation by the Golgi method. A, represents the molecular zone, B, designates the
granular layer, and C the white matter. In the text, Cajal said: . . .the surface of [the dendrites
of Purkinje cells] appears to be covered with thorns or short spines. . . (At the beginning,
we thought that these eminences were the result of a tumultuous precipitation of the silver
but the constancy of its existence and its presence, even in preparations in which the reaction
appears to be very delicate in the remaining elements, incline us to believe this to be a
normal condition).
4 DRAWING OF NEURAL ELEMENTS: WHEN SCIENCE WAS ART

A remarkable aspect of the history of neuroscience is that, in Cajals day, drawing
was the most common method of describing microscopic images in the absence of
the highly developed microphotography and other imaging techniques commonly
available in todays laboratories. In general, the scientists used freehand drawings
with various types of pencils, pens, watercolor dyes, Indian ink, and other common
media, used separately or in a variety of combinations. These were drawn on different kinds of paper or cardboard, either directly or with the aid of a camera lucida. The
type of camera is a plotting device attached to the microscope that allows the observer to outline the optical microscope image that is projected upon a drawing table.
Thus, with this instrument the observer can visualize the paper, the pencil, and the
histological preparation at the same time, allowing an accurate drawing of the objects
to be produced. Readers interested in the various methods for reproducing microscopy images and the material used to generate these drawings can consult the work of
4 Drawing of neural elements: When science was art
Cajal itself, in particular, his Manual de histologa normal y de tecnica micrografica

(Handbook of Normal Histology and Micrographic Technique), first published in
1889 (Cajal, 1889) and reedited over the years with additional and corrected content.
An English version of this work was published with the help of his disciple, Jorge
Francisco Tello (18801958) (Cajal and Tello, 1933).
Nevertheless, there was no section in most of Cajals scientific articles describing
the methods used in detail, and he reported the use of the camera lucida only occasionally. For example, in the paper of 1891 Sur la structure de lecorce cerebrale de
quelques mammife`res (On the structure of the cerebral cortex of certain mammals) (Cajal, 1891, p. 173), in the Explanation of the plates, he wrote:
The majority of our figures have been made using the Zeiss camera lucida, with
the objective C of that manufacturer, and employing sometimes the ocular 4,
sometimes the ocular 2. Figs. 4 and 5 have been made with the very powerful
E and Zeiss 1.30 apochromatic objectives.
However, according to several testimonies of people who knew Cajal, it seems that
he preferred direct drawing and only used the camera lucida as a last resort. Julian de
la Villa, one of his former students, wrote the following paragraph on the occasion of
the first centenary of the birth of Cajal (De La Villa, 1952, p. 24):
. . .the drawing was generated directly from the preparation; with the microscope
on his left and the paper on his right, exact reproductions of [the preparations]
began to appear. Although the camera lucida was known to him, because it was
cumbersome to use, he preferred to avoid it.
Also, it is important to point out that many of Cajals illustrations were composite drawings, in particular the figures showing several cells. This is not only obvious by looking at the histological preparations that Cajal made himself and are
now housed at the Cajal Institute (http://www.cajal.csic.es/ingles/legado.html)
but also because Cajal himself stated this to be the case in some publications,
such as La retine des vertebres (The retina of vertebrates) published in
1893 (Cajal, 1893). In the Explanation of the plates section of this article
(p. 247), he wrote:
The majority of our figures have been made using the camera lucida of Abbe with
the Zeiss C objective. We have reproduced, in the figures of large size, cells found
in different sections of the retina of the same animal. However, they are represented as if they were seen in a single plane.
Thus, many of the illustrations by Cajal are composite drawings that synthetically
show the complex texture of a given region of the nervous system. Although this
method of illustrating the microscopic observations led to some skepticism (see
Section 5), this really was one of the most important contributions of Cajal, as it required a combination of artistic talent and interpretation of the microscopic images in
order to highlight the key features of the structure being studied through the exact
copy of the most relevant elements of the microscopic images.
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FIGURE 5
Watercolor by Cajal in 1865.
Taken from Cajal, A., 2007. Mara de los Angeles Ramon y Cajal Junquera. In: Paisajes Neuronales: Homenaje a
Santiago Ramon y Cajal (DeFelipe J., Markram H, and Wagensberg J). CSIC, Madrid.
As a consequence, drawing of neural elements became an art, providing an outlet

for the early neuroanatomists to express and develop their artistic talent. This was the
case of Cajal, whose boyhood dreams of becoming an artist (Fig. 5) were thwarted by
ngeles
his fathers misgivings. He spoke about this in an interview in 1900 (M.a A
Ramon y Cajal; Speech presented in 1984 at the Ateneo de Madrid with the title
Coloquio sobre Ramon y Cajal en el 50 aniversario de su fallecimiento (Colloquium: Ramon y Cajal on the 50th anniversary of his death)):
Undoubtedly, only artists devote themselves to science . . .. I realized that if I
wanted to make a name for myself as a painter, my hands needed to become precision instruments. I owe what I am today to my boyhood artistic hobbies, which my
father opposed fiercely. To date, I must have done over 12,000 drawings. To the
layman, they look like strange drawings, with details that measure thousandths of a
millimetre, but they reveal the mysterious worlds of the architecture of the brain. . .
Look [Cajal said to the journalist, showing one of his drawings] here I am pursuing
a goal of great interest to painters: appreciating line and colour in the brain.
Later, in his autographical Recuerdos de mi vida-Mi infancia y juventud (Recollections of my lifeMy childhood and youth) (1901, pp. 8486), Cajal shares with us
the following amusing anecdote:
. . .my father, who was already averse to all kinds of aesthetic tendencies . . . and
wearied, no doubt, of depriving me of pencils and taking away my drawings, and
4 Drawing of neural elements: When science was art
seeing the ardent vocation towards painting which I exhibited, he decided to

determine whether those scrawls had any merit promising their author the glories
of a Velazquez . . .. As there was no one in the town sufficiently qualified in the art
of drawing, the author of my days turned to a plasterer and decorator from afar,
who had arrived in Ayerbe around that time . . . to paint the walls of the church,
damaged and scorched by a recent fire. . . . I timidly displayed my picture . . . the
house painter looked at it and looked at it again, and after moving his head
significantly and adopting a solemn and judicial attitude he exclaimed:
What a daub! Neither is this an Apostle, nor has the figure proportions, nor
are the draperies right. . . this child will never be an artist. In fact, the opinion of
this dauber of walls was received in my family like the pronouncement of an Academy of Fine Arts. It was decided, therefore, that I should renounce my madness for
drawing and prepare myself to follow a medical career.
It is also interesting to draw attention to what Cajal wrote in Recuerdos de mi vidaHistoria de mi labor cientfica (Recollections of my lifeThe story of my scientific
work) (1917, pp. 155156), referring to the intellectual pleasure he felt when observing and drawing from his histological preparations providing a fascinating
bridge between science and art:
My work began at nine oclock in the morning and usually lasted until around
midnight. Most curiously, my work caused me pleasure, a delightful intoxication,
an irresistible enchantment. Indeed, leaving aside the egocentric flattery, the garden of neurology offers the investigator captivating spectacles and incomparable
artistic emotions. In it, my aesthetic instincts were at last fully satisfied.
Who could have imagined that the forest that Cajal painted when he was only 13
years old (shown in Fig. 5) would later lead on to drawings illustrating the neuronal
forest that constitutes the brain? Cajal had found a new world of infinite forms with
an extraordinary beauty in the study of the brain. These artistic skills and emotions
were also shared by Po del Ro-Hortega (18821945) and Fernando de Castro
(18961967), as well as by other famous disciples of Cajal and many other important
pioneers in neuroscience, including Otto Friedrich Karl Deiters (18341863), Rudolf
Albert von Kolliker (18171905), Theodor Meynert (18331892), Louis Antoine
Ranvier (18351922), Camillo Golgi (18431926), Gustav Magnus Retzius
(18421919), Aleksander Dogiel (18521922), and Alois Alzheimer (18641915).
Of course, in addition to the Golgi method, other staining techniques were available
in Cajals time, and many others were developed over the years, using different fixation and staining protocols to analyze specific architectonic aspects of the nervous
system, and the morphology and cytology of neurons and glia. A variety of chemicals
(pyridine, methylene blue, mercuric chloride, osmic acid, silver solutions, etc.) have
been used in different procedures to visualize particular elements selectively. Examples include methods to visualize different types of glial cells and not neurons, and
other procedures to label mainly neurons with their dendritic and axonal processes,
as well as the techniques that stain the neurofibrils but not other cytoplasmic organelles. Other selective staining methods were developed that allowed the examination
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of the different types of organelles in the perikaryon (e.g., Nissl bodies, mitochondria, neurofibrils, Golgi apparatus, inclusions such as pigments, fat, and lipids). The
collective work of many scientists made the improvement of these methods possible
and facilitated the analysis of all regions and cells of the nervous system from many
different perspectives. Over the years, this work has unveiled all that we now know
about the structure of the nervous system. As Peters et al. (1991, p. 14) summarized
in the classic book The Fine Structure of the Nervous System: Our image of the nerve
cell at the light microscope level is like a collage of many overlapping views, patiently accrued during a century of study.
5 SCIENTIFIC ART AND SKEPTICISM

An interesting point regarding the representation of the microorganization through
drawings is that clearly the observers did not reproduce the entire field of the histological preparations that they viewed through the microscope, but rather they drew
only those elements that they thought were important for what they wanted to describe. As such, these illustrations were not necessarily free of technical errors,
and they may have been subject to the scientists own interpretations. Indeed, this
subjectivity made fellow scientists reluctant to accept their findings at times.
This skepticism is illustrated well by the response speech that Professor Arthur
van Gehuchten (18611914) delivered at an event marking his 25 years of teaching
service at the University of Louvain. In this speech, van Gehuchten describes the historic moment when Rudolf Albert von Kolliker (18171905)one of the most influential neuroscientists of the timediscovered Cajal in the famous Congress of the
German Society of Anatomy, held at the University of Berlin in October 1889.
The section of the speech where van Gehuchten (1913, pp. 3233) describes this
event highlights the difficult situation that Cajal (and other scientists) had to face:
The facts described [by Cajal] in his first publications were so strange that the histologists of the time . . . received them with the greatest skepticism. The distrust was
such that, at the anatomical congress held in Berlin in 1889, Cajal, who afterwards
become the great histologist of Madrid, found himself alone, provoking around him
only smiles of incredulity. . . I can still see him taking aside Kolliker, who was then
the unquestioned master of German histology, and dragging him into a corner of the
demonstration hall to show him under the microscope his admirable preparations,
and to convince him at the same time of the reality of the facts which he claimed to
have discovered. This demonstration was so decisive that a few months later the
Wurzbourg histologist [Kolliker] confirmed all the facts stated by Cajal.
Kolliker was so impressed with the findings of Cajal that he stated (Cajal, 1917,
p. 147):
The results that you have obtained are so beautiful that I am planning to immediately undertake a series of confirmatory studies by adopting your methodology.
I have discovered you, and I wish to make my discovery known in Germany.
6 Interpretation of the microscopic world
Cajal, encouraged by the success of the Congress of Anatomy and by the beauty of
the histological preparations, was trapped forever by the fascinating world of the
nervous system.
6 INTERPRETATION OF THE MICROSCOPIC WORLD

Although all scientists of Cajals era had the same microscopes and produced similar
histological preparations, the crucial difference was in the pursuit and interpretation
of details that went unnoticed by others. A remarkable example was the different
interpretation of the connections between neurons and the debate about the existence
of dendritic spines. At that time, the most common view regarding the organization
of the nervous system was that it consisted of a diffuse network of nerves formed by
the anastomosing branches of nerve cell processes, with the cell somata principally
playing a role in nourishment (Reticular Theory).
One year after his meeting with Simarro, Cajal published his first important article based on the results obtained with this method in the avian cerebellum (Fig. 4).
In this study titled Estructura de los Centros Nerviosos de las Aves (Structure of
the avian nerve centres) (Cajal, 1888), Cajal made two great contributions. First,
he described the existence of dendritic spines (which he also named). These elements were considered by Cajal and other scientists to be fundamental structures
present in certain neurons (spiny cells, such as pyramidal neurons and Purkinje
cells), while others, like Golgi, considered them to be mere histological artifacts
(DeFelipe and Jones, 1988). At present, dendritic spines generate particular interest
as they are highly plastic and are the main postsynaptic site for excitatory synapses
in the cerebral cortex. Second, Cajal confirmed Golgis conclusion that dendrites
end freely. But, in contrast to Golgi, Cajal came to the decisive conclusion that this
also applies to axons and their branches. Cajals early studies with the Golgi
method were so decisive for the Neuron Doctrine that they represented the main
core of the review published by von Waldeyer-Hartz (18361921) in the journal
Deutsche Medizinische Wochenschrift in 1891. In this article, the term neuron
was introduced to denominate the nerve cell and, at last, the so-called Neuron
Doctrine became popular.
Certainly, the two opposite views regarding the connections of neurons implied
rather different functional consequences. According to the Reticular Theory, nerve
currents would flow through a continuous network of neuronal processes, whereas
for the Neuron Theory these currents passed from one cell to the next by contact
in much the same way that electric current crosses a splice between two wires
(Cajal, 19091911) (Fig. 6). Thus, the new ideas about the connections between neurons led to novel theories about the relationship between neuronal circuits and brain
function (DeFelipe, 2010b).
Cajal was very proud to be recognized as one of the scientists who had contributed most to the victory of the Neuron Doctrine in its battle against the Reticular
Theory. Except for some prestigious researchers, such as Golgi or the well-known
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FIGURE 6
Cajals drawing to explain the differences between the neuron and the reticular theories.
The figure legend states Scheme to compare the concept of Golgi regarding the sensorymotor connections of the spinal cord (I) with the results of my investigations (II). A, anterior
roots; B, posterior roots; a, collateral of a motor root; b, cells with a short axon which,
according to Golgi, would intervene in the formation of the network; c, diffuse interstitial
network; d, our long collaterals in contact with the motor cells; e, short collaterals. This
figure was reproduced as Fig. 9 in Recuerdos de mi vida-Historia de mi labor cientfica
(Recollections of my lifeThe story of my scientific work) (Cajal, 1917).
Franz Nissl (18601919; Nissl, 1903), the Neuron Doctrine was by the end of the
nineteenth century the most accepted theory to explain the organization of the nervous system, in which the neuron was considered as the anatomical, physiological,
genetic, and metabolic unit of the nervous system (Jones, 1994, 2006; Shepherd,
1991). The many, fundamental contributions of Cajal (1933) to the neuron doctrine
were summarized by himself in several articles and books, and especially in
Neuronismo o Reticularismo (Neuronism or Reticularism? published in 1933).
The misinterpretation of Golgi regarding the connections of nerve cells represents the basis for the popular belief in the scientific community that the contributions of Golgi were mainly only methodological. However, he made many
significant discoveries. Perhaps one of the most important was the discovery in
1898 of an internal reticular apparatus in the nerve cells (Golgi, 1898), which
was later named the Golgi apparatus or Golgi complex in his honor (Bentivoglio,
1999). As occurred with other discoveries at that time, the existence of this organelle
was the subject of intense debate since some authors thought that this was an artifact
7 The brain as a neuronal forest
of the method of staining, whereas other scientists believed that it was a real organelle which was found not only in neurons but in most eukaryotic cells as well. Many
years later, after the introduction and development of electron microscope techniques in the 1950s, this discovery was confirmed, proving that Golgi was right
(Bentivoglio, 1999).
Thus, during this period, the drawings used to illustrate their publications were
often considered to be essentially artistic or erroneous interpretations rather than accurate copies of the histological preparations. Indeed, this issue also makes it difficult for us to interpret some of these figures today. This early period represents a
captivating page in the history of neuroscience marked by scientific art and skepticism, when the drawings were subject to different interpretations and considered to
be good or bad depending on the artistic talent of the scientists and their artistic assistants and on their ability to extract the relevant information. Once again, Cajal
explained the importance and implications of this in the Textura (Cajal 1899
1904, vol. 1, p. X): A good drawing, like a good microscope preparation, is a fragment of reality, scientific documents that indefinitely maintain their value and whose
study will always be useful, whatever interpretation they might inspire.
The Golgi method, together with the extraordinary variety of other techniques
used at the time to unravel the complex organization of the nervous system, opened
up a beautiful microscopic world, with an almost infinite combination of forms and
multiple colors. The coming together of art and science was also vividly described by
Del Ro-Hortega (1933, p. 200):
After using a technical process of those that required the careful combination of
several complementary colours: red and green, yellow and blue, the histologist
finally got a true picture from which three sources of pure emotion could be derived: that which stems from the beauty of the landscape itself, with its polychromatic nature, its tones and [depth]; that which emanates from the observer
himself, who feels the hidden satisfaction of achieving his purpose; and that which
emerges from the novelty of the details resolved, [that is] the discovery of ignored
truths.
Indeed, as shown in Fig. 7, many of the illustrations of these great scientists and artists can be considered to belong to different artistic movements, such as modernism,
surrealism, cubism, abstraction, or impressionism.
7 THE BRAIN AS A NEURONAL FOREST

It does not require a great deal of imagination to see some neurons as trees, such as
the pyramidal cells of the cerebral cortex and the Purkinje cells of the cerebellar cortex. Given their high density and arrangement, they seem to constitute a thick forest
(Figs. 8 and 9). This is why Cajal, as well as other scientists, often referred to trees
and forests in their descriptions of the brain and, in particular, of the cerebral cortex.
Another beautiful example is the following comment from Cajal regarding cortical
215
216
FIGURE 7
Drawings taken from Del Ro-Hortega to illustrate different cellular elements of the
hippocampal formation and neocortex. Upper panel, cells in the dog fascia dentate
(Del Ro-Hortega, 1918); lower panel, neuroglial cells of the aging human cerebral cortex
(Del Ro-Hortega, 19181919).
plasticity (Cajal, 1894, pp. 159160): The cerebral cortex is similar to a garden filled
with innumerable trees, the pyramidal cells, which can multiply their branches
thanks to intelligent cultivation, send their roots deeper and producing more exquisite flowers and fruits every day.
7 The brain as a neuronal forest
FIGURE 8
Drawings of the human cerebral cortex (Golgi method), illustrating a forest-like appearance.
Taken from von Kolliker (1893) (left) and Cajal (1899) (right).
These neuronal forests truly represent an unlimited source of artistic and poetic
inspiration to scientists and others since they reveal a fantastic and virtually unknown
world of forms, a brain microuniverse with an aura of mystery (DeFelipe, 2010a).
Indeed, Del Ro-Hortega (1933, p. 193) described the relationships between neurons,
glia, and blood vessels perfectly: In the landscape of the brain, there are endless
irrigation canalsblood vesselsand on their banks, the bush-like cellsglia
collaborate in nerve function.
Finally, it is worth pointing out that trees have also served as artistic symbols in a
variety of contexts to describe texts or concepts. For example, multicolored drawings
of trees have been used to describe cognitive alterations in biblical texts, as can be
seen in one of the trees shown in a miniature belonging to the Mozarabic Beato of San
Miguel de Escalada (Leon, Spain), in work by the monk Maius in the tenth century.
In this miniature, King Nebuchadnezzar II of Babylon (sixth century BC) is shown
217
218
FIGURE 9
Computer-generated image to illustrate the complexity of the cerebral cortex, which
resembles a neuronal forest.
This image was taken from the video Bosque Neuronal (Cajal Blue Brain Project; http://cajalbbp.cesvima.
upm.es/) created (in alphabetical order) by Sofa Bayona, Ruth Benavides-Piccione, Juan Pedro Brito,
Eva Cortes, Javier DeFelipe, Jose Miguel Espadero, Susana Mata, Luis Pastor, Angel Rodrguez, and
Luis Miguel Serrano.
with what might be dementia, eating grass, like the beasts in the field and seemingly walking on all fours, because of the extreme bending of his trunk (camptocormia). Today, it is thought that his condition that might be at least in part due to
parkinsonism associated with Lewy body disease (Martn-Araguz, 2006). As a main
theme in the illustration, a tree is shown whose trunk represents the kingdom with its
inhabitants (the birds in its branches), and a cut at the base of the trunk, possibly
showing the risk posed to the kingdom by the kings disease (DeFelipe 2010a;
Martn-Araguz, 2006). At present there is considerable interest in examining the
possible alterations to the tree-like pyramidal cells and their possible alterations associated with brain disease, as well as their role in memory, learning, and cognition.
Here, we can also imagine an appealing bridge between literature, artistic drawings,
and neuroscience.
Acknowledgments
I am very grateful to the members of my laboratory for their support. I am deeply
ngeles Ramon, for allowing
indebted to the granddaughter of Cajal, Mara de los A
us to use some of Santiago Ramon y Cajals original drawings and paintings, in representation of the Herederos de Santiago Ramon y Cajal, who hold the copyright for
References
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ngeles Langa, librarian at the Instituto Cajal, for her help in obtaining some of
A
the books and articles from which I extracted some of the quotes included in this
chapter.
This work was supported by grants from the Spanish Ministry of Economy and
Competitiveness (Ministerio de Economa y Competitividad: SAF2009-09394,
BFU2012-34963, and the Cajal Blue Brain ProjectSpanish partner of the Blue
Brain Project initiative from EPFL).
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von Kolliker, A., 1893. In: Handbuch der Gewebelehre des Menschen. Nervensystem des
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Centralnervensystems. Dtsch. Med. Wochenschr.17, 12131218, 12441246, 12671269,
12871289, 13311332, 13521356.
CHAPTER
The lead-poisoned genius:

Saturnism in famous artists
across five centuries
Julio Montes-Santiago1
Service of Internal Medicine, Complejo Hospitalario Universitario, Vigo, Spain
Corresponding author. Tel.: 0034-986-81111, ext. 11541, Fax: 0034-986-811138,
e-mail address: julio.montes.santiago@sergas.es
Abstract
Lead poisoning (saturnism) has been present throughout the history of mankind. In addition to
possible ingestion from contaminated food, one of the most important ways in which poisoning caused morbid processes was by occupational exposure. This exposition was pandemic in
the Roman Empire, and it has been claimed that it contributed to its fall, but it also caused
numerous epidemics in Western countries until the nineteenth century. In the case of artists,
and since the Renaissance period, this toxicity has been called painters colic or painters madness. The latter term is partly due to the mental disorders displayed by some of the great masters, including Michelangelo and Caravaggio, although it was long recognized that even house
and industrial painters were prone to the disorder. This chapter examines the historical evidence of recognition of such toxicity and discusses the controversies raised by the possibility
of professional lead poisoning in great artists. In addition to those mentioned above, many other
artists across several centuries will be discussed, some being Rubens, Goya, Fortuny, Van Gogh,
Renoir, Dufy, Klee, Frida Kahlo, and Portinari. This chapter also briefly mentions the possibility
of lead poisoning in two famous composers: Beethoven and Handel. Whether suffering from
lead poisoning or not, about which we cannot always be sure, we should still highlight and
admire such geniuses fighting their disorders to bequeath us their immortals works.
Keywords
lead poisoning, saturnism, Goya, Van Gogh, Michelangelo
1 PREINDUSTRIAL HISTORICAL PERSPECTIVE OF

EXTRACTION AND LEAD POISONING
The use of lead has long been known by mankind. Perhaps, the first records of its use
are the lead-rich pigments used in prehistoric cave paintings. Likewise, lead has been
mined since ancient times. The oldest known mining site is situated in Turkey and
223
224
CHAPTER 9 The lead-poisoned genius
dates back to 80006500 BC. There is a lead necklace from the Anatolian city of
similar antiquity. Lead was widely used by Egyptians, Jews, Assyrians, Phoenicians,
Greeks, and Romans. Furthermore, its toxicity was known in ancient times. It has
been estimated that, throughout history, mankind has extracted nearly 300 million
metric tons of this metal, much of which is still found as environmental pollutants.
Lead production was calculated at 3.5 million metric tons/year during recent industrial era, releasing 126,000 metric tons/year into the atmosphere (Ciudad-Cabanas,
1998; Lewis, 1985; Woolley, 1984). This chapter on the arts, however, will focus
largely on situations and celebrities before the massive occupational poisonings
associated with the industrial and automobile era.
1.1 Ancient times

The first reference to lead toxicity can be traced back to Egyptian medical papyri.
Apparently, it was often used with homicidal intentions at that time. It is curious that
this early use has been tenaciously maintained over the centuries. For example, the
Medicis and the Borgias, to get rid of their enemies, used preparations of this silent
and long-lasting compound to such an extent that the preparations became known as
succession poudre in French (succession powder) (Lewis, 1985). At the beginning
of the eighteenth century, the writer and Spanish Minister Jovellanos, a friend of
Goyas, suffered an attempted assassination using this compound (Rodrguez
Torres, 1993).
In addition to its abundance and easy removal, lead shows many properties that
have made it so attractive since early times: it is easy to work, has a low melting
point, a high resistance to corrosion from atmospheric elements, easily retains
pigments, etc. These features have made this metal an essential element in ancient
societies, but also caused epidemics of chronic intoxication (Table 1) (Aufderheide
and Rodrguez Martin, 1998; Hernberg, 2000; Needelman, 2004; Warren, 2000).
Although the Corpus Hippocraticum (450370 BC) already related gout to meals
and wine, Nicander of Cephalonia (250 BC) is credited with being the first to
mention saturnine colic, anemia, and palsy, although he did not relate them to lead
poisoning. The Greek Dioscorides (first century BC), however, brought up lead
toxicity, and a Roman, Pliny the Younger, who edited the works of Pliny the Elder,
described this frequent toxicity among shipbuilders (Hernberg, 2000; Needelman,
2004; Riva et al., 2012; Waldron, 1973).
The Romans produced nearly 60,000 metric tons of lead annually for more than
400 years, both directly and as by-products from refining the gold and silver that they
were mining. Mining was carried out using slave labor, and the pragmatic Romans
became aware of the discomfort and disorders caused by it. Thus, its extraction was
banned in Italy at the end of the Empire, although it continued in the provinces.
Lead was omnipresent in all areas of Roman life: it was released from
chimneys of the houses that liberated lead pollutants into the air; it was in cookware,
in pipelines to carry water, as a sweetener in foods, as a preservative and stabilizer for
1 Preindustrial historical perspective of extraction and lead poisoning
Table 1 Recognition of lead poisoning: a struggle of centuries

Ancient age
Egypt (2500 BC)
Hippocrates (IV BC)
Nicander (II BC)
Celsus (I BC)
Dioscorides (I AC)
Pliny, Vitrubio (I AC)
Roma
Pablo Egina (VII AC)
Medical Papyri. Poisoning

Colics in mining
Saturnine palsy
Description of toxins and some remedies
Lead toxicity
Toxicity in buildings, pipes, etc.
Wines with content, bones of patricians. Nero: tube to
fine-tune voice. Domitian: fountain with lead pipes. Infertility,
asthenia, malformations
Byzantium. Epidemic of lead poisoning with paralysis
Middle Ages/Renaissance
Alchemy
Daily activities
Avicenna (eleventh
century)
Gutenberg (fifteenth
century)
Borgia, Medici
(sixteenth century)
Epidemics
Saturn. Earthen color destroys metals

Conservative and sweetening of wines
Transmission by food
Plates of lead in printing
Venom: the poudre succession
Colic in Madrid (painters), Poitou, Devon (cider), etc.
Description of poisoning
Paracelsus (fifteenth
century)
Bauer G (n. Agricola)
(1556)
Citois F (1616)
Stockausen S (1656)
Sydenham T (1693)
Gockel E (1697)
Ramazzini B (1713)
Tronchin T (1767)
Baker G (1772)
Franklin Benjamin
(1786)
Laennec (1831)
Thackrah (1832)
Tanquerel des Planches
(1839)
Esquirol (1838), Tuke
(1840)
The miners disease

De Re Metallica. Medical metal use, health problems in miners
Colic of Poitou (painters). France
Description of symptoms in potters
Palsy and colic. No cure
Colica Pictonum. Colic wine due to the addition of litharge
Painters colic in Venice
Industrial and iatrogenic poisoning
Inquiry on colic of Devon. Contaminated cider
Observation on saturnism in plumbers, glaziers, painters, etc.
Anemia
Plumbism in plumbers and piping manufacturers
Traite des maladies de Plomb or saturnines: 1217 cases
Observations on lead encephalopathy
Continued
225
226
Table 1 Recognition of lead poisoning: a struggle of centuriescontd

Garrod A (1854, 1898)
Behrend (1899)
Vigliani and Angeleri
(1934)
Sheets RF (1951)
Haeger-Aronsen B
(1960)
Bonsignore D (1965)
Saturnine gout, increased porphyrin excretion in urine

Basophilic stippled erythrocytes
Synthesis of heme impaired
Shortened life span of erythrocytes
Excretion of ALA in urine
Lead inhibits delta-ADA
Contemporary Era
Brisbane (Australia)
(1892)
1898
1921
1924
1927
1972
1990
Saturnine encephalopathy in children

Abortions, nephropathy, occupational exposure, etc.
Industry inspections
International Conference of Labor (ILO): prohibition of
paintings with lead indoors
Apply treaties in Europe (e.g., in Spain). USA refuses
Fight for prohibition (e.g., H. ZanggerEinsteins doctor)
Tetraethyl lead: antiknock in gasoline
Federal law on prohibition of lead in paintings
Ban of lead in gasoline
wines, etc. It was even used as a component in makeup (Eisinger, 1982; Hernberg,
2000; Nriagu, 1992; Winder, 1994; Woolley, 1984).
With respect to the consumption of wine, it was used as a stabilizing agent, sapa
or defrutum, a kind of sweet syrup obtained by heating the grape juice in lead
containers. This product, in addition to sweetening the wine, was used as an additive
for other seasonings. Thus, some historians attributed the decline of the Roman
Empire to chronic lead poisoning causing sterility, abortions, and premature births
among the elite Romans, who were the almost exclusive consumers of these wines
(Nriagu, 1983; but see Scarborough, 1984). This consumption would have contributed to the frequent presence of gout and would be a cause of the deterioration of
mental capabilities, which was highly evident in some of the Romans emperors.
In this context, we might remember the follies of Caligula, Nero, and Commodo,
the depressions suffered by Tiberius, and the extravagances of the last representative
of Flavian dynasty, Domitian (8196 AC), who installed a fountain with lead pipes in
his garden that continuously spouted wine. High levels of lead have been found in the
bones taken from the tombs of the Romans. These levels were significantly higher in
patricians than in plebeians. It has even been estimated that the intake of lead in
patricians in the Roman Empire approached 1 mg/day (in contrast to 0.3 mg/day
in United States during the 1980s). However, its global rate of use from all sources
of lead could be as high as 550 g per person each year (Lewis, 1985; Needelman,
2004; Nriagu, 1992; Woolley, 1984).
1 Preindustrial historical perspective of extraction and lead poisoning
This known lead toxicity was almost entirely forgotten during the Middle Ages.
Alchemists used lead widely in their searches for methods to convert metals into
gold. In fact, lead was widely used in all facets of everyday life: in makeup creams,
for manufacturing chastity belts, as a rudimentary spermicide, as a sweetener and
popular condiment, in shipbuilding, in the alloys of silver and gold coins, to manufacture all kinds of ammunition, cannons, and other war machines, as well as in
household utensils and cookware, to name but some uses. It was also largely used
in the pigments used to produce beautiful miniated (rubricated or red) codices called
Beatos (tenth to eleventh centuries). With the introduction of Gutenbergs invention of the printing press (fifteenth century), it became widely used in the preparation
of plates for printing (Hernberg, 2000; Riva et al., 2012).
Given its omnipresence in everyday life through the Middle Ages and the Renaissance, it is surprising to observe a paucity of references about its harmful effects
through this time span. Some exceptions are an acute observation from Avicenna,
in a text by Agricola (De Re Metallica; sixteenth century), and a description from
the fifteenth century by Paracelsus, his so-called disease of miners.
It seems worth mentioning how this knowledge led to some early social recognition for Avicenna (9801037), considered the Prince of Physicians of the Middle
Ages (Afnan, 1958). Indeed, at the age of 17, when he was already known for his
erudition in medical topics and philosophy, he was called to assist Ibn Mansur,
the samanid emir of Bukhara (now in Uzbekistan). The emir was seriously ill from
a disease that seemed unidentifiable to his official doctors. Avicenna realized that he
was suffering from serious lead poisoning caused by his habit of drinking a glass of
terracotta from a goblet painted with mineral pigments. Avicenna saved his life, and
with uncommon wisdom only requested unlimited access to the royal libraries of the
Samanids in reward for his work. During the following years, Avicenna wrote over
100 books on diverse subjects. Among them is the famous Canon, a structured
compendium of medical knowledge of his time, which after translating and rewriting
in Latin would serve as the primary medical text in the West until the seventeenth
century. With respect to lead, Avicenna mentions its medicinal use in treating
diarrhea and intestinal ulcerations (Nriagu, 1992).
1.2 Epidemic and modern awareness

Due to its importance, we must now highlight its widespread use as a sweetener (i.e.,
as lead acetate or lead sugar) to preserve the taste of poor-quality wine or as a
preservative for other good wines. There are ancient testimonies of the uprising
of the tribes against the Roman Empire due to the imposition of wine preserved
in this way. Epidemics of colic were a continuous plague in Europe during the
fifteenth to nineteenth centuries. Some states of Germany were aware of this toxicity
and published bans on pain of death in 1498 and 1577 for the addition of lead sweeteners in wine. However, perhaps the most famous case was detected in the German
city of Ulm during the seventeenth century when physician Eberhard Gockel learned
about and experienced the deleterious effect of lead-tainted wine (Eisinger, 1982;
227
228
Pearce, 2007). He stayed in a monastery where he received the hospitality of the

monks: food and wine. There he observed that the monks who drank no wine seemed
healthy, while those who drank were ill with classic abdominal colic pain. He also
experienced the colic pain himself until he realized that it was related to the wine he
drank. This led him to discover that the addition of a sweetener, litharge or white lead
oxide, was responsible. Given that this regions economy depended heavily on wine
exports, and in order not to ruin this source of wealth, Duke Ludwig of Wurttemberg
banned on pain of death the mixing of lead additives with wine.
There were some allusions or detailed descriptions of epidemics in lead workers by
famous physicians (e.g., Sydenham, Citois (Richelieus physician), Tronchin (Voltaires physician), etc.; Eisinger, 1982; Pearce, 2007). Another famous example was that
of the doctor at the Court of King George III, Sir George Baker, who, during the eighteenth century, discovered with Benjamin Franklins help that the so-called colic of
Devonshire (an entity associated with palsy, encephalopathy, anemia, and abdominal
pains that ravaged England for more than one century and caused many fatalities)
was due to lead contamination of wine from the presses used to crush the grapes
(Finger, 2006). Likewise, and although the classical description of saturnine gout is
due to Sir Alfred B. Garrod in 1854 (Storey, 2001), it was established that the major
epidemics of gout that engulfed England in the eighteenth century had their origin in
the mass consumption of Port and Madeira wines from Portugal, which contained
significant lead concentrations (Hernberg, 2000; Riva et al., 2012; Winder, 1994).
Across the Atlantic, one of the first battles in public health was fought in the
colony of Massachusetts in the eighteenth century, where lead additives were banned
in cider and wines, although some of the poisoning might have been due to the widespread use of medicinal lead preparations, such as litharge, due to the popular belief
in their efficacies for colic pains (Eisinger, 1982).
Not only has this contamination of wines been a cause of great tragedies but also
contamination of foods stored in lead containers. In 1845, the entire expedition of
128 men under the command of John Franklin, who sought the Northwest Passage,
perished. Among other causes, this was thought to be due to the consumption of foodstored casks sealed with lead. It is supposed that this must have contaminated the
food causing the illness and madness of the crew (National Geographic, 1990). In
modern times, mass media still periodically report severe epidemics (e.g., in
Hungary with red lead oxide mixed with paprika to brighten up the color of this spice;
in India as a preservative from cold in the manufacturing of ice cream; in Nigeria
with soil contamination resulting in thousands of childhood deaths).
1.3 Scientific era and saturnism

Although Laennec had already described the anemia in 1831, Tronchin, Trackrah, and
others had made detailed observation on workers who handled lead pipes, and some focused on the lead encephalopathy (Esquirol, Tuke, etc.). The modern paradigm on lead
poisoningmainly occupational poisoningcame from the famous Traite des maladies de plomb o saturnines by L. Tanquerel des Planches, edited in 1839 in Paris
2 Poisoned painters
(Eisinger, 1982; Lewis, 1985; Pearce, 2007; Riva et al., 2012). This work gives a detailed
description of the abdominal, neurological, and articular manifestations of poisoning in
more than 1200 cases, yet was unable to provide a single explanation for all of them.
Subsequently, Richard Burton described his famous line on the gums in 1895
(Pearce, 2007). Today, it is considered less specific. Behrend, in 1899, described basophilic stippling of erythrocytes, employed as a means of detecting lead toxicity in
workers during the first half of the twentieth century, until its abandonment due to being
unspecific. In 1898, Sir Archibald E. Garrod described increased porphyrin excretion in
urine with lead poisoning. In 1934, researchers observed the alteration of iron incorporation into heme molecules, causing the accumulation of protoporphyrin IX in erythrocytes, and later the shortened life span of the erythrocytes in patients with lead poisoning.
In 1960, increased excretion of delta-aminolevulinic acid (delta-ALA) in the urine of
lead workers was noted, and in 1965 it was observed that lead inhibits the enzyme
delta-aminolevulinic acid dehydratase (delta-ALA-D), which leads to the increase in
the excretion of delta-ALA (Hernberg, 2000; Pearce, 2007; Riva et al., 2012) (Table 1).
2 POISONED PAINTERS
I have already mentioned the first ornamental trace of lead use by man found in cave
paintings (Ibrahim et al., 2006). Votive objects made from this metal were found in
Egyptian and Minoan tombs, and in the ancient city (now in Turkey) of Troy
(Waldron, 1973). In relation to painters, the expression to be as crazy as a painter,
however, seems to have become popular at a later date, perhaps five or so centuries
ago. In De Morbis Artificum Diatriba, a book published in 1713 by Bernardinus
Ramazzini, regarded as the founder of modern occupational hygiene, we find:
Of the many painters I have known, almost all I found unhealthy. . .. If we search
for the cause of the cachectic and colorless appearance of the painters, as well as
the melancholy feelings that they are so often victims of, we should look no further
than the harmful nature of the pigments. . ..
cited in Rodrguez Torres (1993), p. 11
Further, on referring to potters, this author writes:

They suffer from palsied hands, abdominal colic, fatigue, cachexia, and they lose
their teeth. It is, therefore, extremely rare that one can see a potter who does not
have a lead-colored, cadaverous looking face.
cited in Riva et al. (2012), p. 12
In addition, in a famous letter of Benjamin Franklin (1763), written during his stay in
Europe, we find him referring to dry gripes (colic) and dangles (wrist gout), which
affected tinkers, painters, and typesetters (Eisinger, 1982; Finger, 2006; Pearce, 2007).
The dreaded saturnine colic was, at that time, almost (but not quite) synonymous
with colic of the painters or, more generally, artisans and laborers (e.g., tin
workers). Table 2 presents major fine artists along with two great figures from music,
229
Table 2 Artists and celebrities with possible lead poisoning

Person
Disease
Likelihooda
Exposure to paintings with lead

(minimum)
Unknown
Ten to twelfth centuries

Illustrators of the Beatos
Fifteenth to sixteenth centuries

Michelangelo Buonarrotti
(14751564)
Rafael Sanzio (14831520)
Caravaggio (15711610)
Piero della Francesca
(14631494)
Saturnine gout. Mental disturbances
High
Supposed occupational exposure

High levels in tomb. Mental
disturbances
Eye illness, blindness
Unknown
Poor
Probable rheumatoid arthritis.

Exposure
Rosacea. Supposed exposure
Poor
Colic, deafness, paralysis. Exposure
High
Colic pains. Malaria. Biting brushes
Poor
Madness. Alterations of vision
Controversial
Rheumatoid arthritis. Exposure. Heavy

smoker
Poor
Rheumatoid arthritis. Exposure
Poor
Rheumatoid arthritis. Exposure

Scleroderma. Exposure
Chronic pain. Exposure. Possible
suicide
Colic. Bleeding. Occupational
exposure
Poor
Poor
Poor
Gout. Possible depression. Porto

wines
Colic, irritability, deafness. Wines.
Oinmetric tonsents
Poor
Poor
Seventeenth century
Peter Paul Rubens
(15771640)
Rembrandt van Rijn
(16061669)
Poor
Eighteenth century
Francisco Goya
(17461828)
Nineteenth century
Mariano Fortuny
(18351874)
Vincent Van Gogh
(18531890)
Auguste Renoir
(18411919)
Twentieth century
Alexey von Jawlesnky
(18641941)
Raoul Dufy (18771953)
Paul Klee (18791940)
Frida Kahlo (19071954)
Candido Portinari
(19031962)
High
Other famous people

Haendel (16851759)
Beethoven (17701827)
Controversial
a
The degree of likelihood is a subjective authors assessment of the literature references. Unknown: cited
but without any proof. Poor: quoted but without convincing proofs. High: confirmed or more convincing
arguments. Controversial: contradictory data (see text).
2 Poisoned painters
namely Beethoven and Handel, for whom lead poisoning has been suspected at some
stage. This table is accompanied by subjective assessments, based on the existing
data, about the likelihood of these diagnoses; there being considerable controversy
about these published assessments. I shall now turn to the details of those cases in
which the probability of lead poisoning seems fairly high.
2.1 The Beatos (ninth to eleventh centuries)

In the acclaimed novel The Name of the Rose, with its famous film transposition by
J-J Annaud (1986), Umberto Eco consulted with a biologist friend and chose arsenic
as the poison for the plot. Nevertheless, he recognized that the historical evidence
was poor (Landn Perez, 2008). However, a good candidate for the intoxication of
the copyists of the Beatos (illustrated monastic manuscripts of the ninth to eleventh
centuries commenting on the Revelation of St. John) is lead. Its beautiful illustrations
are made with miniated reddish pigments rich in this metal.
2.2 Michelangelo Buonarrotti (sixteenth century; for dating of

specific artists, see Table 2)
It has long been suspected that the great Florentine painter, author of the admirable
frescos of the Sistine Chapel in Rome and prototype of the Renaissance man (painter,
writer, poet, sculptor, and architect), suffered from gout. One of the more compelling
arguments made stems from the recognition of his probable portrait in the famous
fresco by Raphael in the Vaticans Loggia The School of Athens. This monumental
fresco depicts important Greek thinkers (e.g., Socrates, Plato, Aristotle, Diogenes),
who were in some instances endowed with the faces of well-known people of the
time (e.g., Leonardo da Vinci as Plato and the architect Bramante de Urbino as
Euclid). The man with a crooked nose in the foreground, sitting on the steps,
and dressed in contemporary clothes and leather combat boots is recognizable as
Michelangelo (Espinel, 1989). The notable realism in his portrait includes a
deformed right knee, with excrescences, but without clear signs of current articular
inflammation. This arthritis, presumably tophaceous, together with the correspondence of Michelangelo that repeatedly alludes to the expulsion of stones and urinary
grind, and even an acute obstruction, has pointed to the possibility of saturnine gout.
This poisoning may also justify the well-documented attacks of melancholy and irascibility or madness of this painter (Espinel, 1999; Wolf, 2005). The wine stored in
lead containers that was consumed by Michelangelo has been cited as a source of his
likely contamination. Preservatives rich in tartaric acid, such as fruits, were added to
these wines. This is a recognized solvent of the lead enamels that lined the vats. It is
also known that, when engaged in his work, he followed an almost exclusive diet of
bread and wine. Likewise, he could also have been exposed to airborne particles or
high lead concentrations from handling his paints (Wolf, 2005). And, perhaps, these
ailments led him to paint his aching self-portrait in the St. Bartholomews wrinkled
skin at the Last Judgment in the Sistine Chapel.
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2.3 Raphael Sanzio

Ramazzini mentions him in the De Morbis Artificum Diatriba (Rodrguez Torres,
1993, p. 11) as a possible victim of lead poisoning, although his biographers are more
inclined today to attribute his early death to other causes (e.g., syphilis).
2.4 Caravaggio
A retrospective explanation for the violent behavior and attitudes, including murder,
that marked the life of the great painter of Judith Beheading Holofernes and The
Conversion of Saint Paul has been the high levels of lead found in bones that are
believed to be from his tomb in Tuscany. Like in his life, violent themes are often
present in his paintings, which show strong contrasts between light and shadow
(tenebrism). Pigments in his works are rich in lead, and Caravaggio was very chaotic
when painting (Kington, 2010).
2.5 Piero Della Francesca

We know few details of the personal life of Piero della Francesca, author of fine murals in the Italian Quatroccento, although, according to the Italian artist and historian
Vasari, in his last year, he suffered a serious illness that led to his blindness. This has
also been attributed to lead poisoning (Riva et al., 2012).
2.6 Rembrandt van Rijn

According to some researchers, after the exhaustive analysis of 40 Self-portraits
painted over 41 years, Rembrandt, the great Dutch Master and engraver from the
Netherlands Golden Age (seventeenth century) died mired in depression and
melancholy. However, the biggest drawback to establishing a diagnosis of his illnesses and death is the lack of reliable biographical references about the signs
and symptoms associated with the painter of the Anatomy Lesson of Dr. Nicolaes
Tulp and The Night Watch. Therefore, the hypothesis that his death is at least partially
due to lead poisoning is at present only one more theory to consider alongside others,
such as temporal arteritis, hypothyroidism, rosacea, etc. Only advanced age can be
found on his death certificate as his likely cause of death (Friedman et al., 2007).
2.7 Francisco de Goya

The life of this Spanish Great Master of the eighteenth to nineteenth centuries was
marked by a disorder contracted in 1792 during a trip to Andalusia at the age of 46.
This manifested itself in acutely with abdominal cramp, vertigo, tinnitus and hearing
loss, visual disturbances and tremors, and paresis of the right arm. Therefore, he was
left with irreversible deafness. Without using his fingers, he could not understand
anything, and was thus forced to learn sign language. An allusion to the eye problem
can be seen in the Self-portrait housed at the Museum of Castres (ca. 17941797),
2 Poisoned painters
where he is represented (only here and not on other self-portraits) with glasses. Deafness forced him to resign as Director of Painting of the San Fernando Academy
(Montes-Santiago, 2006).
Such ailment, especially hearing loss, was instrumental in his life and many authors claimed union with ailments that would lead him to the Black Paintings, 30
years later. However, this is improbable because Goya painted luminous works such
as the Majas or the frescoes in Saint Antonio de la Florida, Madrid. Because of this, a
prestigious psychiatrist has argued that such gloomy paintings were the product of a
deep depressive episode within a general framework of bipolar disorder (AlonsoFernandez, 1999). Anyway, the hypotheses about his ailments have varied, and I
have collected opinions from more than 30 experts from the twentieth century. They
have issued almost 20 possible interpretations of his disorder (e.g., manic-depressive
psychosis, schizophrenia, typhus, malaria, encephalitis, multiple sclerosis, syphilis
or mercury toxicity used to treat it, as well as poisoning by quinine) (Felisati and
Sperati, 2010; Montes-Santiago, 2007; Vargas-Origel, 2009).
One of the most accepted theories is that he had lead poisoning. Many of Goyas
symptoms are described accurately in medical texts written by his contemporaries,
including Mitjavilas (1791) On the damage caused by lead preparations to the
human body and Ruiz de Luzuriagas (1796) Treatise on the colic of Madrid. The
first phase of asthenia, constipation, and abdominal colic was followed at variable
time by one of arthralgia, trembling hands, and weakness in the limbs with palsy
of the hands (affectations of the radial nerve) or legs (affectations of the peroneal
nerve). This sometimes culminated with hemiplegia and atrophy of the hand flexor
muscles. Other manifestations were blindness, vertigo, tinnitus, and hearing loss.
Research into the pigments used by this painter reveals a high content of lead and
other toxins; among them are white lead (lead hydroxycarbonate), Naples yellow
(lead antimonite), litharge (lead oxide), and extract of Saturn (lead acetate lead
oxide water or alcohol) (Rodrguez Torres, 1993). In adults, once absorbed via
ingestion (1015% absorption) or inhalation (near 80% absorbed), the lead enters
in blood wherein >99% is found in erythrocytes. Here, delta-ALA-D is the main
binding protein. Around 95% of the total lead concentration is accumulated in
the bones. Of the excretion, 75% is by the kidneys, and other routes are bile,
gastrointestinal secretions, hair, and sweat (Bradberry and Vale, 2007; Goldman
and Hu, 2012).
In Goyas case, in addition to possible airborne poisoning, presumably caused in
part by unloading large amounts of pigments in his workshop (e.g., more than 45 kg
of white lead from July 1792 to June 1793), there are added testimonials that he
sometimes applied the pigments directly on the canvas with his fingers. His physicians prescribed bathing in Trillo, whose waters were considered beneficial for lead
poisoning. Also in his time, white zinc was already being recommended instead of
white lead (Rodrguez Torres, 1993). However, years later, Goya himself confirmed
that he continued to use pigments rich in lead on his portrait of Duke of Wellington,
due to the scarcity of substitutes following the War of Independence in 1808. We
do not know with certainty the cause of the disease in 1819 that motivated his
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234
well-known self-portrait showing him alongside his doctor, Arrieta, although lead
should be considered a possibility (Montes-Santiago, 2007).
2.8 Mariano Fortuny

This Catalan painter of the nineteenth century shares significant affinities with Goya
and Van Gogh. Fortuny studied at the Prado and deeply admired Goya. Not only did
he imitate Goya as an engraversee the well-known Idyllbut also he borrowed
motifs and clothing. In this regard, and in a letter written while he was preparing
The Vicar, his most famous painting, he declared: Each day I realize the growing
affinity between what he [Goya] wanted and what I am looking for (GomezMoreno, 1994, pp. 365379). Van Gogh, for his part, described his admiration for
Fortunys engravings in several letters to his brother Theo.
Fortuny would succumb to his beloved but unhealthy Rome, the climate of which
would often cause him bronchitis and arthralgias. Several attacks of malaria, the latter complicated with intestinal pains from possible lead poisoningacquired by the
inveterate habit of sucking his watercolor brusheswould result in a bowel perforation that would kill him within 2 weeks. However, this did not seem to influence his
paintings, which were always associated with kind themes and bright colors. Symbolically, after a massive burial ceremony, his brushes and palettes were deposited in
his coffin, along with his final drawing, which was drawn when he was already ill and
represented the mortuary mask of Beethovena musical genius also with suspected
lead poisoning (Vives Pique and Cuenca Garca, 1994).
2.9 Vincent Van Gogh

This great nineteenth-century Dutch painter constitutes the paradigm of the genius
who has been profusely studied from medical and psychiatric points of view. He has
been diagnosed with a wide range of problems, from schizophrenia to digitalis and
absinthe intoxication, Menie`re disease, etc. (Blumer, 2002). Two of the most persistently given retrospective diagnoses are temporal lobe epilepsy, which was supported
by the great French neurologist Henry Gastaut, and manic-depressive psychosis
(Carota et al., 2005). This last diagnosis was also defended by American psychiatrist
Kay R. Jamison, in her well-known book Touched with Fire, about the psychopathology of great artists. In the case of Van Gogh, she even suggests the possibility of
having two diseases, epilepsy and bipolar disorder (Jamison, 1995; also see
Naifeh and White Smith, 2012). A stronger case for acute intermittent porphyria
has recently been presented and defended (e.g., Arnold, 2004).
Van Gogh is brought up here due to publications previously in form of a Ph.D. in
the fine arts, and more recently by comparing the artists signs and symptoms with
other cases of documented toxic encephalopathy, in both of which the author argues
that saturnism contributed to his problems and ultimate demise (Gonzalez Luque,
1997, 2012). It has been argued that along with his background of hereditary factors
(exemplified by the supposed mental illness of his brother Theo), often-cited
2 Poisoned painters
environmental factors (e.g., inadequate nutrition, excessive exposure to the sun), and
pathological factors (venereal disease, smoking, absinthe, or digitalis intoxication),
he could have had chronic lead poisoning. This, it is believed, would have contributed to his stomatitis, anemia, abdominal pains, motor paresis of the hand, as well as
to his many psychiatric symptoms (e.g., irritability, epilepsy, delusions, hallucinations and crepuscular states, sleep disorders, depression, and subsequent suicide).
The origin of this poisoning would supposedly be from the repeated ingestion of
lead-rich pigments (such as lead carbonate or chromate, seen with X-rays of his
canvas), which he favored for its distinctive yellow color (Gonzalez Luque, 1997,
2012). And lead poisoning produces a similar picture to acute intermittent porphyria.
Whether this thinking is correct or not, it forces us to be wary of simple, one-factor
explanations for a myriad of complex human behaviors.
2.10 Rubens (seventeenth century), and Dufy, Renoir,

von Jawlesnky, and Klee (nineteenth to twentieth centuries)
Epidemiological evidence linking heavy metal intoxication to suffering from rheumatic disorders is the main argument for blaming lead poisoning for the diseases of
Peter Paul (Pieter Pauwel) Rubens (probable rheumatoid arthritis), Auguste Renoir
(rheumatoid arthritis), Raoul Dufy (rheumatoid arthritis that improved notably with
prednisone), Alexey von Jawlesnky (rheumatoid arthritis), and Paul Klee (scleroderma) (Fields, 1997; Pedersen and Permin, 1988; Sandblom, 1996; Viana de
Queiroz, 2007). Indeed, the bright colors used by these artists are due to the use
of lead-rich pigments, antimony, arsenic, cadmium, cobalt, and other heavy metals.
In the case of Renoir, it is also documented that he was a heavy smoker, which
could result in direct transfer of these pigments by contamination from the cigarette.
Moreover, the preparation and ingestion of food in the studios had the potential for
contamination with dust or paint.
In any case, we should say that such ailments were a source of abundant suffering
for all of them, but that they attempted to overcome their problems with the construction of a kind of adapted splint (Rubens and Renoir) or by painting on small format
canvases (Jawlensky). Dufy was fortunate, as there was a substantial improvement in
the three final years of his life due to the use of ACTH, cortisone, and aspirin. Paul
Klee tried various treatments, including hot springs, albeit with little success.
2.11 Frida Kahlo

The hypotheses about the sufferings of this Mexican painter, especially known for
her self-portraits, much of them depicting pain, have been varied. In addition to
childhood poliomyelitis, she had a very serious tram accident at the age of 17 years
old that caused her multiple fractures and deformity of the spine, and which confined
her to bed for almost a year. To relieve her boredom, she began to paint, giving rise to
her career as an artist. However, the accident meant that she was subjected to more
than 30 analgesic or corrective operations throughout her life. She had stormy
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236
relations with her husband, the Mexican muralist Diego Rivera, and her best-known
works are Self-portraits (i.e., Broken Column), which reflected her moods, sometimes animated and sometimes depressive (Gunderman and Hawkins, 2008;
Herrera, 1983). Kahlo suffered multiple miscarriages, arterial thrombosis, amputation of a foot, and chronic pain that contributed additionally to her alcohol and opiate
habits. Thus, she has been diagnosed with fibromyalgia, antiphospholipid syndrome,
and spondylolisthesis (Martinez-Lavin et al., 2000). Her death was officially
attributed to a pulmonary embolism suffered while recovering from pneumonia,
but it is quite likely that her death was due to suicide caused by her pains and chronic
depression (Herrera, 1983; Viana de Queiroz, 2007).
The reason for bringing her up here comes from the portrait of her childhood
boyfriend, Alejando Gomez Arias. A chemical study of the pigments used showed
that, at least at that time, Frida used white lead pigment (EFE Agency, 2007). To
what extent her symptomatology was due to lead poisoning is an enigma, and more
seems to be made of this association than is warranted, but it is noteworthy that, by
1942, this pigment had already been replaced by less toxic titanium pigments.
2.12 Candido Portinari

Portinari was a Brazilian painter, son of Italian emigrants, who was born on a coffee
plantation. He is known worldwide for his grandiose murals, especially War and
Peace (19531957) painted in the headquarters of the United Nations Building in
New York City. His murals and other well-known works (Coffee, Mestizo) reflect
the most populous social groups in his country and their harsh living conditions
(Blacks, mulattos, emigrants, etc.). In 1928, he traveled throughout England, Italy,
Spain, and Paris. On his return, and from 1936 on, he painted frescoes for the
Brazilian Ministry of Education. In 1942, he painted four frescoes about Latin
American colonization for the library of Congress in Washington (Study for Discovery
of the Land, Entry into the Forest, Teaching of the Indians, Mining of Gold). In 1944,
he painted the famous frescoes and mosaics for the Church of Oscar Niemeyer in the
Brazilian town of Pampulha, Belo Horizonte. In 1950, he participated in the Venice
Biennale. In 1953, already with the first manifestations of lead poisoning, he painted
the two murals of War and Peace, in the United Nations Building (Portinari, 2012).
Portinari was diagnosed with saturnism due to the paints he used 8 years before
his death in 1962. Some of these paintswith arsenic, chrome yellow, etc.were
very similar to those used by Van Gogh. This caused major colic pains and digestive
system hemorrhages requiring hospitalization in 1954, with subsequent relapses. It is
hard to determine the influence of his disease on his paintings, because few works
reflect more dramatically the despair and death associated with the terrible drought
that ravaged the north of Brazil, and that led to the series Os Retirantes (Migrants),
painted in 1944, some 10 years before his illness was diagnosed. However, after
some time away from painting following medical advice, he tried to recover using
other types of materials and techniques, although finally and contrary to repeated
medical warnings (They forbid me to live, he remarked), he restarted using lead
3 Musician connections
pigmentsand during his final years presented repeated episodes of abdominal colic
and digestive bleeding that caused him great prostration and his premature death at
58 years old. At that time, he was preparing an exhibition, eventually posthumously,
at the Royal Palace of Milan (Montes-Santiago, 2006; Portinari, 2012).
3 MUSICIAN CONNECTIONS
For the sake of a more complete picture, the point should be made that lead
poisoning might also have affected some very famous musicians. Thus, without
overdoing it, a few words should be said about Handel and Beethoven, two master
composers who some historians have been suspected might have suffered from lead
poisoning.
3.1 Handel
Handels gout attacks have been attributed to saturnine gout. The origin of the lead
comes from the high lead content in the wines of Porto and Madeira, which were
distilled in lead pipes. However, there is still insufficient data on his purported
mental illness to be able to attribute it to some form of saturnine encephalopathy
(Frosch, 1989).
3.2 Beethoven
The arguments for lead poisoning in Beethoven are based on the finding of unusually
high amounts of lead in Beethovens preserved hair by scientists at the Pfeiffer
Research Center in the United States; on high lead concentrations found in fragments
of his skull in the U.S. National Argonne Laboratory; and on the fact that the DNA of
these hair samples and bone fragments match (Mai, 2006; Martin, 2000). The sources
for such poisoning have been attributed to the high content of lead in the Hungarian
wines that the musician drank, the repeated biting of his lead pencils, and lead-rich
medicines (e.g., expectorants) prescribed by his doctor, Dr. Andreas Wawruch.
Another source might have been the lead-rich poultices applied to punctures for
the repeated paracentesis to relieve the hydropic decompensation of his cirrhosis.
The elimination of this poison would have been hindered by his suspected liver
disease, which would have resulted in higher concentrations of the poison.
Cognitive impairments associated with chronic lead intoxication could explain,
to some extent, the compositional hardship of the composer, especially in his final
years and especially months (Reiter, 2007). However, this does not satisfactorily
explain the musician deafness. In Beethovens autopsy, conducted by his doctors
Wagner and Wawruch, a specific cause for his deafness was not found, apart from
atrophy of the auditory nerves and hardening of vestibular arteries (Montes-Santiago,
2007). In addition, the latest research performed by A.C. Todd of Mount Sinai
Hospital revealed that the lead levels in Beethovens skull were not higher those
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238
for any other person of his age. Therefore, it is concluded that, although he could
have suffered from lead toxicity, this did not substantially contribute to his death
(Barron, 2010). The dispute, therefore, about his alleged lead poisoning continues.
4 CONCLUSIONS
At the current time, and although we have advanced much with respect to understanding lead poisoning, a danger of exposure still exists (Fields, 1997; Kathuria
et al., 2012; MacDonald, 2004) with significant manifestations (Bellinger, 2011).
In 2005, 10,031 workers in the United Kingdom were exposed to significant amounts
of lead and placed under medical scrutiny (Bradberry and Vale, 2007). In Spain,
there were 91 adults hospitalizations (with 1 death) due to lead poisoning from
diverse sources during the period 20002010 (National Statics Institute, 2012).
I have the personal testimony of an artist friend (X. Vazquez Castro, b. 1951),
who informed me that he has met several colleagues intoxicated at work by lead.
In this contribution, I have reviewed the historical discovery of lead toxicity, the
evidence for some of the famous artists who might have been occupationally exposed
to high amounts of lead, and how this might have affected their lives and works.
Sometimes, art hurts, but it also can save. And some artists (e.g., Portinari) have
chosen to succumb to this disease rather than giving up their art. However, regardless
of whether they developed lead poisoning or not, the main highlighted message is
that these individuals fought against their ailments and at least partially overcame
them to bequeath us esteemed and eternal works.
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CHAPTER
Frida Kahlos neurological

deficits and her art
10
Valmantas Budrys1
Clinics of Neurology and Neurosurgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
1
Corresponding author. Tel.: 3705 2365 222; Fax: 3705 2365 220,
e-mail address: valmantas.budrys@gmail.com
Abstract
World-famous Mexican painter Frida Kahlo is an impressive example of a professional artist
whose artistic subject matter was extremely influenced by her chronic, severe illness. Many of
her best-known works depict her physical and mental suffering. She was one of those very
uncommon artists who dared to show their nude, sick body. This chapter describes and explains the biographical events and works of Frida Kahlo that are closely related to neurology:
congenital anomaly (spina bifida), poliomyelitis, spine injury, and neuropathic pain.
Keywords
neurology and art, artist, Frida Kahlo, spina bifida, poliomyelitis, spine injury, neuropathic pain
I never painted dreams. I painted my own reality.
Frida Kahlo
(quoted from Kettenmann (2003, p. 48))
1 INTRODUCTION
Mexican painter Frida Kahlo (19071954) almost attained cult status for her extraordinary life and art. Tempestuous life-long love to prominent Mexican artist Diego
Rivera, love affairs, infidelity, divorce and remarriage, several miscarriages, years
of being bedridden or wheelchair bound, intractable pain, and multiple unsuccessful
The chapter is based on: Budrys V. Neurological deficits in the life and works of Frida Kahlo. Eur
Neurol 2006; 55: 410. S. Karger AG, Basel.
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CHAPTER 10 Frida Kahlos neurological deficits and her art
operations defined this great artists works. Interest in her works has dramatically
increased, and nowadays Frida Kahlo ranks among the worlds most renowned
twentieth-century female artists. Her deeply and even painfully personalized surrealistic paintings fascinate art lovers around the world.
It is difficult to find an artist whose life and works were more deeply affected by
illness than Frida Kahlos. Her art is permeated by her struggle against medical hardships; physical and psychical suffering lays at the heart of her talent (White, 2001).
She was one of those very uncommon artists who dared to show their nude, sick body.
Many of her best-known works depict her physical suffering: her bleeding, broken,
and weeping body. Her paintings and drawings are like medical case reports. Most of
her maladies were related to neurology, and this chapter describes and explains them.
1.1 Spina bifida

One could say that neurological problems in Frida Kahlos life started even before
she was born in Coyoacan (a suburb of Mexico City) in 1907. The third daughter of a
Mexican mother and a German father was born with a congenital anomaly: spina
bifida, that is, nonfusion of the laminae of the spinal arches. This abnormality (a form
of dysraphism) develops due to a defect in the formation of the primitive neural
tube during the first 4 weeks of the intrauterine period. Depending on the severity
of the fusion defect, spina bifida may be asymptomatic or present with different
skeletal, urogenital, and neurological manifestations, including deformation and trophic disorders of extremities (e.g., clubfeet), motor paresis, and others (Golden and
Bonnemann, 1999).
What do we know about spina bifida in Frida Kahlos case? Her biographical
essays usually completely ignore her malformation or merely mention it in passing.
This is nothing unusual: as is often the case in patients with congenital defects, Frida
Kahlo preferred to blame her leg problems on some external causes that took place
during her life: poliomyelitis and trauma. Most of her doctors underestimated spina
bifida, too. However, it is very likely that almost all of her life-long spine and leg
problems are related to spina bifida.
Her doctor and friend, famous American surgeon Leo Eloesser (she met him in
San Francisco in 1930), noticed and properly evaluated Frida Kahlos spine anomaly:
X-rays showed a spina bifida, the decreased sensitivity in the lower part of her body
was characteristically compatible with this disorder. Her disability grew and various
operations to her right foot and leg made matters worse. To hide the disorder she
wore long starched Mexican shirts (quoted from Sandblom, 1999, p. 13).
There are no surviving medical documents specifying the defect, but we do have
the remarkable Frida Kahlo painting What I saw in the water (Fig. 1), illustrating
various events from her life. She was a careful documentarian of her physical condition: the paintings dominant element is a pair of feet sticking out of the bathtub
water. We can clearly see the bleeding sore between the deformed big and second
toes of the right foot, a typical defect accompanying congenital dysraphisms, including spina bifida. Big toe burning pain allegorically depicted as a burning skyscraper.
1 Introduction
FIGURE 1
Frida Kahlo. What I saw in the water, 1938.
Collection Daniel Filipacchi, Paris. # 2013 Banco de Mexico Diego Rivera Frida Kahlo Museums Trust,
Mexico, D.F./Artists Rights Society (ARS), New York.
Furthermore, it is possible that the small portraits of Frida Kahlos parents in the
painting allude to her congenital defect.
1.2 Poliomyelitis
In Frida Kahlos biographies, the earliest documented handicap is poliomyelitis
(polio). Frida Kahlo contracted polio in 1913, aged 6, and had to spend several
months in bed. The paralytic form of the disease was not badly disabling, but it
did have some unavoidable consequencesher right leg remained slightly deformed
and shorter than her left leg, so that she had to wear built-up shoes. Other children
teased her about her peg leg, and this physical defect had a considerable psychological impact on an already energetic and rebellious child.
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That polio was the only cause of Frida Kahlos leg and toe deformity is doubtful.
More likely, the poliomyelitis only heightened an already existing slight congenital
leg defect that became more notable as the child grew up, so her right leg problems
were probably due to the combined effect of both conditions.
Frida Kahlos right leg became visibly damaged. Moreover, tropical ulcers
started to appear and, together with the deformity, were a source of considerable discomfort and pain. My foot is still illtrophic ulcers, what is that? she later wrote in
her diary (Sandblom, 1999). The drawing sketched in 1931 during her 4-year stay in
the United States (where Frida Kahlo, already married to Diego Rivera, had moved to
for artistic and political reasons) depicts a bandaged, ulcerated right leg (Fig. 2).
The suggested postpolio syndrome as an explanation for Frida Kahlos malady
(Nilsson, 2004) seems less likely in the context of burning toes pain and trophic
ulcers.
From 1934 onward, several unsuccessful and unnecessary operations on her foot
and leg were performed that eventually led to gangrene and amputation of the leg
below the knee in 1953, shortly before Frida Kahlos death. Diego Riveras work
FIGURE 2
Frida Kahlo. Self-portrait, sitting, 1931.
Collection Teresa Proenza, Mexico City. # 2013 Banco de Mexico Diego Rivera Frida Kahlo Museums Trust,
1 Introduction
FIGURE 3
Diego Rivera. Sunflowers, 1943.
Collection Jacques and Natasha Gelman, Mexico City. # 2013 Banco de Mexico Diego Rivera Frida
Kahlo Museums Trust, Mexico, D.F./Artists Rights Society (ARS), New York.
painted 10 years earlier (1943) was prescient: a little boy with the face of Diego
Rivera sadly examines a doll with a detached right leg (Fig. 3).
1.3 Spine injury

In 1925, aged 18, Frida Kahlo survived a tram crash which profoundly changed her
life. Due to multiple traumas resulting from the crashher spine was injured in several places, the right (!) foot and leg broken and her pelvis badly damaged by a piece
of metal handrail (one of the reasons she was unable to carry a child to term)she
was confined to bed for 3 months. A votive picture retouched by Kahlo depicts her in
this fateful accident (Fig. 4). Despite the displacement of several vertebrae (later
documented by X-ray), the spinal cord seemingly was undamaged and no serious
peripheral nerve lesions were detected. After initially seeming to make a full recovery, Kahlo began to suffer from frequent pain in her spine and right foot. She also felt
permanently tired. An X-ray examination performed 1 year after the accident
revealed a number of displaced vertebrae. She was readmitted to hospital and for
several months had to wear plaster corsets that considerably restricted her mobility
(Kettenmann, 2003).
Being confined to bed for a long time and trying to escape from boredom and
pain, she asked her father for his box of oil paints and some paintbrushes (he sometimes painted landscapes). A special easel was arranged for her so that she could
paint lying down, and painting became her way to cope with being bedridden. I felt
I still had enough energy to do something other than studying to become a doctor.
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FIGURE 4
Frida Kahlo. Retablo, around 1943.
Private collection. # 2013 Banco de Mexico Diego Rivera Frida Kahlo Museums Trust, Mexico,
D.F./Artists Rights Society (ARS), New York.
Without giving it any particular thought, I started painting (quoted from

Kettenmann, 2003, p. 18). The trauma deeply affected Frida Kahlos life. She gave
up her medical studies and joined the Mexican Communist Party in 1928, where she
met Diego Rivera (also a member of the Communist Party) and developed a life-long
passionate love for him. One year later, they got married for the first time.
A photograph of Frida Kahlo taken by Juan Guzman 2 years before her death
(Fig. 5) shows her in the very same position in which she started off as a painter after
the fateful accident. Symbolically, the photograph frames her artistic life, which began and ended lying in bed with a special easel and a paintbrush in hand.
One of the most shattering artistic testimonies of the impact of the spinal trauma
(traffic accident) on her continuous suffering is a self-portrait with a broken column
(Fig. 6). In 1944, when Frida Kahlo painted this masterpiece, her health had deteriorated to the point where she, unable to sit upright without being tied to the back of a
chair, was encased in a steel corset to support her spine. Her spinal column, represented as an ancient pillar broken in several places, plenty of nails sticking into her
naked body (note the nails going down the right side of the blanket covering the
lower part of her body), and the fissured, dry, bare landscape became a symbol of
the artists pain and solitude. Though very impressive, this famous painting, stressing
the broken spinal column as the main source of her excruciating pain and suffering,
overestimates the role of the spinal column injury from a neurological point of view.
At least facial pain (note the nails sticked in the head) in no case could be causally
attributed to the spinal injury. Another painting (Fig. 7) depicting the deer with the
FIGURE 5
Frida Kahlo working in bed, 1952.
Photo by Juan Guzman, Mexico City. # 2013 Banco de Mexico Diego Rivera Frida Kahlo Museums Trust, Mexico.
FIGURE 6
Frida Kahlo. The broken column, 1944.
Collection Dolores Olmedo, Mexico City. # 2013 Banco de Mexico Diego Rivera Frida Kahlo Museums Trust,
248
FIGURE 7
Frida Kahlo. The wounded deer, 1946.
Private collection. # 2013 Banco de Mexico Diego Rivera Frida Kahlo Museums Trust, Mexico,
D.F./Artists Rights Society (ARS), New York.
face of the artist wounded by arrows along spine, and trunk of the tree with the broken
branch also stress the traumatic vertebrogenic cause of the pain. It is noteworthy that
medical professionals also overestimated her spinal column injuries, performing numerous unnecessary operations.
During 19461950, Frida Kahlo underwent eight operations to her spine. The
first of them was performed in the United States in June 1946, and Kahlo describes
it in a letter to her old friend Alejandro Gomez Arias: So the big operation is now
behind me. . . . I have two huge scars on my back in this shape (quoted from
Kettenmann, 2003, p. 68). The same scars from the incisions which those surgeon
sons of bitches landed me with Frida Kahlo depicted in her self-portrait named
Tree of Hope. Keep firm (Fig. 8). The shape of the two scars reveals the unusual
complexity of this first operation. The unsuccessful fusion of three vertebrae was
complicated by serious infection and began the calvary that would lead to the
end (Herrera, 2003). Figure 9 presents the X-ray picture of Frida Kahlo spine after
the operations (Prignitz-Poda, 2010).
Following her discharge from hospital after the last operation in 1951, Frida
Kahlo was confined to a wheelchair for most of the time. From then on, she regularly
had to take painkillers.
1.4 Pain
Lingering pain in the right foot, leg, and back accompanied Frida Kahlo for almost all
her life, reaching its peak in the last decade of her life. What kind of pain did she
suffer? What were the causes of this excruciating malady? Undoubtedly, neuropathic
pain has several sources.
1 Introduction
FIGURE 8
Frida Kahlo. Tree of hope. Keep firm, 1946.
Collection Daniel Filipacchi, Paris. # 2013 Banco de Mexico Diego Rivera Frida Kahlo Museums Trust, Mexico.
Congenitally and probably as a consequence of the polio infection, Kahlos crippled leg and toe deformity were the source of recurrent foot skin sores, infections,
chronic ulceration (finally ending in foot gangrene and amputation), and pain.
Her congenitally abnormal spinal column, leg deformity, the displacement of several
vertebrae after the traffic accident, and adynamic spinal muscle atrophy due to prolonged use of orthopedic corsets led to spinal column instability, and chronic asymmetrical overstretching of the spinal muscles and back pain.
Another important source of the chronic pain in her right leg directly relates to the
traffic accident in 1925. The documented displacement of several vertebrae could be
and probably was a cause of early posttraumatic albeit transient radicular pain.
Interestingly and essentially, the obvious worsening of the pain in her spine and right
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FIGURE 9
X-ray picture of Frida Kahlo spine, 1954.
Museo Frida Kahlo, Mexico City. # 2013 Banco de Mexico Diego Rivera Frida Kahlo Museums Trust, Mexico.
leg was documented only several months after an initially seemingly full recovery.
Together with the other factors, this strongly suggests posttraumatic causalgia (complex regional pain syndrome type II) or another closely related syndrome, reflex
sympathetic dystrophy (RSD; complex regional pain syndrome type I). The principal
difference between these two syndromes is a peripheral nerve injury in the case of
causalgia. The fact that no clear signs of peripheral nerve injury after the accident are
documented argues in favor of RSD. The pathogenesis of RSD is not completely understood. Though RSD is more common in midlife, it occurs at all ages and women
account for about 70% of cases (Evans and Wilberger, 1999). An individual predisposition to RSD also plays a role. RSD usually develops within days or months after
even minor traumatic tissue injury, bone fracture, surgical intervention, or prolonged
immobilization, and Frida Kahlo had experienced them all. RSD is a syndrome with
variable major components of burning, aching, shooting pain, autonomic dysfunction, edema, dystrophy and atrophy of the mostly distal part (hand, foot) of the affected extremity, and sometimes restricted movement. The pain usually spreads
diffusely from the site of the injury, potentially involving both or even all four extremities and is commonly associated with hyperalgesia, allodynia, and hyperpathia.
RSD patients are often depressed and anxious (Evans and Wilberger, 1999;
Schwartzman, 1996). In summary, Frida Kahlo was affected by virtually all of these
signs, and a diagnosis of RSD as the key source of her permanent intractable pain is
1 Introduction
very credible. Different kinds of conservative and surgical treatment usually have
(and had) an only partial and short-lived effect on her.
Her intractable pain provoked numerous unsuccessful and unnecessary operations. The main medical principleprimum non nocerewas obviously ignored
and had serious consequences. The many operations performed on her foot, leg,
and spine undoubtedly increased her neuropathic pain, becoming extremely severe
and devastating in the last years of her life. Another kind of neuropathic pain,
phantom-limb pain after the leg amputation in 1953, cannot be excluded either.
A sketch from the same year in Frida Kahlos diary (Fig. 10) supports this possibility:
severed below the right knee, the leg radiates stabbing and shooting pain. Despite
various treatments, this kind of pain often is also intractable.
Distressing life events (years of being bedridden or wheelchair bound, her husbands continuous infidelity and devastating miscarriages) undoubtedly lowered her
pain threshold and was an important psychogenic pain component.
FIGURE 10
Page from Frida Kahlos diary, 1953.
Museo Frida Kahlo, Mexico City. # 2013 Banco de Mexico Diego Rivera Frida Kahlo Museums Trust, Mexico.
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252
Fibromyalgia as the source of the persistent widespread pain accompanied by

chronic fatigue and emotional overtones was suggested (Martinez-Lavin et al.,
2000). This disputed syndrome seems likely though cannot explain obviously neuropathic pain components related to the right leg problems and dominating the clinical picture.
With the pain worsening in the last years of her life, Frida Kahlo became exhausted,
depressed, and increasingly dependent on strong painkillers (pethidine and morphine).
Under their influence, her artistic ability started to deteriorate. Her last paintings
are less precise in execution, painterly dry and overtly declarative. She lost interest
in life and began to contemplate suicide. They amputated my leg six months ago, they
have given me centuries of torture and at moments I almost lost my reason. I keep on
waiting to kill myself . . . Never in my life have I suffered more. The last entry in her
FIGURE 11
Frida Kahlo. Marxism will give health to the sick, around 1954.
Museo Frida Kahlo, Mexico City. # 2013 Banco de Mexico Diego Rivera Frida Kahlo Museums Trust,
1 Introduction
diary reads: I hope the exit is joyful . . . and I hope never to come back . . . Frida.
(quoted from Kettenmann, 2003, p. 84). On July 13, 1954, she unexpectedly died from
pneumonia. Pulmonary embolism was diagnosed as the official cause of death. The
suicide (albeit unproved) cannot be ruled out.
1.5 Passion
Passion, of course, cannot be directly attributed to neurology, let alone to a neurological disorder. Kahlos passion, however, could sometimes reach excessive levels,
as can be glimpsed from her immense faith in Communism, especially during her last
years. In one of the last paintings Marxism will give health to the sick (painted
around 1954) (Fig. 11), Frida Kahlo depicts herself standing with crutches thrown
FIGURE 12
Frida Kahlo. Diego and I, 1949.
Collection Sam and Carol Williams, Chicago. # 2013 Banco de Mexico Diego Rivera Frida Kahlo
Museums Trust, Mexico, D.F./Artists Rights Society (ARS), New York.
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254
away in belief that right political conviction can free her (as well others) from pain
and suffering. Another very last painting left unfinished at her death in 1954 depicts
portrait of Stalin.
The remarkable self-portrait with Diego Riveras face on her forehead named
Diego and I (Fig. 12) illustrates her other life-long passion: obsessive love for
Diego Rivera who, like a spider in its web, had trapped his prey and immensely influenced her life. This excerpt from Frida Kahlos diary summarizes her thoughts on
Diego Rivera: Diego: the beginning, builder, my child, my boyfriend, painter,
my lover, my husband, my friend, my mother, me, the universe (quoted from
White, 2001, p. 26).
2 CONCLUSION
Frida Kahlo is an impressive example of an artist whose entire life and creativity was
profoundly affected by chronic, severe illness; a professional artist whose artistic talent was probably genetic (her father was a casual painter and an engineer) but whose
subject matter arose from psychical and physical suffering, and yet was never overcome by it. Her work is the best illustration of her life, thoughts, and diseases. She
documented them well. We just need to look at them, decipher, and admire.
References
Evans, R.W., Wilberger, J.E., 1999. Reflex sympathetic dystrophy and causalgia. In:
Goetz, C.G., Pappert, E.J. (Eds.), Textbook of Clinical Neurology. Saunders, Philadelphia,
pp. 10531054.
Golden, J.A., Bonnemann, C.G., 1999. Neural tube defects. In: Goetz, C.G., Pappert, E.J.
(Eds.), Textbook of Clinical Neurology. Saunders, Philadelphia, pp. 514518.
Herrera, H., 2003. Frida: The Biography of Frida Kahlo. Bloomsbury, London.
Kettenmann, A., 2003. Frida Kahlo. Koln, Taschen.
Martinez-Lavin, M., Amigo, M.C., Coindreau, J., Canoso, J., 2000. Fibromyalgia in Frida
Kahlos life and art. Arthritis Rheum. 43, 708709.
Nilsson, S., 2004. Frida Kahlo suffered probably of post-polio syndrome. Lakartidningen 101,
36963697 (in Swedish).
Prignitz-Poda, H., 2010. Frida Kahlo retrospective. Prestel, Munchen (in German).
Sandblom, P., 1999. Creativity and Disease, 12th ed. Boyars, New York.
Schwartzman, R.J., 1996. Reflex sympathetic dystrophy and causalgia. In: Evans, R.W. (Ed.),
Neurology and Trauma. Saunders, Philadelphia, pp. 496510.
White, A. (Ed.), 2001. Frida Kahlo, Diego Rivera and Mexican Modernism. The Jacques and
Natasha Gelman Collection. National Gallery of Australia, Canberra.
CHAPTER
Neurological diseases
in famous painters
11
Bartlomiej Piechowski-Jozwiak*,{,1, Julien Bogousslavsky{,}

*
Department of Neurology, Kings College Hospital, London, UK

Department of Neurology, The Medical University of Warsaw, Warsaw, Poland
{
Genolier Swiss Medical Network Neurocenter, Clinique Valmont, Montreux, Switzerland
}
Center for Brain and Nervous Disorders (Neurocentre), Genolier Swiss Medical Network,
Genolier, Switzerland
1
Corresponding author. Tel.: 0044 7954556776; Fax: 0044 2030025669,
e-mail address: bartlomiejpj@gmail.com
{
Abstract
Visual art production involves multiple processes including basic motor skills, such as coordination of movements, visual-spatial processing, emotional output, sociocultural context, and
creativity. Thus, the relationship between artistic output and brain diseases is particularly complex, and brain disorders may lead to impairment of artistic production in multiple domains.
Neurological conditions may also occasionally modify artistic style and lead to surprisingly
innovative features in people with an initial loss of creativity. This chapter focuses on anecdotal reports of various neurological disorders and their potential consequences on works produced by famous or well-established artists, including Carl Frederik Reutersward, Giorgio de
Chirico, Krystyna Habura, Leo Schnug, Ignatius Brennan, and many others.
Keywords
visual artists, artistic production, change of artistic style, painters, stroke, dementia, epilepsy,
head trauma, migraine
Recently, the relationship between visual art and brain function and disease has raised
considerable interest among neurologists, neuroscientists, and artists themselves
(Bazner and Hennerici, 2007; Bogousslavsky, 2005, 2006; Chatterjee, 2004;
Heilman, Part 1, Chapter 2, Volume 204). Indeed, brain disease may lead to change, dissolution, or even an emergence of artistic creativity. Visual artistic production is often
impaired in individuals with focal or generalized brain disorders, be they either acute
or slowly progressive. On occasion, however, the development of a neurological disorder may be associated with new, special approaches to art production, and may even
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CHAPTER 11 Neurological diseases in famous painters
become an artistic theme in itself. In this chapter, which complements the chapter on
Focal cerebral lesions and painting abilities by Mazzucchi et al. Part 1, Chapter 4,
Volume 204, we focus on the effects of stroke, epilepsy, migraine, dementia, and head
trauma in recognized and famous painters, who form a particularly spectacular group
of subjects with challenged creativity.
1 STROKE
Stroke refers to a focal neurological deficit of sudden onset caused by a localized cerebrovascular event. In order to address a potential link between focal brain damage
and change in artistic output, the concept of right versus left brain hemisphere specialization may be useful. This concept was introduced in the nineteenth century, probably
starting with the work of Marc Dax and Paul Broca, and was subsequently developed in
the twentieth century, for example, by Roger W. Sperry, the Nobel Prize awardee in
1981 (see the Part 1, Chapter 1, Volume 204, by Zaidel on the split brain literature).
Based on Sperrys work and that of others, it is commonly thought that the right brain is
mainly visual and processes information based on intuition. Moreover, it first looks at
the whole picture rather than at details. On the other hand, the left brain is more verbal and first catches individual items, which are later put together to get a more global
picture (Sperry, 1966). Most recent studies on artists with brain damage show that both
right- and left-sided hemispheric lesions may be associated with changes in pictorial
activities, but that they tend to be different in nature (Annoni et al., 2005; Bazner and
Hennerici, 2007; Mazzucchi et al., this volume).
1.1 Right-hemispheric strokes

Bazner and Hennerici (2007) reported on a series of 13 painters, who had righthemisphere strokes leading to changes in their artistic production. This series included quite famous artists such as Lovis Corinth and Otto Dix. They found that,
in the majority of cases, the emotional impact of stroke was prominent, usually with
depression, sometimes with significant suicidal ideation and attempts. Some artists
ended their professional careers, in particular when they had to deal with severe
stroke-related disabilities. Poststroke artwork was mainly exemplified by negative
visual signs, such as field loss and spatial hemineglect. In some artists, these deficits
were compensated by working on wider representation landscapes. Righthemisphere signs, such as prosopagnosia, were reflected in facial distortions and loss
of self-resemblance in self-portraits. Spatial perception disturbances led to changes
in three-dimensional arrangements of painting composition. Positive righthemisphere phenomena, such as delusions and hallucinations, were also directly
included in some paintings.
Anton Raderscheidt (18921970), one of the 13 artists described by Bazner and
Hennerici, was a member of the Magic Realism movement (Magischer
Realismus), where painting comes close to photography, with emotional content reduced to a minimum. In 1967 at the age of 75 years, he suffered a stroke followed by
1 Stroke
left-sided homonymous hemianopia, hemineglect, spatial disorientation, and

severe prosopagnosia. The stroke changed his working pattern, as he became preoccupied with self-portraits, in order to combat his spatial hemineglect, as he himself
reported. He stated that he wanted to see correctly again, and to regain control over
his perceptual and painting abilities (Bazner and Hennerici, 2007).
Reynold Brown, born in Los Angeles in 1917 (died in 1991), was another visual
artist struck with a right-hemisphere stroke. Before the stroke, he had initially focused on figures, comics, cartoons, posters, and head drawings, later switching to
portraits, harbor scenes, and landscapes. His stroke left him with major left-sided
hemiparesis, hemianopia, and hemineglect. The complicating factor here was that
he previously had been drawing with his left hand. After the stroke, he only partially
recovered his motor function and switched to painting with his right hand.
He struggled with left hemianopia, which remained a major handicap for his painting. Indeed, he would leave blank the hemianopic part of the canvas until the end
stage of an ongoing art work. Hence, his paintings became heavily loaded on the right
side and just thinly covered on the left side. The impact of hemineglect was similar to
that of Raderscheidt, again with distorted facial features (Bazner and Hennerici, 2007).
The involvement of right cerebral hemisphere in poststroke artistic output
changes was also demonstrated in a prominent Polish painter, Krystyna Habura, born
in 1928 in Warsaw. She considered herself ambidextrous, and this was an important
part of her artistic style, since she painted with both hands: She used to draw her main
figures and subjects with her left hand, while she completed fine details with the right
hand. She was also able to write with both hands, although spontaneous writing was
with her right hand. In her generation, left handedness was not tolerated in Polish
schools, and children were forced to switch to right-hand writing. She searched for
new artistic styles through experiments with new forms and ideas, being interested
in portraits ranging from realistic reproduction to surrealistic stylization (Fig. 1).
Habura worked in bouts of exhausting creative spells, when she was barely sleeping, and smoked and drank heavily. Her lifestyle with excessive smoking and alcohol
abuse led to the worsening of her hypertension and made her a high-risk vascular
patient. She was 61 when she developed a right middle cerebral artery territory infarction, which involved the frontal, parietal, and temporal lobes. She had left hemiparesis, aphasia with slow speech output, and difficulties with spatial orientation.
The patient herself emphasized a particular manifestation of a creativity block, which
she named creative aphasia. This corresponded to an inability to imagine anything,
with a sensation of emptiness in the brain. She actually thought that she had lost her
creative gift. She would sit in front of the canvas, feeling that her head was empty,
being totally unable to paint.
She made a drawing of her therapist with clawed left-hand standing above an
open book in which she drew two clasped hands, one of them being clawed as well
(like when she had her own left hand clawed after stroke) (Fig. 2). This appeared on a
painted letter, which included the message in which she wanted her case to be
reported. Haburas creative aphasia was a very disturbing manifestation, as if
her explorativeintuitive premorbid way of working had vanished.
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FIGURE 1
Krystyna Haburas premorbid painting (Elfik).
With permission, Pachalska et al. (2008a).
Nevertheless, she remained motivated and optimistic, claiming that a wounded

artist must be healed by art. She underwent intensive art therapy based on
Neurolinguistic Reprogramming of Images, starting from symbolic drawings
(painted letters), and she eventually returned to active artistic production.
Her first poststroke drawings, however, lacked detailed features and were ambiguously articulated, which was compatible with right-hemisphere damage. Later, she
developed a striking technique, where she used her right hand for details and her left
hand for outlines. Overall, her painting style changed toward more sketch-like and
logically unconnected items (Fig. 3). Drawing lines became less strong, sure, and
crisp. Her interest shifted more toward themes associated with disease and suffering.
Her own view of the poststroke recovery process was that she had become a better
human being through her disease and its consequences on her creativity (Pachalska
et al., 2008a).
1.2 Left-hemispheric stroke

1.2.1 Carl Frederik Reutersward
A very spectacular change in artistic output occurred with Carl Frederik Reutersward,
a right-handed painter and sculptor. Reutersward was born in Sweden in 1934 and went
to Paris to become a student of Fernand Leger. Later during his artistic career, he
1 Stroke
FIGURE 2
Krystyna Haburas painted letter. The text on the open book reads: Aphasia is curable.
Is creative aphasia curable, too?
moved to Switzerland. He was fluent in four languages: Swedish, German, French, and
English. Reutersward had a cerebral hemorrhage involving the left internal capsule and
lenticular nucleus with right hemiplegia, hemisensory loss, and a severe global aphasia
that was prominent in all four languages, although slightly less in Swedish, his mother
tongue. After 6 months, he was still hemiplegic and globally aphasic, and neuropsychological assessment showed moderate associative visual agnosia and executive dysfunction. However, he immediately went back to drawing, using his left hand, though
very awkwardly, while he was still hoping that he would recover strength on the
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FIGURE 3
Haburas poststroke painting Grey Hawk, Chief of the Witkowice Tribe; an oil portrait made
by Habura during art therapy signed Sick Habura.
affected side. But when he realized that he would not sufficiently improve to resume
painting with his right hand, he started a very creative period using his nondominant
left hand.
It took him a year of strenuous exercise to reach the point where he felt ready to
match his previous artistic activity, including drawing, painting, and sculpture.
Reutersward himself emphasized the acquisition of a new artistic creativity using
his left hand. As reported by Colombo-Thuillard and Assal (2007) and later
confirmed by Reutersward to one of the authors of the present chapter (J.B.), he described this change as a Gulliver-like experience, which forced him to discover a
novel artistic world. Despite his persisting aphasia, Reutersward used the following
words to describe this phenomenon: . . .its marvellous. . .its not a handicap. . .the
left hand is the dreamer. . .the soul is localized in the left hand.
Art specialists acknowledged a dramatic change in style as his production became
more emotional, free, and intense, without any loss in technical skills. Reuterswards
work was indeed assessed by art critics a few years after the stroke, with an emphasis
on several changes, which did not lead to any loss of artistic quality, but to new rise in
fresh vitality, expressivity, and psychic intensity (Figs. 4 and 5).
FIGURE 4
Portrait of F. Leger before the stroke.
With permission, Colombo-Thuillard and Assal (2007).
FIGURE 5
Portrait of P. Sandblom painted after stroke with the left hand.
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FIGURE 6
Sketches of nonviolence before (A) and after (B) stroke.
Moreover, Reutersward also developed a playful side, which had not been apparent before his stroke. His pivotal sketches of the famous pistol sculpture now in front
of the United Nations Organization building in New York (see http://www.flickr.
com/photos/loic_brohard/3785829589/), emphasizing nonviolence, dated back from
before his cerebral hemorrhage. These drawings had been made with heavy and decisive strokes, resulting in frank, linear shapes. But after his illness, the drawings of
the lethal weapon lost their crudeness, and now made it look more like a fancy toy
(Fig. 6). Reutersward represents a very unique case of an intriguingly evolving
change in artistic style after a severe stroke with poor recovery, together with a
persistent change of the painting hand.
1.3 Posterior circulation strokes

Posterior circulation territory includes the thalamus, paramedian aspect of temporal
lobes, and occipital lobes. This particular vascular territory is critical for artistic production, in relation with visual sensory processing, spatial awareness, and orientation. The frequency of posterior circulation strokes is lower than carotid territory
ones, with functional outcome depending on stroke location. Worst cases are
1 Stroke
associated with basilar artery thrombosis. In case of basilar bifurcation embolism,

also known as top-of-the-basilar syndrome, an interesting mixture of visual and
cranial nerve manifestations may develop. In addition, vivid hallucinations, dreamlike states, and amnestic dysfunction may occur (Piechowski-Jozwiak and
Bogousslavsky, 2009). The influence of the latter may of course be significant for
visual artistic production.
Annoni et al. (2005) reported on two professional Swiss painters. One of them
(artist not named) was an ambidextrous man, who had started painting at the age
of 50. He focused his artistic production on Swiss landscapes, his artistic style being
defined as figurative impressionism by critics. At the age of 71, he had a transient
ischemic attack with right hemisensory loss, hemiataxia, and hemiparesis caused by
a left thalamic infarction involving the paramedian (thalamoperforate) territory, as
revealed by magnetic resonance imaging (MRI). The etiology of the stroke was
probably cardioembolic, due to atrial fibrillation. On formal neuropsychological
evaluation, he showed impaired executive functions with phonological perseverations, lack of precision in semantic and mental imagination tasks, moderate
executive dysfunction, and minimal emotional control impairment. He resumed
painting 2 weeks after his stroke, but now he started using both hands for painting,
which was new. There was no issue with the quality of his paintings, and he continued selling them as previously. However, family members and art critics noticed a
change in his style. Apparently, his works had become more realistic, and he was
concentrating more on color intensity than on shape and details and also more on
a geometric organization of space. When asked about his new style, the artist
acknowledged a new attentional bias toward the hidden beauty of nature, with
more spontaneous output than before his stroke. By doing so, he said that he hoped
to explore the world more thoroughly, and to get to the true roots of nature.
The second artist studied by Annoni et al. was a 57-year-old right-handed lithographer (artist not named), who had learnt painting by himself. His art was naive and
shared features with primitive expressive styles. This patient had a right occipital
infarction involving the V1 and V2 cortical areas, with sudden onset of right superior
quadrantanopia and autoscopic manifestations (he saw himself in a supine position
lying on the floor with his head turned to the left side). His brain MRI showed an
acute infarct in the V1 and V2 occipital cortex. The most likely cause of his stroke
was paradoxical embolus through a patent foramen ovale. After the acute phase,
visual disturbances evolved toward right-sided upper quadrant paracentral scotoma
and dyschromatopsia in the remaining right upper visual quadrant. Neuropsychological assessment showed distractibility and perseverations in figural fluency compatible with executive dysfunction.
This artist resumed painting 4 weeks after his stroke. Both his family members
and art collectors noticed some changes in his style. He increased the use of single
colors with more stylized figures, while background spaces became more geometrical, with blind spots demonstrating his visual scotomata. He also indicated that,
before his stroke, his inspiration had been coming to him well before he started
painting, while after the stroke, it was coming during his work.
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The authors emphasized that these two painters did not appear to have lost any
technical skills from their ischemic strokes. Indeed, they even developed new stylistic features with renewed artistic output. These changes could be attributed to alterations of executive functions, emotional regulation, and semantic capacities. The
interesting fact is that both suffered from posterior cerebral artery territory
infarctsthe first artist in the territory of perforators from the stem of the artery
and the second one in the territory of its cortical branches. This remains anecdotal,
but it underlines the effect of basal ganglia and cortical damage in artistic production
(Annoni et al., 2005).
In another interesting study, Smith et al. (2003) reported the case of a well-known
artist with stroke, who had embolic basilar artery occlusion with top-of-the basilar
syndrome. The patient showed visual field defects and visual agnosia related to bilateral occipital cortex infarction. After her stroke, her works changed in relation to a
selective omission of the left lower quadrant part of her pictures, which looked like
they were physically clipped out of the whole painting (Smith et al., 2003).
1.4 Conclusion
From these anecdotal reports on visual artists with stroke, we may conclude that there
is no unified pattern of a relationship between disease and artistic production. There
may be changes in artistic style related to poststroke weakness leading to a switch of
the painting hand, with modification in painting techniques. Visual field defects and
hemineglect may influence spatial image processing. Changes in emotional content
may also become visible through different coloring patterns and topic selection.
2 DEMENTIA
There are multiple reports on the influence of dementia on artistic creativity
(Chatterjee, 2004).
2.1 Lewy body dementia

One dramatic example involved Mervyn Peake, born of British parents in Kuling
(now Lushan) in Jiangxi Province of central China in 1911 (he died in 1968), an accomplished British writer and visual artist. Peake developed parkinsonism, progressive cognitive decline, visual hallucinations, and paranoid delusions. His initial
symptoms started in 1956, and they were attributed to Parkinson disease or postencephalitic parkinsonism with Alzheimer disease. The course of his disease was
slowly progressive with periods of lucid intervals, when he would produce works
showing figures with dunce caps or pointed heads expressing fear and apprehension.
He portrayed elements of visual hallucinations and also included contents of his delusions into poems. His clinical state was very fluctuating, and the most likely diagnosis was Lewy body dementia (Sahlas, 2003).
2 Dementia
2.2 Alzheimer disease

2.2.1 Willem De Kooning
Another example of artistic output being affected by neurodegenerative dementia
(probably Alzheimer disease) is the case of the famous Dutch-American abstract expressionist Willem De Kooning, born in 1904 in Rotterdam and who died in 1997 in
East Hampton, Long Island. He was in the main stream of abstract expressionism
together with Mark Rothko, Jackson Pollock, Franz Kline, and Arshile Gorky in
the 1940s. The theme of artistic production was chaos with emphasis on the form.
He gained the title of most expensive living painter during his lifetime
(Stephens et al., 2004). The hallmark of his work was a figure-ground ambiguity,
where background items would overlap with forefront figures, making these appear
in a foreground, which in turn seemed to overlap with dripping lines of paint positioning them again more backward. When his disease started manifesting itself
around 1981, De Koonings painting style changed into clear, graphic, and abstract
compositions with an emphasis on line, form, and simple colors. This change in output was considered by art critics as a new creative development toward a more sensual and lyrical content (Storr, 1995).
Another interesting case is that of an authoritative Italian painter, who developed
Alzheimer disease at the age of 80. While she used to draw realistic landscapes, with
the progression of disease, her drawings became more simplified and schematic in
their graphical outlines (Canu et al., 2002; Chatterjee, 2004).
2.3 Frontotemporal dementia

Budrys et al. (2007) reported on a tragic case of an established female artist who died
with a rare variant of frontotemporal dementia (Pick disease) known as neuronal intermediate filament inclusion disease (NIFID). She had initially presented with forgetfulness and behavioral changes, with apathy, loss of drive, and emotional
flattening at the age of 38. On neurological assessment she had aphasia, amnesia,
echolalia, verbal and motor perseverations, impairment of abstract cognition and
spatial/time disorientation. Her symptoms were progressive and she became unable
to cope with her hygienic needs and to feed herself, and she lost her speaking ability.
She had rigidity, hypokinesia, paraparesis, and right-arm weakness. Just before
death, she stayed in bed with a fixed fetal position. Eventually, she died from
complications. Neuroimaging confirmed progressive frontotemporal and caudate
atrophy. Gross pathological examination showed degeneration of corpus striatum,
thalamus, and pyramidal layers of the hippocampi. Detailed histopathological
examination confirmed the NIFID variant.
Before she became unable to paint, her art had transformed from purely abstract
compositions into a concrete and symbolic style, with representations of aggression.
Soft, elegant colors with predominantly bluegreen spectra changed into rough and
dry taints with pure red, blue, and yellow. She also used an unusual red color, which
was interpreted as an expression of inner fear and a plea for help (Budrys et al., 2007).
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2.4 Alcoholic dementia

2.4.1 Leo Schnug
Sellal (2011) described the case of Leo Schnug, a well-known painter born in 1878
near Strasbourg (died in 1933). He was famous for paintings devoted to historical
themes from the Middle Ages and the French Revolution. His artistic style was expressive, full of colors, vivid, and animated. Over the course of his career, he developed progressive behavioral problems, with strong alcoholic intake, which prompted
a self-referral to a mental hospital. On examination, he had generalized cerebellar
ataxia, with disorientation, and complex visual (big beasts) and auditory hallucinations accompanied by persecution delusions.
His artistic production was directly affected, in part because tremor changed his
brush strokes. He adjusted with short and repetitive strokes to overcome the tremor,
but he significantly lost precision. Moreover, the topics of his paintings switched
from historical subjects to fearful images of his own death, with frightening, grotesque characters and beasts on the background of dark, threatening landscapes
(Sellal, 2011).
Cognitive disorders may affect artistic production in many ways. As these conditions lead to deterioration of higher cortical functions (sensory processing, praxis,
executive functions, and memory), they directly impact on the artistic output. In addition to this, the positive neurological symptoms such as hallucinations may be
translated into pictures. The emotional aspect linked to fear of dying may also become an important theme and message hidden in the picture. Careful consideration
of artistic output in patients with dementia but without premorbid artistic skills may
be a way to gather more comprehensive data, as built on a larger and art na f sample.
2.5 Migraine
2.5.1 Ignatius Brennan and Sarah Raphael
Migraine is one of the most common neurological disorders and one of the most frequent primary headaches. It imposes a significant burden on the affected individuals,
society, and health-care system. As the etiology and pathophysiology of migraine are
not well understood, treatment is largely symptomatic. Despite an important progress
in biomedical sciences, the pathogenesis of migraine remains a matter of dispute.
The diagnosis of migraine is based on occurrence of headaches, warning symptoms
(also known as auras), nausea, vomiting, photophobia, phonophobia, and also focal
neurological deficits ranging from focal (monocular) to more generalized (binocular)
loss/impairment of vision, one-sided weakness, and speech disturbances (Charles,
2013; Piechowski-Jozwiak and Bogousslavsky, 2006).
Migraine is another example of a nonfocal central nervous system disease
influencingand sometimes triggeringartistic production (Fuller and Gale,
1998). One sees mainly the effect of the positive signs of migraine such as photopsias, which are bright lights, zigzag lines, halos, etc., occurring in the visual field.
It has been the curse or the blessed inspiration of many painters.
2 Dementia
The art work of Ignatius Brennan (born in 1949 in the United Kingdom), an Irish
painter, was strongly affected by migraine auras. Migraine auras differ from complex
partial seizures hallucinations, in that the former are more inclined toward the surreal
(Chatterjee, 2004). Indeed, Brennan has been best known for his surrealistic drawings and sculptures. He suffered from very complex visual auras with visual hallucinations of cloudy shapes, geometric figures, zigzag lines, and tunnel and
kaleidoscope vision. Moreover, he had spells with loss of three-dimensional vision,
and body image perception disturbances with delusional duplication of extremities.
These visual phenomena were also accompanied by emotional changes, notably fear.
Brennan incorporated these features into his artistic production, which proved to
be rather successful for his career. In some of his works, such as Always Look on the
Bright Side of Life, he deliberately used scotomas and zigzags to symbolize the unknown and disturbing. He added a symbolical meaning to zigzag lines, which represented the experience of a whole being broken up. His auras constituted the visual
and artistic vocabulary that he was using both consciously and subconsciously
(Chatterjee, 2004; Podoll and Robinson, 2000).
Sarah Raphael, a UK-born painter (19602001), suffered from prolonged migraines. She had continuous headaches for around 18 months in a row, which made
her overuse pain killers. She had started a career as a figurative and portrait painter,
but later she shifted toward abstraction. Her migraines impacted her artistic production in three ways. She started painting strips that were not requiring too much effort
from her, thus letting her work in-between severe attacks in a staccato pattern. She
also incorporated visual aspects of migraine auras in her paintings. In addition,
she became extremely sensitive to smell, as components of her oil paints were triggering her migraines. This is why she needed to switch to odorless acrylic paints,
which she considered flat. It was said that she developed a migraine friendly
painting style. In her strip series produced during her 18-month-long headache,
she painted objects with superimposed photopsia-like zigzag lines and scotomas
(Podoll and Ayles, 2002).
The results of the analysis of the Migraine Art Competition are in agreement with
these individual artists experiences. From all of the artworks submitted, over twothirds showed spectral appearances and one-half showed fortifications. Less frequently, there were artistic alterations related to visual loss and mosaic vision
(Wilkinson and Robinson, 1985). These findings give solid grounds for considering
migrainous positive visual phenomena as a significant component of artistic output
(Chatterjee, 2004; Wilkinson and Robinson, 1985).
2.6 Epilepsy
Impairment of artistic creativity can also be encountered in episodic paroxysmal disorders, such as epilepsy, but as with migraine, certain clinical manifestations may
also be useful to artists. Epilepsy is one of the most prevalent neurological conditions
affecting mankind. Epilepsy is divided into subtypes based on the classification of
epileptic attacks into generalized and partial. In generalized attacks, the whole brain
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is affected at the same time, leading to generalized convulsions or nonconvulsive

state of unconsciousness. Partial seizures affect a restricted part of the brain and
may have a form of olfactory, gustatory, auditory hallucinations, involuntary movements spreading over one side of the body. These symptoms may be accompanied by
partial clouding of consciousness (complex partial seizures) (Schachter, 2006).
2.6.1 Franco Magnani

The Italian painter Franco Magnani (born in 1934 in Pontito, a small town in
Tusccany, Italy) had a severe febrile illness when he was 31, with complications
including delirium and seizures. After this illness, his personality changed
dramatically: he became preoccupied by Pontito, which reminded him of his childhood, and which he started painting over and over in a repetitive way. Besides his
vivid dreams of Pontito, while awake he experienced flashes with images of this
town suggestive of partial seizures, which apparently triggered and directed his
new artistic inspiration (Chatterjee, 2004; Sacks, 1995).
2.6.2 Giorgio de Chirico

Giorgio de Chirico (18881978), a Greek-born Italian painter, remains one of the
leading artists of the twentieth century, mainly for his metaphysical compositions
in the 1910s (Merjian, 2010). He suffered from recurrent neurological symptoms
with abdominal crises, pain, and vomiting. These manifestations have occasionally
been attributed to migraine with visual auras, but complex partial seizures seem more
likely, possibly in association with malaria crises (Bogousslavsky, 2010). De Chirico
had both negative and positive visual symptoms. He described a shadow of a cock
obstructing his visual field, which was an interesting mixture of negative (i.e., the
shadow) and positive (i.e., the silhouette of a cock) visual symptoms.
He was indeed fascinated by visual phenomena, and he described them very
colorfully as delightful ribbons, flames without warmth, thrust forward like thirsty
tongues, disturbing bubbles . . . . De Chirico described these visions as a spiritual
fever (cited by Fuller and Gale, 1998). He regularly incorporated visual geometric
patterns (distortions, metamorphopsias) and blanks (scotomas) into his own artistic
production (Bogousslavsky, 2010; Chatterjee, 2004; Fuller and Gale, 1998).
Schachter collected a series of paintings by contemporary artists with epilepsy
(2006). He showed that epilepsy tends to affect artistic production, mainly in conjunction with seizure experiences, psychiatric comorbidity (such as depression
and anxiety), and psychosocial aspects (such as restriction of independence, isolation, stigma). The perceived content of seizures and the impact of epilepsy on the
artists life are often transferred into specific artistic representations. Examples include a storm associated with seizures, body image distortions, interruption of time,
fatigue, loss of touch with reality, embarrassment, and depression. In addition,
certain artists highlighted societal aspects of a chronic neurological condition, such
as isolation, at family, or social levels (Schachter, 2006).
2 Dementia
2.7 Head trauma

It is well known that closed head injury can lead to various focal and generalized
neurological disorders. There are, however, only few reports on the potential changes
in artistic output following head injury. Pachalska et al. (2008b) reported on a wellestablished painter (WW, born in 1940), who had schizophrenia. As a part of psychiatric rehabilitative therapy, he received art therapy, during which he developed
sophisticated painting skills, enabling him to become a successful painter widely recognized by critics.
He portrayed his own visual hallucinations (Fig. 7), mainly using recollected contents rather than active/ongoing visions, when painting. One day, while actively hallucinating and feeling able to fly with wings, he rushed into a street and was knocked
down by a car. He was unconscious for 5 h, with a brain contusion involving subcortical anterior frontal areas, and with subsequent asymmetric frontal lobe atrophy predominating on the left side (Fig. 8).
After the injury, his painting style changed with a significant reduction in the hallucinatory content. The subjects became more traditional with a selection of hues
now dominated by blunt and earthy colors (Fig. 9).
He also showed signs of perseveration in repeating the reproduction of the same
objects (Fig. 10).
Over time, his psychiatric condition deteriorated and 10 years after his accident,
he had another psychotic burst, also with progressive memory disorder. On detailed
neuropsychological assessment, he showed visual memory deterioration, executive
dysfunction, and hemispatial neglect (Fig. 11).
His artistic output change is rendered particularly complex and difficult to
interpret, given the superimposition of neurological and psychiatric conditions.
FIGURE 7
Painting entitled Laboratory created before the accident based on artists visual
hallucinations.
With permission, Pachalska et al. (2008b).
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FIGURE 8
Computed tomography of the brain done 15 years post trauma. (A) Arrow shows a
hypodense subcortical left frontal lesion; (B) asymmetrical cortical atrophy more pronounced
on the left; (C) right anterior temporal lobe and cerebellar atrophy.
FIGURE 9
A sample of post accident painting.
2 Dementia
FIGURE 10
A sketch made during rehabilitation with perseverations (multiple heads); of note is the
presence of wings, which the artists comments on the sketch with the following words:
. . .I thought I had wings and I could fly. . ..
The author emphasized that the posttraumatic decrease in intensity and activity of
hallucinations was uniquely seen both in his clinical condition and his artistic production (Pachalska et al., 2008b). This case remains unique, with the coexistence
of specific factors, such as painting skills induced by art therapy for schizophrenia, head trauma, and progressive neurological/neuropsychiatric condition.
2.8 Noncerebral central nervous system disorders

The vast majority of reports on changes in artistic output associated with neurological disorders focus on brain conditions. However, in patients with noncerebral
neurological conditions, spectacular changes in painting style may also be observed, which are not just related to mechanical alterations. We followed and
studied the case of a contemporary famous Swiss painter (Diego Smaniotto),
who developed cervical myelopathy due to narrowed spinal canal, and was followed by one of us (J.B.). He had fine movement impairment and proprioceptive
dysfunction in his fingers, which worsened after decompressive spinal surgery.
This triggered a major change in his style of painting, which was not just due
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FIGURE 11
A drawing of a person, a house, and a tree showing left hemispatial neglect.
With permission, Pachalska et al. (2008a,b).
to sensorymotor disability. Indeed, this painter who had never been interested
in nonfigurative, abstract, art, but had become a master in surrealistic,
Dali-like, works over the years (Fig. 11), now switched to nonfigurative art
(Figs. 12 and 13). He explained that he did not accept a decrease in his former
technical skills, and now felt compelled to explore novel directions, which he
had discarded before the disease.
2 Dementia
FIGURE 12
Surrealistic painting made before spinal surgery.
With artists permission.
FIGURE 13
Painting made after spinal surgery.
With artists permission.
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3 GENERAL CONCLUSIONS
We have emphasized the potential impact of nervous system disorders on the production of recognized artists. As stated above, while these case histories are fascinating, they remain anecdotal, and at the present stage of knowledge, one remains
unable to pool even short patient series in order to draw firm conclusions on how
brain lesion influences artistic production. Nevertheless, in these patients, artisticclinical correlations are of interest for at least two reasons. First of all, they may
add to our understanding of some neural bases of artistic creation, along with the
types of change in output triggered by disease. Second, one may occasionally observe that neurological conditions affecting the central nervous system may lead
to new developments of creativity, sometimes even with improvement of the quality of works in already recognized painters. A particularly fascinating issue for clinicians is to have the opportunity to witness the impact of nervous system disorders
on artistic creativity, with often strange, unpredictable, and irrational-looking modifications. However, a major limitation is that these encounters are so infrequent that
any evidence-based analysis and comparison with other patients may quickly lead to
misinterpretations.
Further research is needed in this field, in order to allow a better understanding of
the complex neurophysiological mechanisms of artistic creativity as well as artistic
appreciation. It is likely that careful clinical and cognitive analyses also using new
imaging and neurophysiological techniques in single patients will be more useful and
interesting than attempts at collecting case series, given the rarity of such patients
and their unique, individual characteristics.
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Pachalska, M., Grochmal-Bach, B., MacQueen, B.D., Wilk, M., Lipowska, M.,
Herman-Sucharska, I., 2008b. Neuropsychological diagnosis and treatment after closedhead injury in a patient with a psychiatric history of schizophrenia. Med. Sci. Monit.
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Piechowski-Jozwiak, B., Bogousslavsky, J., 2006. Migraine and patent foramen ovale: a residual coincidence or a pathophysiological intrigue? Cerebrovasc. Dis. 22, 91100.
Piechowski-Jozwiak, B., Bogousslavsky, J., 2009. Posterior circulation strokes. Handb. Clin.
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Podoll, K., Ayles, D., 2002. Inspired by migraine: Sarah Raphaels Strip! paintings. J. R. Soc.
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Podoll, K., Robinson, D., 2000. Migraine experiences as artistic inspiration in a contemporary
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Sahlas, D.J., 2003. Dementia with Lewy bodies and the neurobehavioral decline of Mervyn
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Smith, W.S., Mindelzun, R.E., Miller, B., 2003. Simultanagnosia through the eyes of an artist.
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Stephens, M., De Kooning, W., Swanm, A., 2004. De Kooning: An American Master.
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Wilkinson, M., Robinson, D., 1985. Migraine art. Cephalalgia 5 (3), 151157.
275
Index
Note: Page numbers followed by f indicate figures, and t indicate tables.
A
Acupuncture
acupoints, 117120, 119f
cosmic forces, 117
key sites, 119f
meridians, 117, 119f
palpitations, 120
scarcity, 120121
Western chronology, 120121
Alcoholic dementia, 266
Alzheimer disease, 265
Anatomical illustration
acupuncture, 120121
Bologna, forensic process, 34
Borgognoni, Theodoric, 3436
da Carpi, Jacopo Berengario
anatomy presentation, 4044
brain dissection images, 43f
muscle man illustration, 42f
syphilis treatment, 4044
de Ketham, Johannes and von Gersdorff, Hans
cauterization, 3940
limb amputation, 3940
woodcut anatomical images (see Woodcut)
de Mondeville, Henri
anatomy presentation, 3839
antiseptic surgical practices, 3637
drawings usage, 3738
Galenic doctrine, 37
medical instruction, 37
Medieval surgeon, 38f
muscle man, 37
postmortem examination, 3637
skinned man, miniature, 39f
tuberculosis, premature death, 3839
human dissection, direct observation, 34, 35f, 36f
origins, 3444
textual recovery process, 910
Vesalius, Andreas (see Vesalius, Andreas)
Anatomical wax figures
brain model, 8889, 89f
eyes, 78, 80f
feeling hands, 78, 80f
forearm and deep musculature, 78, 79f
sculptor Ercole Lelli, 7982, 83f
self-portrait, Morandi, 78, 81f
Anatomist
Engravings of the Bones, Muscles and
Joints, 172
The Principles of Surgery
drawings, nervous system, 172
elevation of depressions, skull, 173, 175f
fractures and depressions, skull, 173, 175f,
176f, 177f
head of Thomas Sharpe, 172, 174f
in 1801, 171172
published, 1815, 172, 173f
trauma effect, 172, 174f
Anatomy, Morandis self-portrayal in wax
brainheart dichotomy, 8283
description, 78
eyeballs, wooden display, 78, 80f
feeling hands, 78, 80f
forearm and deep musculature, 78, 79f
Manzolini, Giovanni, 78, 7982, 82f
sculptor Ercole Lelli, 7982, 83f
self-portrait, 78, 81f
taffeta, lace and pearls, 8283
Ancient times, lead toxicity
Avicenna, 227
Corpus Hippocraticum, 224
description, 224, 225t
Medicis and Borgias, 224
metals, alchemists, 227
Middle Ages and Renaissance, 227
Prince of Physicians, 227
Romans, 224226
Appearance of Cajal
autobiography, 205206
axonal growth cone and neurotropism,
207, 208f
laboratory, Valencia, 205, 206f
properties, Golgi method, 206207
scientific articles and books, 205
Artistic production
basal ganglia and cortical damage, 264
Brennan, 267
brush strokes, 266
cognitive disorders, 266
epilepsy, Schachter, 268
figurative impressionism, 263
migraine, 266
277
278
Index
influential protectors, 86
irritability, von Haller, 86
Manzolini, anatomical practice, 84
meticulous inspection, 85
morose and acrimonious disposition, 84
natural perception and higher-level
sensibility, 87
research, anatomy of hearing, 8586
three-dimensional images, 85
Artists
anatomy drawings, 106
Bell, Charles (see Bell, Charles)
Bell, John (see Bell, John)
Galton, 98
Kahlo, Frida (see Kahlo, Frida)
Waterlow, 104
B
Barigazzi, Jacopo, 4044
Beatos, 231
Beethoven, 237238
Bell, Charles
description, 163164
nervous system, 164165, 172
oil painting, 164
remembrance, John Bell, 179180
Bell, John
anatomist, 171173
Charles Bell, remembrance, 179180
description, 163164
family
Bell, William, 164
Charles, 164
Joseph, George, 164165
Robert, 164
marble cross, 177179, 178f
memorial notes, Protestant Cemetery in Rome,
177179, 179f
original gravestone, 176177, 178f
Royal Infirmary, Edinburgh, 170171
surgeon, 165170
swelling, 173
war wounds, 170
Borgognoni, Theodoric, 3436
Brain dissection, 21f, 22
Brain map
Bells realistic drawing, 106f
cerebral physiology, 106107
definition, 105
dog brain, 101f
Ecker concept, 110
Ferriers, 106107, 107f
medical illustrations, 105
Brain power, Morandi
animated anatomy, 87
award, Pope Benedict XIV, 8485
beauty and exactitude, wax models, 85
Carnival Dissection, 85
description, 83, 84
empirical method, 84
hands-on dissection, 84
heart, 87
C
Carpensis, Jacobus Berengarius, 4044
Cerebral cortex
complexity, 215216, 218f
dendritic spines, 213
pyramidal cells, 215216, 217f
Change of artistic style. See Neurological
diseases, painters
Charcot, Jean-Martin
artistic skills
drawing, 190, 191f
drawings and sketches, 189, 189f
self portraits, self-mocking sketch, 189, 190f
art, medical practice, 197198
neurological career
Castor and Pollux of experimental physiology
and pathology, 186187
Senior Resident, Paris hospitals system, 186
Service Cazalis department, 187188
taste, art
drawing, ships, 193, 194f
immense erudition, 194195
living room, Paris, 195, 195f
Nymph Disarming Love, 191192
political engagement, 193
possession, building, 196f, 197
reproduction, Raphaels transfiguration,
192193, 192f
Crankling brain
anatomical wax figures, 89
conversion, food, 88
eighteenth-century empirical anatomy, 88
partial representation, 8889, 89f
renaissance, nineteenth century, 88
snakes and eels crawl, 88
Vesaliuss Fabrica, 88
D
da Carpi, Berengario
functional relationships, ventricles, 22
Isagoge breves, 5, 7
woodcut, Isagoge breves, 18, 19f
de Hamusco, Juan Valverde
Index
copper plates, 12-stage brain dissection, 5860

muscle man holding flayed skin, 58, 60f
portrait, 59f
12-stage brain dissection, comparison, 5860, 61f
Dementia
alcoholic, 266
Alzheimer disease, 265
epilepsy, 267268
frontotemporal, 265
head trauma, 269271
Lewy body dementia, 264
migraine, 266267
noncerebral central nervous system disorders,
271273
Draftsman, 101, 103
Drawing of neural elements
artistic skills and emotions, 211212
autography, 210211
camera lucida, 209
chemicals, 211212
freehand drawings, 208209
histological preparations, 209, 211
microscopic images, 208209
organelles, 211212
skepticism, 209
watercolor, 210, 210f
Ecker, Alexander, 98100

experimental animal, stimulations/lesions, 97
Fritsch and Hitzigs classic illustration, 106107
Galton, John (see Galton, John)
illustrations
brain map, 110
graphic elements, 108
graphs, 109
inconsequential, 108
line drawings, 108
mapped out, 110
regions, 109
line drawings, 105, 105f
Millett role, 98
pictures, 105
Waterlow, Ernest (see Waterlow)
West Riding article, 97
West Riding Lunatic Asylum Reports, 97
Figure
duplicated, 99
Ferriers illustration, 109
West Riding paper, 101, 102
Frontotemporal dementia, 265
Galton, John
comparative anatomy, 102
dog brain, dorsal view, 101f
human brain, drawings, 102103
West Riding Lunatic Asylum Medical
Report, 101
Geminus, Thomas
bone man image, 5456, 55f
Compeniosa totius Anatomie delineatio, 5456
images and woodcuts, 5657
intaglio printing process, 56
medieval text, 57
plate, 56
Vesalius Epitome, text, 5657
Golgi technique
advantages, 205
appearance of Cajal (see Appearance of Cajal)
letter, 202
morphology, neuron, 203205, 203f
neurons and glia, 202203
preparation, nervous system, 204f, 205
scientific community, 205
Goya
Black Paintings, 233
deafness, 232233
lead and toxins, pigments, 233234
symptoms, 233
Edinburgh
Alexander Monro Primus, Secundus
and Tertius, 165
Royal College of Surgeons, 165
Royal Infirmary, 170171
watercolor, painting, 164
Epilepsy
classification, 267268
de Chirico, Giorgio, 268
Magnani, Franco, 268
Estienne, Charles
De dissectione partium corporis humani
libri tres, 22, 23f
F
Fabrica
appearance, 9
dissection procedure, 1718
Vesalius view, illustration role, 2729
Ferrier, David
anatomical labels, 106107
Bell, realistic drawing, 106f
brain map (see Brain map)
brain, stimulation and ablation, 9697
British Medical Journal, 97
279
280
Index
H
Handel, 237
Head trauma
computed tomography, 269, 270f
neurological and psychiatric conditions,
269271, 272f
painting style, 269, 270f
schizophrenia, 269
signs of perseveration, 269, 271f
visual hallucinations, 269, 269f
History of neuroscience
drawing of neural elements, 208212
Golgi method, 205
scientific art and skepticism, 215
Human dissection. See also Anatomical illustration
Fabrica, 47
origin, 34
Humoral function, 25
Hysteria
external manifestations, 198
studies, Charcot, 187188
I
Intaglio
printing process, 56
woodcut printing and, 40
Irritability, 86, 87
K
Kahlo, Frida
description, 241254
pain (see Neuropathic pain)
passion, 253254
poliomyelitis, 243245
spina bifida, 242243
spine injury, 245248
Kooning, Willem De, 265
L
Lead poisoning
ancient times, 224227
description, 223224
epidemic and modern awareness, 227228
musicians, 237238
poisoned painters, 229237
scientific era, 228229
Lewy body dementia, 264
Living cadavers, 910
Localization of brain functions, 9697, 98
M
Manuzio, Aldo, 4044
Manzolini, Giovanni
anatomical wax modeling, 7982

carnival dissection, 85
forearm and deep musculature, wax, 78, 79f
hands-on prosection, heart, 8283, 84
Medieval
anatomy (see Anatomical illustration)
de Mondeville, Henri (surgeon and teacher), 38f
drawings of death, 37
Renaissance anatomical illustrations and, 70
text, English dissecting manual, 57
Michelangelo, 231
Microscopy, 142
Microtubules
axial column formation, 156f
cylindrical walls, 154155
electron micrograph, 155f
intermediate filaments, 154
mechanical roles, 154
Migraine
Brennan, Ignatius, 267
diagnosis, 266
Migraine Art Competition, 267
photopsias, 266
Raphael, Sarah, 267
Morandi, Anna
anatomist (see Anatomy, Morandis self-portrayal
in wax)
archbishop, Lambertini, 76
beatification and canonization, 76
brain power, 8387
chair of obstetrics, 76
crankling brain, 8789
description, 75
eighteenth-century neuromania, 77
knowledge and endorsement, 76
Lambertinis training, medical science, 76
medical culture, Bologna, 77
Minerva, 91
nerves and spinal cord, 77
structures and functions, human body, 77
Valsalva anatomy, 9091, 90f
Mundinus, 4044
Musicians
Beethoven, 237238
Handel, 237
N
Nervous system
invisible pipes, imaging, 138141
microtubules (see Microtubules)
nerve fibers, 142145
neurofibrils, 145154
renaissance (see Renaissance art)
Index
sensation and will, pathways, 121125

Neuroanatomy
Alexandrian Series style, 122125
Aristotle, 122
brain, separate origins, 139f
concept, 121
Descartes, Rene, 139140, 139f
Eastern medical tradition, 125
Flea glasses uasge, 142
Galen, 122
hand-drawn micrograph, 143f
Museum of Alexandria, 122
nerve men, 122125, 124f
neurofibrils (see Neurofibrils)
pneuma, 121
primitive nerve cylinders, 145f
sensory information, medieval theory, 126f
sensory perception, 121
sensus communis, 125
vessels, 142143, 144
voluntary movement, 121
wide pipe enclosed thinner tubes, 139f, 140141
Wren, illustration, 141
Neurofibrils
branched configurations, 150151
continuous and electrically conducting, 150, 150f
cylinders, 146148
Freud, crayfish nerve cord, 149f
ganglion cell, crayfish nerve cord, 147f
intraprotoplasmic skeleton, 152153, 152f
networks, 153f
photomicrography, 153
role, 151
Schwann, drawing, 145
Neurological diseases, painters
dementia, 264273
description, 255256
stroke, 256264
Neuronal forest
appearance of Cajal, 205207
brain, 215218
description, 202
drawing of neural elements, 208212
Golgi technique, 202205
interpretation, microscopic world
artistic movements, 215, 216f
avian cerebellum, 213
connections, neurons, 213
dendritic spines, 213
eukaryotic cells, 214215
Golgi method, 215
internal reticular apparatus, 214215
neuron and reticular theories, 213, 214f
neuron doctrine, 213214

structure and function, nervous system, 202
Neuropathic pain
fibromyalgia, 252
lingering pain, 248
painkillers, 252253
phantom-limb pain, 251, 251f
polio infection, 249
RSD, 249251
Neuroscience, 85, 89f
P
Painters. See Neurological diseases, painters
Pare, Ambroise
autopsy, 6466
cranial nerves representation, 67f
deathbed (woodcut print), Henry II of France,
64, 65f
etching, 63f
master surgeon, 6062
Microcosmographia, 6667
muscle man holding flayed skin, 68f
portrait, 62f
violent convulsions, 64
wound man images, 69f
Plagiarism
blatant, 58
Geminus, 57
rapid, 4546
Vesaliuss frustrations, 4748
Poisoned painters
artists and celebrities, 229231, 230t
Beatos, 231
Buonarrotti, Michelangelo, 231
Caravaggio, 232
cave paintings, 229
de Goya, Francisco, 232234
dry gripes and dangles, 229
Fortuny, Mariano, 234
Francesca, Piero Della, 232
Kahlo, Frida, 235236
Portinari, Candido, 236237
potters, 229
Rubens, Dufy, Renoir, von Jawlesnky, and Klee,
235
Sanzio, Raphael, 232
Van Gogh, Vincent, 234235
van Rijn, Rembrandt, 232
Poliomyelitis
effects, 244
peg leg, 243
281
282
Index
Poliomyelitis (Continued)
Rivera, Diego, 244245, 245f
ulcerated right leg, 244, 244f
Pope Benedict XIV Lambertini, 75, 76, 77, 7982
Posterior circulation strokes
artistic production, 262263
blind spots, 263
figurative impressionism, 263
quadrantanopia and autoscopic manifestations,
263
technical skills, 264
top-of-the-basilar syndrome, 262263, 264
transient ischemic attack, 263
Printing
image, 40
intaglio, 40, 56
paper sheet, 51
roller, process, 5456
woodcut, 40
R
Reflex sympathetic dystrophy (RSD), 249251
Renaissance anatomy
characterization, 1011
delineation, brain base and cerebellum, 7, 10f
fabrica, 9
fabric/construction, human body, 4f, 5
fabric, forearm and tendon construction,
57, 8f
human cadaver, 1314
humoral function, 25
living cadavers, 910
rete mirabile, 1418
standard sources, learned physician, 57, 6f
ventricles, 1824
Vesalius, 2529
vigorous polemics, humanists, 1113
Renaissance art
Black Death plague, 126127
complications, 132137
da Vinci, Leonardo, 127, 128f
De dissectione partium corporis humani
libri tres, 133f
Eustachi, Bartholomeo, 136f
functional relationships, diagrammatic
representations, 136f, 137
Human Brain Project, 138
human head, medieval conception, 127, 128f
movable-type printing press, 131
multiple copies printing, 131
nerves distribution, 127131, 130f, 133f
painters, 127
pivotal importance, 138
plain skeleton, nerves mounting, 137

plastination, 138
semi-diagrammatic display, nerves, 134f
traditional teaching, 127
Vesalius, 131
woodcutting, 131
rete mirabile
fabrica, dissection procedure, 1718
Isagoge breves, 18, 19f
reticular plexus, 15, 16f
sheep brain and reticular plexus, 15, 17f
Reutersward, Carl Frederik
artistic activity, 260
cerebral hemorrhage, 258260
change of artistic style, 260, 261f
sketches, nonviolence, 262, 262f
Right-hemispheric strokes
Brown, Reynold, 257
Corinth and Dix, 256
Habura, Krystyna
artistic styles, 257, 258f
creative aphasia, 257
Neurolinguistic Reprogramming of Images,
258
painted letter, 257, 259f
poststroke painting, 258, 260f
smoking and alcohol, 257
prosopagnosia, 256
Raderscheidt, Anton, 256257
RSD. See Reflex sympathetic dystrophy (RSD)
S
Saturnism. See Lead poisoning
Schnug, Leo, 266
Sensory perception, 78, 85
Spina bifida
malformation, 242
medical documents, 242243
poliomyelitis and trauma, 242
severity, 242
X-rays, 242
Spine injury, Kahlo
before death, photograph, 246, 247f
discharge, 248
displacement, vertebrae, 245
oil paints and paintbrushes, 245246
self-portrait, broken column,
246248, 247f
tram crash, 245, 246f
Tree of Hope. Keep firm, 248, 249f
wounded deer, 246248, 248f
X-ray picture, 248, 250f
Index
Stroke
description, 256
left-hemisphere, 258262
posterior circulation, 262264
right-hemisphere, 256258
Surgeon
Alexander Monro Primus, Secundus and
Tertius, 165
The Anatomy and Physiology of the Human
Body, 169170
The Anatomy of the Bones, Muscles, & Joints,
165166
appointment, Royal College of Surgeons of
Edinburgh, 165
as trainer, 165
Discourses on the Nature and Cure of Wounds
brain and intracranial hemorrhage,
compression, 169
frontispiece, 166168, 168f
gunshot wounds, 168169
skull X-rays, 169
Engravings, Explaining the Anatomy of the
Bones, Muscles and Joints, 166
practical purpose, 165
qualification, 165
T
Theodoric of Lucca, 3436
V
Van Gogh, Vincent, 234235, 236237
Ventricles
and brain, 21f, 22, 23f
functional relationships, 22
lateral ventricles, 2324, 24f
ventricular localization theory and longevity,
influence, 18, 20f
Ventricular localization, 18, 2324
Vesalius, Andreas
brain dissections, illustrations, 5153
de Hamusco, Juan Valverde, 5860
Fabrica, 47
female cadaver, public dissection, 48

folio volume, 46
frontispiece, 48, 49f, 50f
fugitive sheets, students, 4546
Geminus, Thomas (aka Thomas Lambrit)
(see Geminus, Thomas)
lithograph, 46f
mass graves, 45
muscle men, 52f
and Pare, 6068
pen drawing, sepia ink, 48
portrait, 44f
preparatory drawings, 48
sketch preservation, 48
surgery and anatomy, 4546
Tabulae Anatomicae Sex, 53
wood-block cutters, 4748
Vesalius comparative approach, 18
Vesalius views
anatomical structures, 27f, 28f, 29
availability of bodies and services of
artist, 26
awareness, anatomical discrepancies, 2526
collaboration, artists and anatomists, 30
fabrica, 2729
form/structure, brain, 2930
precision and exactitude characterization, 26
relationship, artists, 29
Visual artists. See Neurological diseases, painters
von Haller, Albrecht, 86, 87
W
War wounds, 170
Waterlow
macaque brain, drawings, 103, 104f
Vivisection Act, 104
Wood cut
anatomical images, 3940
block cutters, 40
printing, 40
wound man, 3940, 41f
283
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J. Verhaagen, E.M. Hol, I. Huitinga, J. Wijnholds, A.A. Bergen, G.J. Boer and D.F. Swaab
(Eds.) 2009, ISBN 978-0-12-374511-8.
Volume 176: Attention, by Narayanan Srinivasan (Ed.) 2009, ISBN 978-0-444-53426-2.
286
Other volumes in PROGRESS IN BRAIN RESEARCH
Volume 177: Coma Science: Clinical and Ethical Implications, by Steven Laureys, Nicholas D. Schiff
and Adrian M. Owen (Eds.) 2009, 978-0-444-53432-3.
Volume 178: Cultural Neuroscience: Cultural Influences On Brain Function, by Joan Y. Chiao (Ed.)
2009, 978-0-444-53361-6.
Volume 179: Genetic models of schizophrenia, by Akira Sawa (Ed.) 2009, 978-0-444-53430-9.
Volume 180: Nanoneuroscience and Nanoneuropharmacology, by Hari Shanker Sharma (Ed.) 2009,
978-0-444-53431-6.
Volume 181: Neuroendocrinology: The Normal Neuroendocrine System, by Luciano Martini, George
P. Chrousos, Fernand Labrie, Karel Pacak and Donald W. Pfaff (Eds.) 2010,
978-0-444-53617-4.
Volume 182: Neuroendocrinology: Pathological Situations and Diseases, by Luciano Martini, George
P. Chrousos, Fernand Labrie, Karel Pacak and Donald W. Pfaff (Eds.) 2010,
978-0-444-53616-7.
Volume 183: Recent Advances in Parkinsons Disease: Basic Research, by Anders Bjorklund and
M. Angela Cenci (Eds.) 2010,978-0-444-53614-3.
Volume 184: Recent Advances in Parkinsons Disease: Translational and Clinical Research, by Anders
Bjorklund and M. Angela Cenci (Eds.) 2010, 978-0-444-53750-8.
Volume 185: Human Sleep and Cognition Part I: Basic Research, by Gerard A. Kerkhof and Hans
P.A. Van Dongen (Eds.) 2010, 978-0-444-53702-7.
Volume 186: Sex Differences in the Human Brain, their Underpinnings and Implications, by Ivanka
Savic (Ed.) 2010, 978-0-444-53630-3.
Volume 187: Breathe, Walk and Chew: The Neural Challenge: Part I, by Jean-Pierre Gossard, Rejean
Dubuc and Arlette Kolta (Eds.) 2010, 978-0-444-53613-6.
Volume 188: Breathe, Walk and Chew; The Neural Challenge: Part II, by Jean-Pierre Gossard, Rejean
Dubuc and Arlette Kolta (Eds.) 2011, 978-0-444-53825-3.
Volume 189: Gene Expression to Neurobiology and Behaviour: Human Brain Development and
Developmental Disorders, by Oliver Braddick, Janette Atkinson and Giorgio M. Innocenti
(Eds.) 2011, 978-0-444-53884-0.
Volume 190: Human Sleep and Cognition Part II: Clinical and Applied Research, by Hans P.A. Van
Dongen and Gerard A. Kerkhof (Eds.) 2011, 978-0-444-53817-8.
Volume 191: Enhancing Performance for Action and perception: Multisensory Integration,
Neuroplasticity and Neuroprosthetics: Part I, by Andrea M. Green, C. Elaine Chapman,
John F. Kalaska and Franco Lepore (Eds.) 2011, 978-0-444-53752-2.
Volume 192: Enhancing Performance for Action and Perception: Multisensory Integration,
Neuroplasticity and Neuroprosthetics: Part II, by Andrea M. Green, C. Elaine Chapman,
John F. Kalaska and Franco Lepore (Eds.) 2011, 978-0-444-53355-5.
Volume 193: Slow Brain Oscillations of Sleep, Resting State and Vigilance, by Eus J.W. Van Someren,
Ysbrand D. Van Der Werf, Pieter R. Roelfsema, Huibert D. Mansvelder and Fernando
H. Lopes da Silva (Eds.) 2011, 978-0-444-53839-0.
Volume 194: Brain Machine Interfaces: Implications For Science, Clinical Practice And Society, by Jens
Schouenborg, Martin Garwicz and Nils Danielsen (Eds.) 2011, 978-0-444-53815-4.
Volume 195: Evolution of the Primate Brain: From Neuron to Behavior, by Michel A. Hofman and Dean
Falk (Eds.) 2012, 978-0-444-53860-4.
Volume 196: Optogenetics: Tools for Controlling and Monitoring Neuronal Activity, by Thomas
Knopfel and Edward S. Boyden (Eds.) 2012, 978-0-444-59426-6.
Volume 197: Down Syndrome: From Understanding the Neurobiology to Therapy, by Mara Dierssen
and Rafael De La Torre (Eds.) 2012, 978-0-444-54299-1.
Volume 198: Orexin/Hypocretin System, by Anantha Shekhar (Ed.) 2012, 978-0-444-59489-1.
Volume 199: The Neurobiology of Circadian Timing, by Andries Kalsbeek, Martha Merrow, Till
Roenneberg and Russell G. Foster (Eds.) 2012, 978-0-444-59427-3.
Volume 200: Functional Neural Transplantation III: Primary and stem cell therapies for brain repair,
Part I, by Stephen B. Dunnett and Anders Bjorklund (Eds.) 2012, 978-0-444-59575-1.
Volume 201: Functional Neural Transplantation III: Primary and stem cell therapies for brain repair,
Part II, by Stephen B. Dunnett and Anders Bjorklund (Eds.) 2012, 978-0-444-59544-7.
Volume 202: Decision Making: Neural and Behavioural Approaches, by V.S. Chandrasekhar Pammi
and Narayanan Srinivasan (Eds.) 2013, 978-0-444-62604-2.

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Vesalius and the emergence

Progress in Brain Research, Volume 203, ISSN 0079-6123, http://dx.doi.org/10.1016/B978-0-444-62730-8.00001-3

CHAPTER 1 Vesalius and the emergence of veridical representation

1 A new vision of anatomy

1 A NEW VISION OF ANATOMY

1 A new vision of anatomy

CHAPTER 1 Vesalius and the emergence of veridical representation

1 A new vision of anatomy

CHAPTER 1 Vesalius and the emergence of veridical representation

2 REVIVAL OF CLASSICAL KNOWLEDGE: ART AND ANATOMY

2 Revival of classical knowledge: Art and anatomy

3 The concept of original source: A textual prelude to the human cadaver

than against Galen or Avicenna, as usually claimed10 (OMalley, 1964; Russell,

3 THE CONCEPT OF ORIGINAL SOURCE:

CHAPTER 1 Vesalius and the emergence of veridical representation

4 SEEING AND RECORDING THE INVISIBLE: RETE MIRABILE

4 Seeing and recording the invisible: Rete mirabile

CHAPTER 1 Vesalius and the emergence of veridical representation

4 Seeing and recording the invisible: Rete mirabile

CHAPTER 1 Vesalius and the emergence of veridical representation

Vesalius exemplifies how accuracy of observation in anatomy was achieved

5 VENTRICLES: FROM FUNCTION TO STRUCTURE:

5 Ventricles: From function to structure: Circles to cavities

With the advent of medical publishing of manuscripts, artists were employed by

CHAPTER 1 Vesalius and the emergence of veridical representation

CHAPTER 1 Vesalius and the emergence of veridical representation

CHAPTER 1 Vesalius and the emergence of veridical representation

7 The need for illustration: Vesalius

6 THE ROLE OF ILLUSTRATIONS

7 THE NEED FOR ILLUSTRATION: VESALIUS

CHAPTER 1 Vesalius and the emergence of veridical representation

CHAPTER 1 Vesalius and the emergence of veridical representation

What is expressed here is the accepted expectation from illustrations in teaching

CHAPTER 1 Vesalius and the emergence of veridical representation

CHAPTER 1 Vesalius and the emergence of veridical representation

Medieval and Renaissance

Douglas J. Lanska*,1, John Robert Lanska{,1

Veterans Affairs Medical Center, Tomah, WI, USA

Progress in Brain Research, Volume 203, ISSN 0079-6123, http://dx.doi.org/10.1016/B978-0-444-62730-8.00002-5

CHAPTER 2 Printing and copying anatomical illustrations

1 ORIGINS OF ANATOMICAL ILLUSTRATION

1.1 Theodoric Borgognoni

CHAPTER 2 Printing and copying anatomical illustrations

1.2 Henri de Mondeville

1 Origins of anatomical illustration

Mondeville subsequently conducted classes in anatomy and surgery, possibly in

As noted by Frank, Mondevilles drawings represent an important milestone that

CHAPTER 2 Printing and copying anatomical illustrations

By 1301, Mondeville became surgeon to King Philip IV of France (12681314; also

1 Origins of anatomical illustration

1.3 Johannes de Ketham and Hans von Gersdorff

CHAPTER 2 Printing and copying anatomical illustrations

1.4 Jacopo Berengario da Carpi

1 Origins of anatomical illustration

1 Origins of anatomical illustration

CHAPTER 2 Printing and copying anatomical illustrations

CHAPTER 2 Printing and copying anatomical illustrations

Calcar in Italian, or Johannes Stephanus Calcarensis in Latin), from a skeleton of the

CHAPTER 2 Printing and copying anatomical illustrations

CHAPTER 2 Printing and copying anatomical illustrations

CHAPTER 2 Printing and copying anatomical illustrations

3 VESALIAN COMPENDIA: PLAGIARISTS, IMITATORS, AND