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Andreas Vesalius, the Predecessor of Neurosurgery: How his Progressive Scientific Achievements Affected his Professional Life and Destiny Bruno Splavski1-3, Kresimir Rotim1,2, Goran Lakicevi c4, Andrew J. Gienapp5,6, Frederick A. Boop5-7, Kenan I. Arnautovic6,7

Key words , the father of modern and a predecessor of neuro- - 16th Century science, was a distinguished medical scholar and figure of the 16th - Anatomy - Andreas Vesalius Century . He challenged traditional anatomy by applying - Death empirical methods of cadaveric to the study of the . His - revolutionary book, De Humani Corporis Fabrica, established anatomy as a - Pilgrimage scientific discipline that challenged conventional medical knowledge, but often From the 1Department of Neurosurgery, Sestre Milosrdnice caused controversy. Charles V, the Holy Roman Emperor and King of Spain to Hospital Center, Zagreb, Croatia; 2Osijek whom De Humani was dedicated, appointed Vesalius to his court. While in 3 University School of , Osijek, Croatia; Osijek Spain, Vesalius’ work antagonized the academic establishment, current medical University School of Dental Medicine and Health, Osijek, Croatia; 4Mostar University Hospital, Mostar, Bosnia and knowledge, and ecclesial authority. Consequently, his methods were unac- Herzegovina; 5Neuroscience Institute, Le Bonheur Children’s ceptable to the academic and religious status quo, therefore, we believe that his 6 Hospital, Memphis, Tennessee, USA; Semmes-Murphey professional life—as well as his tragic death—was affected by the political Clinic, Memphis, Tennessee, USA; and 7Department of Neurosurgery, University of Tennessee Health Science state of affairs that dominated 16th Century Europe. Ultimately, he went on a Center, Memphis, Tennessee, USA pilgrimage to the Holy Land that jeopardized his life. While returning home, his To whom correspondence should be addressed: ship was driven ashore on the Greek island of (Zante) where he Kenan I. Arnautovic, M.D., Ph.D. became ill and suddenly died in 1564 at the age of 49. Vesalius’ ideas helped free [E-mail: [email protected]] medicine from the limitations of the 16th Century and advanced scientific Citation: World Neurosurg. (2019) 129:202-209. https://doi.org/10.1016/j.wneu.2019.06.008 knowledge. His influence is still felt more than 500 years later. In this article, we ’ Journal homepage: www.journals.elsevier.com/world- acknowledge Vesalius neuroanatomic contributions and we discuss the his- neurosurgery torical facts and political circumstances that influenced his scientific career Available online: www.sciencedirect.com and personal life, emphasizing the conditions of his pilgrimage to the Holy Land 1878-8750/$ - see front matter ª 2019 Elsevier Inc. All that led to his untimely death. rights reserved.

INTRODUCTION high-quality aesthetic and artistic work. discipline. His influence on medical The novelty and precision of his pio- knowledge in general—as well as on neering findings and his inventive neurologic in particular—is still “There are two ways of spreading methods to propagate these findings relevant today, more than 500 years later. light; to be the candle or the mirror throughout the scientificcommunity Despite his significant contributions, that reflects it.” were indispensable, making Vesalius a Vesalius was harshly opposed by his —Edith Wharton, Vesalius in Zante. central and unique figure in the history critics, which won him both fervent 1 (1564) of medicine. He dared to challenge the supporters and fanatical foes. He status quo regarding research, teaching, substituted traditional reliance on med- Andreas Vesalius (1514e1564) is and spreading scientific knowledge and ical authority with observation and considered a founder of modern medi- in confronting dogmas of his contem- illustration, encouraging his students cine and a distinguished medical scholar porary academic world. not to rely on undisputed preexisting and Renaissance figure of the 16th Cen- Many consider Vesalius also as a pre- knowledge. He exposed and confronted tury (Figure 1). He challenged and decessor of neuroscience because his anatomic inconsistencies presented in changed the understanding of human numerous achievements included major of Pergamon’sworkandinthe anatomy by embracing empirical breakthroughs in the understanding of work of other eminent medical scholars scientific methods via cadaveric the accurate morphology and func- from antiquity.2-4 By doing this, he . His key scientificeffortDe tioning of the nervous system, which challenged the academic establishment Humani Corporis Fabrica is not only an laid the groundwork for modern neuro- and its entire body of medical knowl- innovative study of anatomy, but also a surgery as a separate scientific edge. His critics believed his work

202 www.SCIENCEDIRECT.com WORLD NEUROSURGERY, https://doi.org/10.1016/j.wneu.2019.06.008 HISTORICAL VIGNETTE BRUNO SPLAVSKI ET AL. ANDREAS VESALIUS, LIFE AND DEATH

THE BRIEF BIOGRAPHY OF ANDREAS VESALIUS Andreas Vesalius was born on December 31, 1514 in , in what was then the —a geopolitical entity consisting of the present-day Netherlands, , Luxembourg, and northern . He was the son of a wealthy family of physicians and pharma- cists. Both his parental ancestors served the emperor of the Holy Roman Empire.5-7 Vesalius began his studies in 1529 at the University of Louvain, Belgium, where he learned classical languages, rhetoric, phi- losophy and logic like most of his wealthy contemporaries.7 The university flourished in the 16th Century because of the presence of famous scholars and professors, such as Erasmus of Rotterdam (1466e1536), the great Dutch humanist,8 who advocated an evangelical piety and questioned many of the medieval superstitions that had crept into church philosophy. Afterward, Vesalius went to France in 1533 to study medicine at the to complete his medical degree.5 While there, he was a student of the famous French anatomist (a.k.a. Jacobus Sylvius) (1478e1555), who was very committed to Galen’s ideas and considered Figure 1. Andreas Vesalius. Woodcut, 1543, after J.S. van Calcar (?). (Credit: them infallible.7,9-11 This position made the Wellcome Collection. CC BY.) study of anatomy frustrating for Vesalius, motivating him to go to Paris cemeteries at night in search of cadavers of his own to antagonized academic and ecclesial au- caused his premature death. Therefore, dissect.5,7 Besides, the war between France thority. Consequently, the controversy we consider it necessary to provide a new and the Hapsburg Empire, of which caused by his methods was unacceptable historical version of the controversial Vesalius was a subject, hard-pressed him to to both the academic and religious status circumstances leading to his tragic leave Paris as a persona non grata.9 quo. Therefore, we believe that his pro- demise, relying on the literature, which Finally, Vesalius went to the University of — fessional life as well as his tragic remains sometimes divisive and debat- , Italy in 1537 to complete his — death was affected by the political state able, but also providing our own specu- doctorate, which was a flourishing environ- of affairs dominating 16th Century lative explanation of the events in the ment of medical humanism at the Europe. Ultimately, he took a pilgrimage light of political and social environment time.4,12-14 The University was founded in to the Holy Land that ultimately jeopar- of the 16th Century. 1222, and was one of the oldest and most dized his life. His premature death has In this article, we discuss the historical prominent academic settings in early mod- ’ inspired different hypotheses about why facts and political circumstances of Vesalius ern Europe.12 After completing his fl fi it happened. time that in uenced his scienti ccareerand doctorate, he was immediately appointed a Although the facts described earlier are personal life. We also emphasize the con- Professorship of Surgery at the age of 23 well-known, stemming from the exten- ditions of his pilgrimage to the Holy Land because of his excellent performance sive historical research, we believe that that led to his death, speculating that it was during his studies.15-17 While holding this some of the more controversial details of not a mere succession of unpredicted events post, he transformed anatomic classes fi his life and scienti c career need to be only. This article is also a tribute to Vesalius, entirely, improving them by performing addressed in a slightly different scope. honoring his accomplishments in estab- cadaveric dissection, which was a rare Besides, it is still not known why he lishing human anatomy as a distinguished practice in the major medical fi decided to take a pilgrimage to the Holy scienti c discipline and a prerequisite of of Medieval Europe.7,14,18 In addition, he Land, what were the conditions of his modern medicine, neuroscience, and encouraged direct communication with his voyage back home, as well as what neurosurgery.

WORLD NEUROSURGERY 129: 202-209, SEPTEMBER 2019 www.journals.elsevier.com/world-neurosurgery 203 HISTORICAL VIGNETTE BRUNO SPLAVSKI ET AL. ANDREAS VESALIUS, LIFE AND DEATH students to avoid being a strict and administering medications to V, and established anatomy as a distinctive inaccessible authority figure.7 As a royalty.13,28,30 Vesalius emphasized the evidence-based scientific disci- consequence, he became more importance of understanding correct pline.15,16,27,28,37 Vesalius recognized the scientifically critical and promoted direct anatomic body structure during his importance of visualization and illustra- observation, abandoning the traditional practice,17,28 insisting that surgery had to tion for anatomy education and used these medical curriculum established from the be based on anatomy.17 In 1559, Vesalius techniques in groundbreaking ways. ideas of Galen of Pergamon (AD 129ecirca was asked to give advice concerning However, at the same time, the work was 200/circa 216).3,19 Galen was one of the medical treatment of King Henri II of also a source of controversy and harsh most prominent Greek physicians during France (1519e1559) who was fatally debate because it threatened the academic the Roman Empire, and established injured during a jousting tournament by and medical status quo. animal dissection-based theories of human a penetrating injury from a In hindsight, we can see that De Humani anatomy that dominated Western medicine splintered wooden lance fragment Corporis Fabrica was one of the greatest con- for more than 1300 years.15,17,20 (Figure 2).15,16,31-33 Together with tributions to medical knowledge and science Although Galen’s accomplishments in Ambrois Paré (circa 1510e1590), the up to that time.37 It is one of the most antiquity advanced medicine, he introduced most celebrated surgeon of the influential manuscripts on human anatomy some incorrect theories and errors.4 Many century,2,34,35 Vesalius eventually and one of the remaining leading renowned scholars fiercely defended proposed trephination that was never biological sources in the history of Western Galen’s ideas in opposition to Vesalius’ carried out. Vesalius also treated the science.15,38 The work was comprised of 7 methods.21 It appeared that this brain injury of Crown-Prince Don Carlos volumes encompassing all organic systems antagonism may be one of the reasons why of Asturias (1545e1568) in 1562 when he of the human body, which were Vesalius left Padua in 1543 to be the fell down stairs and fractured his skull.13,36 meticulously illustrated with woodcut personal physician to Emperor Charles V Compared with other established med- engravings.23 The third volume covered the (1500e1558).15,16,22-24 Vesalius also served ical disciplines, anatomy and surgery were vasculature and circulation and included a Charles’ son and successor to the throne, considered lower disciplines. As a result, comprehensive explanation of the arteries King Philip II (1527e1598)forover2 Vesalius’ more conservative and traditional and , including cerebral arteries and decades.14 Apparently, Vesalius did not colleagues did not appreciate his modern veins. The fourth volume of De Humani enjoy life in the Court.7,9 He sought to be methods, which they criticized and vigor- Corporis Fabrica was dedicated entirely to released from royal service and left Spain in ously opposed.7,17,28 nerves, whereas the seventh volume 1564 to return to Padua, Italy to resume the focused on the brain itself and is teaching of anatomy following Garbrelle considered the true foundation of Fallopio (1523e1562) who died from DE HUMANI CORPORIS FABRICA neuroscience.23,39 Almost certainly, tuberculosis.13,14,18,25 Fallopio was another Vesalius’ masterwork De Humani Corporis Vesalius’ work was a fundamental prominent anatomist, who held Vesalius’ Fabrica was published in , inspiration for anatomist ’s previous Chairmanship of Anatomy. in 1543, dedicated to the Emperor Charles (1578e1657) masterpiece of blood On his way back to Padua, he suddenly decided to take a pilgrimage to and the Holy Land, possibly to reaffirm his religious adherence. However, the exact reasons for this voyage remain unknown. Unfortunately, Vesalius’ ship was unex- pectedly stopped on the Greek island of Zakynthos (Zante) when returning to Venice.25 He fell ill and died there immediately after landing on October 15, 1564 at the age of just 49.25-27

VESALIUS AS A PHYSICIAN After successfully completing De Humani Corporis Fabrica, Vesalius went into medical practice, which was family tradition for 4 generations.7,27-29 He accepted the posi- tion of the royal physician at the Spanish Court in 1544, leaving his academic post in 7 Padua. Over the next 20 years, he treated Figure 2. Illustration of the death bed of Henry II of France, 1559. Ambroise battle and tournament injuries as Pare and Vesalius are believed to be the 2 figures standing together at the a military surgeon, as well as conducting end of the table. (Image in the public domain; reprinted from the National Institutes of Health’s National Library of Medicine Digital Collection.) postmortem examinations and

204 www.SCIENCEDIRECT.com WORLD NEUROSURGERY, https://doi.org/10.1016/j.wneu.2019.06.008 HISTORICAL VIGNETTE BRUNO SPLAVSKI ET AL. ANDREAS VESALIUS, LIFE AND DEATH circulation De Motu Cordis,whichappeared and included descriptions of the dura, cranial fossa.30 In the second edition of more than 80 years later in 1628.37 It was skull, and cerebral vessels, as well as cra- Fabrica, the report on the effect of section also influential to the work of Thomas nial, spinal, and peripheral nerves of the recurrent nerve with consequent Willis (1621e1675), another great (Figures 3-5).16,17,30,40 These illustrations laryngeal paralysis was included.30,39,43 anatomist of 17th Century, and a father of were the first in anatomic history with modern neuroscience.40,41 pictorial accuracy.40 Vesalius also ridiculed An abridged version of Vesalius’ work and rejected Galen’s ventricular theory of POLITICAL CIRCUMSTANCES IN EUROPE called De Humani Corporis Fabrica Librorum cognition in which mental functions IN 16TH CENTURY Epitome was printed in 1543,30 and was were thought to be contained within the Historians consider the 16th Century when intended to be a concise and descriptive cerebral ventricles. the ascent of the West over the rest of the handbook for students and surgeons. The Vesalius’ findings added more accuracy world first began. This epoch of colo- book was dedicated to King Philip II of to the ventricular structures, which were nialism and trade established mercan- Spain. The fifth chapter was concerned meticulously drawn and labeled in detail. tilism as the principal economic theory of with the brain and nervous system.17,24,26 However, his drawings of the cerebral the day, which further modernized Europe The drawings in the Vesalius’ Fabrica are hemispheres were short of key dis- and expanded its influence worldwide. some of the most famous medical figures tinguishing cortical features and did not However, it also simultaneously caused in the because of their reveal the gyral-sulcal pattern, as it is numerous power struggles within Europe previously unseen quality and precision. recognized today.41 itself. However, the identity of the illustrators Although Vesalius did not consider the During the reign of Philip II of Spain, who produced the roughly 300 amazingly spinal column with its double curvature who was a harsh enforcer of Catholicism, accurate images remained unknown.9,23 quite as a single arch, he provided a the Spanish empire reached the height of Some researchers have speculated that functional-anatomic idea of the lower its power, having conquered and colo- Vesalius’ drawings were associated with thoraco-lumbar spine, which remained nized lands on every known continent. the studio of a famous late-Renaissance relevant to a certain extent.42 Meanwhile, in the Vatican, Pope Leo X Venetian master painter (1488/ The olfactory tract and bulb—mistak- (1475e1521) was the leading Church au- 1490e1576).5,9,13,18,30,37,40 The illustrations enly not classified as a nerve—were thority and a patron of arts and learning. attracted immediate and enormous inter- nevertheless correctly described at the However, he did not take growing de- est, particularly among medical pro- base of the brain and facing the anterior mands for church reform seriously, fessionals and among the renowned artists of that time.17 The famous Renaissance artist Michelangelo Buonarotti (1475e 1564) allegedly planned a collaboration with anatomist Realdo Colombo (1516e 1559)—Vesalius’ colleague at the —to create a rival book of anatomic drawings to compete with Fabrica’s images.16 However, this collaboration never materialized, possibly due to Michelangelo’s advanced age. Likewise, (1452e 1519) created numerous anatomic draw- ings, including those depicting the spinal lordosis for the first time, but he was unable to complete his objective of pro- ducing a systematic description of human anatomy because those drawings remained unknown to a wider audience.42

NEUROANATOMIC OBSERVATIONS Vesalius was also the most innovative neuroanatomist.30 His contributions to the field of modern neuroscience were highly valued, although not acknowledged enough. The seventh volume of the Fabrica and Figure 3. Illustration of the , brainstem, and cranial nerves from De Humani Corporis Fabrica. the fifth chapter of the Epitome, were (Image in the public domain; reprinted from the National Institutes of Health’s National Library of Medicine Digital Collection.) concentrated on the anatomy of the brain,

WORLD NEUROSURGERY 129: 202-209, SEPTEMBER 2019 www.journals.elsevier.com/world-neurosurgery 205 HISTORICAL VIGNETTE BRUNO SPLAVSKI ET AL. ANDREAS VESALIUS, LIFE AND DEATH

dissections, permitting anatomic studies Universal human values, as well as body on human bodies.44 morphology, took center stage and were Other great scientific breakthroughs observed and researched thoroughly for developed at this time that went against aesthetic, anatomic, and functional the status quo. Nicolas Copernicus (1473e features. 1543)—another Padua University The introduction of the printing press alumnus—proposed the theory of helio- by Johannes Gutenberg (1400e1468) in centric universe. His book De Revolutionibus 1439 in Mainz, Germany, entirely trans- Orbium Coelestium published just before his formed book publishing, and the dissem- death in 1543 was a major landmark in the ination of information to broader history of science and appeared the same audiences. Books, which were once scarce year as Vesalius’ Fabrica. Both books and few and were cautiously cared for in received similar critiques of the revolu- rare libraries, quickly became abundant tionary concepts presented in each. A and widely available. However, the Church contemporary of Copernicus, Pope Paul III and most European governments during (1468e1549) to whom Copernicus dedi- the 16th Century attempted to control cated his book became the first Pope to printing, which permitted widespread and confront Protestantism, but his efforts quick transmission of information and created more problems than solutions. ideas. One of the most momentous artistic works The broad-based combination of the of his reign was The Last Judgment fresco by scientific approach, innovative teaching, Michelangelo, which decorates the altar and publishing made achievable during wall of the Vatican’s Sistine Chapel and the Renaissance was found mostly was completed in 1541, 2 years before throughout the university environment of Fabrica was published. The painting also the Italian city-states, including the city of generated controversy because of its real- Padua, part of Venetian Republic. The istic portrayal of the nude human body. Italian city-states managed to keep strict At the same time, the Ottoman Empire Church control and imperial power at bay, continued to expand and the Ottoman creating an optimal foundation for social Sultan Suleiman the Magnificent (1494e and economic progress, and for major 1566) proclaimed himself Caliph. He intellectual and artistic changes.12,46,47 initiated key legislative improvements in Besides all conflicts and controversies of society, education, science, art, taxation, the 16th Century, which threatened the very and criminal law, and supported religious existence of prominent scientists, including tolerance as well. Therefore, conflict with Vesalius himself, it was still a time of the West was unavoidable. multifocal improvement of every aspect of This was also a time of frequent pil- life, particularly for art and science. Ac- grimages to the Holy Land. Medieval pil- cording to Francis Bacon (1561e1626), the grims of the Crusades who visited holy English philosopher and advocate of the sites experienced the perils of war and scientific method, the aim of modern sci- Figure 4. Illustration of the brain and nervous faced a variety of other difficulties. Unlike ence—after being removed from previous system from De Humani Corporis Fabrica. those who traveled to the Holy Land to metaphysical assumptions—should be (Image in the public domain; reprinted from the National Institutes of Health’s National reclaim it for Christendom, the subse- focused on empirical observation, real 48 Library of Medicine Digital Collection.) quent pilgrims of the Renaissance were experience, and experimentation. Apart mostly motivated by religious piety and/or from being idealistic, and despite the need to apologize personal sins.45 numerous obstacles to progress, it would subsequently leading to the Protestant They were not warriors and soldiers, but be Vesalius’ legacy as well. Reformation. The Reformation greatly mainly the nobility or wealthy seeking diminished the authority of the Roman some kind of atonement. Catholic Church and divided continental Nonetheless, the age of the Renaissance MEDICINE IN 16TH CENTURY EUROPE Europe along religious lines. His succes- brought abundant intellectual change to During the Middle Ages, the Church sor, Pope Clement VII (1478e1534), all of society by modernizing society and controlled all aspects of life, including the declined to invalidate the marriage of King encouraging critical thinking. The medie- practice of medicine.22 At the turn of the 15th Henry VIII of England (1491e1547), which val world retreated slowly but steadily, to 16th Century, Galen’s ideas and concepts instigated the English Reformation and which enabled the eventual rise of a novel still dominated medicine and were thought the separation of the Church of England and progressively more rational philoso- to be infallible.19 Diseases were believed to from papal authority. However, Pope phy founded in the arts, literature, sci- be initiated by body disturbances, mirroring Clement VII also approved cadaveric ence, and medicine to some extent. an inner harmonious imbalance. Prevalent

206 www.SCIENCEDIRECT.com WORLD NEUROSURGERY, https://doi.org/10.1016/j.wneu.2019.06.008 HISTORICAL VIGNETTE BRUNO SPLAVSKI ET AL. ANDREAS VESALIUS, LIFE AND DEATH

Figure 5. Illustrations of the brain from De Humani Corporis ventricles and choroid plexus. (Images in the public domain; Fabrica. (A) Brain with dura mater intact. (B) Exposed brain with reprinted from the National Institutes of Health’s National Library dura mater peeled away. (C) Cross-section of brain revealing the of Medicine Digital Collection.)

general methods for restoring physical Before Vesalius’ time, anatomy and The first formal anatomists of antiquity balance included bleeding, cupping, and surgery were underdeveloped compared were Herophilus (335e280 BC) and Era- purging, administered by barber-surgeons with other medical disciplines. Surgery sistratus (304e250 BC),16,28 both of whom who were often illiterate medical practi- was still nascent, consisting of wound had emerged in Hellenist Alexandria tioners with no formal education.2,22 management and crude limb amputations approximately 300 BC.4,49 Both men Bleeding was a dangerous procedure performed by barber-surgeons.22 Human established the use of cadaveric dissec- because of the lack of anatomic knowledge body dissections were not common in tions for anatomic medical study.50 It is and the increased risk of infection. Never- Europe, apart from some Italian city-state generally accepted that human anatomic theless, it was used randomly for all kinds of republics and largest Spanish cities.46,49 dissections were nonexistent during the ailments. To execute bleeding, leeches were Subsequently, medicine of that time Middle Ages. However, they reemerged commonly used. mainly remained stagnant. in medieval Italy at the beginning of the 14th Century.49-51 The was the earliest place of this revival.7 Mondino de Luzzi (1270e1326) introduced human cadaveric dissection in Bologna in 1315,9,20,49 and published the first practical manual of anatomy, the Anathomia in 1316.20 It became the primary medieval neuroanatomic text as well, describing meninges and cerebral ventricles responsible for fantasy, memory, and cognition.47,51 However, Mondino’s central philosophy was to confirm Galenic writings rather than differ from them.9,51 Nevertheless, dissections remained a limited practice until the Renaissance when such a procedure became less restricted. Dissections were then routinely introduced into many medical universities as an important tool for developing aca- demic medical knowledge.44,49 Throughout the 16th Century, the prac- tice of anatomic dissection was also consolidated in Spain.46 Prior to Vesalius’ work, Guido da Vig- Figure 6. Location of the island of Zakynthos in relation to the Greek mainland (circled). (Image in the evano (1280-1349), Mondino’s successor public domain; adapted from Wikipedia: https://commons.wikimedia.org/wiki/File:Mediterranean_ who wrote the first anatomic atlas,49,51 and Sea_location_map_(blank)_2.svg.) Berengario de Carpi (1460-1530), both the

WORLD NEUROSURGERY 129: 202-209, SEPTEMBER 2019 www.journals.elsevier.com/world-neurosurgery 207 HISTORICAL VIGNETTE BRUNO SPLAVSKI ET AL. ANDREAS VESALIUS, LIFE AND DEATH anatomists from the University of on his own with the full support of the an anatomic textbook, a masterpiece that Bologna, began to modernize the disci- King Philip II who provided him with is considered the most important biolog- pline.9 Bernegario made a number of introduction letters to Spanish embassies ical manuscript in the history of Western entirely novel anatomic observations,51 abroad.53 science. His impact on modern neurosci- and he was the first one not It is surprising that the reasons for his ence was exquisite as well. However, his overwhelmed by earlier authorities.7 He pilgrimage are so contradicting, bearing in life and destiny were burdened by political also contributed considerably to brain mind how renowned and famous Vesalius circumstances and the social conservatism anatomy, providing detailed description was. Nonetheless, we hypothesized that of that time, which supposedly contrib- of the meninges and cranial nerves, as he took the mandatory pilgrimage to Je- uted to his tragic death. well the ventricular system, including rusalem to endorse his obedience to po- choroid plexuses, interventricular litical and ecclesial authorities. REFERENCES foramen, infundibulum, and pituitary Considering the society’s prevailing con- 1. Wharton E. Vesalius in Zante (1564). North Am Rev. stalk and gland. servativism, and political background of 1902;175:625-631. 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The ecumenical vocation of Erasmus. ship was stopped on the Greek island of Erasmus Rotterdam Soc Yearb. 1987;7:96-109. DEATH Zakynthos (Zante) in the Ionian Sea (a The prevailing Christian doctrine during possession of the Venetian Republic), 9. Barr J. The anatomist Andreas Vesalius at 500 years old. J Vasc Surg. 2015;61:1370-1374. the Middle Ages and beyond emphasized where the completely exhausted and the soul but not the body in which it was sickened Vesalius was put ashore alone 10. Koehler PJ. Letter to the editor: Sylvius and Syl- contained.51 Therefore, we suppose that (Figure 6).13,14,26 He died shortly vius. J Hist Neurosci. 1997;6:90-91. Vesalius antagonized religious and thereafter, probably from a contagious 11. Tubbs RS, Linganna S, Loukas M. Jacobus Sylvius political authorities by his methods, his disease or fatigue because of the ship’s (1478-1555): physician, teacher, and anatomist. revolutionary ideas, and the content of poor settings. The most plausible Clin Anat. 2007;20:868-870. fi his scienti c works. explanation of his death seems to be 12. Bylebyl JJ. The School of Padua: humanistic There are a few theories of Vesalius’ illness, possibly exacerbated by general medicine in the 16th century. In: Webster C, ed. final days that attempt to explain the rea- weakness.25,54 Medicine and Mortality in the Sixteenth Century. Cam- bridge, UK: Cambridge University Press; 1979: sons for his sudden departure to the Holy 335-370. Land. Vesalius’ prominent biographer advocated that he used the pilgrimage as a CONCLUSIONS 13. O’Malley CD. Andreas Vesalius 1514-1564: in prerequisite to leave the Spanish Court This historical vignette discusses condi- memoriam. Med Hist. 1964;8:299-308. and to reclaim his professorship at Padua tions and events associated with the life 14. O’Malley CD. Andreas Vesalius’ pilgrimage. Isis. 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