The Neuroanatomical Plates of Guido Da Vigevano

Neurosurg Focus 23 (1):E15, 2007 The neuroanatomical plates of Guido da Vigevano

ANTONIO DI IEVA, M.D.,1 MANFRED TSCHABITSCHER, M.D.,2 FRANCESCO PRADA, M.D.,3 PAOLO GAETANI, M.D.,1 ENRICO AIMAR, M.D.,1 PATRIZIA PISANO, M.D.,1 DANIEL LEVI, M.D.,1 NICOLA NICASSIO, M.D.,1 SALVATORE SERRA, M.D.,1 FLAVIO TANCIONI, M.D.,1 MASSIMO AROSIO, M.D.,4 AND RICCARDO RODRIGUEZ Y BAENA, M.D.1 Departments of 1Neurosurgery and 4Anesthesiology, Istituto Clinico Humanitas IRCCS, 3Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico “C. Besta,” Milan, Italy; and 2Center of Anatomy and Cell Biology, Medical University of Vienna, Austria

PGuido da Vigevano was an Italian physician and engineer who lived in the 13th and 14th centuries. He was the first scientist who used pictures to illustrate his anatomical descriptions, developing for the first time a close relationship between anatomical studies and artistic drawings. This was further developed in the Renaissance. In his textbook Anathomia are displayed six plates showing for the first time neuroanatomical structures and techniques: dissection of the head by means of trephination, and depictions of the meninges, cerebrum, and spinal cord. On the surface of the brain painting it is possible to recognize a vague patterning of cortical convolutions. Ventricles are also described and shown. This book constituted the first attempt in the history of neuroscience to illustrate an anatomical description with schematic pictures to achieve a better understanding of such complex structures. (DOI: 10.3171/FOC-07/07/E15)

KEY WORDS • anatomical plate • Guido da Vigevano • Middle Ages • neuroanatomy

“Anatomy to the surgeon is like the Sun for our planet.” more teutonico). The subsequent trade of relics and bones —R. F. Spetzler (engaged in especially by Neapolitan sailors) forced Pope Bonifacius VIII to promulgate the papal bull “De Sepol- HE WORD “ANATOMY” derives from the Greek word turis” in 1300 to prohibit the manipulation of human bod- “ana temnein,” which means “to cut up.” Anatomy ies.17 He did this despite the fact that Emperor Frederic II T is an ancient discipline that has always involved had promulgated a decree in 1240 by which dissections controversy. were tolerated. Subsequent popes promulgated other bulls that allowed Early Anatomists human dissections during the Lenten period, especially in 10 The first anatomists in history (Erasistratus, Herophilus women, who were believed to have no soul. During this of Calcedon, and so on) performed many dissections in period religious limitations and regulations on human dis- human beings, but for more than 1500 years Galenic the- sections were not clear, but it was often the common peo- ories, based on observations in animals, dominated the ple who were more against such practices than the author- study of human anatomy. It is known that Galen per- ities.7 formed dissections only in animals, especially apes, oxen, pigs, and sheep. His most important anatomical work, De Mondino de’Liucci (ca. 1270–1326) Anatomicis Administrationibus, was based on studies performed in monkeys (Macacus inuus). These observations The first officially sanctioned dissection in the Middle were then arbitrarily adapted to humans, leading to erro- Ages was performed at the University of Bologna by neous descriptions of the human anatomy.4 Mondino de’Liucci (or dei Luzzi) (ca. 1270–1326). He In the Middle Ages, autopsies and dissections in hu- completed his book Anathomia Mondini in 1316. This mans were a controversial and restricted practice, espe- was the first book entirely devoted to the structure and cially limited by religious and popular beliefs. During the function of the human body, and was used for teaching Crusades, dissections of cadavers were permitted only to anatomy for more than 200 years.5 Mondino personally remove the inner organs to carry and bury the remains performed many dissections in human cadavers, distanc- more easily in their native land (the so-called sepultura ing himself from the custom of the time, in which the dis-

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Unauthenticated | Downloaded 09/28/21 08:57 PM UTC A. Di Ieva et al. section was performed by a servant, also called a barber, under instructions from the master.4 With his work he created considerable criticism with respect to Galen’s theories. Mondino was therefore considered to be a “Restorer of Anatomy.”4 Nevertheless, the Anathomia Mondini was lacking drawings and pictures to explain the text. Guido da Vigevano (1280–1349), Mondino’s pupil, also performed dissections in cadavers, and his anatomy manuscript Anathomia, published in 1345, marked the be- ginning of a new trend that became increasingly wide- spread during the following centuries: the use of anatomical illustrations in textbooks.12 In his manuscript Guido da Vigevano displayed for the first time six plates showing the head, brain, and spine. These pictures, although schematic and rudimentary, can be considered to be the first neuroanatomical drawings in the history of neuroscience. The years between 1280 and 1349 are considered to be pivotal in the history of medieval anatomy. The systematic anatomical drawings introduced by Guido da Vigevano in his textbook, although based on empirical and observa- tional concepts,3 set a milestone for further development of anatomical science, especially in the Renaissance. It is in this period that the marriage between science and the arts reached an apex with the publication in 1543 of the De Humani Corporis Fabrica by Andres Vesalius. This legendary work blended the study of human anatomy with the beauty of artistic drawings.4

FIG. 1. Plate XI shows trephination of the head by means of a Guido da Vigevano (1280–1349) scalpel and a hammer (from Wickersheimer E: L’Anatomie de Guido da Vigevano, an Italian physician and engineer, Guido de Vigevano, médecin de la reine Jeanne de Bourgogne was born in Vigevano, one of the most ancient Longobard (1345). Archiv für Geschichte der Medizin 7:1–25, 1913). cities in the Lombardy region (described in Wicker- sheimer17 as a “petite ville lombarde, qui au XIV siècle fai- sait partie du diocèse de Pavia.”), sited between Milan the prototype of the first autovehicle in history; the word and Pavia. He studied medicine in Bologna, learning “automobilis,” meaning “self” and “moving,” was created anatomy from Mondino. He was the personal physician of in the 14th century by the Italian engineer Martini, who Emperor Henry VII until that ruler’s death in 1313; later invented but never built a crankshaft-driven, four-wheeled on he was very close to the King of France, Philip VI, and vehicle.1,13 King Philip never left for the Holy Land, how- from 1335 until her death in 1349 he was the personal ever, and Guido’s wonderful machinery was therefore physician of the Queen of France, Jeanne de Bourgogne. never tested.10 He wrote books about medicine, anatomy, hygiene, and Guido da Vigevano dedicated another book to Philip VI “the art of war.”6,15 titled Anathomia Designata per Figures. Written in 1345, In 1335, King Philip VI of France was planning a new it included 24 anatomical plates, 18 of which have been crusade in the Holy Land. Guido, to strengthen his posi- lost. The plates numbered XI to XVI display the first neu- tion with the king as his personal doctor and engineer, roanatomical pictures and descriptions in the history of wrote and dedicated to him a “crusade book.” In this there neuroscience. were nine folios advising the king on how to take care of Guido’s purpose was to show human anatomy by his health during the journey, and 14 more folios advising means of schematic and systematic drawings of his dis- him on military technology.10,14 This booklet, titled “Tex- sections (“demonstrabo anathomiam corporis humani pa- aurus Regis Francie Aquisitionis Terre Sancte de ultra tenter et aperte, per figuras depinctas recte”).16 Mare,” included instructions on prefabricated portable The book is divided in four sections, as follows: siege equipment in consideration of the difficulty in find- 1) introduction; ing wood in the Holy Land, proposals for innovative body 2) description of the veins for bloodletting; armors, and sketches of military apparatus.9 In this pre- 3) explanation of the drawings; and cious manuscript it is possible to find drawings of many 4) appendix on the swelling of the uvula and palate. machines such as attack boats, pontoon bridges, and also In the third book, six plates (XI–XVI) are dedicated to two self-propelled battle wagons, one crank-driven and the anatomy of the central nervous system. Five plates the other powered by a very sophisticated windmill on the (XI–XV) show the head, meninges, and parts of brain, and back a wooden carriage.10 This last one is considered to be the sixth (XVI) shows the spinal cord.

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FIG. 4. Plate XV (detail of right side of Fig. 3). On the surface of the brain it is possible to recognize some sulci and gyri, and five orifices, two in the anterior frontal region, representing the olfactory nerves, and three in the frontoparietal region, representing the three ventricles. It seems to be the earliest portrayal of cerebral convolutions in the history of neuroscience (from Wickersheimer [see FIG. 2. Plates XII (left side of panel) and XIII (right side of Fig. 1 legend]). panel) depict the removed cranial vault, on which it is possible to recognize the frontoparietal and interparietal sutures, and the external meningeal layer (from Wickersheimer [see Fig. 1 legend]). Plate XV (Fig. 3, right side of panel; Fig. 4) shows the “naked” brain (“cerebrum purum et discoopertum”), without the meninges. On the surface of the brain it is possible Plate XI (Fig. 1) shows the trephination of the head by to recognize some sulci and gyri, and five orifices (two in means of a scalpel and a hammer to expose the brain and the anterior frontal region, representing the olfactory the two meninges known at the time, the dura and pia nerves, and three in the fronto-parietal region, represent- mater. Guido defines the meninges as “pellicula” (layer), ing the three ventricles).17 Following his predecessors’ 17 the same definition found in the Anathomia Mondini. theories (Galen, Avicenna, Mondino),8 Guido writes that Plates XII and XIII (Fig. 2, left and right sides of the the ventricles are the seat of the soul (“ventriculi, in qui- panel) depict the removed cranial vault, on which it is pos- bus stat anima et spiritus”), and from there the soul, by sible to recognize an exaggerated depiction of frontopari- means of the nerves, impresses motion to the peripheral etal and interparietal sutures (left side of panel),17 and the organs and the whole of the body (“dantes sensum et mo- external layer (“illa pellicula que vocatur dura mater” tum toti corpori, mediantibus nervis, et ipsum spiritum [right side of panel]). In plate XIV (Fig. 3, left side of portantibus toti corpori”). He describes the first ventricle panel) the dura mater has been removed, showing the as the seat of learning and imagination (“virtus apresensi- internal layer covering the brain, the pia mater (“amota va sive fantastica”), the second as the seat of the reason illa pellicula que vocatur dura mater, apparebit alia pel- (“virtus raciocinativa”), the third as the seat of the mem- licula que vocatur pia mater, cerebrum cooperiens”). ory (“virtus memorativa”). In this paragraph Guido re- calls also some physiopathological theories elaborated by Avicenna in the Canon Medicine2 about the causes of epi- lepsy and apoplexy. Plate XVI (Fig. 5) shows the spinal cord and the origin of the spinal nerves (only 18 in number), bilaterally passing through the vertebral foramina to reach the whole body.16 Plates XV (Fig. 4; detail of the head on the right side in Fig. 3) and XVI (Fig. 5) show a vague patterning of the cortical structure of the brain surface; as already noted by Yas¸argil,18 these drawings are the earliest por- trayals of the cerebral convolutions in the history of neuroscience. In spite of their vagueness, Guido’s plates have to be re- garded as an important step in the history of medieval anatomy. If Mondino de’ Luzzi can be rightly considered the “Restorer of Anatomy” from the darkness of Galen’s dogmas, Guido’s illustrations compelled scientists and artists to break free from Galen’s dominating influence.12 His work can be considered a milestone in the development of artistic anatomical illustrations as we know them FIG. 3. Plate XIV (left side of panel), showing the internal meningeal layer (“vocatur pia mater, cerebrum cooperiens”). On the today. right side of the panel, the Plate XV shows the “naked” brain The trend he set was further advanced by artists of the (“cerebrum purum et discoopertum”), without the meninges (from caliber of Donatello (1386–1466), the first artist who dis- Wickersheimer [see Fig. 1 legend]). sected human bodies, Leonardo da Vinci (1452–1519),

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In this context, the figure of Guido da Vigevano can be considered a link between the Galenic anatomy of the pre- Mondino Middle Ages and the science of anatomical studies explored in the Renaissance. It represents a pivotal step in the development of anatomy not just as a philosophical subject but as a science.

References 1. Alertz U: Der Windwagen des Guido von Vigevano. Technik- geschicht 68:53–77, 2001 2. Avicenna: [The Canon Medicine.] Reprinted in 1593 (Arabic) 3. Barg L: [Mediaeval anatomic iconography (Part II).] Arch Hist Filoz Med 59:301–320, 1996 (Polish) 4. Calkins CM, Franciosi JP, Kolesari GL: Human anatomical science and illustration: the origin of two inseparable disciplines. Clin Anat 12:120–129, 1999 5. Choulant L: History and References of Anatomic Illustration in its Relation to Anatomic Science and the Graphic Arts. Chicago: University of Chicago Press, 1920, p 435 6. Colombo A: Il medico aulico Guido da Vigevano. Riv Stor Sci med e natur 19: S255, 1928 7. de Morsier G: Essai sur la Genèse de La Civilisation Scien- tifique Actuelle avec une Histoire de l’Anatomie du Cer- veau. Geneva: Georg, 1965 8. Di Ieva A, Tschabitscher M, Rodriguez y Baena R: Lancisi’s nerves and the seat of the soul. Neurosurgery 60:563–568, 2007 9. Guido da Vigevano: Texaurus Regis Francie Aquisitionis Terre Sancte de Ultra Mare. Paris: Bibliothèque Nationale de France, 1335 10. Hall R: Humana civilitas: sources and studies relating to the Middle Ages and the Renaissance, in Hall BS, West DC (eds): On PreModern Technology and Science. Vol. I. Malibu, CA: Undena Publications, 1976, 11. Netter FH: Medical illustration; its history and present day practice. J Int Coll Surg 26:505–513, 1956 12. Olry R: Medieval neuroanatomy: the text of Mondino dei Luzzi and the plates of Guido da Vigevano. J Hist Neurosci 6: 113–123, 1997 FIG. 5. Plate XVI shows the spinal cord and the origin of the 13. Ostuni G: Le Macchine del Re. Il Texaurus Regis Francie di spinal nerves (only 18 in number), bilaterally passing through the Guido da Vigevano. Vigevano, Italy: Diakronia, 1993, p 225 vertebral foramina to reach the whole body (“tota nuca alba 14. Promis C: Gl’ingegneri militari che operarono o scrissero in descendens a substancia cerebri, et apparebunt in quolibet Piemonte dall’anno MCCC all’anno MDCL. Notizie raccolte. spondili duo foramina, scilicet unum ab una parte spondilis et Miscellanea di storia italiana 12:418–419, 1871 aliud ab altera, in quibus foraminibus egredientur nervi proca- 15. Romano G: Guido de Vigevano. Boll Soc Pavia di St Patria dentes a nuca, dantes sensum et motum toti corpori.”) (from 14: S353, 1914 Wickersheimer [see Fig. 1 legend]). 16. Wickersheimer E: L’Anatomie de Guido de Vigevano, médecin de la reine Jeanne de Bourgogne (1345). Archiv für Gesch- ichte der Medizin 7:1–25, 1913 considered by Frank Netter as the “founder of physiolog- 17. Wickersheimer E: Anatomies de Mondino dei Luzzi et de ic anatomy,”11 Michelangelo (1475–1564), to name but a Guido de Vigevano. Paris: Droz E, 1926, pp. 65–91 few. It was also explored in the works of scientists such as 18. Yas¸argil MG: Microneurosurgery: CNS Tumors. Vol. IVA. Eustachius (ca. 1500–1574), Vesalius (1514–1564), and Stuttgart: Thieme, 1994 others. In the Renaissance, three elements were crucial for the development and subsequent advancement of human anatomical studies: the recognition of anatomy as a distinct branch of medical science; the acceptance of human dis- Manuscript submitted April 23, 2007. section as a scientific method for advancing the under- Accepted June 15, 2007. standing of the anatomical structures; and the advance- Address reprint requests to: Antonio Di Ieva, M.D., Department ment of printing techniques, which allowed illustrations to of Neurosurgery, Istituto Clinico Humanitas IRCCS, Via Manzoni, be included alongside descriptive text.12 56, 20089 Rozzano (Milan), Italy. email: [email protected].

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