This book categorizes the lectures held during the 2nd International Meeting on Medicine and Pathology organized by the Working Group History of Pathology of the European Society of Pathology in Padua, Italy in 2015. This content was influenced by the celebration of the 500th birth year of Andreas Vesalius (1514-1564) and this occasion was used to highlight his role in anatomic research.
The first part of the book is therefore dedicated to the importance of Vesalius work, with original contributions on his life, his work and his historical context. The second part contains a variety of papers on the history and medicine and pathology, such as papers about historical aspects of cardiac disease (congenital disorders, heart transplantation, famous people affected by heart disease) and lectures about historical medical collections and other issues. The third part contains interesting medical biographies about persons who had an enormous impact on medical thinking e.g. Norman Barrett, Herman Boerhaave, Giovanni Battista Morgagni, John Morgan, Santiago Ramon y Cajal, and John Snow.
Over the centuries, the history of anatomical theatres has been of particular importance in the development of medical teaching. Since time immemorial people have been interested in the structure of the human body. The dissection of human bodies was carried out as early as in Ancient Greece but the further development of anatomy was hampered by long-standing cultural taboos, which were particularly prevalent in the Roman Empire and in the Middle Ages when it was believed that ‘tampering’ with the bodies of the dead was somehow godless and evil. Therefore, until the 16th century the prevailing dogmas with regard to anatomy were those presented by the Roman anatomist Galen (Galenus) (130–201 CE), who drew his knowledge from the dissection of animals, mostly monkeys and pigs. The interest in the anatomy of the human body only reappeared in the 13th century and was indirectly related to the emergence of universities which also included medical faculties. In the 14th and 15th centuries, public demonstrations of anatomy – originally reserved for students of medicine – became popular. This was related to the dissection of the body and showing how it was built. Such demonstrations usually took place in the homes of the teachers who performed the dissection, in the presence of 20 to 30 people (students). Towards the end of the 15th century, when the interest in anatomy grew exponentially, these demonstrations became so popular that they also attracted non-medical audiences. The interest was so great that they began selling tickets – thus making it necessary to build a place where it was possible to see what was happening during the dissection. Therefore, the first timber theatres began to appear, which were initially temporary and portable and could also be ‘folded up’. With time they became permanent structures which were designated specifically for lessons in anatomy thus giving birth to the foundation of the anatomical theatre. The anatomical theatres were modelled on Roman amphitheatres – they had to provide a good view of the dissecting table from every angle. This was possible thanks to arranging the room in the form of an amphitheatre with rows of seats placed one above the other, in tiers. The dissecting table, lit by candles, was placed in the central part of the theatre, next to which was the teacher’s seat. However, he did not personally take part in the dissection, but instead read out an anatomical treatise (usually the work of Galen). An anatomist was responsible for the demonstration to the assembled viewers, and the dissection of particular parts of the body according to the teacher’s instructions. The guests were seated by a special assistant known as the praefectus, while another of the teacher’s assistants, the custodes, was responsible for preventing crowds of unauthorized people from entering the theatre. These anatomical demonstrations had their own particular allure, their own style of showmanship and specific rules. They were reminiscent of a theatrical performance – the ambience was created by the candlelight, music, the tickets that had to be purchased, and the diffusion of perfume to mask foul odours. The seats were divided into those that afforded a prime view – located in the lower rows, with better visibility, and which were designated for members of the municipal authorities and members of the university senate – and those situated in the higher, less prestigious rows, for students and onlookers. The demonstrations, which lasted several days, were veritable spectacles and often took place during the carnival season (in the second half of January of thereabouts) – in the winter, when temperatures were cooler and better for preserving the body. The city in which the theatre was located was responsible for providing a body. These were usually the bodies of convicts, and those of tall, thin men were preferred (so they could be seen more clearly from the higher rows). Moreover, the body could not be that of a resident of the city where the dissection was taking place, just in case a family member might be present at the demonstration. In the mid 18th century the popularity of anatomical theatres declined. They still existed, even up until the 20th century, when they returned to their roots; they ceased to be paid performances which attracted crowds of people, and once again became strictly connected to the universities.
The Anatomical Theatre in Padua
The anatomical theatre in Padua is the oldest surviving permanent anatomical theatre in Europe. It was built in 1594 in the 14th-century Palazzo del Bo, which was then the main building of the University of Padua. The anatomical theatres built in the 17th century in other European universities were all modelled on the one in Padua. It was visited by Johann Wolfgang von Goethe, who passed through Padua in 1786. He described the theatre in his Italian Journey as being small and dim: ‘The audience are squashed one on top of each other in a tall pointed funnel. They look down the steep sides of the auditorium into a narrow space at the bottom where there is a table on which no daylight falls, so the lecturer has to work by lamplight.’ The theatre was timber built. Under the main the entrance is a Latin inscription which reads Mors ubi gaudet succurrere vitae, in other words This is the place where the dead are pleased to help the living. The auditorium was composed of six steep, concentric tiers – viewing galleries rising steeply around the dissecting table, each of which was surrounded by an elegantly carved balustrade. Each tier was barely 40 cm wide, so there was standing room only, and the observers had to be thin in order to squeeze into the space. The first tier was usually reserved for the rector of the university, professors, and local dignitaries. The second and third tiers were for students and the remaining space was for the general public. The theatre could accommodate approx. 200 people. The disadvantages of the theatre’s ‘funnel’ or ‘well-shaped’ architecture was that there was little free space in the area containing the dissection table and the seat of the professor giving the lecture, the galleries were narrow which made it difficult for people to move around and also the fact that until 1844 the theatre had no natural daylight – the windows were closed when performing a dissection and the classes were held by candlelight – two candlesticks were on the dissecting table and eight candles were held by students seated on makeshift chairs arranged around the table. The theatre has not undergone any modifications over the years and to this very day has survived in excellent condition.
Anatomical Theatre in Bologna
This is one of the most beautiful anatomical theatres and is located in the University of Bologna, also the oldest remaining university in the world. The interiors are lined with pinewood wainscoting (thus enhancing the acoustics in the room) which is of warm brownish-reddish hues. The theatre was built in 1636 but underwent a number of modifications over the years before its completion in 1737. Its construction differs from the one in Padua – the auditorium is rectangular in plan. Every nook and cranny of the theatre is elaborately decorated. Twelve statues representing renowned physicians, such as Hippocrates and Galen, stand in niches along the walls. Gaspare Tagliacozzi, who pioneered plastic surgery, is also among them; he is shown holding a human nose in his hand. In the centre of the ceiling is an octagonal panel with a sculpted figure of Apollo (the Greek god of healing and father of Asclepius). Because physicians in ancient times consulted with the stars before an operation, the ceiling is also ornamented with 14 wooden panels symbolizing the constellations, including Orion, Perseus and Hydra. The canopy above the teacher’s chair is supported by two figures depicting Spellati (écorché), anatomical models of men treated so as to display the musculature. They were sculpted in 1734 by the great Italian anatomist, painter and sculptor Ercole Lelli (1702–1766). The canopy is surmounted by a female figure – an allegory of Anatomy – to whom an angel is offering a femur instead of flowers. The focal point of the theatre is the magnificent marble dissecting table which stands in front of the teacher’s chair. It is surrounded by a wooden balustrade, which acted as a barrier to prevent the table from being crowded by over-inquisitive viewers. Three rows of benches stood along the walls where local dignitaries, physicians and members of the general public sat alongside the students. The anatomical theatre was seriously damaged in the Second World War, during the bombing of Bologna on 29 January 1944. However it was reconstructed immediately after the war ended making use of the original wooden sculptures that were fortunately recovered from the rubble.
Anatomical theatre in Uppsala
The anatomical theatre in the Gustavianum building at Uppsala University was completed in 1663 by a professor of medicine and amateur architect Olaus Rudbeck who located the six-tiered theatre, in the shape of an upturned cone, in the dome at the top of the Gustavianum building, which was then the University of Uppsala’s main building. Rudbeck had spent some time in Leiden, and both the anatomical theatre and botanical garden which he established in Uppsala in 1655 were influenced by the experience he drew on from his stay there. The theatre is smaller than the one in Padua and it is less spectacular than its later
iteration in Bologna. The theatre’s octagonal storeys were intended to provide a good view of the scene taking place below to all attendees. It was built to accommodate 200 spectators – far more than there were students of medicine. The remaining seats were reserved for outside observers who, ofcourse, had to pay to be admitted. At the end of the 18th century, when anatomical theatres went out of fashion, the entire Gustavianum building changed its purpose and became the university library. At the turn of the 19th/20th century the theatre functioned as a zoological museum but it was returned to its original state in the 1950s and became a museum in 1997. The theatre tour is supplemented with an exhibition on the history of medicine consisting of a collection of scientific instruments and medical appliances dating from the heyday of the anatomical theatre.
Anatomical Theatre in Leiden
The anatomical theatre in Leiden was opened in 1594 and was part of the university which had been established 18 years earlier. The theatre was constructed in the apse of a former church (which also housed a library and a school of fencing) which provided good lighting – the light came into the room through large windows, so there was no need to use candles. The theatre took the form of an amphitheatre with a rotating dissecting table located in the centre. The seats were arranged into six tiers, which were not as steep as those in the Paduan theatre or the one in Uppsala; there was also more space between them. Human skeletons were lined up between the seats holding small flags bearing the inscriptions ‘Memento Mori’ and ‘Vita Brevis’ in their hands, thus emphasizing the philosophical character of this place and forcing people to reflect on the transience of human life. Not only physicians and students could attend the dissections, there were also seats available for the general public, who had to pay to be admitted, however only the well-to-do could afford to attend. The dissection of bodies took place in a solemn atmosphere with everyone concentrating on the matter in hand. They were also attended by the Mayor of Leiden and the university authorities for whom the best seats in the front row of the stands were reserved. The bodies to be dissected were those of criminals as was the case in other anatomical theatres. The whole dissection process was accompanied by musicians (a small orchestra or one or two flautists); perfume was diffused throughout the auditorium, and large candles illuminated the dissecting table, at which the teacher stood in ceremonial attire.
All lectures and other academic activities were suspended while the demonstrations were taking place. As in the other anatomical theatres, dissection only took place in the winter months when colder temperatures preserved the body. Throughout the remaining part of the year, the anatomical theatre, which was a permanent structure, was also open to the public and functioned as a cabinet of curiosities – it contained animal and human skeletons, Egyptian mummies and Roman artefacts. What is interesting is that in the 17th and 18th centuries the theatre and its collections were a form of tourist attraction– guides were even published in Dutch, Latin, English and French for visitors. Visitors could, of course, take the opportunity to learn about the human anatomy, but they were also entertained with stories connected with the exhibits, such as the body of a woman who was sentenced to death for theft. The theatre existed until 1821. It was reconstructed at the end of the 20th century and became part of the Rijskmuseum Boerhaave which is a museum of the history of science and medicine. The anatomical theatre is one of the museum’s main attractions.