UPDATED

Cover page of Regimen Sanitatis Salernitatum c. 1480

"Thou to health and vigor should attain
 Shun mighty cares, all anger deem profane
From heavy suppers and much wine abstain;
Nor trivial count it after pompous fare
To rise from the table and take to the air.
Spurn idle noonday slumbers, nor delay
The urgent call of nature to obey.
These rules if thou wilt follow to the end
Thy life to greater length thou may extend".

The original poem is written in Latin and is part of the book "Regimen Sanitatis Salernitarum" published in 1480. This book contains articles and poems by Afflacius, Bartholomeus, Copho, Ferrarius, Petronius, Johannes Platearius, and Trotula. The editor of the book was Arnold de Villa Nova. It was later translated into English.

The author of the book was Constantinus Africanus of Carthage (1020-1087). His birth and original religion is in question, some stating that he was a Sarracen, and therefore born as a Muslim. He traveled extensively in Egypt, Greece, Italy, and India. His ability to read and speak Arabic, Latin, Greek, and other languages, helped him later to be considered one of the important translators of medical books bringing lost Latin and Greek knowledge in books from Arab countries into Europe.

After arriving in Salerno, Constantinus became a monk and dedicated his life to the publication of medical translation, not hesitating to call other's works as his own.

It is considered one of the two great publications of the School of Salerno in the Medieval Ages, the other one being the "Compendium Salernitatus"

More on this wonderful book here.

Source:
"Medieval and Renaissance Medicine" B.L. Gordon 1959 Philosophical Library Inc. USA

This article is part of the series "A Moment in History" where we honor those who have contributed to the growth of medical knowledge in the areas of anatomy, medicine, surgery, and medical research.

Folder of "Sutures in Ancient Surgery"

During a recent 2024 lecture I delivered to a group of engineers at Medtronic, I met with Jack Kennedy, an engineer, past student, and a good friend. Jack and I share a passion for medical history. He has a very interesting collection of antique sutures and books related to the topic. He gifted me a collection of antique photographic prints in a leather-like folder with gilded letters. The name of the work is “Sutures in Ancient Surgery”. Jack was kind enough to sign and dedicate this gift that now holds an important place in my library.

For those who know me, I cannot have a book without looking into its history. What I found was incredible! The findings are in the following areas and topics:

1. The history of the Davis and Geck suture company.
   2. Lejaren à Hillier, main photographer of “Sutures in Ancient Surgery”
   3. The content of the publication, images, and controversy
   4. Missing prints
   
   1. The history of the Davis & Geck company

Davis & Geck (D&G) was founded in 1909 by Charles T. Davis and Fred A. Geck, along with Frank D. Bradeen, and Benjamin F. Hirsch. Interestingly, Fred Geck left the company only a few months after its formation, but the company kept his name.

Located in Brooklyn, NY., the company specialized in the development and manufacture of surgical sutures along with various other medical products. Over the years the company changed ownership and has changed its name a couple of times. In 1930, the company was acquired by American Cyanamid after a trial between Charles Davis and his wife. This particular spot in the company’s history includes a murder, prison, lovers, and a trial. If you are interested, read the story of the company at UConn’s and SNAC web pages (see “sources”).

D&G was acquired by Sherwood, and later by the Tyco Corporation where it was renamed Syneture. Tyco Healthcare became Covidien, Ltd., which was later acquired by Medtronic, where it is today.

In 1970 Davis & Geck introduced Dexon, the first synthetic absorbable suture, followed shortly by Ethicon (J&J) sutures with Vicryl. Since then, research and development in the Medtronic line of sutures makes this company one of the world leaders in wound closure.

2. Lejaren à Hillier, main photographer of “Sutures in Ancient Surgery”

Lejaren à Hillier (1880-1969), was born in Milwaukee. He studied at the School of the Chicago Art Institute; his interest was classical fine arts. His studies and activities drew him to experimenting with photography and novel techniques for the times, where he mixed photography and painting. He became a famous commercial photographer.

One of his most exciting works was that of “tableaux vivants” (living portraits), where he would stage actors and innovative lighting techniques to represent scenes that he would later edit with paintings or use different photographic development techniques to obtain the appropriate mood. His work soon caught the attention of companies that used these tableaux vivants in commercial printings for brochures or newspapers.

Hillier was approached by D&G and the project of “Sutures in Ancient Surgery” was born. Starting in 1927 and all trough 1950, D&G sales representatives would present their customers (physicians and surgeons) with the “latest” image, ensuring an open door when they showed up at the doctor’s office. The doctors were also presented with a leather-like folder to maintain their collection. The number of prints varied each year, and it is interesting to note that none were published during the long years of WWII.

According to JTH Connor, a total of eighty three portraits were published. These show medical scenes that range from prehistory, trough Egypt, Greece, Rome, the Middle Ages, the Renaissance, all the way to the 19th century. The list of individuals portrayed is itself worth of research, as all of them in one way or another influenced medicine and surgery. Albucasis, Avicenna, Celsus, Fallopius, Fabricius, Galen, Harvey, Hunter, Rhazes, and Vesalius are but some of the tableaux vivants created for D&G.

Hillier was criticized for the lack of accuracy in some of the portraits as well as the person depicted, but the ideas for the topics were not his. The consultant used by D&G to suggest the topics was Samuel Harvey (1886-1953), who himself studied under the tutelage of famous neurosurgeon and medical historian Harvey Cushing (1869-1939).

Some of the images were later published in a book by Hillier (“Surgery through the ages”, 1944) showing other tableaux made for other medical publications.

This article continues here: The interesting story of “Sutures in Ancient Surgery (2)"

This article is part of the series "A Moment in History" where we honor those who have contributed to the growth of medical knowledge in the areas of anatomy, medicine, surgery, and medical research.

Folder of "Sutures in Ancient Surgery"

This article is the continuation of The interesting story of “Sutures in Ancient Surgery” (1).

3. The content of the publication, images, and controversy

Each tableaux vivant depicted a scene of history of surgery, with a short description of the individual and their accomplishments. In general, these descriptions are accurate, but very short. The objective was to allow the doctor to read the text, admire the image and leave time for the medical representative to deliver their presentation of a particular product.

Each page was printed in black and white, on a high quality paper measuring 12 by 9 ¼ inches. The paper itself was originally lightly yellowed to denote that this was an historical image. In fact, many doctors believed that these were reproductions of antique paintings, which they were not! The image itself was 6 ½ by 5 ¼ inches.

In some images it is clear that the background was painted. In fact, the image of Hyeronimus Fabricius Ab Aquapendente (157-1619) published in 1927, shamelessly copies part of the background of the 1555 title page of the Fabrica of Andreas Vesalius (1514-1564), or one of the many plagiarisms of the same book.

The controversy today lies with a number of women depicted with their nude breasts. In one case, (“Aspasia”, published in 1933) the photograph depicts five women including Aspasia, all of them showing a naked breast. Although “Sutures in Ancient Surgery” is criticized for this easy depiction of nudity, only 30% fall in this category.

Adding Aspasia of Miletus to this collection of physicians also brought criticism, not only for the nudity, but for the fact that Aspasia is a legendary figure whose life is in question as well as her place in Greek society. Some say that she was a prostitute and the regent of a house of ill repute, other say that she was a teacher of philosophy along with Socrates and that she was married to Pericles. Others say that she never existed, yet her name and life has been used in a novelized two-tome book. Why was she selected for this collection? No one knows.

Following are some images from "Sutures in Ancient Surgery".

4. Missing prints

Because these prints were presented as loose-leaf items to the doctors, many of them have been lost. Some historians comment that doctors would frame these images and use them in their offices, so a complete collection of the 83 photographs is extremely difficult to find. In once case, it is known that a hospital had the complete collection framed in one of its hallways (Sobieszek, 1988) which hospital, or what happened to that collection is unknown.

Today, the “Sutures in Ancient Surgery” folders found for sale in antique libraries have a varying number of prints, all of them incomplete. Some universities list them in their libraries and in one case, they have only three prints in their collection!

My research has been able to find the names of 76 of the tableaux vivants in this collection, but I have not been able to find the names of seven of these prints.

The folder that I received from Jack Kennedy contains 75 prints, and I am looking for the last eight including that of Teodorico Borgognoni, year of printing unknown.

If you have any or know of someone that owns a few in this collection, please contact me. I prepared an PDF file with  the prints I have as well as those I do not. You can download it here.

Once again, thanks to Jack Kennedy for his addition to my collection. It has been an interesting research and I look forward to the next one!!

Sources:
1. UConn library Archives and Special Collections: Davis and Geck company records.
2. SNAC-Social Network and Archival Context: Davis and Geck Company.
3. “Soak it up: Examining bioabsorbable polymers in healthcare” Medical Plastic News
4. “The striking social tableaux vivants of Lejaren à Hillier” J.T.H. Connor. Hetkoen International
5. “Photography view; when tableaux vivants flowered in the magazines” Gene Thorton. The New York Times. March 2, 1986.
6.” Tableaux Vivants: A Long History of Recreating Art” Karolina Dzimira-Zarzycka. Daily Art May 1, 2020
7. “Medical History’s Moment in Art Photography (1920 to 1950): How Lejaren à Hillier and Valentino Sarra Created a Fashion for Scenes of Early Surgery” Journal of the History of Medicine and Allied Sciences, Volume 72, Issue 4, October 2017, Pages 381–421
8. “Aspasia” Wiki,org
9. “The Art of Persuasion: A History of Advertising Photography” Sobieszek, Robert A. 1988
10. “Aspasia” A Romance of Art and Love in Ancient Hellas” Mary J Safford German) Robert Hamerling (Translator) 1882. NY. W.S. Gottsberger, Publisher.
11. “Lejaren A. Hillier Photography Collection” University of Texas, Harry Ramson Center.

1543 Fabrica Title Page

One of the most collectible books in medical sciences and specifically in human anatomy is “De Humani Corporis Fabrica; Libri Septem” (Seven books on the structure of the Human Body) published in 1543 by Andreas Vesalius. This book is known as the “Fabrica” among Vesaliana enthusiasts.

The story of the Fabrica is complicated and the books, research papers, paintings, statues, medals, etc. on Vesalius and the Fabrica number in the thousands.

The first edition of the Fabrica was published in 1543, it was well received and was followed by the second edition in 1555. Vesalius died in 1564 and no further editions of the Fabrica were published. There are several translations in different languages, the latest is the “New Fabrica” published in 2013. This book included annotations by Vesalius himself found in a 1555 Fabrica. This particular “Annotated Fabrica” has a history worth reading and is one of the most expensive books ever sold at an auction in February 2024 for 2.23 million US dollars.

Part of book collectibles are single pages cut off a book. This method was quite common among antiquarians in the late 1800’s and early 1900’s. As a book collector, I think it is not a good idea to destroy a great book in the quest to obtain more money selling it as individual pages.

Be that as it may, in early 2023 I was notified by my good friend Dr. Randall Wolf, one of the contributors of Clinical Anatomy Associates, of an auction by Potter and Potter where two pages of the 1543 Fabrica would be placed on the block. With his help and lots of luck, I was able to secure item 298, which was a single page of the Fabrica, page 187, one of the “muscle men”, which depicts the “Liber II, Sexta Musculorum Tabula” (Book 2, Sixth Muscle Image).

Cover page of the June 2023 Potter&Potter Auction

Item 298 description

One of the problems that collectors face is to prove that a certain item is original, the second one is provenance (where does the item come from?).

The first question was answered in Belgium when Dr. Wolf and I visited Dr. Francis Van Glabbeek and his personal collection in June 2023 with occasion of the 2023 Vesalius Triennial Meeting in the city of Antwerp. We were able to compare in minute detail the original image and my single page, including the type of paper and the text on the opposite page. They were a perfect match, proving that this page was indeed taken of an original 1543 Fabrica.

The second question was answered by the auctioneer, as the page belonged to the library of Ronald K. Siegel, PH.D. (1943-2019), an American psychopharmacologist and associate research professor in the Department of Psychiatry and Behavioral Sciences at the University of California, Los Angeles (UCLA). Before Dr. Siegel, we do not know how or when he acquired this single leaf of the Fabrica.

The page was carefully framed by Becky Gebhart, owner of “Picture This” in Lebanon, OH, and is secured with museum-quality glass. It in now on the wall facing my desk. Here it is:

 
Theo Dirix

Note: The following article was recently published in Dutch by my good friend Theo Dirix. Theo is one of our "Vesaliana" contributors, and he has written or has been part of several of the articles in this website. Theo was kind enough to provide a translation of his publication for this blog. There are footnotes in the original publication and I have added them to the end of this article. Dr. Miranda

Christie’s in New York recently sealed the deal of an exceptional copy of the Fabrica, the masterpiece by Andreas Vesalius. The sound resonated widely: buyers were the alma mater of the doctor, the KULeuven (University of Louvain, Belgium), and the Flemish government.

Earlier, a copy of Vesalius’s 1538 adaptation of a teacher’s manual, with his own notes, had already gone under the hammer. This copy of the second edition of the Fabrica from 1555, also richly annotated by the author, was not allowed to escape.

Vesalius enthusiasts eagerly anticipate seeing this historical wonder with their own eyes, following the promised digitization by the KULeuven and its exhibition in their ‘experience center’.

Non-medical or non-Latinist individuals may also find Vesalius captivating. The allure of such a well-traveled, exceptionally driven, and art-loving man is infectious and timeless. The Inquisition had no control over him, and his free-spirited mind and interactions with those of differing beliefs, such as Protestants or Jews, continues to inspire today.

At the end of the First Book of the Fabrica, there is a list of names for the bones of the skeleton as Vesalius knew them: first as he himself preferred to use them, then in Greek and in the Latin of others, and finally in Hebrew. In a certain way, the latter is also the Arabic translation, so he says, as they are “almost all taken from the Hebrew translation of Avicenna by my good Jewish friend and eminent physician Lazarus de Frigeis (with whom I usually study Avicenna).” 1

The opening print of the Fabrica may even feature an image of his friend.  After all, Vesalius had one of his public dissections illustrated. 2

"A colorful crowd, rows deep, stands, hangs, and drums around the table on which a corpse is being dissected. Three quarters of almost two hundred guests are students, with about fifty doctors and other notables also in attendance."

That is how the German student Baldasar Heseler described in his diary a public dissection in Bologna, conducted by the Flemish anatomist Andreas Vesalius.

Among the attendees were likely curious individuals who also frequented public executions or animal fights. Dissections were not serene practical lessons like today. Sometimes several dissections followed each other, often chaotic and in a festive atmosphere during the carnival period: today a hanged man, tomorrow a prostitute, in between a dog.

The image Vesalius chose for his first version of the Fabrica in 1543 is more symbolic in nature. Various authors see allegories in the ninety characters, as well as historical and contemporary prominent figures and acquaintances. 3

A striking figure who is central yet isolated is a man with a long beard, red in some colored versions, wearing a truncated conical headdress such as a tarboosh or fez. He turns towards his neighbor who whispers or shouts something to him. Or is he responding to the scene unfolding beneath him with the dismissive gesture of his left hand? With understanding or disgust?

Like other guests, he wears a heavy cloak; dissections were preferably performed during the cold winter months. It may be far-fetched, but don’t those stripes on his cloak remind us of the threads of a Jewish prayer shawl? Is this “his good Jewish friend and leading physician Lazarus de Frigeis”?

In the opening print of the second version from 1555, the stripes or threads are less clear. The sharp gaze is also blurred. And isn’t that beard shorter? Things have indeed changed in twelve years.

For example, the originally naked spectator on the balcony now wears a suit. The dog, bottom right, has a goat or goat next to him: is that perhaps the devil? The pennant of the all-dominating skeleton in the center becomes a scythe in the hands of Death.

Many find the later image less appealing than the original and speculate as to the reasons: Was it created by a different and perhaps less talented artist? Was the initial woodcut set aside because it had already been extensively used? Do the alterations suggest censorship or self-censorship, perhaps with an eye towards the advancing Inquisition?

Vesalius also made numerous changes to the text in the second edition. It remains a mystery how he communicated these changes to his Basel printer, Oporinus. This curiosity extends to his annotations and the third edition he had in mind. For instance, in the second edition, he omitted all references to his friends, retaining only the mention of Lazarus de Frigeis. However, the descriptors ‘Jewish’ and ‘leading physician’ were removed. Lazarus is still described as “his good friend.” Why did the reference to Judaism have to vanish?

One explanation posits that the descriptor ‘Jew’ had become redundant. Following the perspective of a researcher who identifies Lazarus de Frigeis as Lazzaro Freschi, the son of Rabbi Raffaele Fritschke, it is thought that Lazarus converted to Christianity in 1549, assuming the name Giovanni Battista Freschi Olivi. 4

Another explanation suggests that it may have been safer at the time to avoid allusions to Jewish beliefs or conversions. According to the same source, Lazzaro Freschi and his mother moved, or were compelled to move, to the Venice ghetto in 1547.

The word ‘getto’ is Italy’s ‘contribution’ to anti-Semitism, akin to later terms such as ‘pogrom’ from Russian, ‘Endlösung’ from German, and the slogan in English today commonly heard on European streets: “From the River to the Sea”.

Vesalius, however, continued to refer to Lazarus de Frigeis as his good friend. Not only was the anatomist well-traveled, passionate about his work, and an admirer of art, he was also loyal, open-minded, and, above all, courageous.

Theo Dirix

With gratitude to Omer Steeno, Maurits Biesbrouck, and Theodoor Goddeeris

Footnotes:

1. based upon: Maurits Biesbrouck. Nederlandse vertaling van het eerste boek van Andreas Vesalius’ Fabrica 1543, handelend over het Menselijk Skelet. P. 394.
2. with differences in the frontispieces of the Fabrica’s of 1543 and 1555: https://exhibitions.lib.cam.ac.uk/vesalius/
artifacts/coloured-frontispiece-1543/, and https://library.missouri.edu/specialcollections/exhibits/show/vesalius500/fabrica/a-tale-of-two-title-pages
3. for example: C.D. O’Malley. Andreas Vesalius of Brussels 1514-1564, University of California Press, Berkeley and Los
Angeles, 1964, p. 140.
4. Toaff, Ariel. Pasque di sangue, Ebrei d’Europa e omicidi rituali, Societa editrice il Mulino, Bologna, 2007, p. 197 - 198

This article is part of the series "A Moment in History" where we honor those who have contributed to the growth of medical knowledge in the areas of anatomy, medicine, surgery, and medical research.

Annotated Fabrica

Everybody has the hope of someday finding a treasure, and we look for it in garage sales, antique shops, anywhere and everywhere. As a book collector, I live for the day when I find a precious book that has been overlooked and that I can add to my collection. This is the story of such a find by a book collector who not only found the treasure, but sold it!!.

No one knows exactly how many copies were printed of Andrea Vesalius' magnificent book “De Humani Corporis Fabrica, Libri Septem”. It is estimated that each run of the first (1543) and second (1555) editions were between 600 -1000 copies, maybe less.  The censuses on the surviving copies of this book published by S. Joffe, MD and V. Buchanan in 2015 tell us that less than 60 copies of each of these books exist in the USA, and the total worldwide number is unknown.

Most of the books available today are in rare book repositories at university libraries, and only a few are available to private book collectors.

The price for a good copy today is close to half a million US dollars (or more). Although some copies can be found for less, they are probably not original, and could be one of the many plagiarized copies of this wonderful book.

In 2007, Vancouver pathologist and book collector Dr. Gerard Vogrincic bought a Fabrica at auction in Germany. This was not the best copy of the Fabrica. The index (an important part of the book, as it was the first anatomy book to ever have one) was missing, but most important, the book text was heavily underlined and annotated; some paragraphs were crossed out with ink, and over one thousand annotations were found on the sides of the pages, as well as in the images, a critical part of this book and the reason for its fame. As a result, the price at the auction was not too high, as it sold for US$14,256.

A careful revision of the handwritten notes led Dr. Vogrincic to believe that the notes may have been written by Vesalius himself, but he had no idea of how to confirm it and he could not read Latin, the language of the annotations. There are only a few examples of Vesalius’ handwriting, as Vesalius burned many of his notes and letters, and only some survived. Dr. Vogrincic obtained a facsimile of one of Vesalius’ letters and was surprised that indeed the writings matched!

Dr. Vogrincic contacted Dr. Vivian Nutton, Emeritus Professor at the UCL Center for the History of Medicine in London. Dr. Nutton, a Latin scholar and Vesalius expert confirmed that this was a book that not only belonged to Vesalius, but that the handwriting, and the style of the Latin annotations was Vesalius'!. The book includes corrections to the style, grammar, anatomy, images, and also instructions for a third edition that was never published.

For a time, the book was on a "permanent" loan at the Thomas Fisher Rare Book Library in University of Toronto, Canada, part of a 2015 exhibit, and was an important addition to the translation and annotations for the “New Fabrica” authored by Drs. M. Hast and D. Garrison. The New Fabrica is now out of print.

In 2022, toward the end of the COVID pandemic,  the University of Cincinnati and the Henry R. Winkler Center for the History of the Health Professions, held an online and in-person exhibit and series of lectures entitled  "The Illustrated Human: The Impact of Andreas Vesalius". One of the lectures was on the Annotated Fabrica. You can watch the whole lecture and interview with Dr. Gerard Vogrincic and Dr. Vivian Nutton here. Here is the link for "The Illustrated Human online exhibit".

Following is a YouTube video by Philip Oldfield, curator of the Thomas Fisher Rare Book Library in University of Toronto, Canada, talking about this book

This book was sold on February 2^nd, 2024 on auction at Christie's New York, for the incredible sum of 2.23 million US dollars. his is one of the top 10 highest amounts of money ever paid for a book. The link posted here will take you to the auction page and 17 images and a video by Christie's curator Rhiannon Kohl.  

It is only fitting that the buyer of the Annotated Fabrica was non other than the University of Leuven, in Belgium, which is the first University that Vesalius attended. In fact, one of the most treasured documents of this University (until now) was the book where Vesalius signed when he matriculated at the University of Louvain (Louven) on February 25, 1530, at 15 years of age. He signed this registry as "Andreas Vesalius Bruxellensis". I had the opportunity of seeing this document personally in 2003.

My personal thanks to my good friend Ron Blumenfeld, MD, world traveler, collector, and author of the book "The King's Anatomist, The Journey of Andreas Vesalius" for bringing this auction to my attention.  He also posted an article about this auction titled "Five Centuries Later, Andreas Vesalius Flashes His Star Power". 

Another article on this topic was published by New Atlas titled ""Bookfind of the century" sells for $2.23 million"

Sources:
1. “The annotated Vesalius” Duffin, J; Duffin, J. CMAJ (2014) 186:11, 856-857
2. “A Clever Collector Makes an Astonishing Discovery” Vogrincic, Click here for the article
3. “Vesalius Revised. His Annotations to the 1555 Fabrica” Nutton, V. Med. Hist. (2012), 56(4), 415–443 Click here for the article
4. “Updated Census in USA of First Edition of Andreas Vesalius’ ‘De Humani Corporis Fabrica’ of 1543” Joffe, SN; Buchanan V. International Archives of Medicine; 2015: 8:1
5. “An Updated Census of the Edition of 1555 of Andreas Vesalius’ De Humani Corporis Fabrica in the United States of America” International Archives of Medicine; 2015: 8:1
6. “Vesalius’ notes for unpublished edition of De Fabrica” Click here for the website 
7. "A Spectacular New Arrival" Oldfield, P; The Halcyon, Issue 49, June 2012 Click here for the article

Note: This article was originally published in 2017, and has been updated several times, in 2019, 2022, and 2023. This is the last version (for now).