If you arrived directly to this article, the first article in this three-page series can be read HERE

Without the organizing skills and drive and energy of Dr. Mark Gardiner and the countless meetings and emails with Theo Dirix, the conference Vesalius Continuum would not have been the huge world class event it became.

In 2013 Dr. Mark Gardiner and I first introduced ourselves to Professor Vivian Nutton who was giving a lecture at Warwick University about the incredible find of a hand written (by Vesalius himself !) edited version of the Fabrica’s second edition, which would have become the third edition, …had Vesalius not met his untimely death. Mark and I were blown away by this wonderfully exciting lecture and we asked Professor Nutton to be a speaker at our conference in 2014, which he accepted gladly. He was invited again in 2017 for the triennial and has now especially for this publication written an exciting account of Vesalius in England, 1544 to 1547.

Sculpting the monument in Richard Neave’s studio

My colleague and dear friend forensic medical artist Richard Neave and I sculpted a bronze monument to commemorate Vesalius’s death on the Island of Zakynthos on 15th Oct 1564. This monument might never have been erected if it were not for the wonderful idea of  Antwerp GP and president of Vesaliana Dr Marc de Roeck together with William Nagels, who devised a way of self-funding this large undertaking. We had countless meetings discussing the monument and agreed with Dr. de Roeck that by making a bronze facial reconstruction portrait (made by Richard Neave and myself) and selling 12 copies we would gather enough money together to make the monument, pay to have it cast in Bronze and drive the sculpture from Belgium to Zakynthos ready to have its grand inauguration at the start of the conference. This was all achieved successfully and the sculpture now stands on the Island of Zakynthos’s Vesalius square, facing the Ionian sea.

After our first visit to “what we thought then was the grave site“ at Laganas, I wrote a letter to the Belgian embassy in Greece, asking for help with our quest,  a year later when Theo Dirix took office as Consul he wrote back to me, my letter had ignited a flame in the heart of taphophile Theo Dirix.

Sculpting the monument in Richard Neave’s studio
Click on the image for a larger version

Theo Dirix wrote 2 books on the quest of the grave and now will reveal some new insights with his article  in the book “In the Shadow of Vesalius”.

This article continues HERE

The following article was written by my good friend Pascale Pollier-Green and it recounts the long road that has taken her and other Vesaliana followers all over the world, and has resulted in the publication of the book "In the Shadow of Vesalius". Dr. Miranda

The concept behind the book “In the shadow of Vesalius” is probably best described by the opening address of the editor and one of the authors, Professor Robrecht Van Hee. Following here are a few excerpts from his transcript:

“The quincentenary of Vesalius’s birthday in 2014 has been characterized by a flow of colloquia and publications on the Flemish anatomist, often presenting new insights concerning his life and death, as well as concerning his works and iconography.

This revival of interest has subsisted and induced new symposia and initiatives, resulting in new congress proceedings and publications, reflecting the search of an increasing number of scholars into the anatomical, social, and artistic influences of Vesalius and his  opus magnum book "De Humani Corporis Fabrica Libri Septem" on 16th century and later scientific evolution.”

Pascale Pollier-Green, author of this article

This is most pertinent in the case of Vesalius’s collaborator and artist Jan Steven van Calcar, whom Vesalius only mentioned as ‘his friend’, but was probably responsible for at least an important number of the plates and figures in the famous Fabrica and Epitome.  This gradually gains momentum enhanced by a recently found drawing (figure 1) which is commented on in the book by Caiati and co-workers, and is believed to be a preliminary sketch  by Jan Steven van Calcar of one of the most iconic drawings in the Fabrica, namely the so-called ‘Philosopher’. (see image)

It is in this light that I would like to take a few people out of the shadows and bring them into the spotlight, and by this, explaining how this book came about.

In 2007 Ann and I were organizing the AEIMS conference “Confronting Mortality with Art and Science”. This conference brought together a group of artists, scientists and medical illustrators.

Bob van Hee and anatomist Francis Van Glabbeek both gave excellent lectures on Vesalius, Triverius and Philip Verheyen during a nocturnal visit to the Plantin Moretus museum in Antwerp.

It was also at this conference I invited Joanna Ebenstein to give a talk on her then new project” The morbid anatomy library blog” which has grown into the amazing art /science platform it is today.

The conference was such a success that we decided to set up BIOMAB, Biological and Medical Art in Belgium,  with a teaching programme ARSIC ( art researches science international collaborations) .

BIOMAB would never have seen the light of day if it wasn’t for the energy, and drive and fearless enterprising spirit of hematologist and medical artist; Dr. Ann Van de Velde. Over the years we have organized many dissection drawing workshops, exhibitions, conferences, made films and books and have written many articles and given many lectures. Our article in the book  “Anatomical Drawing From Cadavers – Limb by Limb Removed -- Brought Us Together” elucidates our collaborations and our intension and achievements.

This article continues HERE

This is a new, as yet unpublished, book authored by several of my good friends who with me follow Vesaliana all over the world. There are too many of my friends to count, but I highly recommend this book. Dr. Miranda

In this richly illustrated book, a multitude of academic scholars present new findings concerning Andreas Vesalius Bruxellensis  and his contemporaries. One of those discoveries includes a preparatory sketch by Jan Steven van Calcar for a drawing in Vesalius’ famous ‘Fabrica’, called ‘The Philosopher’.

Included are authentic letters, written by Vesalius to his friends Benedetto Varchi and Octavo Landi, are presented and translated for the first time and are thoroughly discussed, shedding new light on crucial periods of Vesalius’ life like his leave from academic Padua, exchanged  for imperial service to Charles V, or his contribution in the treatment of Philips II’s son, crown prince Carlos in Spain.

Clicking on this image will download a PDF file with the book information

That Vesalius influenced artists in anatomical models and drawings is newly acknowledged in this book, as well as his influence on veterinary medicine.

In short, an inspiring new account of Vesalius’ extraordinary long-term influence on anatomy, science and art in general. One interesting point is that until now, many of the series of articles that composes the book where only available in Greek!

Jacqueline Vons (Emer. Professor of Latin and Medical History, University of Tours, France) comments "Centered around the figure of Andreas Vesalius (1514-1564), this book ‘In the Shadow of Vesalius’ offers a vast panorama of the anatomical knowledge in Europe during early Modern times.

Click here to download a PDF file with a description of the book, the Table of Contents, and the information to pre-order this book which will be launched on November 14, 2020. To order a book at a pre-launch discounted price, you can go directly to the publisher's website (http://garant.be/shadow-of-vesalius/).

My personal thanks to Pascale Pollier-Green for bringing this book to my attention. Dr. Miranda

UPDATED:The term [proximal], from the Latin [proximus] meaning "next" and its counterpart [distal], from the Latin [distans] meaning "distant", have been poorly defined and this causes misunderstanding in the proper use of these terms. This is particularly true in the medical industry.

The classical definition of [proximal] are "nearest, closer to the origin, closer to the point of reference" and also "closer to the beginning", or "opposite of distal". [Distal] is, of course, the opposite. All of these definitions are lacking a consensus between the participants in a conversation. This lack of proper definition could potentially lead to problems in an interventional situation and a patient could be injured.

In our lectures and training materials we use a working definition¹ as follows:

“Proximal has two meanings:

1- Closer to the point of attachment, where one end of the attached structure is free, and

2- Closer to the point of origin of flow of a fluid”

In the first acception of the word, a clear example is the attachment of the upper and lower extremities. Moving away from the shoulder or the hip joint is a distal movement. “The wrist joint is distal to the elbow joint”. The same is true for the Fallopian (uterine) tube, where the proximal attachment of the tube is to the uterus and the free distal end of the tube is its fimbriated end.

1. Use of this definition is permitted, as long as CAA, Inc. is credited, or a link to this article is posted with it.
Image property of: CAA.Inc. Artist: Victoria G. Ratcliffe

Prevention of Stroke in Atrial Fibrillation;
Elimination of the Left Atrial Appendage.
An online educational video.

Randall, K. Wolf MD, FACS, FACC

This video educational program is hosted by the Houston Methodist DeBakey Heart and Vascular Center Education Center

Atrial fibrillation (AFib) is estimated to affect up to 4% of the population. Characterized by a rapid, irregular heartbeat, AFib is largely due to abnormal electrical impulses that cause the atria of the heart to quiver instead of beating steadily. Blood flow is reduced and is not completely pumped out of the two small upper chambers of the heart, the atria. This negatively impacts cardiac performance and also allows the blood to pool and potentially clot, especially in an extension of the left atrium, the left atrial appendage (LAA). At rest, a normal heart rate is approximately 60 – 100 beats per minute. In a person with AFib, that heart rate can increase to 180 bpm or even higher.

In this educational video Dr. Wolf discusses the above, as well as the benefits of the elimination of the LAA, decreasing blood pressure, decreasing the chances of a stroke, and helping return the heart to normal rhythm.

Dr. Wolf is currently a member of the DeBakey Heart and Vascular Center at Houston Methodist Hospital in the Texas Medical Center. He serves as the arrhythmia specialist of the group. In 2018 Dr. Wolf operated on AF patients from 32 US states. He was also the keynote speaker at the annual Japanese Society for Tobacco Control in Takamatsu, Japan and the annual Chinese Society of Cardiothoracic Surgeons in Shenyang, China.

  When you click the above image you will be taken to the YouTube DeBakey Education Channel
in a separate window

NOTE: Dr. Randall Wolf is a contributor to Clinical Anatomy Associates. My personal thanks to him and to the DeBakey Heart and Vascular Center for their invitation to participate in this educational video. Dr. Miranda.

In my many years working with medical industry, surgeons, and surgery, I have heard many times that such and such surgical technique follows “Halsted’s Rules of Surgery”. The problem is that only two of these “rules” were mentioned and never did I receive an answer while working with Ethicon and Ethicon Endosurgery, and never did I receive an answer as to where could I find the reference regarding the other rules, if they even existed.

I recently read a great 1957 book by Samuel James Crowe, MD (1883-1952), titled “Halsted of John Hopkins; the man and his men”. Dr. Crowe lived for one year with Dr. William Stewart Halsted (1852-1922) and his wife as a medical student at John Hopkins. He was also an intern for Dr. Harvey Cushing, and although he wanted to follow Cushing into neurosurgery, Dr. Halsted placed him in charge of the newly created department of otolaryngology at John Hopkins, a position he did not want. Dr. Crowe went on to become a world-wide renown otolaryngologist.

Here are Halsted’s “Rules of Surgery” as explained by Dr. Crowe, based on Halsted’s research, experiments, and observations (with my own notes and comments):

1. Wounds are resistant to infection when no bits of tissue have been:

a. torn with clamps 
b. torn by the rough handling of retractors 
c. devitalized by hastily and carelessly applied ligatures

William S. Halsted
mouseover for
Samuel J. Crowe

2. Wounds or parts rich in blood vessels usually heal without any visible granulation, even when no antiseptic precautions have been taken.

3. Incisions should be closed carefully and gently, layer by layer

4. The approximating sutures should never put the tissues under tension, since tension interferes with the blood supply and may cause necrosis

Note: Tension-avoidance surgical techniques follow this, one of the prime rules of surgery.

5. The end of the forceps used to pick up bleeding points should be small, to avoid crushing and destroying the vitality of surrounding tissues

Note: This observation led to the creation of fine, multiple toothed thumb forceps used today in cardiovascular surgery , such as the Cooley, DeBakey, Castaneda, etc. type forceps.

6. A drain is essential when there is necrotic tissue and infection

7. Silk should never be used in the presence of infection

Note: This makes sense. Since silk is an organic material, infected tissues will react to the presence of this extraneous material causing more inflammation, and the phagocytic cells in the tissues will destroy the silk and its capacity to hold the tissues together

8. The silk (suture) employed should never be coarser (larger gauge) than necessary and it is well to employ a suture a thread that is not stronger that the tissue it holds

9. A greater number of fine stitches is better than a few coarse ones

Note: This also makes sense. Halsted was known to be extremely meticulous and he could place a hundred stitches of fine silk thread where other surgeons would place a lesser number of coarser stitches. Using a larger number of fine stitches distributes the approximating tension of the sutures over a larger area, thus reducing the chance for suture dehiscence.

10. Avoid when possible the combined use of silk and catgut in a wound

11. For sewing up an abdominal wound, when it is necessary to take heavy deep stitches perforating skin and muscles, silver wire serves admirably

Note: Remember the times when these guiding principles where laid. Nylon, polypropylene, and other synthetic absorbable and non-absorbable sutures had yet to be discovered. Today the same dictum would probably say “For sewing up an abdominal wound, when it is necessary to take heavy deep stitches perforating skin and muscles, a synthetic non-absorbable suture material serves admirably”

It must be noted that Halsted never called the above the “rules of surgery”, rather they are observations that have become guiding principles. These have influenced the world of surgery to this day.

SIDE NOTE: It has been said many times that Dr. Halsted was the first to use rubber gloves. This is not true, Dr. Crowe says that “it was an evolution rather than a happy thought” and it involved his wife Caroline Hampton. This will be the subject of another article.