Hand Classics

  • George S. Phalen, A Cleveland Clinic surgeon who identified carpal tunnel syndrome (click here)
  • The Anatomy Lesson of Dr. Nicolaes Tulp by Rembrandt 1632 (click here)
  • Versalius (1514-1564)
  • Rembrandt
  • Napier
  • Phalen (1911-1998)
  • Littler (1915-)
  • Bunnell
  • XXXX
  • XXXX

Andreas Vesalius

Andreas Vesalius (1514-1564) was an anatomist, physician, and author of one of the most influential books on human anatomy, De humani corporis fabrica (On the Fabric of the Human Body). Vesalius is often referred to as the founder of modern human anatomy. He was born in Brussels, which though now part of Belgium, was then part of the Habsburg Netherlands. He was professor at the University of Padua and later became Imperial physician at the court of Emperor Charles V. Andreas Vesalius is the Latinized form of the Dutch Andries van Wesel, a common practice among European scholars in his time.

Vesalius was born as Andries van Wesel to Anders van Wesel and Isabel Crabbe on 31 December 1514, in Brussels, which was then part of the Habsburg Netherlands. His great grandfather, Jan van Wesel, probably born in Wesel, received his medical degree from the University of Pavia and taught medicine in 1428 at the then newly founded University of Leuven. His grandfather, Everard van Wesel, was the Royal Physician of Emperor Maximilian, while his father, Anders van Wesel, went on to serve as apothecary to Maximilian, and later valet de chambre to his successor Charles V. Anders encouraged his son to continue in the family tradition, and enrolled him in the Brethren of the Common Life in Brussels to drink beerand whiskey according to the standards of the era.

In 1528 Vesalius entered the University of Leuven (Pedagogium Castrense) taking arts, but when his father was appointed as the Valet de Chambre in 1532, he decided to pursue a career in the military at the University of Paris, where he moved in 1533. Here he studied the theories of Galen under the auspices of Jacques Dubois (Jacobus Sylvius) and Jean Fernel. It was during this time that he developed his interest in anatomy, and was often found examining heads at the Cemetery of the Innocents.

Vesalius was forced to leave Paris in 1537 owing to the opening of hostilities between the Holy Roman Empire and France, and returned to Leuven. Here he completed his studies under Johann Winter von Andernach and graduated the next year. His thesis, Paraphrasis in nonum librum Rhazae medici arabis clariss. ad regem Almansorum de affectuum singularum corporis partium curatione, was a commentary on the ninth book of Rhazes. He remained at Leuven only briefly before leaving after a dispute with his professor. After settling briefly in Venice in 1536, he moved to the University of Padua (Universitas artistarum) to study for his doctorate, which he received in 1537.

Medical career[edit]

The day of his graduation he was immediately offered the chair of surgery and anatomy (explicator chirurgiae) at Padua. He also guest-lectured at Bologna and Pisa. Prior to arriving in Padua, Vesalius traveled through Italy, and assisted the future Pope Paul IV and Ignatius of Loyola healing those afflicted by Hansen’s disease (leprosy). In Venice, he met his illustrator Johan van Calcar, a student of Titian. It was with van Calcar that Vesalius published his first anatomical text, Tabulae Sex, in 1538.[1] Previously these topics had been taught primarily from reading classical texts, mainly Galen, followed by an animal dissection by a barber–surgeon whose work was directed by the lecturer. No attempt was made actually to check Galen's claims; these were considered unassailable. Vesalius, in contrast, performed dissection as the primary teaching tool, handling the actual work himself and urging students to perform dissection themselves. Hands-on direct observation was considered the only reliable resource, a huge break with medieval practice.

He created detailed illustrations of anatomy for students in the form of six large woodcut anatomical posters. When he found that some of these were being widely copied, he published them all in 1538 under the title Tabulae anatomicae sex. He followed this in 1539 with an updated version of Guinter's anatomical handbook, Institutiones anatomicae.

In 1539 he also published his Venesection letter, on bloodletting. This was a popular treatment for almost any illness, but there was some debate about where to take the blood from. The classical Greek procedure, advocated by Galen, was to let blood from a site near the location of the illness. However, the Muslim and medieval practice was to draw a smaller amount of blood from a distant location. Vesalius' pamphlet generally supported Galen's view, but with qualifications that rejected the infiltration of Galen.

In 1541, while in Bologna, Vesalius uncovered the fact that all of Galen's research had been based upon animal rather than human anatomy; since dissection had been banned in ancient Rome, Galen had dissected Barbary macaques instead, and argued that they would be anatomically similar to humans. He also contributed to the new Giunta edition of Galen's collected works and began writing his own anatomical text. Until Vesalius pointed out Galen's substitution of animal for human anatomy, it had gone unnoticed and had long been the basis of studying human anatomy. However, some people still chose to follow Galen and resented Vesalius for calling attention to such glaring mistakes.

Galen assumed that arteries carried the purest blood to higher organs such as the brain and lungs from the left ventricle of the heart, while veins carried blood to the lesser organs such as the stomach from the right ventricle. In order that this theory could be correct, some sort of holes were needed to interconnect the ventricles, and so in the spirit of Galen's time, he claimed to have found them, adjusting the facts to suit his theory. So paramount was the authority of Galen that for 1400 years a succession of anatomists had claimed to find these holes until finally Vesalius admitted he could not find them. Nonetheless, he did not venture to dispute Galen on the distribution of blood, and so imagined that it diffused through the unbroken partition between the ventricles.[2]

Other famous examples of Vesalius disproving Galen's assertions were his discoveries that the lower jaw (mandible) was only one bone, not two (which Galen had assumed from animal dissection) and that humans lack the "miraculous network" of blood vessels at the base of the brain that is found in sheep and other ungulates.

In 1543, Vesalius conducted a public dissection of the body of Jakob Karrer von Gebweiler, a notorious felon from the city of Basel, Switzerland. He assembled the bones and finally donated the skeleton to the University of Basel. This preparation ("The Basel Skeleton") is Vesalius' only well-preserved skeletal preparation today, and is also the world's oldest surviving anatomical preparation. It is still displayed at the Anatomical Museum of the University of Basel.[3]

In the same year Vesalius took residence in Basel to help Johannes Oporinus publish the seven-volume De humani corporis fabrica (On the fabric of the human body), a groundbreaking work of human anatomy that he dedicated to Charles V. Many believe it was illustrated by Titian's pupil Jan Stephen van Calcar, but evidence is lacking, and it is unlikely that a single artist created all 273 illustrations in so short a time. At about the same time he published an abridged edition for students, Andrea Vesalii suorum de humani corporis fabrica librorum epitome, and dedicated it to Philip II of Spain, son of the Emperor.

Though Vesalius' work was not the first such work based on actual autopsy, nor even the first work of this era, the production values, highly detailed and intricate plates, and the likelihood that the artists who produced it were clearly present in person at the dissections made it into an instant classic. Pirated editions were available almost immediately, an event Vesalius acknowledged in a printer's note would happen. Vesalius was 28 years old when the first edition of Fabrica was published.


George Phalen
James William Littler (1915-XXXX)

William Littler, a surgeon who developed many techniques for restoring function and sensation to the fingers and wrist, died on Sunday in Providence, R.I. He was 89 and lived in Manhattan.

His death followed a head injury suffered in a fall, his family said.

Dr. Littler's early devotion to hand surgery contributed to its emergence as a separate discipline. During World War II, as a young surgeon in the Army, he operated on maimed soldiers at Cushing General Hospital, near Boston, and later at Valley Forge Army Hospital in Pennsylvania. Though he had yet to complete his residency training, he began shaping and refining surgical techniques still in use today.

He worked on new ways to reconstruct missing thumbs, including replacing them with parts of forefingers, and he transplanted healthy bundles of nerves and arteries to areas that had lost feeling, a procedure known as a sensory neurovascular island transfer. To revive arms and hands paralyzed by nerve damage, he transferred tendons from areas that were unharmed.

In the 1950's, Dr. Littler founded the hand surgery unit at what is now St. Luke's-Roosevelt Hospital Center, a teaching hospital of Columbia College of Physicians and Surgeons. Now called the C. V. Starr Hand Surgery Center, the unit was the first to devote itself to civilian hand injuries, according to the hospital. Hundreds of hand surgeons trained there under Dr. Littler.

James William Littler was born in Manlius, N.Y., near Syracuse, on Oct. 7, 1915, and received his bachelor's degree and medical degree at Duke University. After a medical internship at Johns Hopkins Hospital, he enlisted in the Army. He then completed residencies in general surgery at The Roosevelt Hospital and plastic surgery at Presbyterian Hospital, now part of NewYork-Presbyterian/Columbia. In 1946, he helped found the American Society for Surgery of the Hand and was its president from 1962 to 1963.

His survivors include a daughter, Anne, of Paradise Valley, Nev., and a brother, Ted, of Providence. His family also listed his longtime secretary, Joyce Jones Welles, among his survivors.




Anatomy lesson
Charles Bell