EAU History Office translates and publishes newly discovered Vesalius consilium

Vesalius, known for his De Humani Corporis Fabrica (1543) anatomical study was consulted by letter in 1538 on the case of a young nobleman from Augsburg and his case of (presumably) chronic gonorrhoea.

The consilium goes into great detail and provides new insights into the state of medicine in the early renaissance. It was discovered by the authors, a trio of Belgian Vesalius experts, in 2019.

Volume 28 of De Historia was published digitally on the occasion of the 36th Annual EAU Congress, the EAU21 Virtual Congress. Congress delegates and EAU members can find downloading instructions at the bottom of this article. A print edition will be made available to delegates when regular congresses resume.

The authors of the chapter are retired medical doctors Dr. Maurits Biesbrouck (Roeselare, BE), Dr. Theodoor Goddeeris (Kortrijk, BE) and Prof. Omer Steeno (Louvain, BE), who have had a long-running interest in the works of Vesalius, and are considered to be some of the foremost authorities on his oeuvre. Dr. Goddeeris can rely on his personal rich medico-historical library and personal experience to support the trio.

Authors Goddeeris, Steeno and Biesbrouck with Theo Dirix (second from left) at ‘The Spanish Roof’ in Oud-Heverlee, Belgium. Now a restaurant, the venue was a castle inhabited by several generations of Vesalius’s ancestors.

Vesalius

“Vesalius was a pioneer of anatomy,” explains Dr. Biesbrouck on behalf of the authors. “He was the first to rely on only his own observations to support his findings and recommendations. He knew of others’ works but distanced himself from their conclusions until he could reproduce or disprove their findings himself. In his writings, he even criticised Galen (129- ca.210), whose works were still taught at universities at the time.”

“In that sense, his scientific approach mirrored that of Nicolas Copernicus who also based his revolutionary findings about the solar system on his own observations. It is this independent scientific spirit that sets men like Copernicus and Vesalius apart from the slavish reproducing of centuries-old wisdom that marked the Middle Ages.”

“In the days of Vesalius, it was common for well-known doctors to be consulted ‘long-distance’ to advise local physicians who were treating a wealthy or otherwise prominent patient. The specialist would receive a written case and typically respond with a three-part written response: a summary of the case, the current knowledge on the problem, and finally the recommended course of action. This mainly occurred in Latin, the language of science in Western Europe at the time. From some physicians of the time, we have hundreds of consilia, in Vesalius’s case we only know of 15 so far.”

Vesalius at age 28. Woodcut print from the 1543 edition of Vesalius’s Fabrica.

Discovering the consilium

It was Prof. Steeno who first got wind of this new consilium when he was vacationing with his wife in Nuremberg, in Southern Germany in 2019. “We were there for touristic reasons but I also wanted to visit the family grave of Georg Buchner (1536-1598), a jeweler from Nuremberg who accompanied Vesalius on his last trip to Palestine and was with him when he died on Zakynthos.”

“When I returned home, I started looking at the works of Franconian historical societies to see what was available on Buchner and his family. It was in the Mainfrankisches Jahrbuch für Geschichte und Kunst [Mainfranken Annual for History and Art], Vol. 50 from 1998 that I discovered an article from then 77-year-old GP and amateur archaeologist Dr. Hans Hahn from Geldersheim (1921-2001).”

“His article had the promising title (translated): ‘Does the binder of the Bausch Library contain a copy of a previously unknown consilium by Andreas Vesalius from 1538?’ With the help of Dr. Uwe Müller, historian and archivist of the Schweinfurt city archives and library I received scans of both the article and the manuscript of the oldest known consilium by Vesalius.”

“Dr. Hahn’s discovery in 1998 had clearly not been widely picked up after its publication. Dr. Biesbrouck translated the Latin text into Dutch. It was subsequently translated into English for this publication with the help of Dr. Bert Gevaert, Prof. Van Kerrebroeck and Mr. Jonathan Goddard on behalf of the EAU History Office.”

“Vesalius’s biblio-biography with all his know works was first collected by Dr. Harvey Cushing (1869-1939, known for Cushing’s disease or syndrome) in 1943. Since then more works of Vesalius have been uncovered, either through research or by chance or serendipity.” In 2005, Dr. Biesbrouck started work independently on making an up-to-date and complete bibliography of Vesalius’s works, which is updated annually.

The nature of the consilium

The consilium concerns Bernhardus of Augsburg, 32 at the time of writing and married. As a younger man in Milan, he started to have difficulty urinating, with pain and blood. He also regularly discharged pus, which makes us immediately think of gonorrhoea, which was still unknown at the time. It would take another four centuries for the first antibiotics to become available. Because the disease could not be treated at the root cause, it became a chronic condition that had to be managed. The patient reported recurring strictures and ulcers and episodes of retention.

Biesbrouck: “The fact that the medical problems of a nobleman from Augsburg reached Vesalius, who was at the time based in Padua, was not uncommon, as mentioned. What is unusual for consilia of the time is the thoroughness with which Vesalius (then 24 but already a professor) approached his advice. It is rare for a consilium to exceed twenty pages. He is incredibly detailed in his approach, weighing every possibility and offering advice for any eventuality.”

“What is also typical of Vesalius is the fact that he added a few sketches to support his words. This was also unusual, though Vesalius would go on to do it in later consilia. In this consilium he also backs up his thoughts with his own anatomical observations, which other doctors also did not do. These observations add to Vesalius’s scientific authority.”

Details from the copy of the 1538 consilium that was (re-)discovered in 2019

“Of course Vesalius was still reliant on the medical knowledge of the time. While his anatomical observations are revolutionary, his medical knowledge and therapeutic arsenal are still firmly based in (pre-) medieval times and the works of Hippocrates, Dioscorides, Galen, Avicenna, and Rhazes. Knowledge had not really evolved in the previous centuries and was based on an understanding of the four elements, or the balancing of bodily fluids and humours. Treatment was herbal, or bloodletting or enemas or in some cases surgery without any real anaesthesia.”

New insights

Discovery of a previously unknown consilium of course sheds light on Vesalius as a young anatomist, giving the authors new insights into his knowledge and personality. Biesbrouck:

“This consilium reinforces what we already knew about Vesalius. In it, he first of all tries to stick to facts and offers every possible solution at hand. He suggests a variety of herb-based remedies to treat the patient’s symptoms, but also surgical options to treat the urinary blockage. He would make the fine instruments required for these procedures himself and he sketches their designs on the parchment.”

“This fits in with what we know about Vesalius through his Fabrica and other consilia. The Fabrica is of course known for its fine prints but also includes quick sketches to illustrate his thinking and bring his point across so that physicians with less anatomical knowledge could grasp it.”

“Our search for new Vesalius-related materials continues unabated. Prof. Steeno recently unearthed six letters written by Vesalius from the sickbed of Don Carlos (1545-1568), the son of King Philip II of Spain and grandson of Holy Roman Emperor Charles V. It is well known that Vesalius was involved in treating Don Carlos but not yet what his role specifically was. These letters have now been published in In the Shadow of Vesalius by R. Van Hee (Antwerp: Garant, 2020).”

“When searching for materials, a good starting point is the friends, acquaintances and colleagues that Vesalius mentions in his writings. We keep a list of these names on our site. Great work on this subject is also being done by Jacqueline Vons, Stéphane Velut, Vivian Nutton, Theo Dirix, Pascale Pollier and others.”

• Read the full, annotated consilium in Latin and English as well as much more background information about Vesalius, his established works and this unique discovery in De Historia Urologiae Europaeae Vol. 28. Find out how you can access it below.

• The authors of the chapter maintain a website with the complete and regularly updated bibliography of their famous countryman.

Download your copy of Historia Vol. 28

As every year since 1994, the EAU’s History Office has prepared a new volume of De Historia Urologiae Europaeae to coincide with the Annual Congress. Volume 28, which was made available to EAU21 delegates and EAU members is a digital production for the time being, but will be printed for the next regular EAU congress.

Volume 28 is not only special for its virtual genesis, but also because it breaks the regular editorial format somewhat, making space for two much longer and more in-depth chapters than are usually included. The first extended chapter is an historical overview by world-renowned urethral strictures expert Prof. Tony Mundy, in which he explores centuries of documentation on the subject. The other, the “cover feature” for Volume 28, concerns the chapter on the new Vesalius consilium.

Other chapters in this volume:

• Parsifal: The Story of Geoffrey Parker, British Urologist and Surgeon to the French Resistance by Jasmine Winyard and Jonathan Charles Goddard
• Cosmas and St. Damian’s Role in Urology by Marcos Cherem-Kibrit and Jorge Moreno-Palacios
• Michele Troja: Enlightenment Scientist, and the “Urology Chair” at the University of Naples in the 18th Century by Renato Jungano and Gloria Castagnolo
• Friedrich August von Haken (1833-1888): His Contribution to the Development of Endoscopy by Thaddaeus Zajaczkowski

You can download a complete copy of the 192-page book in PDF format. EAU members can download their copies through UROsource.com. Non-members who attended EAU21 will find links to a special download page in the pre-congress delegate e-mail (July 6) or the post-congress "Thank You" e-mail (16 July).