LEGACY IL FASCICULO DI MEDICINA OF 1493: MEDICAL CULTURE THROUGH THE EYES OF THE ARTIST Salvatore DiMaio, M.D. Department of Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada Federico Discepola, M.D. Department of Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada Rolando F. Del Maestro, M.D., Ph.D. Brain Tumor Research Center, Department of Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada Reprint requests: Rolando F. Del Maestro, M.D., Ph.D., Director, Brain Tumor Research Center, Montreal Neurological Institute and Hospital, 3801 University Street, BT210, Montreal, Quebec, H3A 2B4 Canada. Email: rolando.delmaestro @mcgill.ca Received, June 24, 2004. Accepted, August 5, 2005. THE FASCICULUS MEDICINA, printed in 1491, is considered the first illustrated medical book. The Latin essays and illustrations in this volume provide insight into the medical knowledge of Western Europe and, in the Italian edition published in 1493, glimpses into the medical culture of the late 15th century. We outline the scientific and social environments into which the Fasciculus Medicinae of 1491 was introduced and the transition that occurred with the publication of the 1493 Italian edition. The artist of the 1493 Fasciculo witnessed a paradigm shift occurring. In four woodcuts, the artist captured four themes: the relevance of knowledge-based medicine, the emergence of laboratory medicine, the Hippocratic lessons of patient observation, and the emerging revolution in anatomy. KEY WORDS: 15th century medicine, History of anatomic dissection, History of medicine, Johannes de Ketham Neurosurgery 58:187-196, 2006 DOI: 10.1227/01.NEU.0000192382.37787.80 www.neurosurgery-online.com I mportant advances in the history of med- icine occurred in Northern Italy in the late 15th century. This was catalyzed by the translation and printing of many Greek and Arabic medical treatises initiated by collec- tions of physicians, surgeon-anatomists, and artists. One impetus for this change, the Fasciculus Medicinae, was first printed in Venice in 1491. This compendium of Latin essays and illustra- tions provides insight into the emergence of medical knowledge in Western Europe and, in the 1493 vernacular Italian edition, glimpses into medical and anatomic culture. In this ar- ticle, we outline some of the scientific and social context into which the Fasciculus Medici- nae of 1491 was printed. The 1493 Italian edi- tion is analyzed with emphasis on the artist’s portrayal of medical, surgical, and anatomic culture in the universities of Northern Italy. The illustrations in the 1493 Fasciculo convey a paradigm shift from the medieval approach of the 1491 edition to the emergence of contem- porary medicine. The Fasciculus Medicinae of 1491 In 1481, the brothers Giovanni and Grego- rio dei Gregorii established a printing com- pany in Venice and included medical texts in their output to service an expanding market (2, 16). In 1491, they published the Fasciculus Medicinae by Johannes de Ketham, recognized as the first printed illustrated medical book. The Fasciculus contains a series of Latin es- says related to subjects in clinical medicine and are discussed in the following order: 1) urine and uroscopy, 2) phlebotomy, 3) the judgments of the veins, 4) a section on phle- botomy based on the zodiac, 5) a section on women’s health, 6) reproduction and the se- crets of woman, 7) surgery, and 8) anatomy (16). There were six woodcut illustrations ac- companying the text including 1) a circle of urine glasses, 2) a phlebotomy man, 3) a zo- diac man, 4) a pregnant woman, 5) a wound man, and 6) a disease man. The last three are medieval representations of midwifery, sur- gery, and internal medicine, respectively. Ex- cept for the phlebotomy illustration, all fig- ures appeared in this volume for the first time in a printed book (16). The first edition also contained a treatise related to the plague writ- ten by Pietro da Tossignano. Although the Fasciculus was composed of only 29 printed pages, six of which were occupied by the il- lustrations, it marks an important transition point in the history of the illustrated medical book. The identity of the author of the Fasciculus, Johannes de Ketham, remains enigmatic. Karl Sudhoff (16) has suggested a professor at Vi- NEUROSURGERY VOLUME 58 | NUMBER 1 | JANUARY 2006 | 187