These old, anatomical drawings are worth dissecting

By Gal Koplewitz

During his long journey through Europe and the Levant in 1867, Mark Twain stopped off in Milan. Like many, he was struck by the grandeur of the city’s great cathedral, but it was something else that truly became etched in his memory. Standing inside the cathedral was a statue of St Bartholomew, the apostle who had been skinned alive, and who was depicted with his skin draped around his shoulders as if it were a towel. In “The Innocents Abroad”, Twain’s account of that year of travel, he recounts: “The figure was that of a man without a skin; with every vein, artery, muscle, every fibre and tendon and tissue of the human frame represented in minute detail... It was a hideous thing, and yet there was a fascination about it somehow.”

Animated by this same fascination, physicians and artists have, over the centuries, opened up the human body and recorded what they discovered inside, as visitors to a new exhibition at the Royal College of Physicians in London will find. “Under the Skin” brings together a small yet impressive selection of anatomical illustrations, produced primarily by Western physicians and artists (though there are some striking exceptions) from the late Middle Ages through to the 20th century. These scrolls, prints and woodcuts show how these scientists grappled with the challenges of representing human anatomy, and in so doing made illustrations that are as gruesome as they are compelling.

Various obstacles stood in the way of those who wished to produce accurate representations of our insides. Dissections are the best way to learn about human anatomy: nothing can replace the experience of excavating layers of tissue yourself. But for centuries, the Christian and Islamic worlds imposed legal and religious restrictions on the practice. In 18th and 19th-century Britain, for instance, the only bodies legally available for dissection were those of executed criminals; with demand far outstripping supply, “body snatchers” began digging up cadavers and selling them to medical schools. Once the corpse was on the dissection table, the anatomist had to acclimate to the smells of rotting flesh – Leonardo da Vinci warned the anatomy student that you “will perhaps be impeded by your stomach”. He then (for it was invariably a “he”) had to figure out how to represent a three-dimensional object – one that moves and changes with time – on a two-dimensional medium: how to capture not only the winding contours of the intestines, but a beating heart or heaving lungs, on a flat piece of canvas.

So anatomists collaborated with artists capable of committing their visions to paper. Even though the artist’s knowledge of physiology often matched that of the anatomist, the former was usually obliged to follow the latter’s instructions. Unsurprisingly, they sometimes clashed. Surgeons complained that artists over-embellished what were supposed to be clear depictions illustrating the function of a particular body part. Samuel Thomas von Sommering, a German physician, protested in 1791 that overly detailed sketches could do “harm to the important points”. Arnaud-Éloi Gautier d’Agoty, a late 18th-century French painter whose father had pioneered new colour-printing techniques in his anatomical illustrations, disagreed. “For men to be instructed,” he insisted, “they must be seduced by aesthetics.”

Twain was haunted by the statue of St Bartholomew. “I am very sorry I saw it,” he concluded, fearing he was doomed to forever dream of its “corded arms”, “stringy cold legs” and “dead eyes”. The dead bodies depicted in “Under the Skin” are sure to embed themselves in the minds of visitors, but not because they inspire revulsion so much as marvel – not only at the boundless complexities of the human body but also at the ingenuity of the human mind.

The nervous system in “Tashrih-i Mansur” (1386)

Before there was Gray’s Anatomy, there was Mansur’s Anatomy. A five-volume treatise written in 1386 by Mansur ibn Ilyas, a prominent Persian physician and anatomist, “Tasrih-i Mansuri” is considered to be the first illustrated anatomical manuscript of its kind. In this image depiction of the nervous system, feathered lines represent the intricate fibres weaving through the body in ever-thinner threads, with different colours indicating different routes and branches. The orientation of the body is curious: while the placement of the feet and hands seems to suggest that the body is facing the viewer, the arrangement of the facial features, looking up, indicates that the figure has his back to us.

Male internal anatomy in “De humani corporis fabrica librorum epitome” by Andreas Vesalius (1543)

Andreas Vesalius was the founding father of modern anatomical illustration in the West. Born to a family of prominent physicians in Brussels, he studied in Paris, Leuven, Belgium and finally Padua, where he became the chair of surgery and anatomy in 1537. Thanks to a sympathetic local judge who ensured that he was supplied with a steady stream of corpses of executed criminals, Vesalius was able to spend much of his time dissecting human cadavers. For over a millennium, European doctors had relied on the ideas of Galen, a second-century Greek physician whose theories of the body were considered canonical. But while conducting his own dissections, Vesalius noticed that Galen’s physiology was often incorrect. He eventually concluded that Galen had never actually dissected the human body, a practice which the Roman Empire had outlawed. In his influential book, “De Humani Corporis Fabrica” (“On the Fabric of the Human Body”), he argued that physicians needed to make their own, systematic observations, via dissection, rather than rely on the work of past scholars. This image is part of a sequence of illustrations of “muscle men” that appears in the “Fabrica”, and shows the musculature of the male body from different angles. When the first 12 illustrations are put together, side by side, they paint a continuous landscape of the hills around Padua.

The nervous system of the head, neck and torso in “Nevrologie Dissection” by Ludovic Hirschfeld, drawing by Jean Baptiste François Léveillé, lithograph by Lemercier (1853)

In the 18th and 19th centuries, as Western anatomists’ and artists’ understanding of the body grew more advanced, the works they produced became more detailed – and much more vivid. In this startling, hand-coloured lithograph, the nervous system seems almost three dimensional, an effect enhanced by overlaying the original grey tint of the print with colour. It also became the norm in this era to portray the realities of dissection more clearly: here, the hooks used to pull aside the skin and reveal the heart are clearly visible.

Internal organs and acupuncture points on the arms in “Shishi bessho zui” (Illustrations showing how to perceive those who are to die and identify those who are to live) by Hozumi Koremasa (1820s)

This image, part of a five-metre-long scroll (above), is a stylistic hybrid: it combines traditional Japanese representations of the human body with Western-influenced depictions of the internal organs. This scheme was intended for use in acupuncture, with lines pointing to spots on the body where the insertion of needles would serve some therapeutic purpose. The curators rediscovered this piece in the archives of the Royal College of Physicians as they prepared the exhibition: they knew that a Japanese anatomical scroll from this period existed but had no idea how large and beautiful it was.

Anatomy of the male torso in “Medical anatomy or, Illustrations of the relative position and movements of the internal organs” by Francis Sibson (1869)

The human body is in a constant state of flux: time is yet another dimension that the artist has to somehow compress and project onto the page. In these images, Francis Sibson, an English anatomist and physician, has depicted the body of the same individual twice, once with the lungs deflated (top) and once inflated (bottom), in order to show how breathing changes the size and position of the lungs and adjacent organs like the spleen and the kidney. The artist’s inclusion of the implements used in the autopsy (note the tube inserted into the neck) shows how this illustration would have served as a guide for future dissections.

Horizontal sections of the head of a 35-year-old male in “Atlas of head sections”. Dissection by Sir William MacEwen, sketches by Miss MacEachran, photogravure by Messrs Annan of Glasgow (1893)

In recent decades, medical imaging technologies have made it possible to look inside the body without reaching for a scalpel. But in the 19th century, producing a horizontal cut required a highly laborious and elaborate dissection. To make a series of cross-sections of the human head, Sir William MacEwen, a Scottish surgeon, had to freeze the brain – which would otherwise “sink by its own weight and becomes distorted” – before slicing it up. The segments were then reproduced using photogravure, a photographic technique of the period notable for its high contrast, and then further edited by MacEwan to highlight specific features, like the boundaries between tissues. Our ability to peer swiftly into any skull without first cutting it open is a miracle of modern medicine, but you can’t help thinking that something of the artistry required to produce these images has been lost as new, less-invasive methods of exploring the body have been adopted.

Under the skin: illustrating the human body Royal College of Physicians, London, until March 15th and again from early October