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MEDICAL ILLUSTRATION

ALMA Culture&Medicine - Vol 2. N3 - October 2015 -

The Valverde muscle-man

Prof. Dr. Alfredo E. Buzzi
Full Professor of Diagnostic Imaging.
University of Buenos Aires, Argentina.

In 1543 Andreas Vesalius published De humani corporis fabrica, the most

influential anatomy atlas in history. Little time passed before other scholars
began to appreciate Vesalius’ work at its true value. But the new vision of man
and woman enshrined in Vesalius was controversial in conservative religious
circles. One of these controversialists was the Spaniard Juan Valverde de
Amusco, who published Historia de la composición del cuerpo humano in 1556.
Ironically, Valverde, who portrayed himself as a Galenist, was instrumental in
spreading the Vesalian vision. One of Valverde’s most striking original plates
is that of a muscle figure holding his own skin in one hand and a knife in the
other, which has been likened to Michelangelo’s Saint Bartholomew in the Last
Judgment section of the Sistine Chapel.

The man who is celebrated as the founder
of modern anatomy is Andreas Vesalius
(figure 1), who was born in Brussels in 1514,
the son of an apothecary from Wesel on the
Rhine, whence he took his name. He began
his studies at Louvain, continued them at
Montpellier and then at Paris, where his
master was Jacques Dubois, also known as
Silvius (figure 2). Silvius unfortunately held
that nothing new could be added to the
anatomy of Galen, the prominent Greek
physician and philosopher in the Roman
Empire whose works continued to exert an
important influence over the theory and
practice of medicine until the mid-17th
century. From Paris, Vesalius went back to
Louvain for a short while. In 1537 he left for
Padua where he joined a compatriot, Jan
Stephen Kalker (figure 3), who was studying
painting at the school of Titian. Under the
name of Stephen Calcar, this artist made
superb illustrations for Vesalius’ works,
thereby contributing a good deal to the
fame of the anatomist himself.
In the same year Vesalius took a degree
and was then appointed to the chair of
medicine and anatomy. In 1538 his work
Tabulae anatomicae sex was published in
Venice, with both text and illustrations
containing age-old errors of Galen. The
three osteological illustrations are from
Calcar, and the three visceral illustrations
(liver, portal vein and genitalia; liver and
caval vein; heart and aorta) are from
Vesalius itself. Although still Galenic, the
change this meant in anatomical illustration
was enormous.
We can use figure 4 as a sample of the
influence of Galenic anatomy and physiology

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Figure 1: The Flemish anatomist Andreas Vesalius (1514-1564).

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in Vesalius in that moment, as described by

O’Malley. The title of the illustration is: The
liver, workshop of sanguification, receives
the chyle from the stomach and intestines
through the Portal Vein, called the (stelechiaia)
by the Greeks and the WERIDH HA-SHO’ER or
Varidhascoer by the Arabs, and discharges the
black bile into the spleen. The illustrations
in the first three tables of the series are
intended to convey a great deal more
than the simple anatomy of the vascular
and generative systems. Their purpose
is essentially to express in diagrammatic
fashion the physiological principles of Galen.
In this respect they are unique. In addition,
an attempt is made, with an erudition often
spurious, to correlate the new or “modern”
terminology coming into being under the
influence of classical humanism with the
traditional terms derived from medieval,
Arabic and Hebraeo-Arabic sources. The
Figure 2: The French anatomist Jacques Dubois (1478-1555), also known
diagram shows a schematized five-lobed as Jacobus Sylvius in Latin.
liver as accepted by traditional authoritative
opinion but ultimately derived from the
animal anatomy of Galen. Even at this early
stage in his career, Vesalius had begun to
challenge traditional beliefs in matters
anatomical but was, as yet, unwilling to
expose his anti-Galenism. This is hinted at
by the inclusion in the inset drawing of a
bi-lobed liver (at the superior-left angle of
the figure) evidently intended to represent
the human organ. The portal vein with its
tributaries, the superior mesenteric, the
splenic and other branches represented
with very approximate anatomic accuracy,
is seen entering the liver. This vein, through
its mesenteric tributaries, was supposed to
convey the “chyle” or products of digestion
from the alimentary tract to the liver. Here,
a portion of the nutritive material was
considered to be converted into the blood,
the first of the four humors, which was
then discharged into the caval system as
illustrated in the next plate of the series. Figure 3: The German-born Italian painter Jan van Calcar (1499–1546).

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In the liver the second humor, the yellow
bile or choler, was extracted to pass to the
gall bladder, which is shown with its duct
on the under surface of the liver, where
it was stored and the excess discharged
into the intestines to assist in the process
of digestion. Impure blood passed from
the liver via the splenic vein to the spleen
(seen on the right side of the diagram). The
spleen extracted the black bile or succus
melancholicus from the blood. The black bile
was then discharged into the stomach and
served to whet the appetite. However, this
gave rise to an anatomical difficulty since
no vessel could be found to serve as a duct
from the spleen. Vesalius suggests that the
branch at O, left epiploic vein, may serve
this purpose, or perhaps the black bile is
purged into the intestine through branches
of P, the superior mesenteric vein. Later, in
his Venesection Letter, he was constrained to
propose another pathway with the discovery
that the hemorrhoidal veins are tributary to
the portal system since hemorrhoids were
believed to be due to an excess of black bile.
Over the next five years Vesalius
displayed his brilliance as an experimenter
and observer. Slowly, perhaps without being
fully aware of the processes at work, he
discarded the anatomical dogma of Galen.
This was made possible by the freedom
of investigation then permitted at Padua,
which was enjoying its heyday. There,
Vesalius changed the medieval teaching
method: he left the chair to go down and
stand beside the corpse, dissecting and
showing himself the part he was explaining.
Also, he completed with drawings of what
was difficult to observe in the body.
In 1543, when he was just twenty-eight,
Vesalius finished his monumental work, De
humani corporis fabrica libri septem (figure
5), which was printed at Basle. It caused an
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unprecedented uproar. Most of the dons of
the university were Galenists and they sided
against him, violently denying the truth
of Vesalius’ statements. Even his former
teacher, Silvius, maligned him. But Vesalius’
conscience was clear. He had worked
hard for five years to portray the human
body faithfully-not on the lines of outworn
doctrines, but solely on the basis of his own
observations.
Vesalius showed where Silvius had erred,
but he had no wish to triumph for personal
reasons. The sea of ignorance facing him
was vast, and there was also the ill-will of
his accusers to contend with. Unable to
withstand them, irritated by his colleagues
and threatened by the church, he gathered
together his unpublished work and burned
it all. Then he left Padua to become the
highly-paid physician of Emperor Charles
V, and subsequently of his son Philip II
of Spain, from 1556. A brilliant scientific
career was over. Vesalius made no more
original observations, although he followed
the work of his successors in the study of
anatomy. He died in 1563 on the island
of Xante, on the return journey from a
pilgrimage to Jerusalem, in circumstances
which have never been made fully clear.
De humani corporis fabrica was the
most influential anatomy atlas in history
and the most important milestone in the
development of anatomical illustration. Its
courageous illustrations have echoed down
the centuries, proclaiming the power of
unbiased observation and precise rendering
to overwhelm received opinion. An analysis
of Vesalius’ views between 1538 and 1543
shows a shift in the use of illustrations from
serving as a visual record to compensate
for limited access to cadavers in teaching,
to becoming an indispensable tool to
accurately convey detailed anatomical
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structure through the medium of printing.

With the Fabrica, morphology became
divorced from humoral function and
enduring paradigms established that
dominated until the nineteenth century.

Some little time passed before other

scholars began to appreciate Vesalius’ work
at its true value. The revelation of Galen’s
fundamental errors was a tremendous
shock. The worst of the errors was related
to the anatomy of liver, bile duct, upper jaw
and uterus. What upset the Galenists most
of all was Vesalius’ denial of the existence Figure 4: Illustration from Tabulae anatomicae sex (Vesalius, 1538)

of the pores in the septum through which

blood was supposed to flow from the right
to the left ventricle of the heart. It is strange
that Galen, who after all made numerous
dissections, should have erred also in the
description of such parts of the skeleton as
the sternum, sacrum and articular cartilages
of the knee. Naturally, Vesalius’ work itself
was not entirely free of errors. He had not
fathomed the mechanism of circulation; he
placed the lens in the centre of the eyeball;
he believed the vena cava came from the
liver; that there was a muscle inside the
nose and seven (not twelve) cranial nerves.
These and other faults did not however stop
the new work done by this great anatomist
from producing positive long-term results,
and De humani corporis fabrica must be
regarded as one of the most important
books ever published, and the foundation
of modern medicine. Figure 5: Frontispiece of Vesalius’ De humani corporis fabrica (1543).

Like the new vision of the place of the
earth in the universe that was slowly
gaining adherents, the new vision of man
and woman enshrined in Vesalius was
controversial in conservative religious
circles. Furthermore, anatomists who
wanted to make their mark in the immediate
post-Vesalian world needed a position from
which to attack him, and that was provided
by Vesalius’s mild attack on the stature
of Galen. It is not surprising that one of
these controversialists should have been
Spanish, given that Spain was the bastion
of Catholic traditionalism and a dangerous
place in Europe to espouse new ideas on
controversial topics.
Juan Valverde (figure 6) was born in the

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Figure 6: Juan Valverde de Amusco (1525-1587).

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town of Hamusco (today Amusco) in the

province of Palencia, which belonged to the
Crown of Castile. He studied humanities and
philosophy at the University of Valladolid,
and later medicine in Padua and Rome
under Mateo Realdo Colombo, successor
of Vesalius, and Bartolomeo Eustachi, the
author of Tabulae anatomicae, published
posthumously. He published several works
on anatomy, including De animi et corporis
sanitate tuenda libellus (Paris, 1552). Later,
he lived in Rome.

In 1553 he was appointed personal

physician of Cardinal Juan Alvarez de Toledo,
Archbishop of Santiago de Compostela.
In this way, Valverde entered the circle
sponsored by Cardinal, with the doctor and
astronomer Juan Aguilera, and the painters
Pedro Rubiales and Gaspar Becerra.
Figure 8: Veins and muscles, superficial dissection. Two male figures,
in vivo, anterior and posterior views (Valverde’s Anatomia del corpo
humano, Rome, 1560)

Figure 9: Structures of the abdomen in four numbered illustrations.

Three illustrations show peritoneum, omentum, and portal system in
Figure 7: Frontispiece of Valverde’s Historia de la composición del cuerpo situ. Male figures, in vivo, anterior view. One illustration shows isolated
humano (Rome, 1556) omentum and portal system.

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Figure 10: Organs of the digestive system shown in situ, in five illustrations. Stomach, liver, intestines, peritoneum, mesenteries, and omentum shown.
Section of small intestine, dissected. Anterior views.

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With the help of his patron, to whom he
dedicated the book, Juan Valverde published
in Rome in 1556 his treatise on anatomy
Historia de la composición del cuerpo humano
(figure 7). The Cardinal Alvarez de Toledo,
sponsoring the work, expected to increase
national prestige and exalt the cultural
weight of Spain, and also make available to
the Spanish medicine modern anatomical
treatise on Castilian.
Through his book, Valverde introduced
the work of Vesalius to Spain. Of the 42
engravings in the book, only four new
plates were made (figures 8 to 10). The
others were copied from Vesalius’ work and
are mirror images of those in De humani
corporis fabrica (figures 11 to 14). Valverde’s
book contains not only his observations and
discoveries but also a critique of Vesalius’s
errors, as his depictions of the muscles
of the eyes, nose, and larynx. He was the
first anatomist to describe the muscles for
movement of the eye correctly and the
intracranial course of the carotid arteries.
In his work he made the first drawing of
the stapes, described by the Valencian Luis
Collado. Valverde is considered to have
been the most important Spanish anatomist
of the 16th century.
It is the first treaty of post-Vesalian
anatomy written in a vernacular language,
with later versions in Italian (figures 15
and 16), Latin and Dutch. It was one of
the books of anatomy most widely read
in the sixteenth century. The beautiful
engravings, reproduced with didactic
purpose, contributed to this success. The
work is divided similarly to Vesalius’ Fabrica.
Pathological findings and physiological
experiments and tests are also included,
in a Castilian language that reflects a large
number of slang.
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The original illustrations were most
likely drawn by the Spanish painter and
sculptor Gaspar Becerra (figure 17), who
studied at Rome under Michelangelo and
was an assistant of Giorgio Vasari, and the
copperplate engravings are thought to have
been carried out by Nicolas Beatrizet (1507-
1570), whose initials “NB” appear on several
of the plates.
It was a popular work among medical
students and doctors in Spain. Valverde’s
book might have served as the medical
source of anatomical knowledge that was
diffused in Spanish America (Fig. 176).
Ironically, Valverde, who portrayed himself
as a Galenist, was, thanks to his act of
plagiarism, instrumental in spreading the
Vesalian vision.
Vesalius, who was justifiably resentful
that Valverde’s book consisted of
numerous plates copied from his Fabrica,
said that Valverde was no veteran of the
dissecting room, which is possibly true. It is
conventional to prefer Vesalius’s woodcuts,
but Valverde’s crisp copperplate engravings
are appealing in their own right.
Especially notable is the famously phallic-
looking Vesalian vagina (figure 18). This
extraordinary figure of the female genitalia
has been the subject of much comment.
Vesalius’ original description is as follow:
“The present figure represents the uterus
excised from the body and of the same
size as the one in the last dissection at
Padua. It is the uterus of a woman of very
tall stature who had often given birth. In
dimensions it greatly exceeded the normal.
In order to portray the boundaries of the
uterus we have divided its body through
the middle so that its sinus might come
into view, as well as the thickness of both
uterine coverings in the non-pregnant”.
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Figure 11a: Valverde’s bones of the skeleton in isolation, in fifteen numbered illustrations. Scapula, anterior, posterior, and lateral views. Sacrum,
anterior and posterior views. Spine, lateral view. Bones of the upper extremity. Foot bones. Adapted from Vesalius (see figure 11b).

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Figure 11b: Vesalius original figure (De humani corporis fabrica, 1543).

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Figure 12a: Valverde’s muscles of the body, superficial dissection. Male figures, in vivo, anterior views. Adapted from Vesalius (see figure 12b).

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Figure 12b: Vesalius original figure (De humani corporis fabrica, 1543).

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Figure 13a: Valverde’s muscles, deep dissection. Dissection of the mouth, mandible divided reflected to show palate and tongue. Male figure, in vivo,
anterior view. Adapted from Vesalius (see figure 13b).

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Figure 13b: Vesalius original figure (De humani corporis fabrica, 1543).

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Figure 14a: Valverde’s muscles, deep dissection. Respiratory muscles; diaphragm is displayed on a wall behind the figure. Viscera removed. Male figure,
hanging from a rope through the zygomatic bones of the skull, anterior view. Adapted from Vesalius (see figure 14b).

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Figure 14b: Vesalius original figure (De humani corporis fabrica, 1543).

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Figure 15: Title page for a 1560 edition of Juan Valverde de Amusco’s
Anatomia del corpo humano printed in Rome.
Figure 16: Title page for a 1586 edition of Juan Valverde de Amusco’s
Anatomia del corpo humano printed in Venice.
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Figure 17: The Spanish painter and sculptor Gaspar Becerra (1520-1568),
at the Museo del Prado, Madrid. (Photo: Oilisab)
Figure 18: Organs of the abdomen in two female figures, shown in situ
and in isolation, in five numbered illustrations. Stomach and intestines
removed to show liver, and blood vessels to the urogenital system. On
the left: Isolated structures of female uro-genital system, dissection of
the vagina, uterus, and ovary. Anterior and superior views. (Anatomía
del corpo humano, Valverde de Amusco, Rome and Salamanca, 1560,
folio 100).
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Some have called this figure of the female
genitalia “monstrous” and others have
implied that is a resemblance to the male
organ. However, as O’Malley stated in his
book about Vesalius, if one is familiar with
the circumstances under which the Flemish
anatomist obtained the specimen, it is not
difficult to interpret. It was obtained from
the body of a woman who had been the
mistress of a certain monk. Vesalius and his
pupils, hearing of her death, snatched the
body from the tomb, but, unfortunately,
the monk together with the parents of the
girl complained of the outrage to the city
magistrates so that the anatomist and his
students were compelled to dismember
and free the body from all skin as rapidly
as possible to prevent its being recognized.
Since they had stolen the body expressly
to examine the female organs, the best
they could do was to encircle the external
genitalia with a knife, split the symphysis
and excise the vagina and uterus in one
piece after severance of the urethra. Later,
the uterine cavity was exposed by sectioning
the body longitudinally and turning up
the anterior half. Probably, the uterine
tubes were lost in the hurried method of
preparation. In the Vesalian terminology the
uterus consisted of the fundus or body, the
uterus proper, the cervix or neck, which is
not the cervix of the modern anatomist but
the vagina, and the vulva. The illustration
therefore shows: A,A,B,B, the uterine cavity;
C,D, a slightly elevated line compared to
the raphe of the scrotum; E,E, the muscular
wall called the internal or proper tunic of
the uterus; F,F, a protuberance of the wall
into the uterine cavity; G,G, the cervical
canal; FI,H, the external or peritoneal tunic;
1,1, the broad ligament incorrectly shown
extending along the lateral border of the
vagina; K,K, the divided edge of the vagina;
L, the urethra, in Vesalian terminology the
neck of the bladder. The rest, referring to the
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vulva surmounted by the pubic hairs, is self-
evident, says Vesalius. Note the cut edge of
the skin encircling the vulva and indicating
the method of the urgent excision.
One of Valverde’s most striking original
plates is that of a muscle figure holding his
own skin in one hand and a knife in the other,
which has been likened to Michelangelo’s
Saint Bartholomew in the Last Judgment
section of the Sistine Chapel (figure 19).
In a note on the iconographic interpre-
tation of the Valverde muscle-man, Wells
stressed in 1959 that the ancestry of this
composition attracts discussion from two
points of view. On the one hand, its possible
derivation from earlier anatomical drawings
other than those of Vesalius; on the other,
the iconographic ancestry of the motif
implied by the skin and dagger.
Valverde, although asserting his muscle-
man to be a better representation than
those of Vesalius, does not specifically claim
it as an original production. The pose of the
trunk and legs is very close to that of the
two Vesalian figures (figures 20 and 21),
except that the non-supporting leg is more
strongly flexed, so as to require a raised
support under the ball of the foot. The left
arm also is not greatly different from that of
the first Vesalian figure, but the profile head
and the raised right arm have no Vesalian
counterpart.
In assessing such correspondences,
allowance must be made for the extent
to which all these figures may have been
worked up from drawings of antique
sculpture or of models posed in imitation
of the antique. A number of the Vesalian
figures could be based upon a classical
prototype such as an Antinous in the
Vatican (figure 22). The two frontal muscle-
men of the Fabrica belong to this group. The
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Figure 19: Anatomía del corpo humano (Valverde de Amusco, Rome and Salamanca, 1560, folio 64).

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Valverde muscle-man might therefore have
been worked up independently on a similar
foundation. For the head and right arm of
this figure there is a classical prototype, very
familiar to the cinquecento artist, in which
the face is similarly turned to the side of
the raised arm, namely the Apollo Belvedere
(figure 23).
Much of the detailed anatomy in the
Valverde figure could be regarded as
derived from one or other of the two
corresponding Vesalian figures. The head
and neck, however, are quite unlike any
Vesalian figure, and must therefore depend
either on some other source or on an
original dissection. If the last holds for this
region, it may for other parts also.
in composition with the ‘M.F.’ engraving but
reversed (figure 25). This bears a dedicatory
inscription to Francesco de Medici, Grand
Duke of Tuscany, dated 1581, and the
initials M.M., taken to stand for Melchior
Meier. This 1581 version must be the first, if
only because it has various details that are
misunderstood or slurred over in the other
version. The Medici Grand Duke would not
have been much flattered by receiving a
dedication on an engraving that was only a
copy of something else. Thus a number of
indications point to Meier’s engraving as the
original. It seems highly probable, therefore,
that the date 1536 on the ‘M.F.’ engraving

Harvey Cushing seems first to have

suggested that the motif of the skin and
dagger derives from the Saint Bartholomew
of Michelangelo’s Last Judgement (figure 24).
However, when the two are confronted,
the sum of the resemblance between
them is seen to be that each holds a skin
in one hand and a cutting tool in the other.
The Valverdean figure therefore owes to
Michelangelo at most the germ of an idea.

In 1943 Meyer and Wirt drew attention

to an engraving of Apollo flaying Marsyas,
which bears the initials M. F. and the
date 1536 (this date has been called in
question). The figure of Marsyas is a careful
anatomical study, very remarkable if it is
indeed pre-Vesalian in date. But in 1959,
Wells stated some major differences in
pose between this figure and the Apollo of
the ‘M.F.’ engraving, but could not, in view
of the date I536, completely dismiss the
latter as a remote source for the Valverde
illustration. Finally, in 1961, Wells drew Figure 20: The first muscle-man of Vesalius. Muscles of the body,
attention about an engraving reproduced in superficial dissection. Male figures, in vivo, anterior views. Vesalius’ De
humani corporis fabrica, 1543, folio 170 (from: Historical Anatomies on
Schider-Auerbach in I957, which is identical he Web, www.nlm.nih.gov)

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Figure 21: The third muscle-man of Vesalius. Muscles of the body, superficial dissection. Male figures, in vivo, anterior views Vesalius’De humani corporis
fabrica, 1543, folio 178 (from: Historical Anatomies on he Web, www.nlm.nih.gov)

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Figure 22: Antinous was a Bithynian Greek youth and a favourite, or
lover, of the Roman emperor Hadrian. He was deified after his death,
being worshiped in both the Greek East and Latin West, sometimes as
a god (theos) and sometimes merely as a deified mortal (heros). Museo
Pio-Clementino, Sala Rotunda, Vatican Museums. (Photo: Marie-Lan
Nguyen)
must be rejected as either deliberate
falsification or merely an error, on the part
of the engraver, perhaps for 1586. This
engraving must accordingly be discarded
from the list of possible prototypes for the
Valverde muscle-man.
Also, both in the M. F. engraving and
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Figure 23: The Apollo Belvedere or Apollo of the Belvedere (also called the
Pythian Apollo) is a celebrated marble sculpture from Classical Antiquity.
It was rediscovered in central Italy in the late 15th century, during the
Renaissance. From the mid-18th century it was considered the greatest
ancient sculpture by ardent neoclassicists, and for centuries epitomized
ideals of aesthetic perfection for Europeans and westernized parts of
the world. It is now found in the Gabinetto delle Maschere of the Pio-
Clementine Museum of the Vatican Museums complex. (Photo: Sailko)
in Michelangelo’s painting, the knife is a
practical flaying-knife, whereas the muscle-
man grasps a double-edged fighting
dagger. The substitution of dagger for knife
is hard to understand, since the flaying
plainly could not have been done with the
former, and a dagger is not included in the
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Figure 24: Saint Bartholomew holding the knife of his martyrdom and his flayed skin in Michelangelo’s The Last Judgment. The face of the skin is
Michelangelo’s (Sistine Chapel, Vatican City)

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Figure 25: Apollo flaying Marsyas. Engraving by Melchior Meyer, 1581 (Wellcome Images)
anatomist’s armamentarium as pictured by
Vesalius and Valverde.
It may be suggested that the dagger in
the hand of the muscle-man has a quite
different significance, the intention being
to present the figure in the character of a
duellist with cloak and dagger. The manner
in which the skin is held up is also consistent
with this interpretation. The figure may well
have been reversed in the engraving, so
that in the original drawing the dagger was
held in the right hand, which would make
the motive clearer.
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To justify the muscle-man artistically by
giving him the character of a gladiator is a
conceit well in keeping with the manner in
which Valverde and his artist have treated
some of the Vesalian illustrations.
Equally, that the muscle-man should put
his discarded skin to one of the alternative
functions of a cloak may be reckoned a very
mild conceit. This does not of course exclude
either Michelangelo’s St. Bartholomew or
the Apollo of the M. F. engraving as a remote
source, but emphasizes the transformation
which the idea had undergone by the time it
issued in the Valverdean illustration.

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