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A new glimpse into urology in the 16th century
By Loek Keizer
The latest volume of De Historia Urologiae Europaeae has a world first: an annotated translation of a recently discovered consilium by 16th-century anatomist and physician Andreas Vesalius (15141564). 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.
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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 may download their copies using the QR code at the bottom of this page. A print edition will be made available 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. (Figure 1) Dr. Goddeeris can rely on his personal rich medico-historical library and personal experience to support the trio.
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.” (Figure 2)
Figure 1: 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.
Figure 2: Vesalius at age 28. Woodcut print from the 1543 edition of Vesalius’s Fabrica
“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 and can be found on: www.andreasvesalius.be
“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 wellknown 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.” 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 jeweller from Nuremberg who accompanied Vesalius on his last trip to Palestine and was with him when he died on Zakynthos.” 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. (Figure 3) 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.”
“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.
• The authors of the chapter maintain a website with the complete and regularly updated bibliography of their famous countryman: www.andreasvesalius.be
Download your copy of Historia Vol. 28
Free for all EAU Members and EAU21 Delegates
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 • St. 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 or by scanning this QR code to access a special download page.
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EAU Crystal Matula Award 2022
For a young promising European urologist
The EAU Crystal Matula Award 2022 is the most prestigious prize given to a young promising European urologist aged 40 or under who has the potential to become one of the future leaders in academic European urology. The award will be presented at the Opening Ceremony of the upcoming 37th Annual EAU Congress in Amsterdam, 18-21 March 2022, during the Opening Ceremony.
The list of previous awardees includes many well-known names: V. Phé (2021), D. Tilki (2020), M. Albersen (2019), S. Silay (2018), C. Gratzke (2017), A. Briganti (2016), M. Rouprêt (2015), S. Shariat (2014), P. Boström (2013), P. Bastian (2012), S. Joniau (2011), J. Catto (2010), M. Ribal (2009), V. Ficarra (2008), M. Michel (2007), A. De La Taille (2006), M. Matikainen (2005), P. Mulders (2004), B. Malavaud (2003), M. Kuczyk (2002), B. Djavan (2001), A. Zlotta (2000), G. Thalmann (1999), F. Montorsi (1998), F. Hamdy (1996).
Nomination Process National Societies can nominate a candidate by supplying the following documents: • Letter of endorsement • Motivation letter • Complete curriculum vitae • List of publications in the below sequence: 1. Peer reviewed papers (including the impact factors of the journals) • Original articles • Reviews • Case reports 2. Book chapters or editor of books • Overview of grants received from (inter-)national institutions or from the industry • List of received Awards • The deadline for nomination is 1 November 2021.
Please note that eligible candidates can also apply for this award by contacting their national urological society directly. The candidate is then expected to supply his/ her national society with a CV and the above mentioned documents, requesting a letter of endorsement.
How to apply Please send your nominations to the EAU Central Offi ce at m.smink@uroweb.org and mention “EAU Crystal Matula Award 2022” in the subject line of your e-mail.
The EAU Crystal Matula Award is supported by a grant of €10,000 from LABORIE.
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EAU Prostate Cancer Research Award 2022
With the goal to encourage innovative, high-quality research in prostate cancer, the EAU has launched the EAU Prostate Cancer Research Award. Supported by the Fritz H. Schröder Foundation, an expert jury will select the best paper dealing with clinical or experimental studies in prostate cancer.
The award will be handed over at the 37th Annual EAU Congress in Amsterdam, 18-21 March 2022, during the Opening Ceremony.
Join this competitive search and help boost the quality of prostate cancer research in Europe!
Rules and Eligibility • The topic of the paper should deal with clinical or experimental prostate cancer research. • The paper must have been published or accepted for publication in a high-ranking international journal between 1 October 2020 and 30 September 2021, and submitted in English. • Applicants must be a member of the EAU. • The submitting author must be the fi rst author of the paper or, by exception, the corresponding senior last author. • Applicants should only submit one paper. • Deadline for submission by e-mail is 1 November 2021.
A review committee will screen all entries and an independent jury will select the best paper based on quality and merits.
How to apply Inquiries and correspondence should be addressed to the EAU Central Offi ce, at m.smink@uroweb.org, with “EAU Prostate Cancer Research Award 2022” in the subject line of your e-mail.
The award is supported by a grant of €5,000 from the FRITZ H. SCHRÖDER FOUNDATION. www.fhsfoundation.eu
