The Fasciculus Medicinae: An Introduction to the Images and Texts

The Fasciculus medicinae—literally, the “little bundle of medicine”—is a small group of independently-authored medical treatises and illustrations first printed in 1491. Remarkable as one of the earliest illustrated medical books to be printed, the Fasciculus was reprinted in dozens of different editions and translated into the major European vernacular languages into the 1520s. The Fasciculus also serves as an important witness to a dynamic period of change, reflecting both medieval medical ideas and new advances spurred by the humanistic surge associated with the Renaissance. This is perhaps best illustrated by the inclusion of the first printed scene of human dissection, an indication of the growing importance of empirical investigations of the interior. The images attached to the Fasciculus are a blend of diagrams copied from medieval manuscripts alongside newer, narrative-based scenes demonstrating the modern taste for classical styles in figures and interiors.

The Fasciculus went through several iterations as it was adapted to meet increasing demand and changing tastes. The initial 1491 edition included six illustrations and accompanying texts, all of which had circulated in manuscript form prior to being printed by the brothers Johannes and Gregorius de Gregoriis, or Giovanni and Gregorio de Gregori (or Gregorii), in their Venetian printing house. After the original print run, the Fasciculus was augmented and translated into Italian by the Roman Sebastiano Manilio with the title Fasiculo de Medicina in 1493 (1494 in today’s calendar). In this edition, the existing images were reworked in an attempt to modernize old-fashioned medieval tropes and four new images were added.

The original 1491 “little bundle” begins rather unceremoniously, jumping straight into its medical content without preamble. The title, given simply as “Fasciculus medicinae,” appears on the first page above a diagram of urine in glasses in the shape of a wheel. This image was used to help a physician diagnose a patient based on the color, smell, and sometimes even taste of the urine. These diagrams were relatively popular during the Middle Ages. They sometimes appeared as part of “belt books,” small pieces of parchment folded together containing useful information, worn on the belt of a physician for easy access while visiting patients.

The urine section is followed by a segment on bloodletting, or phlebotomy. This begins with a full male figure labelled with descriptions of the arteries and veins, and an accompanying text, outlining where and when to draw blood from a patient. Next up is a Zodiac figure, each part of his body marked by one of the twelve signs of the Zodiac, supplemented by a treatise explaining when and when not to draw blood from certain body parts, depending on the time of year. The Fasciculus then features a segment on gynecology and obstetrics, including a pregnant anatomical female figure, and texts related to sexuality, generation, and disorders particular to women. The next section begins with an image of the so-called Wound Man: a male figure being stabbed, clubbed, and pierced with arrows and other weapons, followed by a text on grievous injuries and how to treat them. The final figure, known as the Disease Man, is labeled with disorders and illnesses that affect humans, listed and described in full in the treatise immediately following. These five full-bodied figures circulated in manuscripts, oftentimes together, for decades prior to their appearance in printed form.

Where did the Gregori brothers find these texts and images, and why did they decide to have them printed? The 1491 colophon, or inscription describing the production of the work, refers to the group of treatises as the “Fasciculus medicinae of Johannes de Ketham .” Much has been written on the possible identity of this Johannes de Ketham, but there is no concrete evidence to prove who he was with certainty. In the early twentieth century, Karl Sudhoff argued that “Johannes de Ketham” is a divergent spelling of “Johannes von Kircheim,” a medical professor at the University of Vienna between 1455 and 1470. Von Kircheim is described in the annals of the University as both dean of the School of Medicine and an administrator of anatomical demonstrations. Sudhoff believed that von Kircheim compiled these diverse treatises, and they began to circulate under his name. Most recently, after extensively researching records of von Kircheim, Christian Coppens has concluded there is little chance he was the original compiler of the Fasciculus. Regardless, it is important to note that Johannes de Ketham—whoever he was—did not write any of the treatises that circulated under his name. They were, in many cases, several hundred years old by the fifteenth century, and attributed to other medical writers whose work spread in manuscript form across Europe.

Edited by Giorgio dal Monferrato, the initial 1491 Fasciculus was evidently met with success, because the Gregori brothers initiated a second edition in 1493. Under editor Sebastiano Manilio’s guidance, this second edition was translated into Italian, and included several other notable differences: the addition of four new images, two new texts, and the redrawing of five of the original six images. These “updated” woodcuts, exhibiting the influence of contemporary Venetian artists like Giovanni Bellini and Andrea Mantegna, reflect the changing aesthetics of the period. In general, these images include muscled, classicized figures with an emphasis on careful attention to proportion, background, and perspective.

The 1493 edition starts with a frontispiece, or prefatory image, to begin the Fasciculus on a formal, more elevated platform. A robed academic stands at a desk, surrounded by books. Above the figure, the name “PETRUS DE MONTAGNANA” is printed in block capitals, and a new introductory statement at the beginning of the book claims that this is the “Fasciculus medicinae of Johannes of Ketham.” These two names, featured prominently, indicate a desire to connect the miscellaneous texts of the Fasciculus with an authority. We have already explored the possible identity of Johannes of Ketham; like him, that of Petrus de Montagnana remains a mystery. The name must have been associated in some way with medical learning.

The four new images added to the 1493 edition have several things in common: all are presented as narratives, centered around a particular medically-related action. The frontispiece sets up Petrus de Montagnana as an ideal scholar: he knows the great medical authorities, whose names are printed on the covers of the books in his library, and he is an author himself, pictured in the midst of writing. He is also, perhaps, a practitioner. The figures in the foreground could be patients who have come to be examined by him.

The second image, the urine consultation scene, puts into action the static urine glasses of the medieval diagram. Two messengers seek the opinion of the central medical practitioner on the urine jars they present to him. The practitioner appears to be an academic, surrounded by students. The third new scene precedes a treatise on how to treat plague victims, written by Pietro da Tossignano (fl. 1364–1401), a professor at the universities of Bologna and Padua. Pietro is described by the text as a “most famous doctor of arts and medicine,” and his treatise takes the form of a discussion of his specific interactions with plague patients. This tract was printed by the Gregori brothers separately from the Fasciculus and was appended to the end of the 1491 edition. The 1493 version saw the treatise fully integrated and enhanced by its own prefatory image of a physician visiting a plague patient. In this scene, the physician, covering his face, reaches up to grasp the wrist of his patient in order to take his pulse. Attendants hold torches so he can see, and nurses bustle around the patient, who is evidently a wealthy man, given the ornate carvings on his bedframe.

The fourth new section added to the 1493 edition begins with the dissection scene, which appears before a tract on anatomy called the Anothomia Mundini, or “Anatomy of Mondino.” Written in 1316 by Mondino dei Liuzzi (c. 1265-1326), a professor of medicine at the University of Bologna, this treatise is one of the earliest texts to reference first-hand dissection of the human body. Prior to Mondino, most anatomical texts were based upon the writings of the established medical authorities (many of whose names appear in Petrus de Montagnana’s library), especially Galen (129–c. 216 CE). Medieval readers were mostly unaware of the fact that Galen did not dissect human cadavers, but instead based his anatomical observations on dissections of animals believed to have similar interiors to humans, especially apes and pigs.

While Mondino’s text largely adheres to Galen’s teachings, it appeared before dissection was formally introduced as part of the medical curricula in Northern Italian universities in the middle of the fourteenth century, and serves as an indicator of the changing nature of anatomical understanding. (An important distinction to make is the difference between an autopsy and dissection. Autopsies were carried out to determine a cause of death, and were documented—albeit infrequently—from the early thirteenth century onwards. By contrast, a dissection was performed in order to view the interior of the human body.) Dissections were not considered necessary until the rise of medical faculties in universities in the fourteenth century, and even then, the earliest dissections were performed infrequently and as accompaniments to the writings of established medical authorities, especially Galen and Avicenna. In these early dissections, the professor would read aloud from the text, while a surgeon would dissect the body as students observed from their seats in an anatomy theater. Procuring corpses for dissection was difficult; they were generally those of executed criminals without family to claim and bury their bodies.

The dissection scene has gained perhaps the most attention of any aspect of the Fasciculus. It is notable as the earliest printed scene of a human dissection, and is one of only a few pre-1500 images of human dissection in general. It also demonstrates the more active involvement of students witnessing dissections at the end of the fifteenth century. They crowd around the idealized male corpse, many closely watching or even directing the surgeon as he makes his cut. Above them, a male figure stares out at the viewer from a raised lectern, mouth open as he reads. The identity of this figure has been a source of contention; some scholars believe he is not actually there, but rather the spectral figure of Mondino himself, while others argue he is simply an anatomy professor reading aloud from a text, as was customary. In any case, the scene is indicative of the rising interest in human anatomy, peaking with the publication of Andreas Vesalius’s seminal On the Fabric of the Human Body half a century later.

The New York Academy of Medicine possesses five editions of the Fasciculus, each of which contains the texts and images found in the 1493 reprint, save for a few losses over the past five centuries. Three are in Latin, published in 1495, 1500, and 1513, and two are in Italian, published in 1509 and 1522. Together, they provide a testament to the widespread popularity of the text, the small variations found in early printed works, and the marks left by individual owners that give us some indication of the uses of the book and tastes of their users.

The 1495 Gregori version includes the addition of hand-drawn “speedos” to cover the genitals of the male figures, perhaps done by a censorious later owner. The 1500 Gregori edition has hand-colored images in a palette of bright reds and greens that is still striking today, as well as an added treatise on the diseases of children by the Arabic author Rhazes. The 1509 Gregori version features perhaps the greatest difference of each of the Academy’s editions. Printed in Italian by the di Castiglione workshop in Milan, many of the woodblocks are reversed, usually indicating an artist carved a new woodblock directly from the existing illustration. Thus, when the ink was applied to the new woodcut and printed onto paper, a mirror-image of the original is produced. The 1513 edition, again published by the Gregori workshop in Venice, is missing both the frontispiece and the urine consultation scene. The final version was printed in Italian by the Arrivabene in Venice in 1522, and is the last edition of the Fasciculus to be printed, aside from a single reprint in the seventeenth century. By 1522, the medical information in the Fasciculus had become outdated, and it was quickly supplanted by new medical and anatomical manuals.

Written by Dr. Taylor McCall

Recommended Reading:

Jerome J. Bylebyl, “Interpreting the Fasciculo Anatomy Scene,” Journal of the History of Medicine and Allied Sciences, 45 (1990), pp. 285–316.
Ludwig Choulant, History and Bibliography of Anatomic Illustration, trans. and annotated by Mortimer Frank (New York: Hafner, 1962), pp. 115–119.
Christian Coppens, De vele levens van een boek: de Fasciculus medicinae opnieuw bekeken (Brussels: Koninklijke Academie voor Geneeskunde van België, 2009).
[Johannes de Ketham], The Fasciculus medicinae of Johannes de Ketham, Alemanus: facsimile of the first (Venetian) edition of 1491, trans. by Luke Demaitre; commentary by Karl Sudhoff; trans. and adapted by Charles Singer (Birmingham, Ala.: The Classics of Medicine Library, 1988).
Tiziana Pesenti, “Editoria medica tra Quattro e Cinquecento: L’Articella e il Fasciculus medicine,” in Ezio Riondato, ed., Trattati scientifici nel Veneto fra il XV e XVI secolo (Venice: Università Internazionale dell'Arte, 1985), pp. 1–28.
Tiziana Pesenti, Fasiculo de medicina in volgare, Venezia, Giovanni e Gregorio De Gregori, 1494, 2 vols. (Treviso, Italy: Antilia, 2001).