Σάββατο, 24 Μαρτίου 2012

The causes of the enigmatic death of Vesalius in Zante in 1564*


The death of Andreas Vesalius, the Flemish founder of modern Anatomy, has been an unsolved mystery for the last four and a half centuries. It is generally accepted that he died on the Greek island of Zakynthos or Zante in 1564. The cause, the way, the exact location and the burial site have not been hitherto ascertained and all existing testimonies are considered doubtful. The aim of this brief work is to provide a solution to the mystery. It will be shown that there are reliable and unrelated testimonies which, when correlated, and linked to a fitting to the reported symptoms and likely in the circumstances cause of death, corroborate each other and allow us to form a convincing picture of the facts. Simultaneously, a false testimony, which has been allowed to overshadow these facts and hinder the focus of research on them, will be exposed.

***

Andreas Vesalius died during the return journey to Venice after a pilgrimage to the Holy Land. The first reference to his grave in Zante was made by the German Christoph Furer von Haimendorff, who visited the island less than a year after the death of the father of Anatomy. Unfortunately his book (1) was not published until 1621, leaving enough space for the development of many incorrect theories, both about the circumstances of his death and the location of his grave. Von Haimendorff saw the tomb in a ‘convent’ he calls Mariae de Gratia and gave the burial inscription: ANDREAE VESALII BRUXELLENSIS TUMULUS, QUI OBIIT ANNO DOMINI M. D. LXIV. ID. OCTOBRIS, CUMEX HIEROSOLYMA REDIISSET, Anno Aetatis suae LVIII.  Mariae de Gratia can only be the Roman Catholic church of Santa Maria delle Grazie.

The age given by the inscription is not correct. It is known Vesalius was born in 1514, which makes him 50 and not 58 years old in 1564. Charles Donald O’Malley, author of one of the most important books on Vesalius (3), points this out. Though he does not comment on it, he introduces doubts regarding the correctness and validity of the testimony. Immediately afterwards he bypasses the possibility of a burial in Santa Maria, proposing, without any evidence, a Greek Orthodox church in Melinado (4). O’Malley however did not know either the initial source of the information, or the short time distance that separated it from Vesalius’ death. As he admits he only knew of the inscription because it had been pointed out to him by one of his correspondents, who had read the books of Archduke Ludwig Salvator on Zante. It was therefore impossible for him to evaluate it correctly. Von Haimendorff’s information is of huge importance and by no means unreliable. Even if, for some inexplicable reason, the German traveller meant to give false information about the location of the tomb, he did not have to provide some imaginary inscription. The simplest explanation is that either the makers of the inscription did not know Vesalius’ age and guessed, or there had been a communication problem between the makers and their clients.

Besides, the existence of the inscription, and its location, are confirmed by the testimony of Giovanni Zuallardo in 1586 (5). Zuallardo, apart from being particularly reliable, was like Vesalius a Fleming, and his real name was Johannes Schwallart. As one would expect he showed interest in the grave of his famous compatriot. He mentions that the clog-wearing Franciscan brothers had a little monastery called Annuntiata, where the Catholics buried not only their own dead but also the travellers, and that was where the famous doctor and anatomist Andrea Vesalio was buried. Zuallardo did not see the burial inscription. Had he seen it he would not have mistakenly written that Vesalius died on the way to the Holy Land when he had actually died on the return journey. However, he explains that a nice burial inscription (Epitafio) had been taken by the Turks in the looting of 1571 (6).

Zuallardo’s Annuntiata and von Haimendorff’s Mariae de Gratia are the same. It is known that in the 1540’s a grave was found in Santa Maria delle Grazie, which was believed to be that of Cicero. A few years later, in 1553, the Englishman John Locke mentioned this fact (7), giving the name of the monastery as Sancta Maria de la Croce (7). Many later visitors followed his example. Amongst them is George Sandys, also an Englishman, who in 1610 mentioned that Cicero’s tomb was in a monastery called Annuntiata (8). He tells us too that it was there the Latins were buried. His description of Annuntiata’s location fits perfectly the location of Santa Maria delle Grazie.

'Cicero's grave' in Santa Maria delle Grazie.

One would have expected that any testimony related to Vesalius’ death that clashed with these two testimonies about the location of his grave would have been immediately treated with justified doubt. This did not happen. Zuallardo’s book was printed 31 years after Vesalius’ death and von Haimendorff’s 57. In the meantime the rumours about the death of the famous anatomist must have spread, and continued to spread until today. They were strengthened as time passed. They were ‘supported’ by ‘evidence’, which was nothing but older rumours triggered by the same spark, and assisted by newer unsupported theories (9).

The testimonies about Vesalius’ grave in Santa Maria became indeed known in due course. Centuries later it was sought there too. Naturally it was not found, since, even if it had not been destroyed in this earthquake prone part of western Greece, there was no longer any recognition sign as Zuallardo informed us. Any relevant document that may have existed in the church would have of course been also destroyed in the orgy of arson that is known to have followed the looting of Zante. This failure to find it, which should have been expected, was used as a point against the reliability of von Haimendorff and Zuallardo, muddying the water even more.

***

The spark that initiated the rumours was the narration of an anonymous Venetian goldsmith to Pietro Bizzari, an Italian author who was converted to Protestantism and lived a life of wandering in Venice, England, Flanders and Germany. Present was also another Italian, Giulio Borgarucci, a distinguished doctor in the Court of Elizabeth, Queen of England, and also a Protestant. The goldsmith’s testimony was published quite early on by Bizzari, in 1568, while the only testimony opposing it was not published until 1617, leaving it the field free for 44 years.

An English translation of the former, as well as the Latin text of 1573, were provided by George Sarton of Harvard University in 1954 (10), having been informed of its existence by the announcement of the Zantiote researcher Nikolaos Varvianis in 1952. This very important historian of Science devotes several lines in support of Bizzari’s and Borgarucci’s reliability, as if that was the one in doubt, but tells us absolutely nothing about the initial source, the anonymous Venetian goldsmith, about whom absolutely nothing is known of course!

Even Charles Donald O’Malley of the University of California, the world authority until his death in 1970 on the life and work of Vesalius, does not reject the narration of Bizzari because of the veracity, it seems, of Jacques Auguste de Thou, who published a version of it in 1734 (11)! It is therefore necessary to judge here the reliability of the initial source, since unfortunately, as far as the author is aware, this has essentially never been attempted before.

Bizzari mentions that Vesalius had departed for the Holy Land in April along with Malatesta from Rimini (12), whose destination was, however, Cyprus. Upon his arrival there he received the offer of the seat of Anatomy at the University of Padua, where he had taught many years previously, with a high salary. This is most likely information Bizzari had from a different source, hence it will not be looked at here. Below, (I) will signify the points from the Italian text of 1568, an English translation of which is given by O’Malley, and (L) those from the Latin text of 1573, translated to English by Sarton.

While Vesalius was sailing to Italy a violent storm (L) / fortune and contrary winds (I) forced the ship to land in Zante. He went ashore, fell ill and died a little later in a deserted place, a miserable hut (L) / a vile and impoverished inn (I), without any help. Shortly before his death, a ship from the Adriatic (L) / Venetian ships landed in the same area. Amongst her passengers was a Venetian goldsmith, who by chance walked along the beach and reached the point where Vesalius was laid up (L) / was wandering about the island and happened to hear where the unfortunate Vesalius lay sick (I). Though he did not know him (L) he took pity on him and tried to help him. He tried to convince the islanders to assist but they refused because pestilence was rampant in that region (L) / there had been lately an epidemic (I) and they were afraid, or because they lacked humanity and compassion. After Vesalius died the worthy goldsmith paid a lot of money to buy a piece of land (L) / had great difficulty in persuading the locals to allow it (I) and buried him with his own hands.

The first thing one will perhaps notice is that this story is permeated by a general vagueness. To a great extent this can be justified by the fact it is not related to us by its protagonist but by someone else. However, the fact he does not mention which one was the serious infectious disease that killed him, or, if he did not know, at least one of its symptoms, certainly does nothing to enhance its plausibility.

More questions can be raised, like what was the reason the goldsmith was wandering about the island or along the beach. Usually, visitors of the island at that time endeavoured to find some kind of lodgings in the Borgo della Marina (the port and lower town), food and drink, and then visit the sights, like the castle, churches and monasteries. Why should the goldsmith have been wandering on a deserted beach? The only possibility he could have been visiting a sight and was passing by a beach is if he was going to Keri to see the so called Spring of Herodotus. Bizzari however tells us nothing of the sort. If the goldsmith had told him he was visiting a place where tar oozes from the earth he would have remembered. In addition he gives two differing versions in the two texts, signifying he did not really know why the goldsmith had been wandering.

Another serious issue is the story is not compatible with the testimonies about a grave in Santa Maria delle Grazie. Either the goldsmith lied or von Haimendorff and Zuallardo did. There are also other serious credibility issues.

Since, according to the story, Vesalius was for a very brief time healthy upon his arrival at Zante, why was he still in that wilderness? Would it not be the first thing one did to head for a civilised place, preferably the city?

Nowhere is the existence of travelling companions, fellow passengers or even members of the ship’s crew mentioned. This gives the impression they had abandoned him. This would have been extremely unusual, given that he was a nobleman and a man of great fame. It was a matter of honour for fellow travellers and of likely legal repercussions for the ship’s captain. In the 15th century, even when dead the offspring of the noble families of Venice were carried back to their loved ones buried in the ship’s ballast, so that they could be given a funeral with all due honours (13). Already at that time the signing of detailed contracts between passengers and captains was the norm.

Zante belonged to Venice at the time. There was a governor, who was a Venetian nobleman, and for many years by then health officials (provveditori alla Sanità) had existed (14). Since the goldsmith faced problems because of the behaviour of the locals, as claimed, why did he not approach the authorities? In fact it is almost impossible the authorities did not know of the landing of Vesalius’ ship. Because of the frequent pirate raids, there were guarding-posts on the coast all around the island manned for at least eight months a year and they signalled every time a ship approached a deserted coast. John Locke describes how, with fires, the neighbouring island of Cephalonia was alerted from one end to the other (15). This was not particular to the Cephalonians. According to a letter of 1532 by Daniel, the prior of the Strophades Monastery, two soldiers placed on those islets communicated with Zante from an approximate distance of 27 nautical miles (16).
Zante in 1590

The worst in this story is that it allows you to clearly see through it the motive of its inventor. It is of course none but his desire to present himself as a hero. He introduces himself as the brave man, whose sympathy for his suffering fellow man, whom it must be noted he did not know, led him to disregard the danger of contracting the disease, and who finally, after his efforts bore no fruit, generously made the arrangements for the burial. Naturally his virtues are better discerned when contrasted with the lack of feeling and cowardliness of the Zantiotes. Yet, the almost childish story of this big but not very good liar has been allowed to stand for nearly 450 years! Its promulgation by Bizzari, a visitor in Venice, who lived in north-western Europe and seems to have had, along with a hefty dose of naivety, no good knowledge of conditions on the Ionian Islands or Mediterranean shipping, must have contributed to this.

***

We will now turn our attention to the opposing testimony, brought to us by the French (Burgundian) scholar and map-maker Johannes Metellus or Jean Matal, who lived in Cologne at the time. The testimony was given to him by a German from Nuremberg called Georg Boucher, in the presence of Johannes Echtius, a well known Dutch doctor of Cologne.

According to Johannes Metellus, in an English translation given by O’Malley (17), Boucher met Vesalius in Egypt. Vesalius was returning from Jerusalem and had through avarice provided an insufficient amount of money for his journey, though he expected a large sum of money in the future from the people with whom he had agreed to make that journey. This love of wealth had led him to entrust himself to a pilgrims’ ship instead of waiting for the Venetian fleet, for which he had a letter of recommendation from the King of Spain that may have allowed him to borrow funds. Also because of avarice he was not well provisioned for the journey. Boucher had also been planning his return to Venice and Vesalius had invited him to join him. He had accepted because of their common language.

The ship, driven by storms, was unable to reach land for forty whole days. Several of the passengers got sick partly because of lack of biscuit and partly from lack of water. Vesalius’ mind was so disturbed by the casting of the bodies to the sea he fell ill, first from anxiety and then from fear. He asked that should he die not to become food for the fish like the others. In the end the ship reached Zante and Vesalius, as soon as he was able to, leapt out and headed towards the city gate, where he fell dead on the ground. Boucher placed a stone for him as a monument. These were events of the previous October, of 1564 that is, since Metellus wrote this in the spring of 1565.

There are vague points in this story too, as one would have expected anyway, but to a far lesser degree than in that of Bizzari. He provides some details regarding the voyage, Vesalius’ illness, the time, manner and location of death. What is very important is its compatibility with the testimonies of von Haimendorff and Zuallardo.

Vesalius, according to Boucher, died very close to the city, at the northern edge of which Santa Maria delle Grazie was located. As Zuallardo tells us, that was where the Catholics and the foreigners were buried, and since Vesalius fell within both these categories he would have consequently been buried there. In addition, Metellus tells us Boucher made arrangements for a stone to be placed as a monument. This fits with the burial inscription given by von Haimendorff, while it appears it was attractive enough to be looted by the Turks as Zuallardo says. He also tells us Vesalius died in October, in perfect agreement with the inscription given by von Haimendorff. It is perhaps worth noticing that the news of Vesalius’ death reached London through a shard of diplomatic intelligence, sent from Vienna on the 9th of November 1564: Doctor Vesalius, returning from Jerusalem, is dead at Zante (18). The time the news became known in Vienna is compatible with Vesalius’ death in Zante in mid-October and the advent of German-speaking pilgrims heading north.

This story presents no contradictions and the only apparently valid objection raised is that of Nikolaos Varvianis. This testimony cannot be true, says Varvianis, because the city of Zante never had a gate. However, he does not take into account the fact Zante had two cities: Terra, within the castle walls, and the Borgo della Marina, much lower and around the port. The first one did of course have gates and, consequently, his objection cannot stand since Metellus did not specify to which city he was referring. Even if Metellus was referring to the Borgo della Marina he need not have used the word gate literally. We know neither the exact administrative arrangements nor the fortification details of 1564. A simple checkpoint may well have been called the gate of the city. In the map Città del Zanthe of Nicolò Gentilini in 1632 there are three bridges marked near the southern edges of the city, from Episcopiane to St Lazarus (19). Close to each one of them there was a guard-house (corpo di guardia). The reason for their existence could only have been the control of entry to the Borgo della Marina.

Georg Boucher did not present himself as a hero in the testimony he gave to Metellus. The only deed for which he could claim credit is, according to his own story, the payment for the gravestone. He did not even bother to say if the amount he paid was large, or at least Metellus does not mention it. If the stone was the one taken by the Ottomans, presumably to scrape and resell it, we should conclude it was significant. Boucher could probably afford to shoulder the financial weight effortlessly, most pilgrims could. He saw his deed as an obligation to his famous co-traveller, who had frivolously not taken with him enough cash even for a burial befitting his social status.

In spite of all this, Boucher’s story makes the reader keep his distance, presenting an important weakness – it raises more questions than it does answers. While there is no evident attempt to impress, as in the goldsmith’s story, nor does it present glaring contradictions and inconsistencies against which the researcher crashes violently, it is shaken by issues stemming from within that can be felt by everyone.

The image of a man who dissected corpses without hesitation cannot be easily reconciled with his anxiety about the fate of his own body. For a pilgrimage to the Holy Land courage was needed on top of wealth. The probability of not returning was not negligible. A small minority of the pilgrims, the most courageous, extended the pilgrimage by crossing the desserts of Sinai and ending up in Egypt. It is not fitting for one of them to be presented as ill with fear. Also, the possibility that passengers, but not crew members, died from hunger and thirst appears unreal. As unreal as the mysterious illness that was caused by hunger and thirst, and which had possibly killed Vesalius just after he had touched salvation. And yet the strange, almost unbelievable events of this testimony, given to us by Metellus in a much abbreviated form, are amenable to an interpretation that penetrates them and holds them together like an invisible skeleton. 

***

Vesalius never adjusted well in Spain and after the death of Charles V the situation had worsened for his favoured Flemings of the Royal Court of Spain. It is believed that his pilgrimage was, partly, a specious excuse to leave Spain forever. The vacant seat of Anatomy at Padua may have been an additional incentive. At the same time as Vesalius, his wife and daughter departed in the direction of Flanders. Vesalius headed for Venice, from where he departed for the Holy Land in April, according to Bizzari, or March, according to O’Malley.

The pilgrims usually left Venice much later, in May, after the ceremony in which the Doge symbolically married the sea, on Ascension Day. It seems that on this occasion they took advantage of the departure of Giacomo Malatesta, who was sent to Cyprus with troops (20). Apart from the security advantages this opportunity offered, it gave enough time to Vesalius to complete the pilgrimage and return to Padua for the start of the academic year. Such a view matches exactly Boucher’s story and the 15th of October as Vesalius’s date of death. Since, as the German said, the ship took 40 days to arrive from Egypt to Zante, the departure date would have been around the 5th of September, which is quite early.

It also matches Vesalius’ lack of funds at that moment, as related by Boucher. The ‘Venetian fleet’, which Vesalius was not prepared to wait for, was not of course Venice’s war fleet but the annual trade convoy, the ‘muda’ of Alexandria. For centuries, it sailed from Venice usually in August, or early September, and anchored in Alexandria in October. Along with spices and other merchandise it picked up any pilgrims found there and arrived at Venice in November. The extension of Vesalius’ stay by about a month and a half would have meant a considerable extra expense, without considering any unforeseen event that could take place in the meantime.

From this viewpoint, Boucher’s accusation of avarice against Vesalius does not appear absolutely justified. Vesalius was indeed wealthy but he was at a transitional stage of his life and it is possible there were matters pending that Boucher was not in a position to know. It is indicative that the Flemish doctor expected money from certain people after the pilgrimage. Perhaps Vesalius underestimated the cost of the pilgrimage or faced unpredicted expenses, something that was not unusual in such journeys. The customary bribes (baksheesh), arbitrary and extortionate ‘tolls’, thefts, and even robberies, were usual components of a pilgrimage. Illnesses and other delays too. What is certain is that Vesalius, always according to Boucher, would have had to borrow from the Venetian merchants and captains, and it is very likely he was already making do on borrowed money.

The pilgrims made detailed arrangements with the captains of their ships, part of which were the kind and quantity of the food provided during the journey. Usually the ships carried live animals for slaughter, so they could provide their passengers with fresh meat. Beyond what was agreed, the pilgrims themselves could carry with them any other foodstuffs they wanted, like smoked meat or wine. The wealthiest amongst them took along servants and cooks. Whatever the reason, avarice, financial difficulties or complacency, Vesalius took with him limited supplies.
A pilgrims' galley in Rhodes in 1483 with a visible construction for live animals.

We do not know the type of ship Vesalius sailed in; neither do we know their intended course. Because it was a pilgrim ship it is most likely it had already been to Palestine and the next call would have been to one of the ports of Crete, probably Candia (Heraklion). However, they did not manage to enter a Cretan port, or any other, for almost a month and a half. Storms are not unusual in the eastern Mediterranean in the early autumn, and they are violent and full of electricity. It appears they came across at least two, which repeatedly blew them off course. It is also possible they caused serious damage to the ship’s rigging, so that even when the wind was fair they were unable to take full advantage of it. It is not surprising then that they faced serious food and water shortages.

However, it does not appear that they ran out completely. Boucher did not say that some passengers died because of starvation and dehydration but because of an illness caused by the lack of food (biscuit) and water. It should be considered very strange that only some of the passengers fell ill and none of the members of the crew. The crew would have had far greater needs, both in food and water, because they, unlike the passengers, were obliged to work. We cannot assume the passengers were excluded from these goods. Something of this nature would have led to clashes, even killings, and would not have been omitted from the information passed to us by Metellus. It is far more likely that whatever food stocks they had left, and any water gathered during the storms, would have been rationed and distributed in very small quantities.

It is impossible to know when exactly the ship’s captain was forced to cut the rations of food and water, as this would have depended on the time they realised the problem and his assessment of the seriousness of the situation. Because Crete is several days sailing from Egypt, even with a fair wind the whole time, and because unforeseen events were the rule, it seems improbable the captain would have sailed without enough provisions for a much longer period. The issue was not simply that they should not go hungry. He had made contracts with the pilgrims about exactly what he had to provide and they were, as a rule, influential people. If he was unable to keep his promise it would have cost him dearly.

Even if some of the pilgrims had been left completely without food for three weeks, death can only be seen as exceptional, since during that period the body consumes stored fat. Only after this the consumption of non vital tissues starts. What absolutely excludes starvation and dehydration as causes of the deaths though, is that Vesalius showed symptoms only after others had already expired. Such a difference in the appearance of symptoms of starvation and its final outcome is impossible to justify in a journey of only 40 days. Neither is, of course, deadly dehydration possible to justify, since in that case everyone would have been affected. Nobody was carrying his own water reserves and, while the lack of water proved fatal for some, at least some others, like Boucher himself, not only did not die but did not even suffer ill effects. Consequently Boucher must have meant what he said when he spoke of an illness, which he linked to food and water shortages, and not of symptoms of starvation and dehydration.

We can also conclude that this mystery illness was not contagious. The reason is that if its gestation period was short it would have become apparent to at least one person on board in the early stages of the voyage, and not given the impression it was caused by food and water shortages. If, on the other hand, its gestation period was long, then the rest of the affected would not have had the time to show symptoms during the voyage. Naturally, in both cases it could not have been only the passengers who were affected.

There are only two possible causes of this non-contagious disease left: it was either due to the exposure of some of the passengers to an agent of infection before boarding, or they were deficient in some necessary substance or substances. Metellus’ certainty regarding the cause of the disease may mean that once they arrived at Zante, and after they ate and drank, their symptoms improved and were eventually cured, irrespective of the advance of their condition, with the exception of Vesalius, who did not get the chance to be cured. We must turn our attention towards a disease that is estimated to have killed two million people – in their majority seamen – between 1500 and 1800: scurvy.

Scurvy is caused by a deficiency in ascorbic acid, commonly known as vitamin C. Vitamin C cannot be produced by the human body and has to be acquired from external sources, usually through fresh vegetable food intake. This disease, practically unknown before the end of the 15th century, appeared with the first long sea voyages, when sailors started crossing the oceans and relied for months on preserved foodstuffs, which do not contain vitamin C. It took about two centuries before mankind suspected the cause of scurvy and another one before measures were taken to contain the problem.

By 1564 scurvy was still a new, very little known disease, and especially in the Mediterranean something you would never expect to come across. The Mediterranean sailors anchored in a port every few days, or a few weeks at worst, and were resupplied with fresh food regularly. Symptoms of scurvy appear only after someone has been at sea for longer than a month, and much more frequently two or three. This is the reason the crew of Vesalius’ ship did not fall ill in the space of 40 days. The pilgrims, however, had already spent several months in the deserts of the Middle East, feeding on preserved food, and the levels of vitamin C in their bodies were extremely low even before they embarked.

A list of foodstuffs has been compiled for this work, based on those mentioned by the Swiss monk Felix Faber during his group’s preparation to go to St Catherine’s monastery in Sinai and from there to Egypt (21). This leg of their journey started from Gaza on the 9th of September 1483 and they reached Cairo on the 11th of October. In that time they saw very little greenery and relied completely on the food carried by their camels and donkeys. These foodstuffs were: biscuit, smoked meat, smoked cheese, smoked fish, eggs, rice, almonds, oil (probably olive oil), butter, vinegar, salt, wine, live poultry and raisins. Of these, raisins contain traces only of vitamin C, at best, while in poultry it can be found only in their tiny livers. The rest of their food contained none. Jean Thenaud in 1512 had also onions amongst his provisions. These contain a satisfactory quantity but only if you can eat enough of them.
Pilgrims in Egypt in 1610.

The diet of the pilgrims was very similar during their sea voyages, with the addition perhaps of fresh red meat. The wealthy pilgrims would eat the prime cuts. These contain no vitamin C, found only in the intestines and the brains, which are treated with relative contempt by Westerners. They acquired some vitamin C when in cities. In Gaza Felix Faber ate many figs, which contain very little, but took with them pomegranates for the start of their journey, which contain relatively satisfactory quantities. Figs, pomegranates, dates and grapes were, since Biblical times, the traditional fruit of Palestine. Vesalius though would have left Gaza at the end of July at the latest. At that time there are no fresh figs, dates and pomegranates. Some varieties of grapes may have ripened but they contain very small quantities of ascorbic acid anyway. We do not know his route but usually pilgrims went to Cairo and then by river boat to Alexandria. Judging from his haste to return, always according to Boucher, it is very likely he did not have the time to raise the levels of vitamin C in his body.

For those who fell ill on board the ship, excepting Vesalius himself, we only know that some died, while we assume, without being absolutely certain, that those who landed on Zante were cured. If we also assume that they had travelled together with Vesalius all the way from Palestine then their diet would have been extremely poor in vitamin C, if they had not been completely deprived of it, since the second fortnight of July, considering that is when they would have departed from Gaza. In this case it would have been strange for them to not have shown symptoms of scurvy before reaching Zante, given that their diet would have been far from ideal in the previous months (22). However, in spite of the levels of vitamin C in the bodies of Vesalius and his fellow pilgrims being almost certainly very low, it would be extremely risky to claim they developed scurvy without knowing what symptoms they had developed.

Metellus unfortunately did not mention the symptoms of the others, though he gave us some information about Vesalius himself. It would be wrong to assume that Metellus, a scholar and a cartographer with a keen interest in long voyages and explorations, did not show an interest in the disease or its symptoms and that is why he did not mention them. It is exactly the opposite. The reason he did not mention them is because scurvy, even only from hearsay, was known in his circles. However, on the one hand it did not yet have a name (23) and on the other – because the symptoms are many and not all of them occur, nor does the disease always follow the same course – the doctors of the era could not be certain it was just one disease. Even the best known of the symptoms, the swelling and bleeding of the gums, is only present in those who have teeth. Almost two centuries later, in 1762, the surgeon of the warship America ended a letter from Manila thus (24):

The causes of this fatal calamity were principally the sultry heat of the climate and bad provisions, viz. Bread full of maggots, spoilt beef and pork, water full of vermin, and a very scanty allowance of that, and spoilt rice, which last even in its best state affords only a very poor and watery nourishment.


In the rest of his letter he gives an extensive description of the symptoms of scurvy, which had killed 130 of the 420 crew of America. For centuries scurvy, whether named or not, was linked to the sufferings of a long stay at sea and the shortages of good food and water. That is why Metellus, writing to the well known publisher Arnold Birckmann the Younger, was not referring to a particular disease but a possible group of diseases with a common cause – and it is the cause, namely the shortages, he focused his attention on. Characteristically, within his brief description of events, he repeats four times as a warning that Vesalius’ provisions were lacking due to avarice.

More than just hypotheses are necessary, however logical they may be, before settling the cause of death of the famous doctor. Fortunately, about Vesalius himself, we know from Metellus’ letter two specific events. The first is the dramatic changes in his personality. This is one of the little known but very characteristic symptoms of scurvy. Ascorbic acid is involved in many body processes and that is the reason the list of symptoms is extremely long. Between the most usual early symptoms are the paleness of the face, inaction, quick-setting fatigue and mental disorders (25). The reason for the last one is that vitamin C plays an important part in the synthesis of neurotransmitters like serotonin and norepinephrine.

It may be very difficult for someone to notice paleness in the face of a person who has spent the entire summer wandering all over the Middle East. Inaction and easy tiredness are certainly not easy to spot on the passenger of a ship either. It is perfectly natural that the first difference Boucher noticed in Vesalius was the change in his behaviour. Unable though to see this mental change as a symptom of disease, and having observed no other symptom, he considered it a factor in bringing it about. That is why he told Metellus that Vesalius fell ill through his anxiety and fear.

The second is his sudden death. This is also a distinctive characteristic of scurvy. Though there are far more modern descriptions of the phenomenon, it is worth looking back to the work of the Scot James Lind, a doctor who had examined thousands of patients with scurvy and was the first to conduct a clinical experiment for a cure in 1747. Lind, whose advice for the supply of oranges to seamen was unfortunately ignored, mentions this phenomenon repeatedly and says characteristically (26):
 



Hence such people drop down dead suddenly, without any other visible cause of their death found upon dissection than the weakened auricles of their heart enlarged, and distended with blood. They are observed to have a panting or breathlessness for about half a minute before they expire.


Lind and others, like the surgeon of the America, link the sudden deaths with a change in conditions. Many patients died in the boats taking them ashore, or during some effort. About Vesalius, Metellus says he dropped dead near the gate to the city. Perhaps this means he became tired during his effort to approach the city. We do not know how far from that point he had landed but, for someone suffering from scurvy, even walking a few metres could prove fatal.

According to tradition Vesalius’ ship landed at a spot in the bay of Laganas, in the island’s south. As a landing point it is certainly possible for a ship with damages, exhausted supplies and many seriously ill on board, while it agrees with a course from the south or southwest. The distance from the city is about eight kilometres, too far for a sick person, even if he was not suffering from pain in the joints and swollen legs, like many victims of scurvy. It is not impossible though that they had found mounts that carried some of the passengers. In this case the place where the father of Anatomy drew his last breath would be the bridge of St Lazarus, still wooden at that time, which was where the mule path started, linking the city to the island’s villages.

Alternatively, if he had gone directly to meet the island’s authorities, the place would be one of the two castle gates where the branches of the Strada Giustiniana ended (27). It is doubtful though if, in his condition, he would have been allowed to cross the Borgo della Marina, in spite of the fact no quarantine house existed yet on Zante. The bridge of Episcopiane is also a candidate, if the ship had anchored between today’s St Charalampus and the Lazareta. Since there is not enough evidence, all that can be said is that, according to the description of Metellus, Vesalius passed away very close to, or very likely within the present borders of, the city of Zante.

***

In summary the following conclusions are submitted:

The description of events, brought to us by Pietro Bizzari, is considered unreliable, imaginary and fabricated from beginning to end. There are several reasons, and these were explained in detail, with most important its clash with two testimonies asserting the existence of a grave with a burial inscription at the church of Santa Maria delle Grazie. These testimonies, by Christoph Furer von Haimendorff and Giovanni Zuallardo, are unrelated, support each other, have no hidden motive, they come from known travellers who visited the island, and they are unique, in the sense that apart from Bizzari’s narration there is no other piece of evidence contradicting them. This should perhaps be emphasised again, because in the past several authors have tried to present unsupported theories, their own or others, as evidence.
   


Unlike that of the goldsmith, the description of Georg Boucher, as salvaged by Johannes Metellus, is truthful, accurate and reliable. The doubts it has raised for centuries have their source, to a great extent, in the surpassing of imagination by reality. More specifically, it is in full harmony with the testimony of von Haimendorff and Zuallardo on the location, timing and description of the tomb. It presents no contradiction, shows no attempt of self-promotion, or other ulterior motive, and does not give the impression that any of the inevitable ambiguities and omissions is deliberate.

Of utmost importance in its evaluation is the complete compatibility of the circumstances it describes, and of those it points to, with an attack of scurvy on Vesalius while at the same time describes two of the less well known but very distinctive symptoms of the disease, in the early stage and at the end. Because this disease was at that point in time very little known and studied, any fabrication of this combination by Boucher would have been absolutely impossible. Any fabrication  in its presentation by Metellus, who must have known a few things about scurvy, is considered improbable. It would have necessitated the complicity of the doctor Johannes Echtius, present in the conversation, whose testimony Metellus invokes. The possibility of a coincidence finally, already negligible, is brought to zero by the assessment of the well known cartographer that Vesalius died from an illness caused by his long stay on a ship with inadequate provisions. In his time this meant scurvy, even if the disease had yet to be named. We cannot but agree with this diagnosis.


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*This is a translation of the previous post, with somewhat extended notes, for those not familiar with the geography and history of Zante.

(1)  Itinerarium Aegypti, Arabiae, Palaestinae, Syriae, aliarumque regionum orientalium, printed in Nuremberg in 1621. The reference to Vesalius’ grave is in p. 2.

(2)  Santa Maria, close to the sea and about 600 metres north of the port, was not a convent. However there was a monastery very close to it, so that the two were often confused or thought of as the same compound.

(3)  Andreas Vesalius of Brussels 1514 – 1564, University of California Press, 1964. The inscription is mentioned in p. 312.

(4)  A location several kilometres inland that appears to make no sense at all. There is no conceivable reason why Vesalius should have been in that area when he died, or why his body should have been taken there for burial.   

(5)  Il devotissimo Viaggio Di Gierusalemme, Rome 1595, pp. 85 – 86.

(6)  On the 5th of July 1571 Zante was attacked by a powerful naval squadron of the Ottoman Empire, under the command of Uluç Ali, Pasha of Algiers. He landed 12,000 troops on the island, a huge number, considering  Zante’s total population at the time is estimated to have been no more than 25,000. The Zantiotes withdrew to the castle and other fortified locations, abandoning the port area and the island’s plain to the Turks and North Africans. The fighting lasted for approximately four weeks, with attacks and counter attacks by the two sides, until the Muslims withdrew. The lower city and the port had been thoroughly looted and burnt by then, as was much of the rest of the island. Churches and monasteries were prime targets of looting at the time. The Zantiotes avenged the destruction very soon, joining with two galleys and several smaller vessels the combined Christian forces that destroyed the Ottoman fleet in the Battle of Lepanto in October.

(7)  The voyage of M. John Locke to Jerusalem, The Principal Navigations, Voyages, Traffiques and Discoveries of the English Nation by Richard Hakluyt, v. 5, 1904, p. 82.

(8)  A relation of a journey begun Anno Domini 1610, 1621, p. 8.

(9)  The case of Nikolaos Varvianis is typical. In his Academy of Athens announcement of 1952 (through the member S. Dontas) he presents as supposed evidence an epigram of Justus Rycquius Gandensis, who was not even born when Vesalius passed away, and the searches for the grave in the area of Laganas by Maltese priests and Englishmen at the end of the 19th century or the beginning of the 20th. Synedria of 3rd April 1952, volume 27, pp. 193 – 196, Athens 1952.

(10)  The Death and Burial of Vesalius, and, incidentally, of Cicero, Isis, volume 45, The University of Chicago Press, July 1954, pp. 131 – 137.

(11)  Andreas Vesalius’ Pilgrimage, Isis, volume 45, The University of Chicago Press, July 1954, pp. 138 – 144.

(12)  This was most likely Giacomo Malatesta, a contemporary condottiero in Venetian service.

(13)  Tullio Vidoni, The journal of Roberto Da Sanseverino: A Study of Navigation and Seafaring in the Fifteenth Century, Doctoral dissertation, University of British Columbia 1993, p. 109.

(14)  Katerina Konstantinidou, The disaster creeps crawling: The plague epidemics of the Ionian Islands [in Greek], Istituto Ellenico, Venice 2007, p. 104.

(15)  See n. 7, p. 81.

(16)  I Diarii di Marino Sanuto, v. LVI (26), 104.

(17)  See n. 3, pp. 310-311.

(18)  Max H. Fisch, Vesalius in English State Papers, Bull Medical Library Association, April 1945, 33 (2), pp. 231 – 253.

(19)  Old churches of Zante. Episcopiane, by the mouth of the river, no longer exists.

(20) This piece of information of Bizzari had not come from the anonymous goldsmith and there is no reason to dispute it.

(21)  The book used was Once to Sinai: The further pilgrimage of Friar Felix Fabri, by H.F.M. Prescott, New York 1958.

(22)  The journey from Jerusalem to Gaza normally took two to three days but it took Felix Faber five, because they did some sightseeing on the way. Pilgrims travelled about quite a lot during their stay in Palestine and Vesalius is known to have visited the plain of Jericho. Vesalius’ diet must have been deficient in vitamin C at least since his departure from Venice in the spring.

(23)  The word scurvy first appeared at exactly that time, possibly with a Dutch or German origin.

(24)  James Lind, A Treatise on the Scurvy, 1772, pp. 279 - 282.

(25)  J.V. Hirschmann and Gregory J. Raugi, Scurvy in Adults, Journal of the American Academy of Dermatology, v. 41, pp. 900-901.

(26)  See n. 24, p. 250.

(27)  The road that led from the Borgo della Marina to the castle, climbing the side of the hill.

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