History of Medicine

 The “Autopsy” of St. Ignacius de Loyola and the 

Anatomists Who Performed It

 

       On July 31, 1556, Ignatius de Loyola limped into Rome to die. The limp stemmed from a cannonball injury to his right leg sustained during his youthful days as a soldier. During convalescence Ignatius, born Íñigo López de Oñaz y Loyola in the Basque village of Loyola, experienced a spiritual conversion. After a pilgrimage to Jerusalem

Saint Igantius of Loyola (Wikipedia)

followed by studies of theology in Spain and Paris, he and colleagues in Paris formed the Society of Jesus. He expired in Rome after a long illness.

 To avoid decomposition of the body in Rome’s July heat, embalming (the custom for important religious figures) was undertaken quickly. Realdo Colombo, a famous anatomist and at that time a physician in the papal household, was assigned to open the body. Juan Valverde, a prominent Spanish anatomist, assisted him (Valverde, like Ignatius, was Basque.) Who were these anatomists and did the future saint undergo an autopsy?

         Realdo Colombo, the son of an apothecary, was born in Cremona, Italy, around 1515. After an apprenticeship with a Venetian surgeon, he moved to Padua to study medicine. His anatomy professor, Andrés Vesalius, noticing his anatomical skills, appointed him as his assistant. After a dispute with Vesalius, Colombo taught at

Realdo Colombo (Wikipedia)

Pisa and then moved to Rome where he taught at the papal university, the Sapienza, and served as a physician in the papal court. He began work on his own anatomy text, De Re Anatomica, that saw publication shortly after his death in 1559. In it he corrected some of Vesalius’ anatomical statements and, more importantly, described the pulmonary circulation and the proper function of the heart valves. William Harvey studied the work intensely, crediting it with helping him unravel the scheme of circulation in 1626. Colombo had asked Michelangelo to illustrate his planned anatomy text, but the latter was too old and died soon after.

Juan Valverde de Amusco, after obtaining a university degree in Spain, studied medicine under Vesalius and Colombo in Padua and followed Colombo to Pisa, pursuing anatomy studies. Valverde, like Colombo, came to Rome where he studied under Bartolomeo

Juan Valverde (Wellcome Library)

Eustachi, professor of medicine at the Sapienza. Valverde later taught anatomy at the Hospital Espíritu Santo, which boasted an anatomical theater. Cardinal Juan Álvarez de Toledo chose him as his personal physician, and both Valverde and Colombo moved in prominent social and scientific circles in Rome. Valverde worked closely with Colombo while investigating the pulmonary circulation. 

Valverde’s move to Rome from Spain was not unusual. The Spanish population in Rome had been growing, partly due to the election of two Spanish popes (Callixtus III, 1455-58 and Alexander VI, 1492-1503). The educational reforms of Pope Julius III (1550-55) had enhanced Roman medical education,

Bartolomeo Eustachio (Wikipedia)

reformed medical licensing, and encouraged the formation of new hospitals. In Spain, medicine was less advanced and bodies for dissection were harder to obtain. Additionally, the majority of physicians in Spain had been Jewish and the Spanish expulsion of the Jews in 1492 had driven many to Rome and elsewhere. Whether Valverde had Jewish origins is uncertain. 

Valverde published an anatomy text, Historia de la Composición del Cuerpo Humano in 1556, three years before Colombo’s work. It was well illustrated but most of the illustrations, attributed to Gaspar Becerra, who trained in Michelangelo’s workshop, are copies of those in Vesalius’ text, though smaller in size. The book includes corrections from Vesalius’ original Fabrica (which angered Vesalius), and some original findings that include a correct rendition of the pulmonary circulation, though still with Galenic overtones. The main advantage of

Striking illustration from Valverde's Historia
(Wellcome Library)

Valverde’s book is the readability and clarity of text, making it popular with medical students and physicians. The book was published in Spanish (many Spanish surgeons did not know Latin) but eventually appeared in Italian, Dutch, and Latin translations during some sixteen editions. It was one of the most widely used anatomy texts in Europe at the time. 

Colombo recorded in De Re Anatomica that inside Ignatius he found stones in the kidneys, lungs, liver, and portal vein and that the stomach and intestines were empty, the latter finding attributed to Ignatius’ frequent fasting. The dissection has often been characterized as an autopsy of Ignatius, but Colombo was there to embalm him and did not speculate on a cause of death. The nature of the “stones” is uncertain and may have alluded to gallstones, urinary tract stones, phleboliths, or some combination.

Actual autopsies were, however, not so rare at the time. Leonardo da Vinci had written in the latter 1400s, “…and I did an autopsy on him to see the cause of such a quiet death.” Antonio

Antonio Benivieni (Wikipedia)

Benivieni, a Florentine physician and contemporary of da Vinci, penned the first known book of autopsies, published posthumously in 1507. In it Benivieni describes 110 cases with postmortem findings. Normal anatomy was not fully understood at the time, not to mention abnormal anatomy, and Benivieni was steeped in Galenic medicine, a doctrine that explained health and disease in terms of the balance of humors. Thus, Benivieni did not always relate autopsy findings with the clinical picture. By Colombo’s time autopsies, still brief by modern standards, were more common. 

St. Ignatius’ death occurred at an important moment when post-Vesalian objective anatomy investigations were eroding the ancient Galenic framework of medical thought. The work by the Spanish anatomist, Valverde, was an important and often overlooked contribution. And findings at autopsy gradually reshaped concepts of disease though it was not until the great work of Morgagni in 1761, De sedibus et Causis Morborum, correlating the clinical picture with autopsy findings, that modern pathology began to take shape.

 

Sources:

King, L S and Meehan, M C, “A History of the Autopsy.” Amer J Pathol 1973; 73 (2): 513-44.

 

Andretta, E, “Juan Valverde, or Building a ‘Spanish Anatomy’ in 16^th Century Rome.” Working paper, European University Institute, Max Weber Programme, 2009. https://cadmus.eui.eu/bitstream/handle/1814/12094/MWP_2009_20.pdf?sequence=1

 

Rosenman, L D, “Facts and Fiction: The Death of Saint Ignatius of Loyola.” Surgery, 1996; 119 (1): 56-60.

 

Hernandez-Mansilla, J M, “Autopsia, embalsamamiento y signos de santidad en el Cuerpo de Ignacio de Loyola.” Rev de Ciencias de las Religiones 2016; 21: 79-91.

 

Fye, W B, “Realdo Colombo.” Clin Cardiol 2002; 25: 135-37.

Arráez-Aybar, L, et al, “Juan Valverde de Amusco: Pioneering the Transfer of Post-Vesalian Anatomy.” Anatomia 2023; 2: 450-71. 

Burgos Lázaro, R, et al, “Juan valverde de Amusco en la Medicina del Renacimiento Español.” Anales RANM 2021; 138 (1): 82-91.

Singer, C.(translator), de Abditis Nonnullis ac Mirandis Morborum

et Sanationum Causis by Antonio Benivieni. 1954; Charles C Thomas.

 

Coppola, E D, “The Discovery of the Pulmonary Circulation: A New Approach.” Bull Hist Med1957; 31 (1): 44-77.

 

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