JOHANN BACHOVEN VON ECHT (1515–1576) AND HIS WORK ON SCURVY: AN OMEN OF VESALIUS’ DEATH?

A discussion is given of the figure of Johann Bachoven von Echt and his family, and on his work on scurvy. The disease is evaluated as a possible cause of the death of Andreas Vesalius. Echt’s relationship with Jan Wier and his connections with Vesalius and Metellus are illustrated. A historical overview of the literature on scurvy is provided highlighting the importance of the work of Echtius and Ronsse for the early knowledge of that disease. A report by Metellus on the circumstances of Vesalius’ death is added.


Introduction
We know why Vesalius undertook his fatal journey to Jerusalem. The reason was both religious and diplomatic. This is clear from the correspondence between Philip II, King of Spain, and Garcihernández, the deputy ambassador in Venice about Vesalius, which was found by José Baron Fernandez in Fig. 1 Echtius, amicus noster ('Doctor Johann Echt, our friend'). 7 His hypersensitivity to roses is frequently mentioned. 8,9,10 Some writers claimed that this quirk even led to his death, although this could not be confirmed. 11 Because of his interest in plants, he was also in regular contact with Conrad Gesner, who tried to persuade him in Cologne to collaborate with him on his edition of Dioscorides. 12 There were frequent bouts of the plague at this time. During one such outbreak in 1564, Echtius urged Petrus Ximenius (Pedro Jimeno, 1515-1595) and Georg Cassander (1513-1566) to move to his vineyard for the sake of safety. 13 In the Acta Nationis Germanicae (official records of the German nation), under the heading of philosophy and medicine, there is a mention in Padua for the year 1561 of the costs on the death of a young Echtius from Cologne, who died on 29 August. The first name 'Ioannis' which was added in a different hand between the lines was later deleted, however. 14 This cannot be 'our' Johann von Echt, as these reports do not start until 1553 and he had been back in Cologne for several decades by then, as we will see.
Although little reliable biographical information about Echtius can be found, there are quite a few anecdotes about him. Echtius is mentioned 7 Bernardus Dessenius Cronenburgius, De Compositione Medicamentorum..., Libri X, Lugduni apud Gulielmum Rouilium, 1556, liber X, p. 881. 8 Adam, Melchior, Op. cit. 9 Hartzheim, Josephus, Bibliotheca Coloniensis, Coloniae Augustae Agrippinensium: Thomas Odendall, 1747, p. 169. 10 "Echt (Jean)", Biographie médicale, tome quatrième, Paris: C.L.F. Panckoucke, [no year], p. 6. 11 Moreri, Louis, Le grand dictionnaire historique ou le mélange curieux de l'histoire sacrée et profane, tome quatrième, Paris: les Librairies Associées, 1759; see p. 16. See also Theoph. De Meza, Tentamen Historiae Medicinae, pars altera, Hafniae, apud C.G. Proft, fil.et soc., 1795; see pp. 44-45. several times by Reiner Solenander (1524-1601 in his Consiliorum Medicinalium Sectiones quinque. Of interest is the section on the preparation of fluids for embalming corpses, in which he indicates that Echtius saw this method being used in Bologna on 2 January 1538, during the embalming of Bishop Megalotta Scaevola. 15 Echtius was barely 23 years old at the time, and was probably there during his studies. Another consilium, addressed personally to Echt in Cologne (scriptum ad Clariss. Virum D. Ioannem Echtium, Coloniensem Medicum), concerns the state of health of Wilhelm ab Orsbek Iuliacensium (Jülich), the Duke's chancellor, and discusses the medicinal properties of the sources of Spa. The consilium is dated 24. Iunii, Anno 70. Dusseldorpii. This patient also complained of loose teeth. 16 In yet another, consilium LX, sectio III for Merheim, a citizen of Cologne with swellings and palpitations, Solenander goes through the medicines that the patient had previously been prescribed by Echtius. This is dated 7 July 1574 (Signatum 7. Iulii, Anno,&c,74). 17 In still another, Solenander submits to Echtius a case of peculiar symptoms that had occurred in a girl from the nobility in the women's house (Gynaeceion) of Jülich, who suffered severe pain from urinary stones. It is not dated, but the opening phrase of this consilium indicates that Echtius and Solenander were in frequent contact: Apart from a single letter, I have sent you nothing else this month, because there has been nothing worth writing about. 18 In section five of his work, Solenander briefly discusses three other cases in pro consilio XV, such as the case in which on 5 May 1562, Echtius, together with the doctor Faber and the surgeon Cosma, encountered a creature 'the size of a caterpillar that had crawled out of a woman', and which they dissected after it had died several days later. This story is also mentioned by Hoorens. 19 Again, Solenander learned from Echtius of the case of a young 15 Solenander, Reinerus, Consiliorum Medicinalium Sectiones Quinque, Francofurti apud Andreae Wecheli heredes, Claudium Marnium, & Ioan. Aubrium, 1596 (reissued Hanoviae, 1609); see pp. 486-487. 16 Solenander son of Johannes Michelbach who secreted hairs in his faeces (trichobezoar). 20 He also recounts the story, from a colleague named Gisbertus, of a man whom he believed to be dead, who was lowered into the grave after the funeral ceremony, and who only when they were tossing earth onto him began to call out loudly that he was alive; he survived this experience and outlived everyone else. Echt's name is not mentioned by Solenander in this last case, but he was linked with it by Johannes Laurentius Bauschius, who repeated the story later. 21 Others mention Echtius' name too. Hieronymus Jordanus from Brunswick, a doctor of medicine and physician in Göttingen, mentions in his De eo quod Divinum aut Supernaturale est in morbis humani corporis, eiusque curatione liber (Book on the divine or supernatural in human diseases and how to cure it), in the chapter on the obsessions, the case of a young patient of Johannes Echtius who suffered from narcolepsy: J.E., a physician from Cologne, was also deceived by 'swan's tongue pills', which he gave to a girl, of whom it was not known that she was possessed by sleep. When she had swallowed one of them and he closed one eye of the patient with his finger, the demon said, 'Look how beautifully I'm sleeping now!' 22 Johannes Wier who, as we shall see, was related by marriage to Echt, mentions in his De Praestigiis Daemonum (Basel: Oporinus, 1564) the case of a thirteen-year-old girl, a nun at the convent near Susato, whom famous jurists believed to be bewitched and who was healed of a swollen abdomen after passing urinary stones with great pain, through the intervention of Johann von Echt and Hubert Faber. 23 It is not clear whether this is the same case as that mentioned by Solenander. These works come from the age of witch trials, and are steeped in that atmosphere. Wier was the first to oppose such persecutions seriously. This last case is also discussed by Vera Hoorens. 24 20 Solenander, Reiner, Op. cit; see p. 488 (case III). 21  Almost everyone agrees that Echt was born in 1515, although Lindeboom states that according to a certain Banga he was born much earlier, in the closing years of the 15th century. 25 He came from a wealthy Cologne family of councillors who were engaged in commerce. He matriculated in Cologne on 5 October 1528, gaining a bachelor's degree there on 28 November 1531 and a licence degree on 15 March 1533. He then studied in Italy, together with Bernhard Dessen von Cronenburg, who would later persuade him to return to Cologne. 26 His death has been put in 1545, 1554 or 1564. But given that, as we shall see, he discussed the death of Vesalius (Zakynthos, 15 October 1564) with Metellus and an eyewitness, he must have still been alive on that date. Therefore, the death date of 10 January 1576, as reported by the chronicler Hermann Weinsberg, is more credible. This date is given in his work Die autobiographischen Aufzeichnungen Hermann Weinsbergs, and he adds the detail that Echt was no more than 61 years old at the time: Ludeking states that 'Echter' (Echt) was in fact the physician of the Duke of Jülich. 29 However, the Duke of Jülich, Duke of Berg, Duke of Cleves, Count of Mark, Count of Ravensberg and Lord of Ravenstein was one and the same person, namely Wilhelm V, who reigned from 1539 to 1592. For a short period (1539 to 1543) he was also Duke of Guelders, when Charles V brought him to his knees with his expedition to Düren and the destruction of that town. Vesalius was also present there, on his return from Italy via Basel. Wier and Solenander were the official physicians of this Wilhelm. Echt was sometimes consulted, as on his last trip to Hambach, where Wilhelm had a castle and a country retreat. Echt was summoned on that occasion because Wilhelm was sick with a fever.
Solenander also writes about Echtius in a lengthy consilium for Gotschalcus von Frechen, a lawyer in Cleves who had a tongue and lip problem; this is dated 13. Iulii, Anno, &c. 76: ... desiderium D. Ioannis Echtii, celeberrimi Medici, piae memoriae. This addition indicates that he had recently died, which corresponds to the date of death given by Weinsberg. 30 After his studies in Wittenberg and Italy, Echtius had a thriving practice as a physician in Cologne, as we have seen. He lived right in the city centre, in the house zur Stessen on Laurenzplatz. 31 Along with Hubertus Faber, Bernhardus Croneburgius and Theodorus Birckmannus, he wrote the Pharmacopoeia sive Dispensatorium Coloniense there, having been commissioned by the city of Cologne. The work was published in 1565 and later reissued in Cologne by Birckmann in 1627. 32 33 The year 1565 is listed for the first edition of the Pharmacopoeia in the Historische Studien und Skizzen due to sickness with fever. Echt probably travelled from Cologne in the direction of Jülich. Hambach lies in the municipality of Niederzier in the state of North Rhine-Westphalia, on the road between Aachen and Cologne, an area known for its lignite mining. Was the Duke there, or did Echt succumb there on the way to Jülich? 29 Ludeking, W.E., 'Johannes Echter' in Idem, Levensberigten en lettervruchten van Nederlandsche geneeskundigen, van  and later to an unknown woman; Friedrich (+ 1577), a doctor of civil and canon law, who was married to Christine Boese von Halteren; Agnes, who was married to Michael Magnus Gesper and died before 2 June 1553; and Reinhart. Jan's oldest brother Heinrich had a son Richard, a licentiate of civil and canon law who married Sophia Stephens. Their son Johann married Anna, daughter of Laurenz Richwein and Cath. von Culenburg, in 1613. 37,38 (Fig. 2) On 18 August 1550, one Fredericus Bachonius Echtis of Cologne, a j.u.dr. (a doctor of civil and canon law), was one of four witnesses in Padua to the promotion of Hupertus Faber, also of Cologne, to the degree of master of arts and philosophy. 39 The fact that Frederik Echt(ius) took the trouble to attend this promotion indicates that he knew Faber or his family. Incidentally, this must 37 Heuser, Peter Arnold, "Gicht-und Syphilistherapie in Köln   The two brothers Friedrich and Arnold Echt, the father and uncle of Johann von Echt respectively, obtained imperial letters patent issued by Emperor Charles V on 24 March 1532. There was also a coat of arms: d'azur à un agneau de sable, passant sur une terrasse de sinople. Johann von Echt is not listed in Lothar Gross' Die Reichsregisterbücher Kaiser Karls V. Johann von Echt was 61 when he died, which means he was born in 1515, as is commonly said. In 1532 he was 17 years old. In 1683, through the descendants of his brother Heinrich, the family was ennobled, more than a century after the death of Johann von Echt.
A letter of 11 October 1564 from Metellus to Cassander from Cologne reveals that Echt lost his wife to the plague on 8 October, causing him great grief. She was trying to escape from the disease, and had fallen sick three days earlier. She was buried at St Alban. Before 31 January 1565, he also lost his daughter Gertrude, and a few days after her his father-in-law. This Gertrude may have died as a child, which is why she was not mentioned by name by the genealogists. 40 On 14 October 1564, Echtius also became very ill with the plague. Despite the risks, Metellus visited him from the start and remained at his bedside. On 18 October Metellus received the good news that Echtius, although still in bed, was starting to feel a little better. Eventually he would recover. This shows the extent of Metellus' devotion to Echtius. During this period of illness, Echtius also had to deal with an unscrupulous priest who was after his money. 41 40 Illustrium After the death of his wife Jan Echt remarried to Gertrude von Mühlheim, who died of the same disease on 30 March 1581. Johann von Echt became a personal physician to the Duke of Berg and Jülich-Cleves, and to the Elector of Trier. In 1573 he was invited to move to the court in Vienna to take up a position as imperial physician, but he turned down the offer. Vesalius had been dead nine years by this time. 42,43 Jan Wier thought highly of Echtius. He called him 'equal in worth to many others together and known for his erudition, integrity and experience'. 44 We also have an Echt's letter to Philipp Melanchthon in Wittenberg from 1559, which is preserved in the Landeshauptarchiv of Saxony-Anhalt. 45 In addition, there is a letter to Carolus Clusius (1526-1609) from a Johann von Echt, but this is dated 1591 and was probably written by his son, also a doctor. 46 On the other hand, a letter to Echtius from Metellus (Cologne, 1 July 1564) is preserved in the Biblioteca Apostolica Vaticana (Pal. Val. Lat. 1564, fol. 150v). We learn from the letter that Echtius owned a valuable Carolingian manuscript, a copy of a Roman codex on agrimensura (surveying), which Metellus, ihn trotz der Ansteckungsgefahr am Krankenbett". See further in Illustrium & clarorum virorum epistolae selectiores, Leiden, apud Ludovicum Elzevirium, 1617, Epistola 65, dated 31 Jan, 1565, also from Cologne; see p. 332: "Qui Alban gregi praeest, scelus in Echtium admisit. Peste laborantentem [i.e. laborantem], ac fere animam agentem, non vocatus, invisit: ac tum, graviter, & supra quam dici potest, iracunde, in eum invectus est, propter calicem. Neque Echtius, moribundus, hominem cohibere potuit, ulla ratione, a quo, se rectius institui, Christiane petebat, quin prope fureret. Itaque, proximo sequenti die, Echtio significavit: se, eum non permissurum tradi sacrae sepulturae. Putabat enim, non convaliturum, & pecuniam, ea arte, ab Echtii propinquis, emungere volebat: sed Deus, hominem servavit." (The man who was head of the parish of St Alban, committed a crime against Echtius. The latter was sick with the plague and almost dying. Uninvited, he came to visit him and then flew into a rage with him, faster than I can say, with the chalice in his hand. The dying Echtius was unable to calm the man, who was completely out of his mind, at which, the better to make him understand, he asked him in a Christian manner exactly why he was angry. Then, the next day, Echtius indicated that he would not allow him to give him communion. For the man thought that he would not recover and wanted in this way to cheat the family of Echtius out of money. But God spared the man.) 42 Bachofen von Echt, Karl Adolf, Op. cit., p. 14. 43 'Heinrich Weyer (Arzt)' in Wikipedia, found on 7 August 2013, see <de.wikipedia.org/ wiki/Heinrich_Weyer_(Arzt)> 44 Wier, Jan, Op. cit., p. 420: "Hunc insignis doctrinae, integritatis atque usus vir D. Ioannes Echtius,..." 45 Echtius, Johannes, "Brief an Philipp Melanchthon in Wittenberg 1559", in Landeshauptarchiv Sachsen-Anhalt, Z 6, no. 325, film signature 4731. 46 Echtius, Johannes, "Brief aan Carolus Clusius (1526-1609)", found on 30 July 2013 in de Virtual International Authority File, see <viaf.org/viaf/280102989> being a cartographer, studied. 47 Metellus was not just a friend of Echtius, he was close to his family and was practically a member of the household.
Aretius from Marburg was also among his acquaintances, and he received a visit from Echtius, which is mentioned in a letter dated 1 March 1572, as a preface to Wigand Happelius for a work about Paracelsus published by him. This letter is about botanical excursions in Marburg. 48 There is also a remarkable letter sent from Cologne by Oporinus to Wier 53 Franz and Arnold Birckmann from the Duchy of Guelders, who were acquaintances of Erasmus, bought a house in Cologne in 1511, which was named 'Zur fetten Henne'; this also became their printer's mark. They first established an international reputation as booksellers, and later also turned to printing. Franz died in 1530, and his brother continued until his death in 1541. After this, his widow Agnes (+1580) ran the business until 1561. The two sons then took over, Arnold the Younger (1523-1574) and Johann II (1527-1572). A third brother, Theodor Birckmann (+1586) was a physician and follower of Paracelsus, and the press thus obtained a monopoly over the printing of works of Paracelsus. After the death of the two printer brothers, Theodor transferred the business in 1585 to his brother-in-law Arnold Mylius. Metellus' letter will thus have been addressed to Arnold Birckmann the Younger. See Arnold Birckmann found in August 2012 at <de.wikipedia. org/wiki/Arnold_Birckmann> ship. 54 Two days earlier (on 15 April 1565), Metellus had already written on the same subject to Cassander, but that letter contains fewer details. Echtius was also a friend of Cassander. 55 In view of the interest in the circumstances of Vesalius' death, we reproduce the full text of the letter to Birckmann in an addendum. (Fig. 3

echtius' work on scurvy
Joannes Echtius is assumed to have been the first physician to have written a treatise on scurvy. But as far as we have been able to ascertain, this 58 Ronsseus twelve-page treatise was never published separately. Its first publication is frequently put in 1541. It is currently impossible to find, but according to Th. Blondin, Albrecht von Haller (1708-1777) held a copy in his hands. However, Haller himself merely writes that he had read that the work had appeared in 1541. 62 James Lind (1716-1794) was the first to date the work to that year. He mentions it in his A Treatise on the Scurvy (1757), briefly summarising the contents. 63 63 Lind, James, A Treatise on the Scurvy, London, A. Millar, 1757; see pp. 305-307. James Lind (Edinburgh, 4 October 1716 -Gosport, 13 July 1794) was a Scottish physician and pioneer of hygiene at sea in the Royal Navy. In 1739 he began his naval service in the Mediterranean, off the coast of West Africa and in the West Indies. In 1747 he was appointed surgeon on HMS Salisbury in the Channel fleet. During a mission in the Bay of Biscay, he conducted his clinical experiment on scurvy. He discovered that citrus fruits can cure scurvy, called for improved hygiene on board and suggested that drinking water should be produced by distilling sea water. He subsequently wrote a doctoral thesis on venereal diseases and taught in his hometown.

.On this, consider the treatise of my old friend and very learned doctor Boudewijn Ronsse, published as 'De scorbutu'. It is sufficient that we know that the name 'scorbut' is essentially a disease caused by a disorder of the spleen, which sometimes becomes congested or indisposed by an incipient scirrus, which hinders its power of attraction and the usual removal of the excess of black bile from the liver and the veins of the peritoneum, as a result of which the body becomes damaged, being flooded by this coloured moisture. But in particular, the legs are contaminated by the thicker dregs and the gums by the volatile astringency. Thus Echtius also reports in his 'Epitome
to your uncle and now I send you the same again. There are also quotations in them from the two letters on scurvy of Blyenburg, which I certainly could not omit, and also from the letter of Echtius which were subsequently (as I have said) included in the Epitome and were also printed at the end of Ronsse's book." 64 The Epitome of Echtius was subsequently always issued together with another work: it appeared as a part of compilations on scurvy a total of four times. probably not yet appeared in print.
Although no systematic search has been conducted of all existing copies, it is clear that these editions are rare. The K. K. Hofbibliothek of the Austrian Nationalbibliothek has a copy of Ronsseus' first edition (Antwerp, 1564). There is a copy of the second edition in the library in Erlangen (Bibliotheksverbund Bayern). Durling mentions the inclusion in the compilation of Baudouin Ronsse (1525-1597) from 1585. 68 A copy of the edition of Daniel Sennert (1572-1637) from 1624 can be found in the Yale University Library. 69 There is also a copy in the Bayerische Stadtsbibliothek München, which can be accessed via books.google. Other copies can be found in the British Library (London) and It is also mentioned in several bibliographical surveys of scurvy. The oldest is -as mentioned -that of James Lind in the last part of his A Treatise on the Scurvy. After an overview of passages in Greek and Roman writers who probably discuss this subject, he provides a comprehensive annotated list of sources from more recent times. Among those from the 16th century, he refers to the work of Echtius De scorbuto, vel scorbutica, epitome (1541), which Lind describes as the very first description of scurvy by a physician. He then briefly mentions two letters from Jo. Langius, 71 72 Lind's bibliographical survey is not quite complete. Rudolph Krebel remedied this later on. Krebel also mentions Echt's publication of 1541, as well as that of 1564 (in Ronsse). As the place of printing/publication he gives 'Wittenberg  73 Krebel, Rudolph, "Chronologische Uebersicht der Gesammt-Literatur des Scorbuts", idem, Der Scorbut in geschichtlich-literarischer, pathologischer, prophylactischer und therapeutischer Beziehung, Leipzig, Rudolph Hartmann, 1862; see pp. 30 and 35. Krebel may have meant by Wittenberg 1541. 1624 that he saw Echtius' work in Sennert 1624, which was printed in Wittenberg. 74 In Krebel's survey, incidentally, an inaccuracy has crept in regarding Lange. Three volumes of Lange's Epistolarum Medicinalium were issued. According to Krebel, the first this, as he himself was already writing about scurvy in 1559. 75 It was Wier who spoke to him for the first time about Echt, and if he was referring to a letter, Ronsse cannot have known this. As he is not the only one to link the text of 1541 to Wittenberg, a printed publication from that year cannot be definitely ruled out.
A remarkable amount was published about scurvy or scorbut after Vesalius' death. We may wonder whether this was a coincidence, or whether it was brought about by the correlation with his death. If Echtius still enjoys any fame, then this is mainly due to his treatise on the disease. Lind already knew that his long letter was first forwarded by Petrus Forestus from Alkmaar (1521-1597) to his brother in 1558 and later in 1590 to his two nephews, who were students of medicine. The supposed 1541 edition was apparently nothing more than this long letter about scurvy by Echtius, which was passed from hand to hand. This would explain why this 'edition' cannot be found. In this case, it must -with a great deal of luck -be held in private ownership somewhere at the moment. Forestus already had this letter in the same year 1541, and wrote about it to his brother Jacob in 1558 and sent (a copy of) the same letter in modified form to his two nephews Jordanus and Adam in 1590. Meanwhile, Forestus had also been able to find this letter in the two editions of Ronsse of 1564 and 1585. He says that these editions differ only slightly from the actual letter that he has. Either this letter had already accidentally ended up in Wier's hands, or Wier merely had a copy, which he had carelessly transcribed by his son for Ronsse in 1563 (i.e. possibly a copy of a copy), who apparently did not realise that it was a work by Echt and not Wier, as he falsely implied in his first edition of 1564, but corrected in his second edition, to which he also added texts by Wier and Lange. Sennert simply used Ronsse's texts in his two editions of 1624 and 1654, in addition to his own contribution and the texts of Albertus and Martinus. A copy of this last edition is preserved in the Otto von Guericke University in Magdeburg. volume was published by Oporinus in Basel in 1554, and a second volume was issued in 1560, also in Basel, having been outsourced by Oporinus (see above). But it is only in this second volume that the two letters about scurvy appear. The third volume was published posthumously together with the previous two volumes in Frankfurt in 1589 by the Heirs of Andreas Wechel, and reprinted in Hanau in 1605 at the Wechel press by Claude Marne and the heirs of Johan Aubry. It must therefore have been 1560 rather than 1554. 75 Ronsse was already working on scurvy in 1555: in his first printed work from 1559, a letter from 1555 is added:

Scurvy
In the view of Echtius -and his contemporariesscorbut was a chronic disease of the spleen, consisting of (1) an obstruction of the spleen; (2) an excess of 'melancholic humour' (lit.: black bile), which was expressed in various ways by a feeling of tightness in the chest, defecation problems, pallor coupled with red, itchy and sore gums and weak legs; and (3) loss of self-control with a varying degree of reckless behaviour. These are the three main symptoms, according to him, to which a number of others may be added. Even then, the disease had various names: scorbutus, scorbuck, gingipedium, stomacace, sceletyrbe. 76 The causes he cites are, firstly, unripe and spoiled foods, and on Dutch and Frisian ships the use of tainted water, the lack of fresh water, especially in hot weather, which caused the water to spoil quickly, bad meat, rancid bacon, spoiled fish, bread or beer, etc. The second cause was the ambient air, which could have a bad influence on the properties of the blood, as well as lack of sleep, overwork, anxieties, and, finally, prior fevers. The conclusive symptoms, however, were bad breath, flabby, bloody and swollen gums, loose teeth, dark purple spots on the legs, and numerous spots (lentigines), sometimes only round the mouth, and sometimes only on the legs. Eventually, the patient became unable to move, experiencing laboured breathing with wheezing, especially when moving or standing up, and he who after standing upright attempts to sit down stops breathing and falls down dying. If a patient had fallen down, then came to and was able to breathe freely again, he assumed he was well again, but being unable to do anything and lying motionless, he would waste away. He also mentions many other problems such as appetite disorders, intestinal problems, problems with bowel movements, fever, 76 The terms used for the disease in most Western languages, including Greek and Russian, are etymologically related. The 13th century Old Norse term skyrbjúgr is thought to derive from skyr (sour milk) and bjúgr (tumour), because the disease was attributed to the prolonged consumption of skyr, used by the Vikings as ship's provisions on long voyages; in Old Swedish, the term is skörbiûgh (ca. 1330 swellings in the legs reminiscent of elephantiasis, etc. In the eyes of Echtius and many of his contemporaries, scurvy was a contagious disease. The treatment consisted mainly of general recommendations on how to avoid or eliminate the causes and of symptomatic treatment. The use of fresh vegetables and fruits, especially citrus fruits, still lies in the distant future. Our modern concept of a vitamin C deficiency was still remote. Nutritional deficiencies were not associated with scurvy. That citrus fruit was the solution to the problem was only realised thanks to James Lind (1716-1794). Not until the end of the 18th century did the use of lemon become standard, and even then this was based on empirical observations. The term 'vitamin' only originated from 1911, and in 1937 A. Szent-Györgyi (1893-1986) finally received the Nobel Prize in Medicine for the discovery of, among other things, the role of vitamin C in cellular metabolism.
Thus Echtius himself already mentions the occurrence of behavioural or emotional instability under the symptoms of scurvy in his treatise. We come across this regularly, though not always, in later works, such as the brief reference in the travel account of George Anson (1748), and increasingly in theses, such as those of the British writer David Stuart (1770) and Josephus Demschick (1816). 77 78 79 Nevertheless, we can assume that Echtius, at his meeting with Metellus and Boucher -the eyewitness from Nuremberg -in Cologne shortly after Vesalius' death, must have had scurvy in mind as a possible cause of Vesalius' death or that they must have talked about it. Echtius' description of the terminal stages, which he gives towards the end of his work under Signa propinquiora, & certiora ('More reliable and certain symptoms'), bears a striking resemblance to the eyewitness account in the letter of Metellus (addendum).
However, the first person to have thought of scurvy as the possible cause of death of Andreas Vesalius very recently was Pavlos Plessas. He devoted a thoroughly substantiated study to the question, and although it is not conclusive his conclusion is fairly convincing. Vesalius himself did not discuss the terms scorbut or spleen scirrus or any of the synonyms common at that time either in his Paraphrasis or in his Fabrica. 77 Anson Research has already been done in humans into the relationship between behavioural disorders and a lack of ascorbic acid (vitamin C). 80 Very recently, Fiona E. Harrison was able to demonstrate that even in mice, behavioural disorders can occur as a result of a vitamin C deficiency, which may suggest that fatigue and emotional and personality changes have a physiological rather than a psychological basis in patients with scurvy. 81

vesalius' death
If we consider the now familiar differential diagnostic possibilities of Vesalius' death, we must first firmly reject the long-held hypothesis of a shipwreck -in many people's minds still regarded as a certainty -for the reasons mentioned at the outset. The possibility still remains that he died of deprivation, through lack of food and especially of drinking water. As they were at sea for forty days longer than expected, this seems the obvious cause of his death. Some reports from that time do indeed suggest this, and Solenander also writes that he had not brought enough supplies with him. But on closer consideration it seems in that case very unlikely that his fellow travellers would have left someone so important, and moreover, a wealthy man, without assisting him -to the point of allowing him to die! To all appearances, some of those on board, both crew members and fellow passengers, remained in good health until the end of the journey. The merchant from Nuremberg was obviously one of them. He recounts the terrible events on board, but at no point does he give the impression that he himself was in any danger. He makes it appear perfectly normal that he took the initiative of providing Vesalius with a decent burial, without mentioning any personal problems. What is more, keeping a ship afloat represented strenuous physical exercise for the crew. 'Throwing bodies regularly overboard' would not have been light work either. Now that Pavlos Plessas has convincingly shown that vitamin C deficiency could have been a problem and that it was also possible at that time -even in the Mediterranean -scurvy turns out to be a third plausible explanation for Vesalius' death (as well as some other disease or exhaustion due to lack of water and food). It would explain why some died while others remained 80 Kinsman, Robert A. and James Hood, "Some behavioral aspects of ascorbic acid deficiency", The American Journal of Clinical Nutrition, 1971, 24: 455-464. We wish to thank Theo Dirix, the former Belgian consul in Athens, now in Copenhagen, for this article. healthy. Their different itineraries, and hence the diet that each of them had in the period prior to sailing, might account for a vital difference in bodily reserves of vitamin C.
Although scurvy has not been established with scientific certainty as the cause of Vesalius' death -as his body tissues cannot be tested for vitamin C -it now at least seems to be an interesting working hypothesis. Metellus sends Arnold Birckmann his warmest greetings.
A certain Nuremberger relates how Andreas Vesalius died last October, on his return from Jerusalem. This is said to have happened as follows.
When Vesalius undertook the journey there, having spent very little money because he was inflamed by lust for profit, although on his return he was to receive a lot of money from many people with whom he had entered into an agreement to this effect, through excessive meanness he entrusted himself to a pilgrims' ship, not a merchant ship from Venice, for which he had a letter of recommendation from Philip [II] and with whom a request for credit would have been accepted, and, likewise from greed, took very meagre provisions.
On his return, he fell in with this man from Nuremberg, who was travelling from Egypt to Venice, and persuaded him to leave his company and join his ship, which the man willingly did, on account of their common language. Again, Vesalius made too little provision for himself. Buffeted by storms for a whole forty days, unable to reach land, having run short of both hard tack and water, many fell ill and their bodies were thrown into the sea. 84 Vesalius was so afflicted in his mind by this that he fell sick from anguish and then from fear, and often asked that, if he should die, he should not become food for the fish like the others.
At length, the ship reached Zakynthos and shortly after having been almost perished at sea Vesalius was among the first to leave the ship, and started towards the city gate, where he fell to the ground, quite dead. This travelling companion from Nuremberg set up a stone for his grave. He told me this in the presence of Echtius. Behold the miserable death of a great man, which will serve as an example to many. I wish you well.
Cologne, 17 April 1565. 84 Metellus' source says that Vesalius' ship drifted at sea for 'a full forty days'. Solenander's source -who was presumably the same, i.e. Georg Boucher or Buchner, the merchant (or goldsmith) from Nuremberg, who also buried Vesalius -referred to a period of several weeks (aliquot septimanas