- Email: [email protected]
Historical Perspectives of Thoracic Anatomy
Thorac Surg Clin 17 (2007) 443–448
Historical Perspectives of Thoracic Anatomy Stanley C. Fell, MDa,*, F. Griffith Pearson, MD, FRCS(C)b a
60 Cabin Ridge Road, Chappaqua, NY 10514, USA b RR#1, Mansfield, Ontario L0N IM0, Canada
The simultaneous fascination and revulsion that has existed over the ages regarding dissection of the human body continues to the present day [1–3]. This ambivalence was exemplified in a New York Times article of November 18, 2005, entitled, ‘‘Cadaver exhibition rouses question beyond taste.’’ This commercial exhibition of 22 cadavers and 260 other specimens from China provoked controversy. Among the reasons cited are China’s poor human rights record and practice of recycling the organs of executed prisoners. A similar but smaller show organized by the same company in Tampa, Florida, in the summer of 2006 provoked condemnation from religious leaders, the state medical board, and the state attorney general who could not identify legal recourse to close the show, which drew large crowds. Although the authors have been given a broad mandate to discuss the historical aspects of thoracic anatomy, they have chosen to focus this discussion on several major themes, culminating with the work (contributions) of Vesalius. The anatomy that Greek physicians learned was identical to the sculptor’s knowledge of the subject; it was acquired from the appearance of nude bodies of athletes. Hippocrates (460–370 BC) gave medicine its ethical ideals. Many of these writings, however, are fictive and incomplete but they are the only ones of value before those of Celsus. The greatest scientific name after Hippocrates is Aristotle (384–322 BC), who contributed to medicine, among other things, comparative anatomy. He taught anatomy by dissection of animals and the use of anatomic diagrams (paradigms) (Fig. 1). Galen (131–201 BC) was the
* Corresponding author.
founder of experimental physiology. He was the most voluminous of all ancient writers and his works are an encyclopedia of the knowledge of his time. As an anatomist, Galen left many excellent descriptions, especially of the motor system, but his work was faulty regarding human anatomy and was based largely on dissection of apes and swine. Up to the time of Vesalius, European medicine, in which everything related to anatomy, physiology, and disease, was referred back to Galen as the final authority, to whom there could be no appeal. The study of anatomy remained static for nearly 14 centuries (Aristotle to Vesalius). Pope Boniface VIII (1300) is credited with discouraging anatomic dissections, to prevent the bodies of dead crusaders from being boiled and dismembered before returning them to their relatives. Dissection probably came about because painters formed a subculture of the Florentine ‘‘Guild of Physicians and Apothecaries.’’ Dissection, for which the Florentine University statutes of 1387 gave explicit directions, became an ambition of the artists, who soon became involved in assisting at private dissections with their doctor friends, or even doing a little body-snatching on their own account. With the development of surgery during the middle ages, there was some effort to improve the status of anatomy; anatomic dissection commenced again in Padua by Mandamus of Bologna, whose first Anatoshemia was published in Padua in 1487. It was full of galenical errors and fanciful anatomy of the Arabists. Public dissections were decreed at the University of Montpellier in 1366 and subsequently in Venice, Florence, Vienna, Bologna, Padua, Prague, Paris, and Tubingen by 1485. An anatomy theatre was constructed at Padua in 1445. Even before the
1547-4127/07/$ - see front matter Ó 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.thorsurg.2006.12.001
thoracic.theclinics.com
444
FELL & PEARSON
Fig. 1. Typical anatomic illustration of the Middle Ages. Note the frog-like stance. (Courtesy of the New York Academy of Medicine Library, New York, NY.)
advent of Vesalius, the great painters of the Renaissance were making dissections in the hospitals of Florence, Milan, and Rome. In England, the material for dissection was usually obtained by
grave robbing. In Germany, dissections were the nature of civic events attended by festivities. The dissections were done in the cooler months because cadavers were not embalmed.
HISTORICAL PERSPECTIVES OF THORACIC ANATOMY
445
Fig. 2. Leonardo da Vinci (self-portrait) 1452–1519. (Courtesy of the New York Academy of Medicine Library, New York, NY.)
Leonardo da Vinci (1452–1519) (Fig. 2), the great artist and scientist of the Italian Renaissance, was the founder of iconographic and physiologic anatomy. His work is the result of the quest for uncompromising realism he initiated by the ‘‘Guild of Physicians and Apothecaries.’’ Da Vinci made over 750 separate sketches delineating muscles, the heart, the lungs, and cervical, thoracic, abdominal, and femoral blood vessels,
and bones and nerves based on observations he made at the dissecting table. He was the originator of cross-sectional anatomy. The individual who released anatomy from the restrictions of the past was Andreas Vesalius (1514–1564) (Fig. 3), the most commanding figure in European medicine after Galen and before Harvey. He might have been eclipsed by Leonardo da Vinci, who preceded him, except that
446
FELL & PEARSON
Fig. 3. Andreas Vesalius (1514–1564). (Courtesy of the New York Academy of Medicine Library, New York, NY.)
his chalk drawings (circa 1512) remained buried for the next 200 years. Vesalius made anatomy a living work of science. He was born in Brussels into a family of physicians who adapted the name Vesalius after a town on the Rhine from which they originated. Between 1528 and 1534, he studied at Louvain and became interested in medieval works of scholarship and anatomy, and he dissected animals. In 1533, he entered medical school in Paris and studied the works of Galen and Hippocrates. In 1537, he obtained his Doctor of Medicine degree from Padua and on the following day was voted to become the Professor of Surgery and Anatomy (Fig. 4). He started work on his book De Humani Carporis Fabrica in 1539, and
completed it in 1542. In that year, he packed his manuscripts and engraved wood blocks, which were sent to his publisher in Basel, on mule back across the Alps. Accompanying the manuscript and illustrations were perhaps the most precise and detailed instructions ever sent by an author to any publisher for the printing of a book. In January 1523, Vesalius arrived in Basel and supervised the production of the book. Written in Latin, De Fabrica swept aside the errors of Galenic anatomy. After its publication, no other worthy anatomic book was to appear for over a century (Fig. 5). The work can be judged by the extent that it was copied and plagiarized. Vesalius introduced the word ‘‘plagiarism’’ in a letter
HISTORICAL PERSPECTIVES OF THORACIC ANATOMY
447
Fig. 4. Anatomic theatre, from De Humani Corporis Fabrica. Note the dog, lower right, who fed on scraps of discarded flesh. (Courtesy of the New York Academy of Medicine Library, New York, NY.)
to his printer in the 1543 edition of De Humani Corporis Fabrica. The effect of the publication in such a superstitious age led his peers to cast discredit on Vesalius, leading him to burn his manuscripts and leave Padua. He became the court physician to Emperor Charles V. He married, gave up anatomy, and became a courtier. His favorite
pupil, Gabriele Fallopic, succeeded him at Padua. In 1563, Vesalius made a pilgrimage to Jerusalem. On his way back, in 1564, he received word of an invitation to resume his post in Padua, just vacated by the death of Fallopic, but he became ill and died before he could return. Garrison [1] wrote of Vesalius that ‘‘his mind was too active, his spirit too keen and
448
FELL & PEARSON
Fig. 5. The heart and lungs as dissected by Vesalius. (Courtesy of the New York Academy of Medicine Library, New York, NY.)
independent to feed long on the dust of ages and he soon established a reputation for first-hand knowledge of the dissected human body.’’ In a Dutch edition of De Fabrica (circa 1642) appears the following: Just as night, the moon when full, Outshines all her brother stars with her light: just so, this one book of Vesalius is superior to all others It shows how skillfully the body is constructed There, students, you may learn the Structure of your body: You will find it is not your least honour.
Acknowledgments The author thanks Miriam Mandelbaum, Curator of Rare Books, and Arlene Shaner, Reference Librarian, of the New York Academy of Medicine; Nicole Fell; Richard Brodman, MD; and Linda Gao for their invaluable assistance. References [1] Garrison FH. An introduction to the history of medicine. Philadelphia: W.B. Saunders; 1929. [2] Nuland S. Leonardo da Vinci. New York: Viking; 2000. [3] Persaud TVN. Early history of human anatomy. Springfield (IL): Charles C Thomas; 1984.
Historical Perspectives of Thoracic Anatomy Stanley C. Fell, MDa,*, F. Griffith Pearson, MD, FRCS(C)b a
60 Cabin Ridge Road, Chappaqua, NY 10514, USA b RR#1, Mansfield, Ontario L0N IM0, Canada
The simultaneous fascination and revulsion that has existed over the ages regarding dissection of the human body continues to the present day [1–3]. This ambivalence was exemplified in a New York Times article of November 18, 2005, entitled, ‘‘Cadaver exhibition rouses question beyond taste.’’ This commercial exhibition of 22 cadavers and 260 other specimens from China provoked controversy. Among the reasons cited are China’s poor human rights record and practice of recycling the organs of executed prisoners. A similar but smaller show organized by the same company in Tampa, Florida, in the summer of 2006 provoked condemnation from religious leaders, the state medical board, and the state attorney general who could not identify legal recourse to close the show, which drew large crowds. Although the authors have been given a broad mandate to discuss the historical aspects of thoracic anatomy, they have chosen to focus this discussion on several major themes, culminating with the work (contributions) of Vesalius. The anatomy that Greek physicians learned was identical to the sculptor’s knowledge of the subject; it was acquired from the appearance of nude bodies of athletes. Hippocrates (460–370 BC) gave medicine its ethical ideals. Many of these writings, however, are fictive and incomplete but they are the only ones of value before those of Celsus. The greatest scientific name after Hippocrates is Aristotle (384–322 BC), who contributed to medicine, among other things, comparative anatomy. He taught anatomy by dissection of animals and the use of anatomic diagrams (paradigms) (Fig. 1). Galen (131–201 BC) was the
* Corresponding author.
founder of experimental physiology. He was the most voluminous of all ancient writers and his works are an encyclopedia of the knowledge of his time. As an anatomist, Galen left many excellent descriptions, especially of the motor system, but his work was faulty regarding human anatomy and was based largely on dissection of apes and swine. Up to the time of Vesalius, European medicine, in which everything related to anatomy, physiology, and disease, was referred back to Galen as the final authority, to whom there could be no appeal. The study of anatomy remained static for nearly 14 centuries (Aristotle to Vesalius). Pope Boniface VIII (1300) is credited with discouraging anatomic dissections, to prevent the bodies of dead crusaders from being boiled and dismembered before returning them to their relatives. Dissection probably came about because painters formed a subculture of the Florentine ‘‘Guild of Physicians and Apothecaries.’’ Dissection, for which the Florentine University statutes of 1387 gave explicit directions, became an ambition of the artists, who soon became involved in assisting at private dissections with their doctor friends, or even doing a little body-snatching on their own account. With the development of surgery during the middle ages, there was some effort to improve the status of anatomy; anatomic dissection commenced again in Padua by Mandamus of Bologna, whose first Anatoshemia was published in Padua in 1487. It was full of galenical errors and fanciful anatomy of the Arabists. Public dissections were decreed at the University of Montpellier in 1366 and subsequently in Venice, Florence, Vienna, Bologna, Padua, Prague, Paris, and Tubingen by 1485. An anatomy theatre was constructed at Padua in 1445. Even before the
1547-4127/07/$ - see front matter Ó 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.thorsurg.2006.12.001
thoracic.theclinics.com
444
FELL & PEARSON
Fig. 1. Typical anatomic illustration of the Middle Ages. Note the frog-like stance. (Courtesy of the New York Academy of Medicine Library, New York, NY.)
advent of Vesalius, the great painters of the Renaissance were making dissections in the hospitals of Florence, Milan, and Rome. In England, the material for dissection was usually obtained by
grave robbing. In Germany, dissections were the nature of civic events attended by festivities. The dissections were done in the cooler months because cadavers were not embalmed.
HISTORICAL PERSPECTIVES OF THORACIC ANATOMY
445
Fig. 2. Leonardo da Vinci (self-portrait) 1452–1519. (Courtesy of the New York Academy of Medicine Library, New York, NY.)
Leonardo da Vinci (1452–1519) (Fig. 2), the great artist and scientist of the Italian Renaissance, was the founder of iconographic and physiologic anatomy. His work is the result of the quest for uncompromising realism he initiated by the ‘‘Guild of Physicians and Apothecaries.’’ Da Vinci made over 750 separate sketches delineating muscles, the heart, the lungs, and cervical, thoracic, abdominal, and femoral blood vessels,
and bones and nerves based on observations he made at the dissecting table. He was the originator of cross-sectional anatomy. The individual who released anatomy from the restrictions of the past was Andreas Vesalius (1514–1564) (Fig. 3), the most commanding figure in European medicine after Galen and before Harvey. He might have been eclipsed by Leonardo da Vinci, who preceded him, except that
446
FELL & PEARSON
Fig. 3. Andreas Vesalius (1514–1564). (Courtesy of the New York Academy of Medicine Library, New York, NY.)
his chalk drawings (circa 1512) remained buried for the next 200 years. Vesalius made anatomy a living work of science. He was born in Brussels into a family of physicians who adapted the name Vesalius after a town on the Rhine from which they originated. Between 1528 and 1534, he studied at Louvain and became interested in medieval works of scholarship and anatomy, and he dissected animals. In 1533, he entered medical school in Paris and studied the works of Galen and Hippocrates. In 1537, he obtained his Doctor of Medicine degree from Padua and on the following day was voted to become the Professor of Surgery and Anatomy (Fig. 4). He started work on his book De Humani Carporis Fabrica in 1539, and
completed it in 1542. In that year, he packed his manuscripts and engraved wood blocks, which were sent to his publisher in Basel, on mule back across the Alps. Accompanying the manuscript and illustrations were perhaps the most precise and detailed instructions ever sent by an author to any publisher for the printing of a book. In January 1523, Vesalius arrived in Basel and supervised the production of the book. Written in Latin, De Fabrica swept aside the errors of Galenic anatomy. After its publication, no other worthy anatomic book was to appear for over a century (Fig. 5). The work can be judged by the extent that it was copied and plagiarized. Vesalius introduced the word ‘‘plagiarism’’ in a letter
HISTORICAL PERSPECTIVES OF THORACIC ANATOMY
447
Fig. 4. Anatomic theatre, from De Humani Corporis Fabrica. Note the dog, lower right, who fed on scraps of discarded flesh. (Courtesy of the New York Academy of Medicine Library, New York, NY.)
to his printer in the 1543 edition of De Humani Corporis Fabrica. The effect of the publication in such a superstitious age led his peers to cast discredit on Vesalius, leading him to burn his manuscripts and leave Padua. He became the court physician to Emperor Charles V. He married, gave up anatomy, and became a courtier. His favorite
pupil, Gabriele Fallopic, succeeded him at Padua. In 1563, Vesalius made a pilgrimage to Jerusalem. On his way back, in 1564, he received word of an invitation to resume his post in Padua, just vacated by the death of Fallopic, but he became ill and died before he could return. Garrison [1] wrote of Vesalius that ‘‘his mind was too active, his spirit too keen and
448
FELL & PEARSON
Fig. 5. The heart and lungs as dissected by Vesalius. (Courtesy of the New York Academy of Medicine Library, New York, NY.)
independent to feed long on the dust of ages and he soon established a reputation for first-hand knowledge of the dissected human body.’’ In a Dutch edition of De Fabrica (circa 1642) appears the following: Just as night, the moon when full, Outshines all her brother stars with her light: just so, this one book of Vesalius is superior to all others It shows how skillfully the body is constructed There, students, you may learn the Structure of your body: You will find it is not your least honour.
Acknowledgments The author thanks Miriam Mandelbaum, Curator of Rare Books, and Arlene Shaner, Reference Librarian, of the New York Academy of Medicine; Nicole Fell; Richard Brodman, MD; and Linda Gao for their invaluable assistance. References [1] Garrison FH. An introduction to the history of medicine. Philadelphia: W.B. Saunders; 1929. [2] Nuland S. Leonardo da Vinci. New York: Viking; 2000. [3] Persaud TVN. Early history of human anatomy. Springfield (IL): Charles C Thomas; 1984.