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Realdo Colombo's De Re Anatomica: The renaissance origin of the term “placenta” and its historical background
Placenta 33 (2012) 655e657
Contents lists available at SciVerse ScienceDirect
Placenta journal homepage: www.elsevier.com/locate/placenta
Short communication
Realdo Colombo’s De Re Anatomica: The renaissance origin of the term “placenta” and its historical background M. Pizzi a,1, M. Fassan a,1, M. Cimino b, V. Zanardo b, S. Chiarelli a, * a b
Department of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University of Padua, Via Aristide Gabelli, 61, 35121 Padua, Italy Department of Women’s and Children’s Health, University of Padua, Via Nicolò Giustiniani, 2, 35128 Padua, Italy
a r t i c l e i n f o
a b s t r a c t
Article history: Accepted 13 March 2012
Over the centuries, great interest has been devoted to the placenta and to its highly symbolic significance. The Renaissance represented the age of historical and cultural transition between classical and modern scientific paradigms. In the medical setting, Realdo Colombo represents one of the protagonists of this revolution. In his masterpiece, De Re Anatomica, he revolutionized the former medical perspective. We present a passage from this book, which carries invaluable information on the Renaissance viewpoint on pregnancy and placental biology. The connections between Colombo’s theories and the previous medical tradition are also analysed. Ó 2012 Elsevier Ltd. All rights reserved.
Keywords: Placenta History of medicine Realdo Colombo Michelangelo
1. Introduction In the course of human history, the Renaissance was an epoch of great optimism and faith in human capacities. Scholars in every field approached their subjects in a new way, without being conditioned from any Authorities and Medieval dogmas. This resulted in the development of modern theories both regarding the Universe and Mankind. This new culture also led to a deep progress in medical knowledge. Some of the greatest anatomists of all time lived in this period and their discoveries allowed fundamental acquisitions in human anatomy and physiology. Among others, the female genital tract and pregnancy were thoroughly investigated. Matteo Realdo Colombo (1516e1559), the discoverer of pulmonary circulation [1], was a protagonist of this medical revolution, and his masterpiece, De Re Anatomica (Fig. 1), is considered one of the most important anatomical treatises of the Renaissance. He was professor of Anatomy at the University of Padua (around 1543) before moving to Pisa (in 1546) and later to the University of Rome (in 1549). Whilst in Rome he was summoned by Pope Paul III and became the physician of many illustrious patients, including the painter, architect and sculptor Michelangelo Buonarroti [1]. He also performed the autopsy on the body of St Ignatius of Loyola [2].
* Corresponding author. Tel.: þ39 49 8272272; fax: þ39 49 8272277. E-mail address: [email protected] (S. Chiarelli). 1 These authors equally contributed to the paper. 0143-4004/$ e see front matter Ó 2012 Elsevier Ltd. All rights reserved. doi:10.1016/j.placenta.2012.03.004
The exceptional page of De Re Anatomica, where Colombo coined for the first time the term “placenta” is presented and commented (Fig. 2). 2. The text: Matteo Realdo Colombo, De Re Anatomica libri XV (1559) (a web-based copy of the original book is available for consultation at the Noma collection website: http://shinku.nichibun.ac.jp/ NOMA/new/). 2.1. Liber XII: on foetus’ formation and infant’s location in the uterus [3] “At first, Nature spawns the allantois and those multiple veins and arteries that leave through the navel. Then, it makes those vessels fuse to each other, to be sustained. Finally, these vessels divide at the end of their course and form a sort of flat circular cake (that is placenta). Galen, who did not describe the human one, referred to this organ as membranous and named it “chorion”, i.e. “secundina”.2 However his description is not that of a human placenta, which is indeed not membranous but rather similar to a thick mass of excrements.
2 In Latin: Genita allantoide, venis arterisque per umbilicum tendentibus quae suo in exortu plurimae sunt, ut fulcirentur, natura affusionem quandam genuit quae orbicularis fit placentae in modum. Facta autem fuit, ut vasa, quae diximus, unita detineret: haec a Galeno, qui humanam non descripsit, membrane chorion, hoc est secundina appellatur.
656
M. Pizzi et al. / Placenta 33 (2012) 655e657
beasts, the allantois is located under the foetus: this is not a coincidental finding, since the allantois serves as a collector of foetal urine. In addition to the two already mentioned membranes, a third one (the amnion) has to be considered. The amnion is an envelope in direct contact with the foetus and contains its sweat and its excrement.3 The foetus swims in it and is sustained by this fluid, to be less troublesome for the mother. Don’t marvel that no excrements other than urine and sweat are produced. This is due to the cleanness and purity of the blood that feeds the foetus. Thus, it is false what common people believe (i.e. that only menstrual or impure blood reaches the foetus). [.] When the time of delivery comes, these two membranes tear off and come out with the foetus. Obstetricians call “waters” the excrements that flow after the membranes rupture and their coming is considered a sign of imminent birth. Moreover, if the baby is visible when the waters flow, the outcome is considered favourable and easier. This is due to the humidity of excremental liquid that lubricates the mother’s genital channel. [.] The foetus is nourished through the umbilical cord by its vein. With respect to this, Hippocrates made some incorrect premises: he stated that the foetus imbibes his own nourishment from the mother by mouth; I cannot marvel enough at this error from such a great man! In fact, between the foetus’ mouth and maternal uterus there is a great deal of substance. However, even supposing them to be in contact, how could Hippocrates imagine the foetus sucking the juice actually contained either in the mother’s stomach or gut? Therefore be sure without doubts, Reader, that the foetus cannot take anything by mouth. And even if it could, it would certainly die, overwhelmed after having drunk its own sweat: on the contrary, it is fed through the umbilical vein with good and perfect blood.” 3. Comment Fig. 1. Title page from Realdo Colombo’s De Re Anatomica. The Author himself teaches anatomy while dissecting a cadaver. In the lower left, note the two men representing the renaissance fusion of past and present in the medical and anatomical studies: the young artist attending to human dissections and sketching on a blank paper may represent the direct experience helped by another spectator who holds an illustrated edition of an ancient anatomy treatise.
Although placed over the allantois, the placenta does not completely surround the foetus and strongly adheres to the uterus. It is therefore not surprising that abundant bleeding occurs during delivery, due to the tearing off of both placental veins and arteries. In dogs, the placenta is a band-shaped organ closely resembling that which also Vesalius pictured. The human placenta represented by Vesalius is indeed a canine one: he just substituted the puppy dog with a baby child! [.] In humans the allantois is a large membrane, which completely encloses the foetus. In cows, goats and mares, it is similar to a sausage, which is indeed called allantoydes in Greek. In those
Fig. 2. Realdo Colombo’s De Re Anatomica: for the first time the term “placenta” is coined. Liber XII page 248, adapted from the original text.
To gain full comprehension of Realdo Colombo’s passage, it has to be considered in the context of a medical tradition that can be traced back to antiquity. Despite their rudimental knowledge of anatomy and physiology, Egyptians worshipped the pharaoh’s placenta (wrapped in the so called “bundle of life”) and considered it to be the second royal soul [4]. Traces of this tradition can be found even in the Bible (Deuteronomy 28:57 and I Samuel 25: 29) [5]. Ancient Greeks had contrasting opinions on the origin and function of this organ: Diogenes of Apollonia (V century B.C.) was the first to consider it responsible for fetal nutrition [6]. On the contrary, many philosophers and even Hippocrates thought the fetus sucked the amnion to be fed [7]. This theory, strongly rejected by Aristotle [8,9], was still present in the XVI and XVII century and gained further credibility thanks to famous scientists such as William Harvey (1578-1657) [10] and Giovanni Battista Morgagni (1682e1771) [11], who sustained it. As also testified by Colombo’s viewpoint, Renaissance scientists still paid a great tribute to classical authors and referred to them whenever possible. Just to make an example, Realdo Colombo’s theory of fetal excrements is directly drawn from Galen (129e200 AD) [12]. Tradition, however, was constantly challenged by the renewed confidence in the power of observation and experiment. Colombo’s
3 In Latin: Dicitur agmios, vel ammios: ab hac quoque universus involvitur foetus, et in ea immediate foetus situs est, et sudor a foetu emanans atque eius excrementum continetur.
M. Pizzi et al. / Placenta 33 (2012) 655e657
thought is not an exception to the rule. Apart from the open criticism to Hippocrates, it is worth considering Colombo’s sentence on the nature of blood that reaches the fetus. The author apparently disapproves of those “common people” who consider this blood of menstrual origin. In fact, this is a sharp criticism against an old tradition that can be traced back to Aristotle [8,9]. The constant search of truth could also lead to fierce quarrels among scientists, as exemplified by Colombo’s direct attack against his master, Andrea Vesalius. The latter is blamed for having deliberately depicted a canine placenta as a human one. Despite partially moved by a true scientific interest, the impudent and brazen tone of Colombo’s criticism seems to be due to private reasons too [13]. Of note, Vesalius’ initial blunder was corrected in the second edition of De Humani Corporis Fabrica (1555), i.e. four years before the publication of Colombo’s De Re Anatomica [14,15]. It is unlikely that Colombo would have been unaware of this correction: he could have deliberately chosen the word ’placenta’ in order to highlight Vesalius’ initial error. De Re Anatomica also provides an opportunity to consider a peculiarity of Renaissance medicine. Artists of the XVI century usually co-worked with anatomists and even attended human dissections; the famous anatomical sketches of Leonardo da Vinci (among which are those of a pregnant uterus) were possible thanks to a close collaboration with the anatomist and physician Marcantonio della Torre [16]. Something similar also happened to Realdo Colombo and Michelangelo. The two met in Rome when Colombo was asked to treat Michelangelo’s recurrent urolithiasis [1]. Colombo succeeded in healing the artist and, as a mark of gratitude, Michelangelo agreed to illustrate De Re Anatomica. Unfortunately, however, the project was never carried out and the only figure present in the whole book is the wonderful title page by Paolo Veronese (1528e1588) (Fig. 1) [17]. Disclosure No conflict of interest to declare.
657
Acknowledgement The authors thank Dr. Heather Fulwood De Nogales for her valuable suggestions about the manuscript and for helpful discussions.
References [1] Eknoyan G. Michelangelo: art, anatomy, and the kidney. Kidney Int 2000; 57(3):1190e201. [2] Rosenman LD. Facts and fiction: the death of Saint Ignatius of Loyola. Surgery 1996;119(1):56e60. [3] Realdi Columbi Cremonensis. De Re Anatomica Libri XV. Venice: ex typographia N. Beuilacquæ; 1559. [4] Murray MA. The bundle of life. Ancient Egypt 1930;3:65e73. [5] Croft Long E. The placenta in lore and legend. Bull Med Libr Assoc 1963;51(2): 233e41. [6] Diels H. Die Fragmente der Vorsokratiker. Berlin: Weidmann; 1922. [7] De Witt F. An historical study on theories of the placenta to 1900. J Hist Med Allied Sci 1959;14:360e74. [8] Gaza T. Aristoteles de historia animalium libri novem. De partibus animalium, et earum causis libri quattuor. De generatione animalium libri quinque. Venice: apud H. Scotum; 1545. [9] Gotthelf A, Balme DM. Aristotle’s De partibus animalium I and De generatione animalium I. with passages from II. 1e3. Oxford: Clarendon Press; 1992. [10] Harvey W. The works of William Harvey: translated from the latin with a life of the author by Robert Willis. London: Printed for the Sydenham Society; 1847. [11] Morgagni GB. De sedibus, et causis morborum per anatomen indagatis libri quinque. Padua: Sumptibus Remondinianis; 1765. [12] Kühn CG. Claudii Galeni opera omnia. Lipsia: ex officina libraria C. Cnoblochii; 1821e1833. [13] Moes RJ, O’Malley CD. Realdo Colombo: “On those things rarely found in anatomy”. An annotated translation from the De Re Anatomica (1559). Bull Hist Med 1960;34:508e28. [14] O’Malley CD. Andreas Vesalius of Brussels. Berkeley: University of California Press; 1964. [15] Saunders JB, O’Malley CD. The Illustrations from the Works of Andreas Vesalius of Brussels. Cleveland & New York: The World Publishing Company; 1950. [16] Premuda L. Storia della Medicina. Padova: Cedam; 1960. [17] Renazzi FM. Storia dell’Università degli studi di Roma, detta comunemente la Sapienza, che contiene anche un saggio storico della letteratura romana, dal principio del secolo XIII sino al declinare del secolo XVIII. Roma: Pagliarini; 1804.
Contents lists available at SciVerse ScienceDirect
Placenta journal homepage: www.elsevier.com/locate/placenta
Short communication
Realdo Colombo’s De Re Anatomica: The renaissance origin of the term “placenta” and its historical background M. Pizzi a,1, M. Fassan a,1, M. Cimino b, V. Zanardo b, S. Chiarelli a, * a b
Department of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University of Padua, Via Aristide Gabelli, 61, 35121 Padua, Italy Department of Women’s and Children’s Health, University of Padua, Via Nicolò Giustiniani, 2, 35128 Padua, Italy
a r t i c l e i n f o
a b s t r a c t
Article history: Accepted 13 March 2012
Over the centuries, great interest has been devoted to the placenta and to its highly symbolic significance. The Renaissance represented the age of historical and cultural transition between classical and modern scientific paradigms. In the medical setting, Realdo Colombo represents one of the protagonists of this revolution. In his masterpiece, De Re Anatomica, he revolutionized the former medical perspective. We present a passage from this book, which carries invaluable information on the Renaissance viewpoint on pregnancy and placental biology. The connections between Colombo’s theories and the previous medical tradition are also analysed. Ó 2012 Elsevier Ltd. All rights reserved.
Keywords: Placenta History of medicine Realdo Colombo Michelangelo
1. Introduction In the course of human history, the Renaissance was an epoch of great optimism and faith in human capacities. Scholars in every field approached their subjects in a new way, without being conditioned from any Authorities and Medieval dogmas. This resulted in the development of modern theories both regarding the Universe and Mankind. This new culture also led to a deep progress in medical knowledge. Some of the greatest anatomists of all time lived in this period and their discoveries allowed fundamental acquisitions in human anatomy and physiology. Among others, the female genital tract and pregnancy were thoroughly investigated. Matteo Realdo Colombo (1516e1559), the discoverer of pulmonary circulation [1], was a protagonist of this medical revolution, and his masterpiece, De Re Anatomica (Fig. 1), is considered one of the most important anatomical treatises of the Renaissance. He was professor of Anatomy at the University of Padua (around 1543) before moving to Pisa (in 1546) and later to the University of Rome (in 1549). Whilst in Rome he was summoned by Pope Paul III and became the physician of many illustrious patients, including the painter, architect and sculptor Michelangelo Buonarroti [1]. He also performed the autopsy on the body of St Ignatius of Loyola [2].
* Corresponding author. Tel.: þ39 49 8272272; fax: þ39 49 8272277. E-mail address: [email protected] (S. Chiarelli). 1 These authors equally contributed to the paper. 0143-4004/$ e see front matter Ó 2012 Elsevier Ltd. All rights reserved. doi:10.1016/j.placenta.2012.03.004
The exceptional page of De Re Anatomica, where Colombo coined for the first time the term “placenta” is presented and commented (Fig. 2). 2. The text: Matteo Realdo Colombo, De Re Anatomica libri XV (1559) (a web-based copy of the original book is available for consultation at the Noma collection website: http://shinku.nichibun.ac.jp/ NOMA/new/). 2.1. Liber XII: on foetus’ formation and infant’s location in the uterus [3] “At first, Nature spawns the allantois and those multiple veins and arteries that leave through the navel. Then, it makes those vessels fuse to each other, to be sustained. Finally, these vessels divide at the end of their course and form a sort of flat circular cake (that is placenta). Galen, who did not describe the human one, referred to this organ as membranous and named it “chorion”, i.e. “secundina”.2 However his description is not that of a human placenta, which is indeed not membranous but rather similar to a thick mass of excrements.
2 In Latin: Genita allantoide, venis arterisque per umbilicum tendentibus quae suo in exortu plurimae sunt, ut fulcirentur, natura affusionem quandam genuit quae orbicularis fit placentae in modum. Facta autem fuit, ut vasa, quae diximus, unita detineret: haec a Galeno, qui humanam non descripsit, membrane chorion, hoc est secundina appellatur.
656
M. Pizzi et al. / Placenta 33 (2012) 655e657
beasts, the allantois is located under the foetus: this is not a coincidental finding, since the allantois serves as a collector of foetal urine. In addition to the two already mentioned membranes, a third one (the amnion) has to be considered. The amnion is an envelope in direct contact with the foetus and contains its sweat and its excrement.3 The foetus swims in it and is sustained by this fluid, to be less troublesome for the mother. Don’t marvel that no excrements other than urine and sweat are produced. This is due to the cleanness and purity of the blood that feeds the foetus. Thus, it is false what common people believe (i.e. that only menstrual or impure blood reaches the foetus). [.] When the time of delivery comes, these two membranes tear off and come out with the foetus. Obstetricians call “waters” the excrements that flow after the membranes rupture and their coming is considered a sign of imminent birth. Moreover, if the baby is visible when the waters flow, the outcome is considered favourable and easier. This is due to the humidity of excremental liquid that lubricates the mother’s genital channel. [.] The foetus is nourished through the umbilical cord by its vein. With respect to this, Hippocrates made some incorrect premises: he stated that the foetus imbibes his own nourishment from the mother by mouth; I cannot marvel enough at this error from such a great man! In fact, between the foetus’ mouth and maternal uterus there is a great deal of substance. However, even supposing them to be in contact, how could Hippocrates imagine the foetus sucking the juice actually contained either in the mother’s stomach or gut? Therefore be sure without doubts, Reader, that the foetus cannot take anything by mouth. And even if it could, it would certainly die, overwhelmed after having drunk its own sweat: on the contrary, it is fed through the umbilical vein with good and perfect blood.” 3. Comment Fig. 1. Title page from Realdo Colombo’s De Re Anatomica. The Author himself teaches anatomy while dissecting a cadaver. In the lower left, note the two men representing the renaissance fusion of past and present in the medical and anatomical studies: the young artist attending to human dissections and sketching on a blank paper may represent the direct experience helped by another spectator who holds an illustrated edition of an ancient anatomy treatise.
Although placed over the allantois, the placenta does not completely surround the foetus and strongly adheres to the uterus. It is therefore not surprising that abundant bleeding occurs during delivery, due to the tearing off of both placental veins and arteries. In dogs, the placenta is a band-shaped organ closely resembling that which also Vesalius pictured. The human placenta represented by Vesalius is indeed a canine one: he just substituted the puppy dog with a baby child! [.] In humans the allantois is a large membrane, which completely encloses the foetus. In cows, goats and mares, it is similar to a sausage, which is indeed called allantoydes in Greek. In those
Fig. 2. Realdo Colombo’s De Re Anatomica: for the first time the term “placenta” is coined. Liber XII page 248, adapted from the original text.
To gain full comprehension of Realdo Colombo’s passage, it has to be considered in the context of a medical tradition that can be traced back to antiquity. Despite their rudimental knowledge of anatomy and physiology, Egyptians worshipped the pharaoh’s placenta (wrapped in the so called “bundle of life”) and considered it to be the second royal soul [4]. Traces of this tradition can be found even in the Bible (Deuteronomy 28:57 and I Samuel 25: 29) [5]. Ancient Greeks had contrasting opinions on the origin and function of this organ: Diogenes of Apollonia (V century B.C.) was the first to consider it responsible for fetal nutrition [6]. On the contrary, many philosophers and even Hippocrates thought the fetus sucked the amnion to be fed [7]. This theory, strongly rejected by Aristotle [8,9], was still present in the XVI and XVII century and gained further credibility thanks to famous scientists such as William Harvey (1578-1657) [10] and Giovanni Battista Morgagni (1682e1771) [11], who sustained it. As also testified by Colombo’s viewpoint, Renaissance scientists still paid a great tribute to classical authors and referred to them whenever possible. Just to make an example, Realdo Colombo’s theory of fetal excrements is directly drawn from Galen (129e200 AD) [12]. Tradition, however, was constantly challenged by the renewed confidence in the power of observation and experiment. Colombo’s
3 In Latin: Dicitur agmios, vel ammios: ab hac quoque universus involvitur foetus, et in ea immediate foetus situs est, et sudor a foetu emanans atque eius excrementum continetur.
M. Pizzi et al. / Placenta 33 (2012) 655e657
thought is not an exception to the rule. Apart from the open criticism to Hippocrates, it is worth considering Colombo’s sentence on the nature of blood that reaches the fetus. The author apparently disapproves of those “common people” who consider this blood of menstrual origin. In fact, this is a sharp criticism against an old tradition that can be traced back to Aristotle [8,9]. The constant search of truth could also lead to fierce quarrels among scientists, as exemplified by Colombo’s direct attack against his master, Andrea Vesalius. The latter is blamed for having deliberately depicted a canine placenta as a human one. Despite partially moved by a true scientific interest, the impudent and brazen tone of Colombo’s criticism seems to be due to private reasons too [13]. Of note, Vesalius’ initial blunder was corrected in the second edition of De Humani Corporis Fabrica (1555), i.e. four years before the publication of Colombo’s De Re Anatomica [14,15]. It is unlikely that Colombo would have been unaware of this correction: he could have deliberately chosen the word ’placenta’ in order to highlight Vesalius’ initial error. De Re Anatomica also provides an opportunity to consider a peculiarity of Renaissance medicine. Artists of the XVI century usually co-worked with anatomists and even attended human dissections; the famous anatomical sketches of Leonardo da Vinci (among which are those of a pregnant uterus) were possible thanks to a close collaboration with the anatomist and physician Marcantonio della Torre [16]. Something similar also happened to Realdo Colombo and Michelangelo. The two met in Rome when Colombo was asked to treat Michelangelo’s recurrent urolithiasis [1]. Colombo succeeded in healing the artist and, as a mark of gratitude, Michelangelo agreed to illustrate De Re Anatomica. Unfortunately, however, the project was never carried out and the only figure present in the whole book is the wonderful title page by Paolo Veronese (1528e1588) (Fig. 1) [17]. Disclosure No conflict of interest to declare.
657
Acknowledgement The authors thank Dr. Heather Fulwood De Nogales for her valuable suggestions about the manuscript and for helpful discussions.
References [1] Eknoyan G. Michelangelo: art, anatomy, and the kidney. Kidney Int 2000; 57(3):1190e201. [2] Rosenman LD. Facts and fiction: the death of Saint Ignatius of Loyola. Surgery 1996;119(1):56e60. [3] Realdi Columbi Cremonensis. De Re Anatomica Libri XV. Venice: ex typographia N. Beuilacquæ; 1559. [4] Murray MA. The bundle of life. Ancient Egypt 1930;3:65e73. [5] Croft Long E. The placenta in lore and legend. Bull Med Libr Assoc 1963;51(2): 233e41. [6] Diels H. Die Fragmente der Vorsokratiker. Berlin: Weidmann; 1922. [7] De Witt F. An historical study on theories of the placenta to 1900. J Hist Med Allied Sci 1959;14:360e74. [8] Gaza T. Aristoteles de historia animalium libri novem. De partibus animalium, et earum causis libri quattuor. De generatione animalium libri quinque. Venice: apud H. Scotum; 1545. [9] Gotthelf A, Balme DM. Aristotle’s De partibus animalium I and De generatione animalium I. with passages from II. 1e3. Oxford: Clarendon Press; 1992. [10] Harvey W. The works of William Harvey: translated from the latin with a life of the author by Robert Willis. London: Printed for the Sydenham Society; 1847. [11] Morgagni GB. De sedibus, et causis morborum per anatomen indagatis libri quinque. Padua: Sumptibus Remondinianis; 1765. [12] Kühn CG. Claudii Galeni opera omnia. Lipsia: ex officina libraria C. Cnoblochii; 1821e1833. [13] Moes RJ, O’Malley CD. Realdo Colombo: “On those things rarely found in anatomy”. An annotated translation from the De Re Anatomica (1559). Bull Hist Med 1960;34:508e28. [14] O’Malley CD. Andreas Vesalius of Brussels. Berkeley: University of California Press; 1964. [15] Saunders JB, O’Malley CD. The Illustrations from the Works of Andreas Vesalius of Brussels. Cleveland & New York: The World Publishing Company; 1950. [16] Premuda L. Storia della Medicina. Padova: Cedam; 1960. [17] Renazzi FM. Storia dell’Università degli studi di Roma, detta comunemente la Sapienza, che contiene anche un saggio storico della letteratura romana, dal principio del secolo XIII sino al declinare del secolo XVIII. Roma: Pagliarini; 1804.