The development of anatomy and pathanatomy. (Lecture on history of medicine for foreign students Program track general medicine)

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1 Federal state budgetary higher education institution «Ryazan State Medical University named after I.P. Pavlovа» Ministry of Health Care of the Russian Federation Department of public health and health care with the course of public health organization; the faculty of further education Freshman class The development of anatomy and pathanatomy. (Lecture on history of medicine for foreign students Program track general medicine) Author's translation: O.V. Medvedeva M.D., professor, the head of department of public health and health care with the course of public health organization; the faculty of further education;e.s. Manakina, Candidate of Medicine, assistant professor of department of public health and health care with the course of public health organization; the faculty of further education Ryazan

2 The development of anatomy and pathanatomy. 1. The history of anatomy Anatomy (Greek anatome cut) is a science about the structure of the organism, conformity to natural laws of its development in connection with the function and surrounding. First descriptions of body structure are dated back to II-I millenium B.C. and they are contained in the ancient Chinese, Egyptian and Indian manuscripts. The founder of scientific anatomy is Vesalius Andreas ( ), the golden age of anatomy began with his works. After Vesalius the professors began to prepare the corpses, the aim of it was the research of human body and teaching of anatomy to the students. Autopsies in XVI-XVII centuries were rare and were made in buildings which were not suitable for that purpose and later they transformed into solemn demonstrations. Special buildings in form of amphitheatres were made for it. In 17 century the center of anatomic research moved from Italy to France, England and Netherlands. The greatest anatomist of that time was Ruysch Frederik ( ) a convinced follower of Vesalius, Ruisch studied in Leiden University and in 1665 he defended thesis and was invited to Amsterdam for delivering of the lectures in anatomy to the guild of surgeons of the city. He possessed perfect technique of making of anatomic preparations and method of injection of blood vessels with colored and hardening liquids, he invented an original way of embalming of corpses, he carried out a unique collection of museum pieces (congenital anomalies and abnormalities) and created the first anatomic museum(the figure shows the part of Ruisch collection). For his deserts F. Ruisch was made a member of the German Academy Leopoldina (1705), London Royal Society (1720) and Paris Academy of Sciences(1727). 2. The development of anatomy in Russia The beginning of anatomic autopsies in Russia is connected with the name of Peter I ( ), who had great interest to medicine. Visiting Amsterdam Peter I attended the lectures and anatomic museum of Ruisch, was present at the operations and anatomic autopsies. After his first trip to the countries of Western Europe Peter I 2

3 established in Moscow in 1699 the course of lectures in anatomy for noblemen with demonstrations on corpses. In 1717 Peter I bought anatomic collection of Ruisch, which made a basis for the funds of the first Russian museum Kunstcamera Peter s museum of rarities. According to tsar s order (1718) this collection was enlarged and increased with the works of Russian scientists. Nowadays the preparations of F. Ruysch are kept in the museum of anthropology and ethnography AS, in military-medical Academy and Kazan medical institute. As a science and a subject of teaching anatomy was not singled out as independent discipline till the beginning of 19 century. It was united with physiology, pathology and later with pathologic physiology and was studied in tight connection with surgery. The first Russian atlas of anatomy in Latin was made in 1744 by Martyn Ivanovich Shein ( ). He could draw perfectly and made the illustrations to this book mostly by himself. He was the first who translated in 1757 Short anatomy of Laurenty Geister into Russian. It was the first manual of anatomy in Russian (The figure shows the «Short anatomy» of Laurenty Geister into Russian). A great contribution into development of Russian and world anatomy was made by I.V. Buyalsky ( ). In 1828 I.V. Buyalsky published Anatomicsurgical tables, which became world famous. They consisted of 36 drawings and 14 tables, which had a special value because in that time the textbook of anatomy of P.A Zagorsky and textbook of surgery of I.F. Bush didn t have illustrations. Tables of I.V. Buyalsky united the data of topographical anatomy and operative surgery and became the first in the history of Russia atlas of operative surgery. I.V. Buyalsky was a good anatomist and perfect surgeon. He made a lot for creation of new surgical instruments, worked out the methods of corpses embalming, suggested new way of making of thin corrosion anatomic preparation. The corrosion preparations of kidneys, made by him in 1863 are preserved till nowadays (The figure shows the portrait of I.V. Buyalsky). Among the first Russian surgeons I.V. Buyalsky used narcosis, starched bandage and means of antisepsis. He worked out series of new surgical operations (at the upper jaw, blood vessels and so on). In 1866 in honor of I.V. Buyalsky was made memorable golden medal. 3

4 In the end of 19 century in the leading scientific centers of Russia were formed the biggest anatomic schools. In St. Petersburg the functional direction developed P.F.Lesgaft ( ) a founder of native science about physical training. He studied the correlation of structure and function and their interaction with the surrounding. In Moscow University was formed a scientific school of D.N. Zernov ( ), who made a great contribution into study of anatomy of central nervous system. In Kiev University worked V.A. Bets ( ) a creator of teaching about architectonics of cerebral cortex. Inculcation of new methods of research widened the possibilities of scientific anatomy and made it closer to clinical medicine. The discovery of X-rays and creation of X-ray anatomy made the use of method of X-ray diagnosis possible. 3. Pathologic anatomy Pathologic anatomy (Greek pathos disease) is a science, studying structural bases of pathologic processes was singled out from anatomy in the middle of XVIII century. Its development in new history conditionally can be divided into 2 periods: 1 macroscopic (till the middle of 19 century) 2 microscopic, connected with the use of microscope. 1. Macroscopic period. The founder of pathologic anatomy as a science was Italian anatomist and doctor G.B.Morgangni ( ). At the age of 19 he became a doctor of medicine, at 24 he became the head of the anatomy chair of University in Bologna and in 5 years the chair of practical medicine of University in Padua. Carrying out the autopsies of dead people, G.B. Morgangni compared the discovered changes of defeated organs with the symptoms of diseases, which he observed as a doctor during the life of patient. So, he generalized the information, accumulated by this way 700 autopsies and works of his teacher, professor of anatomy and surgery of Bologna University Vasalva Antonio Maria ( ), G.B. Morgangni published in 1761 a classical 6-volumed research About position and causes of diseases, discovered means of cut. G.B. Morgangni proved that every disease evokes some definite changes in some certain organs and defined the organ as a place of localization of process of disease. So the notion of disease was connected with concrete material substance that made a great shock to metaphysical theories(the figure shows the portrait of Morgangni). Morgangni made anatomy closer to clinical medicine and laid the beginning to clinical-anatomic 4

5 principle and created the first classification, which had a scientific basis. According to his deserts Morgangni received honorable certificates of academies of science in Berlin, Paris, London and St. Petersburg. An important stage in the development of pathologic anatomy is connected with activity of French anatomist, physiologist and Doctor Mari Fransoise Bisha (The figure shows the portrait of Mari Fransoise Bisha). Developing the thesis of Morgangni he proved that vital functions of separate organ is made up of functions of different tissues it consists of and that pathological process affects not the whole organ as Morgangni thought but only its separate tissues. Without use of techniques of microscopy, that was not perfect at that time, Bisha laid the basis of teaching about tissues histology. 2. Microscopic period. In the middle of 19 century the development of pathology took place in 2 directions: old, humoral (Latin liquid) and later one solidary (Latin dense, hard). The leading representative of humoral direction was Karl Rokitansky ( ), the member of Vienna (1848) and Paris (1870) Academies of science. In 1844 he created the first in Europe chair of pathologic anatomy. His 3 volumes of Manual of pathologic anatomy ( ), made on basis of more than autopsies, which were carried out with use of macro- and microscopic methods of research were republished 3 times and were translated into English and Russian. The main reason of unhealthy changes Rokitansky considered disorder of composition of liquids (juices) of organism dyscrasia (the term of ancient Greek doctors). At the same time the local pathological process he considered as manifestation of general illness. Understanding of the disease as a general reaction of the organism was the positive point of his conception. In the middle of 19 century humoral pathology of Rokitansky contradicted to new data. The use of microscope lead natural history to the level of cellular structure and widened the possibilities of morphologic analysis in norm and pathology. The principles of morphologic method in pathology were laid by Rudolf Wirhoff a German doctor and pathologist. Taking into account the theory of cellular structure (1839), Wirhoff applied it to study of the organism of the ill person and created theory of cellular pathology, which is stated in his article Cellular pathology (1855) and his book 5

6 Cellular pathology as a study, based upon physiologic and pathologic histology (1858). According to Wirhoff life of the whole organism is a sum of lives of autonomous cellular theories, material substance of disease is a cell (i.e. the solid dense part of the organism, this forms the term solidary pathology); the whole pathology is a pathology of a cell. Some points of cellular theory of pathology, which are based upon mechanistic materialism contradicted to teaching about integrity of the organism. They underwent criticism (I.M. Sechenov, N.I. Pirogov and so on) during his life but on the whole theory of cellular pathology was a step forward in comparison with theories of tissue pathology of Bisha and humoral pathology of Rokitansky. It got recognition very quickly and had positive influence upon the following development of medicine. R. Wirhoff was elected a member of scientific societies and academies of almost al the countries of the world. R. Wirhoff made a great contribution into formation of pathologic anatomy as a science. Using the method of microscopy he described and studied pathologic anatomy of inflammation, leukocytosis, embolysm, thrombosis, flebits, leucaemia, amiloidosis of kidney, fatty degeneration, tuberculous nature of lupus, cells of neuroglia. Wirhoff created terminology and classification of main pathological states. In 1847 he founded a scientific magazine Archives of pathologic anatomy, physiology and clinical medicine, nowadays it is published under the name Wirhoff s archives. R. Wifhoff is also the author of numerous works in general biology, anthropology, ethnography and archeology. In Russia the beginning of pathologic anatomy and medico-legal autopsies was laid in 1722, when Peter s Regulations about hospitals were published. In this paper the compulsory autopsy was ordered to those who had violent death. The first chair of pathologic anatomy in Russia was created in 1849 in Moscow University. Its chief was A.I. Polunin ( ) the founder of the first pathologic anatomical school in Russia. A great contribution into development of pathologic anatomy in Russia was made by the following scientists: M.N. Nikiforov the author of one of the first textbooks in pathologic anatomy that was republished many times; N.I. Pirogov who taught the course of autopsies from 1840 in medical-surgical academy; M.M. Rudnev the founder of St. Petersburg school of morbid anatomists and others(the figure shows the portrait of N.I. Pirogov). 6