Giovanni Battista Morgagni and the Dawn of Pathology. Giovanni Battista Morgagni ( ) (fig. 1) is considered the father of pathological

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1 Giovanni Battista Morgagni and the Dawn of Pathology Zampieri Fabio, MA, PhD Researcher University of Padua Medical School Department of Cardiac, Thoracic, and Vascular Sciences Group of Medical Humanities Via Aristide Gabelli 86, Padua, Italy Phone Fax E mail: fabio.zampieri@unipd.it Giovanni Battista Morgagni ( ) (fig. 1) is considered the father of pathological anatomy and one of the most important innovators in the history of medicine. He was born in Forlì and studied medicine at Bologna University ( ), where he became friend and assistant of the anatomist Antonio Maria Valsalva ( ), famous, in particular, for his researches on human ear. In Bologna Morgagni became a follower of the school of Marcello Malpighi ( ), who was Valsalva s master, applying his method and concepts. As told by Morgagni in his autobiography: [ ] under the direction of many scholars of the famous Malpighi I studied medicine and attended all the three Hospitals of Bologna. In these latter I dissected an incredible number of cadavers and each year I helped the late renowned Antonio Maria Valsalva in the Public Anatomical Theatre, combining the great effort of dissecting and observing with the continue effort of thinking and reading almost all the modern and ancient Authors. In Bologna Morgagni published his first book on human anatomy, the Adversaria anatomica prima (First anatomical dissertation, 1706), which gave him celebrity all around Europe. In this treatise, following Malpighi s rational approach, he investigated not only macroscopic anatomy, but also the smallest components of organs, such as glands, and he interpreted his findings with mechanistic models. In other terms, for Morgagni and for Malpighi s school 1

2 human body was a set of mechanical tubes, engines, and implements in which the blood circulated as a congeries of particles in corpuscular agitation. Having drawn envy from Bologna academic environment, Morgagni was forced to leave the town in He lived for some years in Venice, attracted by the freedom of research ensured by Venetian Republic, and there he established good relationships with professors of the University of Padua, where he planned to obtain a professorship. After a further period of medical practice in Forlì, his hometown, Morgagni was finally called by the University of Padua at the chair of Theoretical Medicine on October Morgagni s first opening lecture was focused on medical education. Published with the title Nova institutionum medicarum idea (New proposal for medical curriculum, 1712), this lecture recommended medical students to attain a universal culture, ranging from anatomy, botanic, clinic, to mathematics and rhetoric. Even more important, in this lecture he established his scientific program, which consisted in dissecting cadavers to investigate the seats and causes of diseases. In 1715 Morgagni moved to the chair of Anatomy. It is probable that he took over this chair that belonged, throughout most of the Renaissance, to renowned anatomists such as Andreas Vesalius ( ), Gabriele Falloppius ( ) and Girolamo Fabrici d Acquapendente ( ), with the aim to restore its fame. He taught anatomy for almost 60 years, from 1715 to 1771, becoming the most renewed anatomist in Europe. In his courses he was able to connect ancient medicine with the most new advancements, as he declared in his biography: [ ] he was the first to teach the discovery of blood circulation, drowning practical and theoretical consequences completely opposites to the theories which have been maintained in high esteem by the most part of Padua University Professors. His exposition was always modern: he sometimes excused the ancients, and others he 2

3 showed that Galen and the old Padua professors did not have different concepts and teachings from those of the moderns. In this way he was not disliked by anybody, even those most faithful to the ancients. After having published other books on human normal anatomy, almost at the end of his long carrier, in 1761, he published De sedibus et causis morborum per anatomen indagatis (Seat and causes of diseases investigated by anatomy, Venice 1761) (fig. 2), settling what we now call the method of anatomo clinical correlations. His De sedibus was divided into five Books, each one dedicated to a scientist related to a European scientific association: the first to the Livorno Academy of Those Curious about Nature, the second to the Royal Society of London, the third to the French Academy of Science, the fourth to the Imperial Academy of St Petersburg and the fifth to the Berlin Royal Academy of Science. Each book contained several clinical histories correlated with autopsy records, organized according to different apparatus, in total almost 700 cases. For Morgagni, the conjunction et between sedibus and causis meant that the identification of the anatomical seat of disease coincided with the explanation of clinical symptoms. He considered the lesion in the organ, revealed by autopsy, as the fundamental cause of disease, its origin, progress and clinical symptoms. His De sedibus, more precisely, consisted of clinical histories collected by groups of similar symptoms and subsequently interpreted with anatomical dissections and mechanical models of pathophysiological processes. This strict relationship between a disease and a specific seat in the body was only possible inside a mechanistic perspective. The idea that the body was a machine, in fact, meant that this machine was composed by different devices, each one in a specific place in the body, with a specific function and a specific relationship with the whole mechanism. This implied that a rupture of a single device, that is, an organic lesion, was the seat of a specific mechanical problem, that is, a disease. This treatise marked a new era in medicine. Before Morgagni, according to the humoral system, diseases were considered to be caused by one of the four humours supposed to be at 3

4 the base of human physiology and pathology, that is, blood, phlegm, yellow and black bile. Even if Morgagni didn t completely deny the existence of humours in the body, he was the first to systematically consider the morphological substrates of pathologies as the fundamental aspect to understand and treat them. Morgagni was the first to understand and to demonstrate the absolute necessity of basing diagnosis, prognosis, and treatment on an exact and comprehensive knowledge of anatomical conditions. The Encyclopedia Americana rightly states that Morgagni: established pathological anatomy as a science, thus changing the course of medical diagnosis. 4

5 Figure 1: Portrait of Morgagni in the Hall of Medicine at the Bo Palace of the University of Padua 5

6 Figure 2: Frontispiece of "De sedibus et causis morborum per anatomen indagatis" (Venice 1761) 6

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