Development of anatomophysiologic knowledge regarding the cardiovascular system: from Egyptians to Harvey

On the Heart of the Hippocratic Corpus: its meaning, context and purpose

Though the Hippocratic text On the Heart has garnered significant attention in the twentieth and twenty-first centuries from classicists, physicians and historians of medicine alike, no commentary on this important work currently exists. There remain, however, central questions of interpretation concerning a number of important points: in particular, how the author understands the structure and functioning of the heart.The significance of this text for the history of cardiovascular medicine can be found first in its position as being radically advanced in its portrayal of the inner structure of the heart when compared with any other Hippocratic text. At the same time, the text falls dramatically short of the discoveries of the Alexandrian researchers who studied during the Hellenistic period-that is, around the same period as this text's likely composition. In addition, this work contains the first extant description of the valves of the heart, and its detailed descriptions of a cuspid valve and the chordae tendineae have led several scholars to imagine that this text even contains evidence of either a systematic dissection of an animal heart or-what seems impossible outside of Alexandria, Egypt at that time-evidence of the dissection of a human heart.This article intends to provide a full commentary on the text by consolidating, and in some cases correcting, previous interpretive attempts to understand an often referenced, and at times misinterpreted, ancient medical treatise.

The Galenic Heart in the Gothic Cathedral and the Adjournment in Discovery of Circulation

Background

Aristotle's tripartite concept of man-body, soul and spirit-formed the basis of the Galenic system that distinguished nurturing, vitalizing and animating tributary domains, governed by the liver, heart and brain, respectively. The Gothic cathedral structures into similar tripartite arrangements of nave, choir and sanctuary. We studied whether consistent parallels can be found between the Galenic concept of man, the Galenic heart itself and the structuring of the Gothic cathedral.

Methods

Galenic literature along with scholastic texts were reviewed. Examples of Gothic cathedrals were visited and studied in locations. We used medieval analytical tools to compare characteristics of cathedral architecture and contemporary concepts on man and the heart.

Results

Consistent parallels were found between the Galenic system and the structural parts of the Gothic cathedral. The principle of homology, intrinsic to both the Galenic system and Gothic architecture, identified the same tripartite organization in the Galenic heart itself and the segments could be projected onto the cathedral structure. Thus, the physical/nurturing domain was identified with the right ventricle inlet and the nave; the psychological/vitalizing domain corresponded with the right ventricle outlet/interventricular septum and the cathedral's choir; the animating/spiritual domain paralleled with the left ventricle/aortic valve and the sanctuary in the cathedral.

Conclusions

The Aristotelian/Galenic tripartite concept appears consistent with Gothic architecture and both provided a comprehensive view of the world; their relationship stems in a common philosophical and symbolic foundation. The tripartite interpretation was so coherent that it effectively delayed recognition of circulation and the heart's role in it.

The Middle Ages Contributions to Cardiovascular Medicine

The historical period called the Middle Ages, a long interval between the 5^th and the 15^th centuries, is still commonly known as the Dark Ages, especially in the area of health sciences. In the last decades, this "classic" view of the Middle Ages has been gradually modified with advances in historiographical studies and the history of science. During that period in Western Europe, knowledge about the human body suffered a regression in terms of anatomy and physiology, with the predominance of religious conceptions mainly about diseases and their treatments. Knowledge on the cardiovascular system and heart diseases has been classically described as a repetition of the concepts developed by Galen from the dissection of animals and his keen sense of observation. However, the Middle East, especially Persia, was the birth place of a lot of intellectuals who preserved the ancient knowledge of the Greeks while building new knowledge and practices, especially from the 8^th to the 13^th century. The invasion of the Arabs in North of Africa and the Iberian Peninsula and the eclosion of the Crusades resulted in a greater contact between the East and the West, which in turn brought on the arrival of the Arab medical knowledge, among others, to 12^th century Europe. Such fact contributed to an extremely important change in the scientific medical knowledge in the West, leading to the incorporation of different concepts and practices in the field of cardiovascular Medicine. The new way of teaching and practicing Medicine of the great Arab doctors, together with the teaching hospitals and foundations in the Koran, transformed the Medicine practiced in Europe definitely. The objective of this paper is to describe the knowledge drawn up from the Middle Ages about the cardiovascular system, its understanding and therapeutic approach to cardiologists and cardiovascular surgeons.

A brief history of topographical anatomy

This brief history of topographical anatomy begins with Egyptian medical papyri and the works known collectively as the Greco-Arabian canon, the time line then moves on to the excitement of discovery that characterised the Renaissance, the increasing regulatory and legislative frameworks introduced in the 18th and 19th centuries, and ends with a consideration of the impact of technology that epitomises the period from the late 19th century to the present day. This paper is based on a lecture I gave at the Winter Meeting of the Anatomical Society in Cambridge in December 2015, when I was awarded the Anatomical Society Medal.