Padova e La Medicina

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Padua: The Renaissance of Human Anatomy and Medicine[Legacies]

Andrioli, Giancarlo M.D.; Trincia, Giuseppe M.D.

Divisione Neurochirurgica, Ospedali Galliera, Genova, Italy (Andrioli)Divisione Neurochirurgica, Ospedale Civile, Mestre-Venezia, Italy (Trincia)Reprint requests: Giancarlo Andrioli, M.D.,Department of Neurosurgery, Galliera Hospital, Via Volta, 8, 16128 Genova, Italy.

Email: [email protected], February 5, 2004.Accepted, June 1, 2004.

Abstract

THE CITY AND University of Padua have a long tradition and a great reputation in anatomic studies, dating from the founding of theuniversity in the year 1222. We present a historical review of the study of human anatomy, for which Padua was a most important center. Thebackground for the development of this culture was represented by the scientific freedom and political wisdom of the Serenissima Republic ofVenice, a liberal and tolerant state in the midst of a feudal, imperial, and pontifical Europe. During the second half of the 15th century, theflourishing trade and cultural, social, and political life of Venice attracted a great number of scientists and students from all over Europe whocontributed to the establishment of Padua as an international center for culture and the sciences. Vesalio, Fabrizio dAcquapendente, andGiovanni Battista Morgagni represent milestones in the history of anatomy as well as in medicine and surgery. History shows that anatomy andsurgery evolved together, just as anatomy of the nervous system and neurosurgery developed in tandem. The tradition of neurosurgery inPadua is considered one the most important schools in Italy.

Substantial research has focused on the history of the University of Padua and its ancient origin, speculated by historians to date back to

Charlemagne or Tito Livio. Actually, we know that early universities developed from the ecclesiastical and lay schools already existing in Italy

around AD 1000 as a process triggered by cultural and political changes (6).

Copyright by the Congress of Neurological Surgeons Volume 55(4), October 2004, pp 746-755

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After his appointment as Bishop of Padua in 1213, Giordano Malatraversi soon realized how the clerics interest in higher education and

ambition for prestigious doctorates attracted them to Bologna, with resulting poor attendance to their curial duties. The Fourth Lateran Council,

held in Rome the following year, recommended that the bishops appoint a grammar teacher and a theologian in their cathedrals to educate the

priests. While in Bologna to resolve litigations in the ecclesiastical order in 1222, Bishop Malatraversi himself seems to have had a decisive

influence in convincing the students (already contesting the city policies of the municipal authorities) to prefer Padua for their studies (2).

It should be noted how customary it was at that time for the students to move from a school, sometimes for economic advantages (e.g.,

cheaper lodging), but most often to obtain freedom and privileges. Together with their teachers, they would relocate to another school and

municipality offering better opportunities at a time when the Italian Comuni(city-states) were already competing to attract students and secure

the best teachers. For these purposes, laws were issued that forbade teachers from abandoning the schools to move to other Comunior even

from taking short leaves without the students permission. Also worth remembering is the students substantial power. For instance, they used

to elect one student to the office of dean (6). They dictated norms regulating the Universities and were actually independent from any authority

except the Church (establishment of a new school or confirmation of graduations were impossible acts without the Popes permission). On the

other hand, the Church authority (as represented by Bishop Giordano; Cardinal Ugolino dei Conti di Segni, who later became Pope Gregorio IX;

and Pope Onofrio III) had a crucial role in the foundation of the Paduan school (2).

As an important step encouraged by Cardinal Ugolino, Onofrio III in April 1220 issued the famous bull claiming the students freedom from

the restrictive laws issued by secular authorities in Bologna. Giordano and the Mayor of Padua, Giovanni Rusca, can rightly be regarded as the

founders of the Studii Padvani Universitas, which began its courses in 1222, on St. Michaels Day, September 29 (12).

Courses in medicine began by the end of 1200 with the spread of the Arabic doctrines from the major centers of Islamic culture and

tradition. At that time, doctor and philosopher Pietro dAbano (12501315) acquired a great reputation as a teacher but also attracted the

attention of the Inquisition. Tried in court for and declared guilty of witchcraft, he was sentenced to death, although he had died before the end

of the trial, and his corpse was burned (4).

During the plague that exterminated two-thirds of the European population in 1300, many scholars in Padua performed studies on the

epidemiology and prophylaxis of the disease. On the basis of their results, the Republic of Venice promulgated health regulations that were

exemplary for the time.

In 1405, the da Carrara family lost their lordship of Padua, and the city was incorporated into the Republic of Venice. This major event had

a crucial impact on the university. The Senate of the Serenissima Republic of Venice immediately realized the importance of the school with

regard to politics, international relations, and prestige. Venice dedicated great care to its development, selected the lecturers with the greatest


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attention, and always tried to appeal to the most distinguished and famous to move to Padua.

Ad hoc provisions from the government guaranteed their salaries, and the city imposed a special tax whenever these were insufficient. It

was mandatory for all citizens and peasants in the entire territory of Padua to pay a monthly tax of 2 soldi (farthings) per head and 3 lire per

cart (7). The Republic respected its deal with the City of Padua to maintain the privileges, statutes, and customs (6) and forbade its subjects

from attending any other University.

During the second half of the 15th century, the flourishing trade and cultural, social, and political life in Venice attracted a great number of

students from all over Europe who contributed to establishing Padua as a international center for culture and sciences. Padua became the

Renaissance center for science as Florence was for art.

A significant contribution certainly also came from the spread of the printing technique. In the last decade of the 15th century, the more

than 200 printing shops active in Venice produced more publications than all those of the rest of Italy and turned Venice into one of the most

important publishing centers of medical handbooks in Europe (7). Accurate and detailed anatomic illustrations obtained though the direct

observation of corpses could circulate thanks to the printing technique. The first printed and illustrated medical books and the first anatomic

tables date back to this period. Aldo Manuzios fine editions spread across the world because of increasing awareness of the need to provide

doctors and students with better anatomic illustrations than ancient drawings.

The establishment in 1616 of the Collegio Veneto gives further indication of how highly the Republic of Venice respected culture and the

university autonomy. After the Protestant Reformation, the Catholic Church was concerned with the inflow to Padua of Protestant students from

northern Europe and the lack of an ecclesiastical control that was, conversely, almost total in universities such as Paris and Bologna. In this

regard, the Republic of Venice came to challenge the power of the Catholic Church in Rome. In fact, the Catholic students in Padua received

their degrees from the hands of the pontifical vicar after making their profession of faith (doctores promoti), whereas the Protestants and the

Jews could not graduate in the church. Instead, they were allowed by the Republic of Venice to refer to the Counts Palatini (doctores bullati),

who had been granted the power to confer degrees by the Emperor himself (7).

In opposition to this, Pius IV (15591565) issued the bull In Sacrosanta, in which he stated that the profession of the Catholic faith had to

be mandatory for all graduating students. The Venetian Senate, after due protests and various attempts to mediate, resolved to establish the

Collegio Veneto and provided it with the power of conferring degrees (ex autoritate veneta). These were the first university degrees to be

issued by a secular state authority.

This liberal and tolerant environment in the Republic of Venice and in Padua was an ideal background, with provisions for the development




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of culture. Some of the basic achievements of the Serenissima (freedom in science and political wisdom) (Fig. 1) made it the only republic

(with the exception of Genoa) in an otherwise feudal, imperial, and pontifical Europe. It was established as a stronghold of freedom in a world

of spreading obscurantism, notwithstanding its role of protector of Christianity and jealous custodian of ancient traditions (23).

FIGURE 1.Carving of the lion of St. Marc, the standard of the Serenissima Republic of Venice.

THE GOLDEN CENTURY OF ANATOMY

The substantial development of medicine during the 15th and 16th centuries was primarily a result of the flourishing of anatomic studies

and their teaching in medical schools. The cultural and political environment fostered by the Republic of Venice and mentioned above was in

itself a privileged background for the development of anatomy and science: it [the Republic of Venice] was among the first governments to

abandon the prejudice preventing the laying of hands on human corpses to carry on anatomic investigations and to promote, encourage,prescribe, or impose the study of anatomy to doctors and surgeons (9).

An act of the Maggior Consiglio (a sort of parliament in Venice) on May 27, 1368, stated that it was mandatory for physical doctors (the

true physicians according to the ranking of professionals at that time) as well as for surgeons (the sore doctors) to attend anatomy at least

once every year (15). The obligation was extended in 1483 to barbers, who, in addition to cutting hair and beards, in those times practiced




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phlebotomies to draw blood and cured pimples, contusions, wounds, and other events not involving the risk of death (bruschi,

amacadure, sgrafadure, ferite ed altri casi lezieri et non in pericolo di morte) (26). Conspicuously, anatomic dissections were performed in

sacred places in Venice. The incongruity is only apparent, however. Churches and convents were, or were close to, places of burial. In case of

accidental or sudden death, corpses were transferred to vestries and chapels, where autopsies were performed to search for indications of

epidemic diseases, in compliance with the orders of the Republics health authorities and at the urging of immediate measures fighting

contagion. The sacred place also compensated in some way for a practice that was perceived at that time as abnormal and cruel (5). Anatomic

dissections became increasingly frequent everywhere during the 15th century, thus preparing that renaissance of anatomy in which Padua

played an important role around the end of the century.

The flourishing of anatomy and classical and humanistic studies, the arrival in western Europe of Greek-speaking scholars after the fall of

Byzantium, and the spread of print were the main circumstances allowing the recovery of books and handbooks in their original languages and

cultures. A philosophical trend favoring empirical approaches to Aristotles biology prevailed during the 15th century in Padua, thus encouraging

the observation of nature, including anatomy (13). The Codes of the School of Padua established that two bodies (one of each sex) had to be

dissected every year (anatomy was permitted only on executed criminals at that time in Venice and became penal anatomy at later times in

the rest of Europe as an additional mark of infamy and part of the punishment rite) ( 22).

Alessandro Benedetti (14501512), teacher of practical medicine and anatomy in Padua, in hisAnatomiae sive historiae humani corporis,

libri quinque (3) (1493), supported the need for anatomic dissection in the course of studies as essential to medical education and conceived a

permanent, collapsible anatomic theater (18) as an alternative to the wooden anatomic theaters that used to be built temporarily for the

occasion. According to Benedetti, the anatomic theater (the name perhaps referred to the spectacle of the human body and its perfection and

a public demonstration of mortality) had be built large and ventilated, with seats placed in circles as in the Roman Coliseum or the Arena of

Verona to accommodate a large number of spectators without disturbing the surgeon (Maestro). Two ushers had to be ready to expel those

who might try to enter without permission or cause a disturbance. Two trusted guards were to collect from the spectators the money that was

necessary to purchase the anatomic instruments. The corpse was placed on a high table in the center of the theater to be visible to all and

easily accessible to the Maestro; the instruments, described in detail by Benedetti, were placed on a table nearby (16). The famous anatomic

theater built in Padua by Fabrizio DAcquapendente in the following century conformed to these directions.

Andrea Vesalio

In this cultural climate and era of intense scholarship, Andrea Vesalio (15141564) moved from Brussels to the then f lourishing and already

potent Padua (Fig. 2). A member of an important family of Flemish doctors close to the imperial court, he studied anatomy in Paris. The cultural

environment there was conditioned by tradition and worshipped the work of Galen (AD 131201) and Scholasticism, in contrast to Vesalios




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deep needs for independent research.




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FIGURE 2.Illustration of Andrea Vesalio (from, Vesalio A: De humani corporis fabrica, libri septem. Basilea, Operinus, 1543 [28]).

After performing anatomic dissections under difficult conditions (to the point of stealing corpses from the scaffold), he became aware that

anatomy could not be learned or taught with the methods currently in use: while a surgeon or barber dissects a human body, the teacher

imparts a literary description of the various parts of the body, standing on the stage with open disdain and talking about facts he does not know

at all from personal experience but that he simply learned by heart from other peoples books [i.e. , the anatomic textbooks by Galen based onanimal observations]. Those who perform the autopsy are so ignorant that they are not able at all to show or explain to the students the parts

they are preparing, and since the teacher does not touch the corpse and the dissector does not know Latin and therefore cannot follow the

lecture, each one goes on by himself (Fig. 3) (27, 4r) (in this description, Vesalio refers to his first teacher of anatomy, Winther von

Andernach [15051574], whom he described as having never used a knife except at the table).




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FIGURE 3.Illustration of frontispiece ofAnathomia, by Mondino de Liucci. Lipsia, 493.

This description provides some detailed explanation of Vesalios decision to move to Padua. Officials of the Serenissima asked to attend one

of his lessons in anatomy before welcoming him. Vesalio explained his program before the College of the Doctors of Venice and was promised

he would receive the corpses necessary to his lessons. On December 5, 1537, before the assembly of the Great Chancellor, the Papal Vicar, and

the professors and members of the College of the Doctors magnificently attired in their robes, the famous doctor and prior of the College,Francesco Frigimelica (14911559), praised the merits of Vesalio and conferred on him the degree in medicine. The next day, Vesalio (at the

time 23 yr old and on a quite fast career track) was appointed by the Senate of the Republic as professor of surgery under the explicit condition

of giving anatomy lectures and performing dissections (7). He soon began performing anatomic dissections in the wooden theater built for him,

and his success exceeded any expectation. More than 500 students crowded the theater to attend his lessons, which Vesalio used to begin with

the galenic description of the part of the body he was about to dissect and then proceeded to dissect it with the assistance of a student (19).

At the students request, he drafted the venous, arterial, and nervous systems in tables that were printed the next year as Tabulae

anatomicae sex. The precision and care of his anatomic observations, together with his scrutiny of Galens anatomic text (a universal reference

book in his time), led Vesalio to conclude that Galen had performed most of his research on nonhuman primates, without realizing the

differences except for those regarding the fingers and knees. At this point, the activity of Vesalio as a teacher and researcher became crucial forthe development of anatomy. He strongly supported the preeminence of direct and objective observation over the authority of ancient texts.

Touch, feel with your hands and trust them! he was reported to have told students during an autopsy (11).

He was not the first, though. Berengario da Carpi (14601530), from Bologna, who also worked in Padua, described for the first time in his

book Isagogae breves the encephalon anatomy in a naturalistic way, although with poor approximation. He later published the Tractatus

erutilis et completes de fractura crani. With no medical education but a keen interest in knowledge, Leonardo da Vinci himself (14521519)

stood as a remarkable though lonely forerunner.

However, nobody before Vesalio had opportunities comparable to the uninterrupted cycle of lessons with direct observation of corpses he

held with support from the University of Padua and the Republic of Venice. The proof of this is that he stopped teaching and performinganatomy after leaving Padua. The result of this intense but unfortunately short activity was the De humani corporis fabrica, libri septem (28)

(Fig. 4), the first complete and systematic description of the human body as a factory (fabrica), a wonderful structure created by the

Supreme Creator and Divine Artist, Nature (27, 3v).




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FIGURE 4.Illustration of frontispiece ofDe humani corporis fabrica, libri septem (from, Vesalio A: De humani corporis fabrica, libri septem.Basilea, Operinus, 1543 [28]).

Book IV of the Fabrica deals with the spinal and cranial nerves, Book VII with the encephalon. Vesalio gave the first realistic and detailed

(although inaccurate) illustration of the base of the brain (Fig. 5). He also disproved the theory of the rete mirabilis, which had been fashionable

for 18 centuries as a fundamental of Galens physiology. According to this theory, the vital spirit originating in the heart (as the refinement of

the natural spirit produced by the liver) was brought to the bottom of the brain by the carotids, which developed there into a complex net of

blood vessels (the rete mirabilis). In this area, the vital spirit was further refined to become the animal spirit to provide the body with

sensibility and movement through the peripheral nerves (at the time believed to be hollow). The impurity created by the process of refinement

(called phlegm) was expelled through two imaginary openings at the bottom of the cranium. The first, corresponding to the cribriform lamina,

connected the anterior ventricles to the nasal cavities. The second (a series of pores in the sphenoid) connected the third ventricle with the

nose and pharynx through the infundibulum and the pituitary gland. Galens theory of a rete mirabilis further suggests that his observations

were on animals, possibly ungulates, and that his knowledge on humans was inferential (29).




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FIGURE 5.Illustration by Vesalio represents the first illustration of the base of the brain. The cranial nerves show only seven pairs: theolfactory nerve (F) is considered a pure extroversion of the brain, the optic (I) is the first nerve, the oculomotor (K) comes directly from thetemporal lobe. The trigeminus is separated into two distinct nerves: the sensitive nerve (M) (IIIrd nerve) and the motor nerve (Z) (IVth nerve).Facial and acoustic nerves are fused (d), from which the abducens nerve originates (d); the VIth and VIIth vesalianis nerves include the other




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four cranial nerves (from, Vesalio A: De humani corporis fabrica, libri septem. Basilea, Operinus, 1543 [28]).

Vesalio admitted the existence of a rete mirabilis in his Tabulae anatomicae sex(1538), only to acknowledge his mistake and analyze it

critically just few years later in the Fabrica (1543) I myself now really wonder at my stupidity. Because of my devotion to Galen, I never

undertook a dissection of a human head in public without contemporaneously availing myself of a head of a lamb or ox to show what I could

not detect in the human at all, and to prevent the onlookers from reproaching me for being unable to find that plexus so well known by name toall of them. But the carotid arteries do not form the reticular plexus described by Galen at all (29).

Throughout the Fabrica, Vesalio corrects some of Galens remarks made on the anatomy of the nervous system: there is no hole in the

sphenoid bone for the passage of the phlegm these little holes below the pituitary gland seen by Galen do not exist (28). Further on, he

denies the existence of any communication from the anterior ventricles to the nasal cavities through the olfactory nerves there is not such a

passage (28, p 641). He equally denied another fundamental of Galens theories, the hollow nerves: I can affirm I never found a passage of

any sort, notwithstanding the fact that for this purpose I have examined the optical nerves during the vivisection of dogs and other species of

animals of larger size, and the head of a man which was still warm, less than one hour after he was beheaded (28, p 324).

The implications of these statements go far beyond morphological description in proposing a complete physiological and functional revisionof available knowledge of the nervous system. Vesalios main merit is to have replaced tradition with a teaching based on the systematic use of

naturalistic observation. The approach was crucial when dealing with the nervous system and allowed him to introduce a realistic, albeit

imprecise, iconography as a substitute for the concept of an encephalon made up of three ventricles (each one the site of intellectual functions)

that he himself had been taught at the University of Lovanio. The series of images of brain sections from top to bottom reveal anatomic

structures (such as veins, meninges, corpus callosum, lateral ventricles, choroid plexus, and white and gray matters) never shown or seen

before. The greatness and intellectual modernity of this anatomist l ies also in his explicit refusal to indulge in theorization on higher brain

functions. He actually attributed these functions to the brain but set borders between observation (anatomy) and philosophy: I am absolutely

unable to understand how the brain can carry out its functions of imagining, thinking, meditating, and remembering (30). He recommended

that anatomic observations be described as accurately as possible, without interpretation. His Fabrica marks the beginning of systematic

teaching and scientific research in anatomy.

Wonderfully illustrated by the Flemish painter Johan Stephen von Kalcar (14991546), a pupil of Titian (23), and carefully edited by Vesalio

himself, his book is a valuable document for contemporary art and everyday life too. The Renaissance dominates and smiles from within the

ponderous anatomic text, conferring on it the unsurpassed grace and beauty that contributed to its success. The prospects drawn in the

background of sectioned bodies in the Fabrica have been identified by Harvey Cushing in the landscape between Padua and the small town of




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Abano nearby (Fig. 6).

FIGURE 6.Illustration of muscle apparatus, by Vesalio. Behind the bodies, the landscape in the neighborhood of Padua (from, Vesalio A: Dehumani corporis fabrica, libri septem. Basilea, Operinus, 1543 [28]).

At the age of 30, after teaching in Padua for 7 years, Vesalio left the school, the city, and the country in 1544 to become the personal



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physician of Emperor Charles V on whose kingdom the sun never sets. The academic career and scientific work of the greatest anatomist

were over, despite his unchanged interest in anatomy. Before leaving Padua, he burned his books (an impulsive action never understood) and

some unpublished manuscripts. In later years, he was sentenced to death under the accusation of practicing vivisection but was pardoned by

King Philip II, and his sentence was changed into a pilgrimage to Jerusalem. On the way back, an illness forced him to land on the beautiful

island of Zante, where he died in 1564. His grave was never found.

Realdo Colombo, Gabriele Falloppio, and Gerolamo Fabrizio DAcquapendente

A disciple of and assistant to Vesalio, Realdo Colombo (15161559), was appointed to succeed him. He documented the small circulatory

system (heart and lungs), thus confirming the interest existing in Padua even before Harveys time in the problems connected to the blood

circulation (18).

Gabriele Falloppio (15231563) succeeded him after working in Ferrara and Pisa. He was the most famous among the Italian anatomists of

the 16th century (and still is) because of his descriptions of the uterine tubes named after him and of the extrinsic eye muscles, cranial nerves,

and tympanum cord. The first edition of his Observationes anatomicae (Venice, 1561) was sent to Vesalio, at that time in Madrid (10).

Gerolamo Fabrizio dAcquapendente (15331619), a disciple of Falloppio, succeeded him as a teacher of anatomy and surgery. A diligentscholar and a famed anatomist and surgeon, he dedicated himself to the anatomic and physiological study of the uterus and fetus. He also

supervised the construction of the new anatomic theater in Padua (Fig. 7), in which anatomy was taught continuously until the second half of the

19th century (24); it is difficult today to resist the feelings of deep wonder and emotion that arise from the view of such architectural perfection

and its wonderful preservation and from actually touching the place where, for more than two centuries, human anatomy was taught and

studied by such numerous and such distinguished teachers.

FIGURE 7.Photograph of Gerolamo Fabrizio dAcquapendentes Anatomical Theater. Padova, Building of University Bo.

It is reported but not proved that the anatomic theater was built at dAcquapendentes own expense, which he certainly could afford, as a

famed and rich anatomist and surgeon. After all, his former pupil and then rival Giulio Casseri owned a personal anatomic theater in his home

(7).

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Fabrizio dAcquapendente was regarded as one of the greatest scholars of the university, with reason. He studied embryology and

comparative anatomy there and also designed orthopedic devices. He also devoted scholarly and scientific attention to the blood circulation.

William Harvey (15781657) was among the students attending his lessons with a group of students interested in blood circulation under

Fabrizios supervision. Among them was Paolo Sarpi (15521623), a wise friar who was also an authoritative advisor of the Republic of Venice

and an illustrious mathematician respected by Galileo Galilei (15641642), he himself a former student in medicine and at that time a teacher

in Padua. The publication ofExercitatio de motu cordis et sanguini in animalibus (Frankfurt, 1628) by Harvey increased the fame of the

anatomy school of Padua even more. The statement best summarizing the cultural centrality of this city, haec Schola a renatis literisuniversam Europam per sesqui seculum erudivit, ut paucissimi incisores sint, qui ex ea non prodierint, belongs to this period (Albrecht von

Haller [17081777], quoted by A. Castiglioni [7]) (Fig. 8). The university welcomed foreign students and teachers from all over Europe.

FIGURE 8.Illustration of the building of the University of Padua: 17th century engraving. Padova, Palazzo del Bo.

In addition to Vesalio, we should name Spigelius (15781625) (who described the hepatic lobe named after him), Johannes Vesling (1598

1649) (author of the Syntagma Anatomicum), and Johann Georg Wirsung (16001643), who discovered the pancreatic duct. We should also

mention Giulio Casseri (15521616), from Piacenza, who began his career as a servant to Fabrizio and finally succeeded him. His enthusiasm

about anatomy turned him into such an expert dissector that the Maestro himself had him appointed as his substitute teacher in anatomy and,

years later, in surgery (25).

A flourishing of the study of other disciplines followed as a consequence of the progress of anatomy. In physiology, Marcello Malpighi

(16281694) documented the capillaries and Harvey the blood circulation. Giovanni Battista da Monte (14981551) was the first to teach

clinical medicine at the patients bed by getting his students to examine patients in the hospital of San Francesco.

A major impulse to pharmacology came with the establishment of the botanic gardens (the Orti Semplici, the first of which was funded in

Padua in 1545 and still exists), where plants and medicinal herbs were grown and studied (Fig. 9) (1).

FIGURE 9.Illustration of the botanic garden in Padova. Topography (from, Ceni A: Guida allimperial Regio Orto Botanico in Padova. Padova,1854 [8]).

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GIOVANNI BATTISTA MORGAGNI AND THE END OF THE REPUBLIC OF VENICE

The first comprehensive approach to combine anatomy and clinical medicine came from Giovanni Battista Morgagni (16821771) (Fig 10).

He taught at the Scuola Medica of Padua for almost 60 years and gave medicine new potentialities by his approach focusing on the sites and

causes of diseases investigated by anatomy, as implied by the title of his most famous work, De sedibus et causis morborum per anatomen

indagatis (Venice, 1761). During his inaugural lecture in Padua in 1712, he stated a number of humanistic and scientific principles based onpathology and observation that are still applicable today and on which he was to ground his teaching ( 17).

FIGURE 10.Portrait of Giovanni Battista Morgagni. Oil on canvas. Padova, Building of University Bo, Room of Medicine.

Born in Forl, he graduated in Bologna in medicine and philosophy and perfected his knowledge of anatomy under the guidance of his

teacher, Antonio Maria Valsalva (16661723). At age 22, he was elected president of the Accademia degli Inquieti (later transformed into the

Institute of Sciences), to which he brought his intellectual liveliness and preference for discussion based on experiments and observations. Helater published theAdversaria anatomica prima, a book on the large blood vessels, neck, and reproductive organs that had a deep impact on

the scientific community and won him an appointment to the prestigious Cesarea Accademia dei Curiosi della Natura.

Morgagni moved to Venice and gained widespread appreciation. In 1711, he was called to the second chair of theoretical medicine at the

University of Padua. A few years later (1715), he was appointed to the chair of anatomy and gave his first lesson in the anatomic theater of

Fabrizio dAcquapendente. He published scientific articles as well as historical essays, such as one on the causes of Cleopatras death inferred

from the reports of Roman historians, or comments about the pharmacopeia of Quintus Serenus Sammonicus (3rd century AD).

In addition to teaching, Morgagni dedicated most of his work in Padua to the patient. His meticulous and systematic collection of

information resulted in an immense database he used, at age 80 years, to publish De sedibus. This work crowned a long lifespan untiringlydedicated to study and research and is unanimously considered as the act of birth of pathology. The book is a huge collection of pathological

cases described with admirable precision, including personal reports, descriptions from corpses dissected in his presence by his teachers

Valsalva and Santorini, and reports from the literature. Most relevant, however, is the method he used: presentation of symptoms and

anatomic findings and logical correlation between the two (20).

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With Morgagni, the method combining pathology and clinical medicine was established so firmly as to remain in the centuries to follow as a

fundamental of medicine. It is practically impossible to list all of the discoveries made by Morgagni in the field of normal and pathological

anatomy. Only a few are named after him: ventricles and wedge-shaped tubercles of the larynx, urethral sinuses, nodules on semilunar valves

in the lungs, the pyramidal lobe of the thyroid, columns of the rectum, internal frontal hyperostosis and its association with obesity and virilism

in woman, cataracts, hepatic cirrhosis, etc.

Morgagnis teaching improved the fame of Medical School of Padua after decades of decadence. Increasing numbers of scholars andstudents traveled or moved to Padua to attend his lessons. Among them was John Morgan (17351789), who pioneered medical teaching in

Philadelphia after graduating in Edinburgh with a thesis on purulence and meeting Morgagni in Padua, where he attended his lectures.

Leopoldo Marcantonio Caldani (17251813) followed. Istitutiones anatomicae, Istitutiones pathologicae, and Istitutiones semeioticae are

some of the publications in which he pursued his clinical and anatomic studies in detail. The most important work is Icones anatomicae, a huge

series of accurately and finely drawn anatomic illustrations.

Napoleons armythe first foreign troops to enter the city in the history of Veniceput an end to the 1000-year-old Republic of San Marco

in 1797. The University of Padua also declined for decades under French and then Austrian domination, when it became a major center of the

rebel movements that later gave origin to the Italian Risorgimento. Italy became a state and a kingdom in 1861. After the third war ofindependence from Austrian domination (1866), the University of Padua returned to its traditional status as one of the most heavily attended

medical schools.

ANATOMY, SURGERY, AND NEUROSURGERY

History shows that anatomy and surgery evolved together. J.F. Fulton (18991960) reports in his biography of Harvey Cushing (1869

1939) that he died with Vesalios anatomy text in his hands. Cushing himself wrote a biography of Andrea Vesalio. These examples provide

testimony to the importance that neurosurgeons attributed to the great anatomist of Padua and his work and to a sort of spiritual will for the

neurosurgeons to come.

The long-standing tradition of Padua in neurosurgery is not a coincidence. The first independent neurosurgical unit in Italy was establ ished

in Padua in 1951. Its first director, Marino Quarti-Trevano (19101954), had graduated from that university with a thesis in neurology on

intracerebral hematoma (21) and began his work as a surgeon under the direction of G.M. Fasiani. In Padua and later in Milan, he focused on

neurosurgical techniques and neurological diseases with surgical indications and obtained his board certification in surgery with a dissertation

on brain angiography. A medical officer during World War II, he was held prisoner in Russia for 4 years and, at the end of the war, returned to



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Padova e La Medicina

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