Concepts of Cardiac Pathology Before Morgagni*

CONCEPTS OF CARDIAC PATHOLOGY BEFORE MORGAGNI* By ESMOND R. LONG, M.D. PHILADELPHIA HIS title has been chosen with erroneous concepts of cardiac pathol the purpose of presenting not ogy, the hairy heart and the clot within only the bizarre notions of car the heart. The first was of minor im diac pathology that clouded portance, but the puzzle of the polyp Tmedicine in the early years of theits heart made a jumble of treatises growth, but also the substantial devel on cardiac disease for three centuries, opment in its true understanding be from which we have hardly recovered fore the great morbid anatomist Mor yet, and the great Morgagni was no gagni came upon the scene. The view more free from its influence than his is still widely current that modern predecessors. knowledge of pathological anatomy be The advent of the “hairy heart” in gan with the distinguished professor of pathological literature is an illuminat anatomy at Padua. It is true that the ing example of the explosion of rev huge collection “De sedibus et causis erence for the classics incident with the morborum” formed a compilation of Renaissance and the naive acceptance accurate observations in morbid anat of anything from ancient Greece or omy such as had never been seen be Rome. Homer wrote of the Xao-tov Kfjp fore, and set a new standard in the ana of certain heroes of old; Hesiod used a tomical description of disease. Yet it is similar term, as did other Greek and only fair to add that almost every lesion Latin authors. Pliny the Naturalist described by Morgagni had been seen took pains to note the hairy heart of and described, in part at least, if not Aristomenes, the semilegendary hero of well, by some predecessor, and this the Messenian revolt against Sparta, holds not only for general pathology, and in one place or another hairy but for cardiac and vascular pathology, hearts were accorded to various other in which Morgagni was preeminent. ancient heroes, including the Spartan The discussion will be limited to the Leonidas, who held the pass at Ther two and one-half centuries before Mor mopylae, and the Spartan warrior Ly- gagni, i.e., the early period of patho sander, who three times defeated the logical anatomy. Athenian fleet and finally captured The first printed book in which an Athens. Indeed it was recorded that all appreciable number of necropsy pro the Sabine men, the Italian tribe so tocols are recorded is the work “De intimately bound up with the begin abditis causis morborum’’ of Antonio nings of Rome, were characterized by Benivieni of Florence, and in it are two the same badge of courage, a hairy reports that illustrate two interesting heart. * Read before the American Association of the History of Medicine, Atlantic City, May 4, 1936- And so Benivieni, a lover of the clas as in our own. as presumptive evidence sics. was misled. Watching the autopsy of exceptional fortitude, and a mark of a highwayman who had been hanged enjoyed by Aristomenes. Lysander. for his crimes, he was impressed by the fact that once before this man had been hanged, but proved so hardy that he had survived the first hanging, and on resuscitation by his friends returned to terrorize the countryside. In the peri cardial sac of this lusty robber was a stringy substance, which to us would be a fibrinous exudate. But to Benivieni. fresh from the pages of Pliny, it was a confirmation of the Naturalist, for here was a hairy heart like that of Aris- tomenes. Other similar reports followed, and were readily taken at their face value in a time when the bizarre and the mirac ulous were favored over the ordinary and commonplace. But even then the doubters would have overthrown this curious concept of cardiac pathology had not the anatomists Fabricius Hil- danus, Ruysch and others called atten tion to the unquestionable occasional From the “Observaiioncs medicae” of Nicholaas Tulp, Amsterdam, 1641. The polyp occurrence of hair in cysts of the ovary, (bb, with branches aa and feet ccc') was and if hair could occur in the ovary, recorded as present in the left ventricle of why not in the heart? the heart in a man dying suddenly. It was more than two centuries be fore this error was finally buried. In the Leonidas and the rest in company with meantime serofibrinous and fibrino- a multitude of other men. purulent pericarditis, not to mention I he other cardiac abnormality re adherent pericardium, had been seen corded by Benivieni was a frustulum and reported as such over and again, nigrioris carnis, a piece of black flesh but the old records stood, and were still shaped like a medlar, in the left ven quoted, if a little doubtfully. At last tricle of the heart, found in a woman the French cardiologist Senac, in the long troubled with pain in the chest, second edition of his treatise on the and considered by Benivieni to be the heart, which followed Morgagni’s great cause of her death. This was presum book, with all the new knowledge be ably a postmortem clot, and the obser fore him, and a longer acquaintance vation is of importance only as an early with the classics behind, gave the sim forerunner of countless descriptions of ple explanation that the ancients were “polyps’’ within the heart. Every pa prone to poetic license, that the “hairy thologist today knows how variable is heart’’ was probably nothing but a the appearance of the postmortem hairy chest, accepted in Senac’s time, intracardiac clot. I he length of time between death and necropsy, the posi the difference between the true and the tion of the body after death, the viscos false polyps of the heart. ity and coagulability of the blood, all If space were available it would be these and other factors affect the size interesting to go into the ramifications and appearance of such clots. But from of the subject of polyps, such as the the fifteenth to the nineteenth century curious belief in the occurrence of these clots were taken very seriously. worms and snakes in the chambers of They were by far the most frequently the heart. These were also ordinary described lesion of the heart, and time postmortem clots, pulled out of the and time again were reported as the great vessels attached to the heart, but cause of death. To the early patholo in the seventeenth century as “serpents gists and anatomists, not omitting corroding the walls of the heart’’ these Vesalius, the polyps of the heart were coagula received extended recognition. so conspicuous that the necropsy in ob Riolan, Zacutus Lusitanus, Severino, scure cases, including judicial necrop Bartholin, and many more put more or sies, commonly ended with their dis less faith in the reports of worms in the covery. Even the finding of polyps of heart, and Pierre de Castro of Verona, the heart in men dead of wounds in Vidius the younger and others reported battle did not explode the myth; the their constant occurrence in the hearts polyps were unexpected evidence of of those dying in certain widespread, disease already present, or by the less fatal epidemics. credulous were looked upon as forma The subject of polyps may be con tions subsequent to the wound and the cluded by pointing out that the signifi actual and final causes of death. cance accorded to the postmortem clots A huge literature devoted to the prevented recognition of the signifi polyp of the heart grew up, most of it cance of vegetations on the valves. Un purely objective, but some of it theo mistakable descriptions of such vegeta retical and philosophical like the dis tions are found in the pre-Morgagnian sertation “De polypo cordis’’ by the literature as well as in the “De sedibus” celebrated Malpighi. of Morgagni, but in general no more Men of great experience must have importance was attached to them than known that polyps were adventitious to the polyps in general. One of the products, but so much importance was best descriptions is in Lancisi’s book attached to them in the general medical on Sudden Death, in which he de literature that even Morgagni in the scribed a necropsy performed by two of middle of the eighteenth century, me his physician friends at which “he was ticulously, and often at great length, present, noting all things diligently.’’ described their appearance in his cases, His report states that the heart ex without committing himself, however, hibited a rare thing to them, viz., cer on their significance. At approximately tain irregular fleshy tumors, “like con this time tracts casting doubt on the dylomas,’’ adherent to the semilunar importance of polyps of the heart be valves of the aorta. He added that many came increasingly common, but the had seen fungoid bodies on the outside term endured into the nineteenth cen of the heart, but it was new to find tury and physicians still living were them in the heart (except, of course, medical graduates when Rokitanksy polyps) . There was an ordinary polyp was teaching students, none too clearly, in this case, but it is interesting to note that Lancisi ascribed little significance early seventeenth centuries, were oc to it, but related the fungoid masses on casional vague correlations of general the aortic-valve cusps to the man's his edema and abnormality of the heart. In tory of repeated syncope. In passing it may be noted that just a century later this same condyloma tous appearance was to lead Corvisart astray.

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