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MesquitaSPECIAL ET, et ARTICLEal. - Andreas - HISTORICAL Vesalius 500 years RECOVERY - A Renaissance that Braz J Cardiovasc Surg 2015;30(2):260-5 revolutionized cardiovascular knowledge Andreas Vesalius 500 years - A Renaissance that revolutionized cardiovascular knowledge Andreas Vesalius 500 anos - Um renascentista que revolucionou o conhecimento cardiovascular Evandro Tinoco Mesquita1, MD; Celso Vale de Souza Júnior, MD1; Thiago Reigado Ferreira1 DOI 10.5935/1678-9741.20150024 RBCCV 44205-1640 Abstract Resumo The history of medicine and cardiology is marked by some A história da medicina e da cardiologia é marcada por alguns geniuses who dared in thinking, research, teaching and trans- gênios que ousaram na forma de pensar, investigar, ensinar e trans- mitting scientific knowledge, and the Italian Andreas Vesalius mitir o conhecimento científico, sendo o italiano Andreas Vesalius one of these brilliant masters. His main scientific work “De Hu- um desses brilhantes mestres. A sua principal obra científica “De mani Corporis Fabrica” is not only a landmark study of human Humani Corporis Fabrica” não é apenas um marco do estudo anatomy but also an artistic work of high aesthetic quality pub- da anatomia humana, mas também uma obra artística de eleva- lished in 1543. In the year 2014 we celebrated 500 years since the da qualidade estética publicada no ano de 1543. No ano de 2014, birth of the brilliant professor of Padua University, who with comemoraram-se 500 anos do nascimento do genial professor da his courage and sense of observation changed the understand- universidade de Pádua, que com sua coragem e senso de observa- ing of cardiovascular anatomy and founded a school to date in ção mudou o entendimento da anatomia cardiovascular e fundou innovative education and research of anatomy. By identifying uma escola até hoje inovadora no ensino e na investigação da ana- “the anatomical errors” present in Galen’s book and speech, tomia. Ao identificar “os erros anatômicos” presentes nos livros e he challenged the dogmas of the Catholic Church, the academic discurso de Galeno, desafiou os dogmas da Igreja Católica, o mun- world and the doctors of his time. However, the accuracy of his do acadêmico e os médicos do seu tempo. No entanto, a exatidão findings and his innovative way to disseminate them among his de seus achados e sua forma inovadora de disseminá-los junto aos students and colleagues was essential so that his contributions seus alunos e colegas foi fundamental para que suas contribuições are considered by many the landmark of modern medicine. His sejam consideradas por muitos o marco da moderna medicina. A death is still surrounded by mysteries having different hypoth- sua morte ainda hoje é cercada de mistérios, havendo diferentes eses, but a certainty, suffered sanctions of the Catholic Church hipóteses, porém uma certeza, sofreu sansões da Igreja Católica for the spread of their ideas. The cardiologists, cardiovascular pela difusão de suas ideias. O cardiologista clínico, cirurgiões car- surgeons, interventional cardiologists, electrophysiologists and diovasculares, hemodinamicistas, eletrofisiologistas e imaginologis- cardiovascular imaginologists must know the legacy of genius tas cardiovasculares devem conhecer os legados do gênio Andreas Andreas Vesalius that changed the paradigm of human anatomy. Vesalius, que mudou o paradigma da anatomia humana. Descriptors: Anatomy. History of Medicine. Cardiology. Descritores: Anatomia. História da Medicina. Cardiologia. 1Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil. Correspondence address: Celso Vale de Souza Júnior Rua Doutor Mário Vianna, 734, Bloco 5, Apto 402 - Santa Rosa - Niterói, This study was carried out at Universidade Federal Fluminense (UFF), RJ, Brazil. Zip code: 24241-001 Niterói, RJ, Brazil. E-mail: [email protected] Article received on March 4th, 2015 No financial support. Article accepted on March 23th, 2015 260 Braz J Cardiovasc Surg | Rev Bras Cir Cardiovasc Mesquita ET, et al. - Andreas Vesalius 500 years - A Renaissance that Braz J Cardiovasc Surg 2015;30(2):260-5 revolutionized cardiovascular knowledge INTRODUCTION GALEN OF PERGAMUM AND HIS INFLUENCE ON CARDIOVASCULAR ANATOMY AND PHYSIOLOGY The history of medicine is marked by men and scientif- ic discoveries that have transformed how medical pratice is Claudius Galenus, also known as Galen of Pergamum, conducted and knowledge of biological phenomena in the was one of the most influential Roman physicians of Greek human body both in health and in disease, the professor of origin, his theories dominated the practice and medical sci- anatomy and physician Andreas Vesalius was one of these ence for over 15 centuries. Galen made important contri- geniuses. butions to distinguish veins, arteries and the venous blood The medieval world was gradually giving rise to a new from the arterial blood, besides the concept of the brain thinking present in arts, music, literature, science and medicine, controlling the body and the role of the kidneys in the urine where the human body became worshiped, studied and thus formation[1,2]. better understood its aesthetic, functional and anatomical value. In his treatise “De usu Partium” he expresses his the- In addition, the observation followed by experimentalism and ory about blood circulation. According to his concept ve- critical thinking were central to change the way how we search nous blood present the function of nourishing the body, for solutions and see the world. Galen’s ideas that influenced for as this would be secondary to the absorption of the useful 15 centuries teaching and medical practice were progressively part of the food and its subsequent transformation in the challenged and replaced front of new evidence from the obser- liver, an organ which has key role in maintaining the cir- vational method and systematic experimentation. culatory system[2]. The Italian peninsula, the cradle of the Renaissance, was This venous blood reaches the heart and lungs, where where were consolidated two important universities -Bolonha in addition to the nutrients being consumed, a portion of it and Pádua- that enabled new knowledge in the academic envi- would pass through the pores in the interventricular septum ronment, broadened the knowledge and promote the free de- and in the process it would get in touch with the pneuma bate of ideas, allowing that a new scientific research model, the from the lungs and the very center of the innate heat, lead- Scientific Method, could advance over the dogmatic knowl- ing to the formation of the arterial blood which is respon- edge that influenced medical education from Galen’s texts. sible for distributing the vital heat around the living body. Cardiology and Cardiovascular Surgery, as medical spe- Therefore, according to this view both venous and arterial cialties that emerged centuries later, have large debts to Vesa- blood circulate together and were governed by repelling lius as he questioned and shown through his systematic study properties by the heart and liver, and the attraction of other of the heart, Galen’s errors concerning this organ, and formed body organs[2]. the basis for that years later, Harvey -also a student in Pádua University- demonstrates the role of circulation involving the PARADIGM SHIFT IN MEDICINE heart and blood vessels. The story of Vesalius combines a revolutionary approach In many societies, formerly, the dissection was a prohib- to anatomy, innovative teaching method through the execu- ited act to be performed in human bodies, animals were the tion of dissection by the professor of medicine alongside the only source for some of these, which provided poor anatom- students and an innovative technique of publication. Those ical knowledge or misapplication of it by trying to interpret were made possible by the university environment of Padua these findings to humans. The first anatomists, properly, in the Venetian Renaissance setting and, this way, a testament probably emerged only in the Hellenistic Alexandria, with to the history of medicine of the importance and benefits be- Herophilus and Erasistratus, being considered the medical tween science and art, in particular with the publication of school founders in the region and performed dissections in his important book “De Humani Corporis Fabrica” becom- public. Herophilus, in particular is considered the father of ing certainly the father of modern anatomy. Besides, due to anatomy, accounting for important descriptions of the struc- his ideas ahead of time and the content of his literary works ture and functioning of nerves and vessels[3]. he suffered persecution of religious and political attitude that Only in the mid-twelfth century, with the rediscovery of contributed to his tragic end. Aristotle’s works, it was found that some studies were based Free will, critical thinking and freedom of expression, on the dissection of animals and vivisection of these, which which still in the contemporary world faces challenges and somehow legitimized the practice at this time, being an im- threats, in the Renaissance period was through him that we portant driver to beginning of a new ideology that would began to consolidate a new paradigm of looking at scientific allow less restricted execution of human dissection. Those phenomena - the scientific method. subject to dissection varied during the historical context, The aim of this review is to present a summary of his from a private investigation because of a noble death, the career
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