Morgagni, the creator of pathological anatomy

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Oliver Thansan
Oliver Thansan
31 January 2024 Wednesday 10:01
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Morgagni, the creator of pathological anatomy

* The author is part of the community of readers of La Vanguardia

Giovanni Battista Morgagni (Forli, 1682 - Padua, 1771) was a philosopher, writer and the doctor who took the first step to change the point of view of modern pathological anatomy, since his ideas acquired vital importance for the study of diseases.

The concept that pathological processes could originate in localized regions of the body was unknown to the ancients.

He entered the University of Bologna at the age of 16, earning a doctorate in medicine and philosophy at the age of 22. He began to sporadically substitute teachers of the stature of Valsalva or Albertini in classes. He created a study group called Academia inquietorum, whose name indicates that they wanted to experiment, observe and innovate scientific theories.

She had 15 children, of whom the eight daughters became nuns and one of the sons who followed in her footsteps died young.

When he was 24 years old (1706) he wrote a series of notes called Anatomical Adversaries, which were published, achieving popular interest, which is why the University of Padua asked him to work as a professor for more than 50 years.

It was one of the most prestigious of the 18th century, honored by men of the stature of Vesalius, Colombo, Fallopian, Acquapendente, Casseri, Spigelius and Vesling, in the famous circular amphitheater built in 1594.

He published several books, of which we highlight De sedibus et causis morborum per anatomen indagatis, which he published in 1761 and which contained more than 700 medical records with their autopsy protocols. This work was translated into several languages ​​to serve as a basis for the pathological anatomy that followed it.

Giovanni Battista Morgagni performed autopsies using another, more rationalist form of vision and opinion, avoiding a primary diagnosis as the main one and delving deeper into the pathology in a more thorough manner.

He even designed instruments suitable for the practice of medical dissections; even today, the table on which autopsies are performed is known as the "Morgagni Table." It was stainless steel. Removable base with drainage holes throughout its entire length. Headrest and a sink for washing the body.

He carried out studies that were of great importance on aneurysms and lung diseases. For him, tuberculosis was an infectious disease, refusing to perform autopsies on people who suffered from it.

He managed to modify the laws on tuberculosis, considering it from then on as a contagious disease and for which special disinfection and hygiene measures had to be taken.

He did not agree with the bloodletting that was common at that time and was thought to serve as treatment. He was also interested in studying the pulse and heartbeat in some cardiac disorders, helping a lot in the treatment of these conditions. For him, the only way to successfully treat cancer was to remove it.

In addition to being the creator of modern pathological anatomy, his book is a pathology and clinical book. He describes the diseases in order "from head to toe", as was common at the time, exposing more than 500 clinical cases one after another and, each case, followed by an autopsy report. Most are by Morgagni himself, although it includes many by Valsalva and some by authors he trusts.

Morgagni tries to explain each clinical picture by systematically relating the symptoms observed in the patient with the injuries found in the autopsy of the body. He presents the special pathology in its entirety, on an anatomical basis.

Anatomical lesions became the foundation of medical science and practice at the beginning of the 19th century in the "anatomoclinical" program of the Paris school.

While in Morgagni's work the injury is still subordinated to clinical observations, for the new medicine that was established in post-revolutionary Paris, the diagnosis was to be based on objective signs of injury ("pathological signs") and not in the patient's symptoms.

The doctor and writer Pedro Laín Entralgo has described Morgagni's work as a "decisive milestone" because his company, founded on observation and experience, made possible both the construction of "a pure pathological anatomy, conceived as a fundamental science of the entire pathology." ", as well as the generalization of the "anatomoclinical mentality", two of the great novelties of the birth, in the 19th century, of modern medicine.

As a great anatomist at the height of his time, Morgagni described numerous anatomical structures, some of which today bear his name.

Among others, the laryngeal ventricle, the testicular appendix and the paraovarian appendages vesiculosae; The middle lobe of the prostate is the "caruncle of Morgagni" and we call the navicular fossa of the urethra "crypt of Morgagni"; The columnae and anal sinuses are the "columns and sinuses of Morgagni." Several spaces we know today as "Morgagni foramina", including the lingual cecum (foramen cecum linguae), the singular of the inner ear (foramen singulare) or the pleuroperitoneal (sternocostal trigone or also Larrey's fissure).

Likewise, he has left us the detailed description of numerous lesions such as cerebral gums, acute yellow atrophy of the liver, renal tuberculosis or aneurysms, always as autopsy findings related to the clinical picture that the patients presented in life.

This is also the case with mitral disease. We call "Morgagni syndrome" the association of frontal hyperostosis, virilism and obesity, and we owe Morgagni the first precise description of heart block ("Morgagni-Stokes-Adams disease"), which explains a case of sudden loss of consciousness accompanied by convulsions.

"Morgagni's hernia" today refers to the congenital retrosternal diaphragmatic hernia, with expulsion of abdominal tissue into the thorax through the small sterno-costal space (one on each side of the diaphragm) that gives way to the superior epigastric vessels and which we call the foramen. pleuroperitoneal or Morgagni.

Morgagni was appointed member of various European Scientific Academies, such as London, Paris and Berlin and St. Petersburg.