Makers of Modern Medicine

by James J. Walsh

It is interesting to note that comparative [{45}] pathology--that is, the study of the diseases of animals as illustrating corresponding conditions in human beings--had already attracted the attention of the Bolognese school of medicine. Albertini, who had been a professor of Morgagni's, pointed out that aneurisms are rarely found in animals, because brutes were not subject to emotions as are human beings. Morgagni made still further observations in this line to confirm his own conclusions in the matter. For a time in his earlier life he devoted himself to the study of fishes, because they seemed to promise to throw light on certain problems in human anatomy and pathology.

How closely he studied pathological changes in tissues can be gathered from the fact that his observations led him to point out that aneurism of the aorta occurs most frequently at that part of the curvature of the aorta against which blood is constantly projected by the heart. The realization of the importance of this mechanical factor in the production of aneurism is one of the first successful results of carefully applied observation and knowledge of physical laws in the causation of changes in the tissues as opposed to elaborate theories with very little foundation in fact.

Variations in the pulse attracted his attention, and he was among the first to point out that the occurrence of flatulency is liable to cause disturbance of the heart's action and to bring on noticeable cardiac palpitation in the absence of any organic affection of the heart itself. Morgagni also pointed out that intermittence of the pulse may be due to nervous conditions. He showed that severe mental shock or trying emotions may cause irregularity of the heart's action and pulse intermittency. Some of his observations in this matter show an intuition with regard to the nerve supply of the heart that is quite beyond the anatomy of his time, and seems to indicate that he suspected the existence and [{46}] function of the sympathetic system and also the existence of a special nerve supply to the small arteries.

Perhaps Morgagni's most penetrating evidence of insight in pathology and its relations to clinical medicine is with regard to tuberculosis. Over a century and a half ago he insisted on its contagiousness. He refused to make autopsies on patients who had died of tuberculosis, and his position in the matter was undoubtedly of the greatest service in directing the attention of his contemporaries, and especially those closely in contact with him, to the important question of intimate association with tuberculous patients as a potent factor in the acquirement of the disease, more potent even than heredity which then occupied all men's minds on this subject.

It might be deemed that this advanced position of Morgagni was due rather to intuitive abhorrence of the disease than to the conviction of actual observation, and that his conclusions were the result more of prejudice than of real knowledge. Any such opinion, however, is absolutely contradicted by the fact that he knew and understood better than any one of his generation the pathology of consumption. He pointed out at a time when any chronic affection of the lungs was liable to be considered consumption that there are a number of forms of chronic bronchitis that are not due to pthisis pulmonalis, but to other slow-running conditions within the lungs.

He anticipated very completely the present position of surgery with regard to the treatment of cancer. He advised the operative removal of these malignant tumors whenever possible. As Benjamin Ward Richardson points out, this advice was given evidently not with the idea that the disease could be always thus completely cured, but because early operation gave speediest relief of annoying [{47}] symptoms and assured the greatest prolongation of life. Many other methods of removal of cancerous growths were suggested in Morgagni's time, as in our own, and many false promises made and false hopes raised by their advocates. He pointed out that the quickest, the safest, the surest and in the end, for the patient, the easiest method of removal is by the knife in the hands of the bold and skilful surgeon. After a century and a half of vauntedly great advance, especially in surgery, we are practically in the same position as when Morgagni's advice was penned, and his opinion remains practically as valuable to-day as then.

In another important point of medicine Morgagni seems to have anticipated the opinion of our own time. It was the custom to practise venesection very freely. On one or two occasions in his own lifetime Morgagni fell ill and venesection was recommended. His biographer says that he constantly refused this method of treatment, adding very naively, "and he who had often cured others by venesection would never allow this remedy to be used upon himself because, as I believe, he had a natural abhorrence to it."

It was an index of thoroughgoing independence of thought in those days to stand out, even for personal reasons, against the overwhelming tradition in favor of blood-letting. But Morgagni had well-grounded doubts as to the remedial efficacy of abstraction of blood, and at least avoided it in his own case.

Besides his skill in practical and theoretic medicine, Morgagni was a man of cultivated taste in art, and he was conversant not only with the literature of his own language, but also of French, Latin and Greek. He was always welcomed in the literary circles of the cities of Northern Italy, and counted among his friends many of the great writers of the time. His success in winning the friendship of rulers was especially [{48}] noteworthy, and had not a little influence for the advantage of education and science. The patricians of Venice were proud to consider him as a personal friend, and to the Venetian Senate he owed his professorship at Padua. The King of Sardinia, Emanuel III, looked upon him as an intimate acquaintance. All the Popes, five in number, of the second half of his life were on terms of personal intimacy with him, and his advice was asked on many important questions with regard to educational matters in his own day.

Some of these Popes are among the most influential pontiffs that ever occupied the Roman See. The great Benedict XIV, himself a native of Bologna and an intimate friend of the scientist, in his classic work "De Beatificatione Servorum Dei" mentions Morgagni in terms of special commendation. His scarcely less famous successor, Clement XIII, had often consulted Morgagni professionally at Padua before his elevation to the See of Rome. After his election as Pope he assures Morgagni of his continued esteem and friendship, and asks him to consider the Vatican always open to him on his visits to Rome. In an extant letter Clement praises his wisdom, his culture, his courtesy, his charity to God and men, and holds him up as an example to others, since with all his good qualities he had not aroused the enmity or envy of those around him.