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February 27, 2017
Chronologic Approach 16th Century

16th Century

Galenic Teaching

For more than 1400 years, Galen's concept of the cardiovascular anatomy, blood motion and humoral theory of disease had prevailed in Europe. Claudius Galen is considered the last great Greek physician and philosopher of the antiquity. He believed in the concept of "pneuma" or "spirit" and described three distinct types: Pneuma physicon, or natural spirit that was created in the liver, Pneuma zoticon, or vital spirit that was generated in the left ventricle, and pneuma psychicon, or animal spirit which was the true substance of the soul and created in the brain.

Galen considered the heart as primarily an organ of respiration and the production of animal heat.

According to Galen, the blood was formed in the liver and then transported via the vena cava to the right ventricle during diastole. During the same time the air was transported from the lungs via the pulmonary veins to the left ventricle. During the systolic phase, the blood from the right ventricle was passed into the lungs to nourish them. The blood was also passed from the right to left ventricle through small and invisibles pores in the interventricular septum. In the left ventricle, the blood and air were mixed forming "vital spirits" which was then conveyed to the entire body via the arterial system. Another function of the lungs and the heart was to clean the blood from its impurity. That function was accomplished by the transport of the blood through the pulmonary artery during the expiratory phase of respiration.

Cesalpino Andrea

From anatomic point of view, he considered the heart as a two-chamber structure. The right and left atrium were described as reservoir chambers and were not an integral component of the heart. According to his theory of blood motion, the valves were incompetent allowing the blood circulation in both directions. The mitral valve was particularly considered incompetent as it was only composed of two valvules or leaflets.

Galen's humoral theory of disease was based on the concept that disease resulted from an imbalance between the 4 humors which were blood, phlegm, yellow bile and black bile. They were directly linked to four elements of fire, water, air, and earth respectively. This aberrant concept therefore ignored the anatomic structural changes that could affect negatively an organ function as well as abnormal physiologic conditions that could lead to an end organ dysfunction.

Cesalpino Andrea

Galeni omnia qvae extant opera. Venetiis: Apud Iuntas, 1550