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March 29, 2017
18th Century Giovanni Battista Morgagni

Giovanni Battista Morgagni (1682-1771)

Adversaria anatomica omnia. Venetiis, typog. Remondiniana.1719

De sedibus, et causis morborum per anatomen indagatis libri quinque. 2 vols. Venetiis, typog. Remondiniana, 1761.

Giovanni Battista Morgagni
Portrait of Giovanni Battista Morgagni
Portrait of Giovanni Battista Morgagni


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Giovanni Battista Morgagni was an Italian physician and anatomist and is considered one of the greatest physicians of the 18th century. He is recognized as the founding father of anatomo-pathology. He studied philosophy and medicine at the University of Bologna and graduated in 1701.

His initial appointment was as an assistant to Antonio Maria Valsalva, the great anatomist who had been a pupil of Malpighi. His collaboration with Valsalva led to the publication of his first book, "Adversaria anatomica Prima." His "Adversaria anatomica omnia" appeared in 1719 and underwent multiple re-editions allowing him to get recognition across Europe. The most complete version of this monograph appeared in 1762.

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Cesalpino Andrea

Morgagni published his most important work, "De sedibus, et causis morborum per anatomen indagatis," in 1761, when he was 79 years old. This monumental work was written over a period of 20 years after Morgagni published Valsalva's "Opera omnia" in 1740 (see below).

After Vesalius' De fabrica and Harvey's De motu cordis, Morgagni's De sedibus is viewed as the third most important publication in the history of medicine. This outstanding work regroups about 650 observations with a detailed clinical description followed by postmortem autopsy findings. The originality of this work was the systematic attempt to correlate the clinical symptoms with pathological findings introducing the anatomical concept of the disease, laying the foundation for the field of anatomo-pathology. Morgagni was convinced that postmortem autopsy examination was indispensable to the understanding of a disease.

De sedibus was divided into five sections:

     Diseases of the head

     Diseases of the thorax

     Diseases of the abdomen

     Diseases of a general nature and diseases treated by surgery

     Supplement

In section two on the diseases of the thorax, Morgagni described several clinical observations of major significance covering the entire spectrum of cardiovascular disorders. He described several cases of ossification (term used instead of calcification) of cardiac valves involving the aortic or mitral valve. He agreed with Lancisi's observation that valvular diseases could be at the origin of cardiac enlargement. He also described cases of aortic valve endocarditis, aortic aneurysm, purulent pericarditis, ventricular rupture, chest pain accompanied with postmortem findings of calcified coronary arteries and a case of heart block.

Regarding his observation on mitral stenosis, Morgagni wrote:

"Peter Fasolati, an engraver, at Padua, in the sixty-second year of his age, yet still of a full habit, and liable to no indisposition, died at the very same season as Tita (m), and even the very day after him, in the following manner. He had gone through no labour, had not been troubled with care and anxiety, as he had been used at other times, and made no complaint of anything . He had even supped heartily, forhe always used to eat freely; and desired to go to bed more early than usual, which he did: but two hours afterwards, his wife happening to wake, found him not only dead, but even cold, and streched out in the same manner he had layed himself when he went to bed.

The day following, when the integuments of the cranium were cut into, and while the upper part of the skill was sawed through, and taken off, much blood was discharged. Yet there was none at all extravasated within the skull; none in the substance of the cerebrum, or cerebellum: and both these parts seemed, to the touch, to be perfectly natural: there was, I say, nothing raptured, nothing injured in any part. There was some water in the lateral ventricles almost limpid, but in small quantity; and some also seemed to flow from the sides of the cerebellum, which was found as I have said; or might it not come from the tube of the vertebrae? But such a quantity of fluid blood distended all the vessels in and about the brain, that I do not remember to have seen the like before: even some small vessels, which used to be scarcely perceptible, were extremely large and turgid. I ordered, however, that the thorax should be opened also. The left lobe of the lungs was strongly connected to the ribs, but both of them were sound. The colour of the fat, in the mediastinum, was brown; which I attributed to the blood remaining in the smallest vessels. In the pericardium was some bloody water, but not much. The heart was large, and its proper vessels and auricles turgid with blood, which came forth very black and grumous while the heart was cut off from its larger vessels, that I might examine it the more closely, out of the body. The blood was also black and grumous in the ventricles of the heart, yet not in very great quantity. The right valvula mitralis was white; and in like manner some of the semilunar valves: the former were much harder than usual, and the latter a little so: but in both mitral and semilunar, the membranous nature had degenerated almost into the nature of a ligament. In the middle and posterior surface of the heart, a kind of little membrane protruded, of a white colour, and looked like the remains of an hydatid. On the right auricle externally, also, were some white spots. But the aorta and other vessels, as far as I could see, were according to their natural appearances..."

The original text of this observation is displayed here in Latin and French.

  Latin Version                                                                                                                 French Version

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In 1740, Morgagni published the anatomic writings of his mentor Antonio Maria Valsalva, under the title "Opera."  For the first time in this work, the detailed  anatomy of the aortic root  and the first description of the aortic sinuses or so-called sinuses of Valsalva were presented.

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REFERENCES

Morgagni GB. The seats and causes of diseases. Translated by Benjamin Alexander, 3 Vols. London, Johnson and Payne, 1769

Morgagni GB. Recherches anatomiques sur le siege et les causes des maladies.Traduit par Desormeaux A et Destouet P, 10 Vols. Paris, Chez Caille et Ravier, 1820-1824

Virchow R. Morgagni and the anatomic concept. Bull Hist Med 1929;7:975-990

Ventura HO. Profiles in cardiology: Giovanni Battista Morgagni and the foundation of modern medicine. Clin Cardiol 2000;23:792-794


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