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July 29, 2014
18th Century Giovanni Maria Lancisi

Giovanni Maria Lancisi (1654-1720)

De subitaneis mortibus libri duo. Romae, J. F. Buagni, 1707.

De motu cordis et aneurysmatibus. Romae, J. M. Salvioni, 1728.

Giovanni Maria Lancisi
Portrait of Giovanni Maria Lancisi
Portrait of Giovanni Maria Lancisi


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Giovanni Maria Lancisi was an anatomist, clinician and epidemiologist. He was one of the greatest Italian physicians of the first half of 18th Century and shares with Vieussens the honor of laying the foundation of cardiac pathology.

In 1705, Lancisi investigated an epidemic of sudden death in Rome at the request of Pope Clement XI.  He performed a significant number of autopsies to identify the causes of death among the victims. The results of his research were published under the title, "De subitaneis mortibus" (On sudden death), in 1707.

 One of the major findings of this famous work was that structural abnormalities of the heart and the great vessels could be at the origin of sudden death. Among the etiologies of sudden death he reported cerebral hemorrhage, vegetations on the heart valves, severe obstruction of coronary arteries, cardiac hypertrophy and dilatation, and arterial aneurysms.

Lancisi's other classic monograph, "De motu cordis et aneurysmatibus" (On the motion of the heart and on aneurysms), was published posthumously in 1728. Lancisi displayed in this monograph his views on cardiovascular anatomy and diseases and particularly on cardiac enlargement. The term aneurysm is used throughout the book to refer to cardiomegaly or cardiac enlargement.

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Cesalpino Andrea Cesalpino Andrea


Lancisi noted first that in patients with cardiac enlargement, dilatation affects more frequently the atria compared to the ventricles (proposition LII). He explained that "...the reason why this happens must be deduced entirely from the weaker resistance of the auricles and the stems of the veins, since we must take into account the strong and manifold tissue of the ventricles, especially the left..."

Latin version                                                  English version

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In proposition LIII, Lancisi reported a case of "ossification of the aortic valve". He also noted that the lesions of the aortic valve orifice had created a disturbance in the circulation of the blood that led to cardiac enlargement.   In his account, Lancisi wrote "...that of the valves of the aortic orifice one had become ossified and two cartilaginous, and from this cause the path of blood from the heart into that artery had become markedly narrow. In the same subject we found also that the vena cava and the right auricle and ventricle were so dilated that they would admit the fist. But there we observed, not without surprise , that the left cavities of the heart were quite sound and had not suffered at all from dilatation."  Lancisi also stressed that if the dilatation of left-sided chambers occurs that will affect the left atrium with a greater frequency compared to the left ventricle.

Latin version                                                  English version

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In proposition LVII, Lancisi described one of the first cases of cardiac enlargement with tricuspid insufficiency. He also explained that the vein neck distension was a consequence of dilatation of right-sided cardiac chambers with significant tricuspid regurgitation ( Lancisi's sign). In his observation, Lancisi remarked:

"From the dilatation of the right auricle and ventricle there are two especially important results that are worth most careful consideration, for it is they above all that bring about the alternating dilatation of the jugulars. In the first place, when these cavities are extremely dilated and enlarged, a far too large amount of blood is collected in them; next, the orifice of the stem of the vena cava also becomes too large for it to be completely closed by the valves attached to it. Thus it comes to pass that, when the heart contracts, the blood from the right ventricle is not only propelled into the lungs through the pulmonary artery, but both beacuse of its excessive amount and on account of the incompletely closed valves at the mouth of the vena cava, it is driven back again through the gaping chinks of the valves and forced back along the whole path of the superior vena cava; then from that path it flows straight into the jugulars more violently than into the other branches of the cava, because the jugulars are situated directly in line with the motion of the blood."

Proposition LVII was illustrated with a historical engraving demonstrating tricuspid valve insufficiency due to the dilatation of the annulus and the right atrium.  The sign of  jugular vein distension with "neck venous pulsation" would be rediscovered and described two centuries later by Sir James MacKenzie using a polygraphe. 

                                                                                    Latin version                                            English version 

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Cesalpino Andrea Cesalpino Andrea

Finally, it is important to note that Lancisi was among the first to mention syphilis as an important cause of aortic aneurysms.

REFERENCES

Lancisi GM. De subitaneis mortibus libri duo. Romae, Francis Buagni,1707

Lancisi GM. De Aneurysmatibus,opus Posthumum. Aneurysms, the Latin text of Rome, 1745. Revised, with translation and notes by Wilmer C. Wright. New York, Macmillan Co.,1952

Castiglioni A.  Italian medicine. New York, Paul B. Hoeber,1932

Fye WB. Profiles in cardiology: Giovanni Maria Lancisi 1654-1720. Clin Cardiol 1990;13:670-671

Foote J. Giovanni Maria Lancisi (1654-1720). Int  Clin 1917;2: 292


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Raymond Vieussens Jean Baptiste de Senac


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