Engines of Our Ingenuity

No. 358:

by John H. Lienhard

Click here for audio of Episode 358.

Today, we meet the father of pathological anatomy. The University of Houston's College of Engineering presents this series about the machines that make our civilization run, and the people whose ingenuity created them.

Hippocratic medicine gave us two ideas. One is that the physician treats the whole patient. The other is that he must learn to hear the things his senses tell him.

17th-century physicians had forgotten Hippocratic empiricism. The cure of disease had turned from observation into an exercise in logic. Physicians still believed that treatment must address the whole body, but they'd let that idea wander strangely off track. They believed disease was caused by gross imbalances of body fluxes and humors, and that's what they tried to treat.

That began changing in Italy during the 1600s. Italy was the new center of medical science and anatomy. Her anatomists were learning how the body worked, but not how to localize disease. They kept trying to fight it by adjusting body humors.

Giovanni Morgagni entered medical school at Bologna as the century ended, and he graduated in 1701. From then on, he worked to make sense of disease using anatomy and dissection.

Sixty years later he published The Seats and Causes of Disease Investigated by Anatomy. That book set the foundations of pathological anatomy. The key word in its title is Seats. For it was here that Morgagni showed that we cannot understand disease until we've pinned it down within the body.

The book is written in five parts. Four deal with the head, the belly, the thorax, and generalized disease. The fifth part is a meticulous index, and that was the key. By including it, Morgagni kept sight of the whole body as he led us to seats of illness in its various parts. The work is more than a museum of case histories. It provided a road map at the same time it took us on the trip. When he was done, clinicians and scientists alike could trace the symptoms they saw back to common origins.

Morgagni showed beyond any doubt that specific disorders cause suffering and death. We find a ruptured appendix, syphilis of the aorta, and epidural hematoma. A lifetime of compassion and clear thinking lies behind this chamber of horrors. A great change in medical thinking unfolds, case by case, as we read.

Human ingenuity takes many forms. Morgagni's genius lay in a change of perception. He gave medicine a new way to see illness. What he did was radical and revolutionary, but patient and methodical at the same time.

Historians can usually find feet of clay, or a mean streak, in heroes. But not Morgagni. His powerful religious and humanitarian convictions drove him to work without haste and without rest until he was 89. He was still going strong when he died of a stroke in 1771.

I'm John Lienhard, at the University of Houston, where we're interested in the way inventive minds work.

(Theme music)

Nuland, S.B., Doctors, the Biography of Medicine. New York: Random House, Inc., 1989, Chapter 6.

See Episode 1095 for the aftermath of Morgagni's thinking.

The Engines of Our Ingenuity is Copyright © 1988-1997 by John H. Lienhard.

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