JMS Pearce
Hull, England

The four great early schools of medicine were in Alexandria, Bologna, Pavia, and Padua. Herophilus and Erasistratus initiated rational anatomy and physiology at the Alexandrian school of medicine founded c. 300 BC. In the second century AD, they were succeeded by Rufus of Ephesus—the medical link between Hippocrates of Cos, Galen of Pergamum (AD 129–199), and Aretaeus, the leading physician of Cappadocia. A prolonged dark age followed when dissection was prohibited and there was little interest in biological science, natural history, or experimentation until the tenth and eleventh century Persian scholars Avicenna and Rhazes.

The advent of the Italian schools of Bologna and Padua renewed the quest for academic progress. The famous Lion of St. Mark and St. Mark’s Basilica, built especially to house its patron’s ancient relics, were symbols of the city republic of Venice. In 1440, Venice incorporated the ancient university of Padua founded in 1222 and made it a premier institution,¹ free of papal control, where scholars and professors leaving the older universities of Bologna and Salerno sought greater academic independence. Padua became home to eminent scholars, many guided by the maxims of Aristotle in science and the arts (humanitas).² Shakespeare referred to “…the great desire I had/ To see fair Padua, nursery of arts” (Taming of the Shrew 1.1), reflecting Padua’s eminence in disciplines other than medicine.³ It is easy to forget that many medieval concepts of knowledge were dominated by religious mysticism, superstition, astrology, and by Jean Fernel’s idea that celestial heat operates in living bodies.

Padua’s history of scholarship was at times marred by turbulent periods of political and military restrictions, but it slowly advanced. To prevent nepotism, Venetian noblemen were barred from academic office. Chairs were given mainly to intellectuals from outside the city. The university was disciplined, progressive, and produced notable scholars including theologians, lawyers, physicians, surgeons, philosophers, mathematicians, and astronomers.⁴ Amongst their number were: physician-philosopher Pietro d’Abano, poets Francesco Petrarca and Pietro Bembo, humanist Giacomo Casanova, botanists Prospero Alpino and Pietro Arduino, physician-astronomer Nicolaus Copernicus, philosopher-scholar Elena Cornaro Piscopia (the first Western woman to receive a doctorate), and mathematician-astronomer Galileo Galilei.

The Padua School of Medicine⁴

The medical school started during the Renaissance in the “golden age” between the sixteenth and seventeenth centuries, by which time Padua had forged links with other universities in central and Western Europe.

Padua created highly organized professorial medical chairs in:

• Theoretical medicine, still dependent on Galenic doctrines, which focused on the etiology of disease, clinical features and treatment;
• Practical medicine based on clinical cases, many founded on the works of Avicenna and Rhazes;
• Anatomy and surgery founded on animal and human dissections;
• Botany derived from the Padua botanic garden;
• Semiotics, which applied iatromechanics to medical theory.

Students were taught symptoms and physical signs of disease in patients in the local hospitals. The catalogue of medical discoveries of Padua is vast.

Anatomy

After the dark ages of prohibition inflicted by the church that followed the anatomists of Alexandria,^5,6 dissections were largely re-established, at first in Bologna by Mondino de’Luzzi whose book Anathomia (1316, not printed until 1478) was the first illustrated manual of anatomy after Galen.

In Padua, anatomy progressed when Girolamo Fabrici (? 1537–1619) of Acquapendente, a surgeon and innovative embryologist, designed the first Teatro Anatomico in 1594.

Almost forty years later in Bologna, an elliptical Teatro Anatomico was built inside the Palazzo dell’Archiginnasio, carved in spruce wood; it had six tiers to facilitate students’ views of dissections on the marble table.⁶

Even before anatomical theaters, the Belgian Andreas Vesalius (1514–1564) at the age of twenty-three was appointed professor of anatomy and surgery at Padua.³ Anatomical material was scarce, but in 1539 when a Paduan judge became impressed by Vesalius’s work, it was decreed that he could perform dissections on the bodies of executed criminals. When only twenty-nine years old, he published in 1543 his results in the famous De humani corporis fabrica Libri septem, illustrated profusely by Jan Stephan van Calcar (1499–1546), a pupil of Titian. Before Vesalius, medical texts were mostly derived from Greco-Roman and medieval Arabic tracts, many destroyed, some suffering from inaccuracies of translation. Vesalius’s magnum opus corrected longstanding errors in Galen’s anatomy, which was based on animal, not human dissections. De fabrica was the bedrock of all subsequent anatomical texts. It transformed anatomy.

Many distinguished anatomists from Padua followed. Gabriele Falloppio (1523–1562) taught anatomy, surgery, and botany in Padua. Admired by his friend Vesalius, he described the eponymous uterine tube, the facial canal, the minute structures of the middle and inner ear, and the ileocecal valve. He died aged thirty-nine. Realdo Colombo, who succeeded Vesalius, was said by William Harvey to be the first to describe the pulmonary circulation. Giulio Cesare Casserio in Tabulae anatomicae (1627) and Johannes Vesling in Syntagma anatomicum (1647), both described the arterial circle at the base of the brain before Thomas Willis with Richard Lower and Christopher Wren provided the first complete illustration in 1664 in Cerebri Anatome.⁷ (The Swiss Johannes Jakob Wepfer, known as The Hippocrates of Helvetia, in 1658 had also accurately described the arteries at the base of the brain although Willis is often credited as the first.⁸)

Medicine surgery and pathology

The countless accomplishments and advances of the medical Renaissance unfortunately read like a truncated encyclopedia. In Padua, Giovanni De Monte (Montanus) (1498–1552) was the first to introduce into the curriculum the study and practice of clinical features observed at the bedside, based on patients in the hospital of St. Francis. Montanus was professor of practical medicine at the Universities of Ferrara and Padua. A friend of Vesalius and editor of Galenic texts, his students included John Caius, second founder of Gonville and Caius College Cambridge who graduated in Padua in 1541.

Santorio Santorio (1561–1636), professor of medical theory, was a stalwart of the iatrophysical school of medicine. He devised methods of measurement of body weight, insensible sweating, pulse, and temperature. His Ars de statica medicina was the first text to advise and apply quantification and experimental procedures. He devised a pulsimeter, a hygrometer, and a clinical thermometer.

William Harvey (1578–1657) studied at the University of Padua from 1599 to 1602. He said that his teacher Girolamo Fabrici was the principal inspiration for his original and revolutionary demonstration of the human heart and circulation Exercitatio Anatomica De Motu Cordis et Sanguinis in Animalibus (1628).

…the blood by the beat of the ventricles flows through the lungs and heart and is pumped to the whole body. There it passes through pores in the flesh into the veins through which it returns from the periphery everywhere to the centre, from the smaller veins into the larger ones, finally coming to the vena cava and right atrium… the blood in the animal body moves around in a circle continuously and that the action or function of the heart is to accomplish this by pumping.

The study of the pancreas arose from two murders in Padua in 1642/3. Johann Georg Wirsung (1589–1643) was a prosector at Padua who in March 1642 demonstrated the pancreatic duct in the dissection of Zuane Viaro della Badia, hanged in the Piazza del Vin for murder. His assistant Moritz Hoffman vehemently disputed priority for the discovery and was suspected of instigating the subsequent assassination of Wirsung in August 1643, though this was never proved.*

Giovanni Battista Morgagni (1682–1771) studied the writings of Valsalva and of Marcello Malpighi, the foremost microscopist of Bologna. Morgagni published De Sedibus et causis morborum per anatomen indagatis (1761), an extraordinary and original treatise on pathological anatomy. By performing necropsies on patients he had personally examined, he compared signs and symptoms with pathological findings, thus inventing the system of morbid anatomy and clinico-pathological correlation. Morgagni’s work marked an epoch in medical science, reflected in the treatise The Morbid Anatomy of some of the most Important Parts of the Human Body (1793) by the much-revered Matthew Baillie (1761–1823), a nephew of the Hunter brothers.

Girolamo Fracastoro (c.1478 –1553) was a brilliantly original physician, geologist, astronomer, and colleague of Copernicus, who in De contagione et contagiosis morbis (1546) proposed a theory of transmissible disease 300 years before Henle’s “miasms and contagions and on miasmatic-contagious diseases” in 1840, and before Pasteur in 1863 and Koch in 1876 showed that microbes caused infectious diseases. Remarkably, Fracastoro presciently concluded that seminaria [nurseries of infection] had the power to “propagate and engender themselves”; they were caused by rapidly multiplying minute bodies transmitted by direct contact, by soiled clothing, or in the case of typhus, through the air. Fracastoro is best known for his poem “Syphilis sive morbus Gallicus” (1530)—”the French disease”—in which he described and named syphilis.^9,10

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The Venetian senate ruled the city of Padua and through its university encouraged learning and liberal, uncensored thought and research. It attracted many students and scholars from Europe and was the chief center for the training abroad of English students (most famously Thomas Linacre in c. 1492, and William Harvey) until about 1670 when many students chose Leyden.³ Despite the university’s temporary decline towards the close of the eighteenth century, its academic tradition has continued with researchers from Padua making discoveries of importance in many major medical specialties.

End note

* The story, full of intrigue, is related by Dr. Ligresti at https://www.linkedin.com/pulse/murder-padua-rosario-ligresti-md-fasge

References

1. Rossetti L. The University of Padua. An Outline of Its History. Trieste: Edizioni Lint; 1983.
2. De la Croix D, Vitale M. Scholars and Literati at the University of Padua (1222–1800). Repertorium Eruditorum Totius Europae 2021;3:33-42.
3. O’Malley CD. The lure of Padua. Medical History. 1970;14(1):1-9.
4. Zampieri F, Zanatta A, Elmaghawry M, Bonati MR, Thiene G. Origin and development of modern medicine at the University of Padua and the role of the “Serenissima” Republic of Venice, Global Cardiology Science and Practice 2013; (2):149-62.
5. Clarke E, and O’Malley CD. The Human Brain and Spinal Cord: A Historical Study. 2nd edn San Francisco, Norman. 1996, pp. 22-3.
6. Pearce JMS. Foundations of Anatomy in Bologna. Hektoen Int Fall, 2017.
7. Willis T. Cerebri Anatome: cui accessit nervorum descriptio et usus. London, 1664. From Hughes JT. Thomas Willis 1621-1675: His Life and Works, Royal Society of Medicine Press, 1991.
8. Meyer A, Hierons R. Observations on the history of the ‘circle of Willis’. Med Hist. 1962;6(2):119-30.
9. Quétel C. History of Syphilis. Translated by Judith Braddock and Brian Pike. Johns Hopkins University Press, 1990.
10. Pearce JMS. The origins of syphilis. In: Fragments of Neurological History. London, Imperial College Press. 2003. Chapter 122: 558-63.