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A Moment in History 

Title page of Anathomia Corporis Humanis by Mondino de Luzzi. Image courtesy of the National Library of Medicine
Title page of "Anathomia Corporis Humanis" by Mondino de Luzzi

Alessandra Giliani

 
(1307 – 1326

Italian prosector and anatomist. Alessandra Giliani is the first woman to be on record as being an anatomist and prossector. She was born on 1307 in the town of Persiceto in northern Italy.

She was admitted to the University of Bologna circa 1323. Most probably she studied philosophy and the foundations of anatomy and medicine. She studied under Mondino de Luzzi (c.1270 – 1326), one of the most famous teachers at Bologna.

Giliani was the prosector for the dissections performed at the Bolognese “studium” in the Bologna School of Anatomy. She developed a technique (now lost to history) to highlight the vascular tree in a cadaver using fluid dyes which would harden without destroying them. Giliani would later paint these structures using a small brush. This technique allowed the students to see even small veins.

Giliani died at the age of 19 on March 26, 1326, the same year that her teacher Mondino de Luzzi died.  It is said that she was buried in front of the Madonna delle Lettere in the church of San Pietro e Marcellino at the Hospital of Santa Maria del Mareto in Florence by Otto Agenius Lustrulanus, another assistant to Modino de Luzzi.

Some ascribe to Agenius a love interest in Giliani because of the wording of the plaque that is translated as follows:

"In this urn enclosed are the ashes of the body of 
Alessandra Giliani, a maiden of Persiceto. 
Skillful with her brush in anatomical demonstrations 
And a disciple equaled by few, 
Of the most noted physician, Mondino de Luzzi, 
She awaits the resurrection. 
She lived 19 years: She died consumed by her labors 
March 26, in the year of grace 1326. 
Otto Agenius Lustrulanus, by her taking away 
Deprived of his better part, inconsolable for his companion, 
Choice and deservinging of the best from himself, 
Has erected this plaque"

Sir William Osler says of Alessandra Giliani “She died, consumed by her labors, at the early age of nineteen, and her monument is still to be seen”

The teaching of anatomy in the times of Mondino de Luzzi and Alessandra Giliani required the professor to be seated on a high chair or “cathedra” from whence he would read an anatomy book by Galen or another respected author while a prosector or “ostensor” would demonstrate the structures to the student. The professor would not consider coming down from the cathedra to discuss the anatomy shown. This was changed by Andreas Vesalius.

The image in this article is a close up of the title page of Mondino’s “Anothomia Corporis Humani” written in 1316, but published in 1478. Click on the image for a complete depiction of this title page. I would like to think that the individual doing the dissection looking up to the cathedra and Mondino de Luzzi is Alessandra Giliani… we will never know.

The life and death of Alessandra Giliani has been novelized in the fiction book “A Golden Web” by Barbara Quick.

Sources 
1. “Books of the Body: Anatomical Ritual and Renaissance Learning” Carlino, A. U Chicago Press, 1999 
2. “Encyclopedia of World Scientists” Oakes, EH. Infobase Publishing, 2002 
3. “The Biographical Dictionary of Women in Science”Harvey, J; Ogilvie, M. Vol1. Routledge 2000 
4. “The Evolution of Modern Medicine” Osler, W. Yale U Press 1921 
5. “The Mondino Myth” Pilcher, LS. 1906 
Original image courtesy of NLM
 


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Ventricular system of the brain

The ventricular system of the brain is an interconnected system of cavities and ducts within the brain through which cerebrospinal fluid (CSF) circulates. The CSF is produced in the choroid plexuses located within the ventricles.

There are two large curved lateral ventricles, each found within a cerebral hemisphere. They connect with the third ventricle via an opening called the "foramen of Monro". The third ventricle connects with the fourth ventricle by way of a slender canal called the "cerebral aqueduct" or the "aqueduct of Sylvius".

The third ventricle is found deep within the brain between the right and left diencephalic portion of the cerebrum.

The fourth ventricle is located between the pons of the brain stem anteriorly and the cerebellum posteriorly. This ventricle has a rhomboidal shape and it connects with the external aspect of the brain and the subarachnoid space. Failure of this CSF drainage from the ventricles to the subarachnoid space can lead to pathological accumulation of CSF within the ventricles and hydrocephalus.

The superior image shows a lateral view of the brain with a superimposed image of the ventricular system. If you click on this image, you will see a superior view of a cast of the ventricular system (by Retzius). More information on these images at www.bartleby.com.

The inferior image shows a posterior view of the brain stem and the cerebellum which has been opened in the median plane to expose the 4th ventricle. Click on the image to see a larger version.

Ventricular system of the brain (www.bartleby.com)
Superior image courtesy of: www.bartleby.com
4th ventricle - Human brain dissectionInferior image property of: CAA.Inc.
Photographer: Efrain Klein


Cerebrospinal fluid

The cerebrospinal fluid (CSF) is a colorless, transparent fluid produced from the arterial flow of blood by the choroid plexuses found within the ventricular system of the brain. The CSF exits the ventricular system and enters the subarachnoid space and its cisterns. It is then absorbed at the level of the arachnoid granulations into the venous component of the cardiovascular system.

The CSF has many functions, some of them being protection, the creation of a fluid environment where the brain 'floats", cleansing, and others. For a more detailed description of the CSF, click here.

The CSF is produced at an average rate of 550-700ml/day. It is absorbed at the same rate. An imbalance between production and absorption of CSF (as well as a blockage within the ventricular system) can lead to an accumulation of CSF within the brain, causing hydrocephalus.


Hippocrates of Cos


This article is part of the series "A Moment in History" where we honor those who have contributed to the growth of medical knowledge in the areas of anatomy, medicine, surgery, and medical research.To search all the articles in this series, click here.

Hippocrates of Cos (460 BC - 370 BC). A Greek physician, Hippocrates was born on the Greek island of Cos (Kos) c. 460BC. Considered the "Father of Medicine" he removed Medicine from the realms of superstition and magic. He was the first to record medical writings and is considered the first one to use and maintain proper medical terminology. There are many writing attributed to Hippocrates, but there is no assurance that these were actually written by Hippocrates himself. Hippocrates changed the art of medical diagnosis by replacing supernatural precepts with observation-based methodology. Natural, rather than supernatural causes, would from here on explain all disease processes, what was known as Rational Medicine.

He is known for having set the oath that governs medical principles, the Hippocratic Oath, although there are many authors that contend that this oath was written long time after he died.

Sources:
1. "Hippocrates himself" JAMA. 1968;204(12):1138-1139

2. "Hippocrates: father of medicine" Tan, S Y (01/01/2002). Singapore medical journal(0037-5675), 43(1), p.5.

Original image courtesy of  www.nih.gov

Atrioventricular sulcus

This is a combined word arising from terms [atrium], [ventricle], and [sulcus]. For the etymology of each word, click on the corresponding link.

The atrioventricular sulcus, also know as the "coronary groove" or "coronary sulcus" is an evident incomplete groove between the atria and ventricles of the heart. It is complete posteriorly and is separated anterosuperiorly by the roots of the aorta and the pulmonary trunk.  It contains the right coronary artery on the right side, and the circumflex artery on the left side, hence the name "coronary groove". These coronary arteries are not visible as they are usually covered by subepicardial fat.

The atrioventricular sulcus (and the corresponding coronaries) are also in relation to the deeper situated atrioventricular (AV) valves, the tricuspid valve on the right; and the mitral or bicuspid valve on the left side. The accompanying image depicts the location of the AV valves, and therefore the location of the AV sulcus.

Source: "Gray's Anatomy"38th British Ed. Churchill Livingstone 1995

Anterior view of the thorax, showing surface relations of bones, lungs (purple), pleura (blue), and heart (red outline). P. Pulmonary valve. A. Aortic valve. B. Bicuspid valve. T. Tricuspid valve (www.bartleby.com)

Images courtesy of www.bartleby.com 
Click on the image for a larger version.
Anterior view of the thorax, showing surface relations of bones, lungs (purple), pleura (blue), and heart (red outline). P. Pulmonary valve. A. Aortic valve. B. Bicuspid valve. T. Tricuspid valve


Plexus

The term [plexus] comes from the Latin term [plectere] meaning " to twine, or to braid". In anatomy, the term [plexus] refers to a group of structures that are intertwined or form a meshwork.  The plural form is [plexuses]. Gabrielle Fallopius used the term to denote "a tangle of nerves"

There are many plexuses described in the human body. Most are formed by nerves, but there are many that are lymphatic or vascular. The best known are the plexuses of nerves formed by the ventral rami of the spinal nerves. These are the cervical plexus, the brachial plexus, the lumbar plexus, and the sacral plexus. The image depicts the brachial plexus. For a larger version, click on the image, and for further information on the cervical and brachial plexuses, click here

Images and links courtesy of: www.bartleby.com

Brachial plexus (www.bartleby.com)

Galen of Pergamon


This article is part of the series "A Moment in History" where we honor those who have contributed to the growth of medical knowledge in the areas of anatomy, medicine, surgery, and medical research.To search all the articles in this series, click here.

Galen of Pergamon (129AD - 200AD). A Roman physician of Greek origin, Galen is a seminal character in Medicine and Physiology for the ages. He has been known as Galen, Galenus, Aelius Galenus, Claudius Galenus, Claudius Clarissimus Galen, and Galen of Pergamus. He was born in 129 A.D. in a Roman-Greek community in Pergamum (today's Turkey). As a very young man, he studied Medicine at the Pergamum  temple of Asclepius.  After traveling for additional studies, Galen obtained the appointment of "physician to the gladiators" back at this hometown of Pergamum.

The post required of him to study and develop hygiene, preventive medicine, as well as dealing with the gladiator's injuries. The horrible wounds allowed him to observe and study human anatomy and develop incredible skills at treating battle wounds. Galen traveled to Rome, where he was appointed Physician to the Emperor Marcus Aurelius.

Galen performed human and animal anatomical dissections, writing over 300 medical, pharmaceutical, and philosophical treatises in Greek, many of which were translated into other languages, especially Latin and Arabic.

Galen of Pergamum
Even though most of the original books were lost, the translations and interpretations of Galen's work have survived until today. His teachings and dictums were considered undisputable for over 1,500 years. In fact, in Medieval times and early Renaissance doubting Galen's teachings was considered heresy!

Galen's name is preserved in the eponymical "Vein of Galen", the great central cerebral vein.

Sources:
1. "Claudius Galenus of Pergamum: Surgeon of Gladiators. Father of Experimental Physiology" Toledo-Pereyra, LH; Journal of Investigative Surgery, 15:299-301, 2002
2. "Galen: history’s most enduring medic" Tan, SY; Singapore Med J 2002:3 (43):116 –117
3. "Galen and His Anatomic Eponym: Vein of Galen" Ustun, C.; Clinical Anatomy 17:454–457 (2004)
Original image courtesy of Images from the History of Medicine at nih.gov