Heart
The Heart
‘The Prince of all the Bowels’.
Johann Vesling, The anatomy of the body of man (London, 1653), p. 39.
Worth’s earliest anatomical investigation of the heart was undoubtedly in his 1526 edition of Hippocrates of Cos’ Opera, which included Hippocrates treatise ‘On the Heart’. Hippocrates and his colleagues at the 5th century BC school of Cos argued that the heart was composed of two ventricles, connected via the interventricular system and they believed that it contained only one of the four humours, yellow bile.[1] In Worth’s editions of Aristotle’s works, he would have seen that Aristotle disagreed, arguing that the heart had three chambers; and in his editions of the works of the 2nd century AD Roman writer, Galen of Pergamon, heavily influenced by the ancient Greek schools, Worth would have noticed that Galen, agreeing with the Hippocratic school, suggested that the heart had two ventricles but instead argued that the right chamber/ventricle contained blood, while the left contained air.
Johann Vesling, Syntagma anatomicum publicis dissectionib[us] in auditoriu[m] usum, diligenter aptatum (Frankfurt, 1641), plate opposite p. 242: image of a heart.
Vesalius (1514–64) likewise argued for a two-chambered heart and it was really only in the seventeenth century that great strides were made in the understanding of the anatomy and physiology of the heart. Like Vesalius, William Harvey (1578–1657), famous for his revolutionary theory of the circulation of the blood, rejected the idea that the interventricular septum was porous. When it came to the anatomy of the heart, Harvey, as Loukas et al. note, used the term ‘heart’ to describe the ventricles and ‘auricles’ to describe the atria.[2]
In the above image of a heart, taken from Worth’s copy of Johann Vesling’s Syntagma anatomicum publicis dissectionib[us] in auditoriu[m] usum, diligenter aptatum (Frankfurt, 1641), we can see Vesling’s attempt at portraying the structure of the heart. Kumar Ghost notes that Vesling’s experiments in embryology proved to be crucial for understanding the development of the four-chambered heart.[3] Vesling’s book became a highly influential textbook, not only at Padua, where he taught in the seventeenth century, but also throughout Europe.
Vesling discusses the emptying of four pulmonary veins into the left atrium of the heart as follows:
‘From the left Ventricle of the Heart, proceeds an Artery which the Antients call Venosa because it hath but one Tunicle and dividing its branches, it is carried to the right and left region of the Lungues, taking the Blood mixed with Air to its self, and carrying it to the left Ventricle of the Heart. It hath two shutters to stay the blood from flowing back from the Heart into it, which the Authors call Mitrae because they are like a Cardinals Cap; but this vessel is rather to be called a Vein than an Artery, because its substance is the same with the Veins, neither hath it pulse as Arteries have, it carries the Blood tempered with Air to the Heart’.[4]
The mitral valve (the left atrioventricular valve), which Vesling mentions here, did indeed get its name from a bishop’s hat – it had been so named by Vesalius.
Richard Lower, Tractatus de corde. Item de motu & colore sanguinis et chyli in cum transit (London, 1669), plate 1: Fig. 4 showing the branches of the aorta.
In the Tractatus de corde of the English physician Richard Lower (1631–91), the author correctly depicted the heart as a four-chambered organ.[5] His work on the heart is commemorated in the naming of the intervenous tubercule of Lower, a tubercule which he located between the fossa ovalis and the inferior vena cava. The above image depicts the branches of the aorta. Lower commented on it as follows:
‘The divine Artificer constructed the trunk of the aorta (next the Heart) with such skill in Animals, whose Hearts move rather forcibly, that the blood does not run straight into the axillary and cervical arteries, but first turns through part of a circle. Midway between the ventricle and these arteries, the aorta (to a varying degree in different animals) is strongly arched, Consequently it is the curved angle which bears the shock and the full force of the ejected blook and directs the greatest part of the rushing stream into the descending trunk of the aorta …
All this is fully shown in Plate 1, Fig. 4 in his figure:
a is the root of the Human aorta.
b is its descending trunk.
c is the angle where it curves on itself.
d is the right axillary artery.
e is the right cervical artery.
f is the left cervical.
g is the left axillary.
h are the two coronary arteries’.[6]
William Cowper, The anatomy of humane bodies, with figures drawn after the life by some of the best masters in Europe, and curiously engraven in one hundred and fourteen copper plates, illustrated with large explications, containing many new anatomical discoveries, and chirurgical observations: to which is added an introduction explaining the animal oeconomy, with a copious index (Oxford, 1698), Table 22.
William Cowper’s images were far less diagrammatic than those of Lower, but, as Schott notes, the anatomical accuracy of his illustrations, many of which were re-used from Govart Bidloo’s Anatomia Humani Corporis (Amsterdam, 1685), did not always match their artistic élan. Schott points to the fact that some Galenical remnants may be seen, particularly in figure 7 of Tabula XII, where Cowper names the left atrium ‘Vena pulmonalis’.[7] Cowper explains his Figure 7 as follows:
‘The Heart with its Left Ventricle Open’d.
A, The Inside of the Vena Pulmonalis.
B, The Aorta in like manner Open’d.
C C, The Septum Cordis, which divides the Right Ventricle from the Left.
D, The Left Auricle intire which in Humane Bodies is very little, as appears by this Figure; and the Trunk of the Pulmonick Vein very large.
d, The Trunk of the Arterìa Pulmonica cut off.
e e, Two of the Three Semilunary Valves at the Beginning of the Arteria Magna; which hinder the Reflux of the Blood when the Heart is in Diastole; in which Action they are Exprest, Fig. 3. e e.
f f, The Two Mitral Valves in the Pulmonick Vein, which prevent the Blood repassing that Vessel when the Heart is in Systole.
g g, The Carneae Columnae compos’d of Muscular Fibres, deriv’d from those of the Sides of the Heart, whençe divers small Tendinous Filaments do Arise, and are fastned to the Inferior Limbus of the Mitral Valves; by which means those Valves are drawn down towards the Cone of the Heart, and prevent the Blood from passing out again that way when the Heart is in Systole. I know Dr. Lower in his Accurate Book De Corde, Supposes that these Mitral and Tricuspid Valves are Relax’d in the Systole of the Heart, and by their Rising up stop up the Passages of the Veins: But if the Structure of the Heart and these Parts are Attentively consider’d in a large Animal, as in an Ox, &c. it will appear reasonable to conceive that these Mitral and Tricuspid Valves are rather drawn down than suffer Extrusion upwards: nor need Nature have been at any trouble in making those Valves at the Orifices of the Veins, any otherwise than the Reverse of the Semilunary Valves of Arteries; if as the Expert Dr. Lower Supposes they are driven up and Extended like a Sail with Wind when the Heart is in Systole; but by fastening those Tendinous Fibres to the Lower-parts of those Tricuspid and Mitral Valves; which, are of a Conical Figure, seems to me to be an Argument that they cannot suffer such Extension upwards, without letting some Part of the Blood repass them in the Systole of the Heart: Besides there must constantly a considerable Part of the Blood remain in the Ventricles of the Heart, if those Valves are so dispos’’d in its Systole; which I think the Dr. himself seems no where to conceive; but on the contrary the Ventricles of the Heart are with great Strength adequately Comprest in it’s Systole, for which End the Insides of its Ventricles are compos’d of divers Fleshy Columns; between which divers Intersticia necessarily Result, (that are elegantly Exprest in this Figure,) by which means, the Ventricles are more exactly Closed in their Systole, than they could have been, had they been smooth’.
William Harvey is primarily known for his work on cardiac anatomy, but he also made significant contributions to the fledgling field of embryology. In his final treatise, Exercitationes de Generatione Animalium, published in 1651, Harvey established theories on animal generation that set the stage for the development of modern embryology.[8] The following century saw ongoing debates on the subject until the field crystallised under the prevailing theories of Baltic German polymath and scientist Karl Ernst Von Baer (1792– 1876). In 1828, Baer published his book Über Entwickelungsgeschichte der Thiere (‘On the Developmental History of Animals’) in which he posited four conditions governing embryonic development, now known as von Baer’s Laws of Embryology.[9]
The growing interest in the field and its integration in medical education curricula is reflected in the collection of the Old Anatomy Museum at Trinity College Dublin. Before the advent of modern medical imaging like ultrasounds and X-rays, anatomy educators relied on models and dissected specimens to teach their students. The delicate and minute structures of foetal anatomy poses an additional challenge. To meet that challenge model-makers like Medicinishes Warenhaus in Berlin created larger than life models out of a variety of material, metal being one of the more unusual choices.
Large metal model of the human foetal heart created by Prof. Dr. E. Winternitz. Manufactured by Medicinisches Waarenhaus, Berlin. Early 20th century. Courtesy of the Old Anatomy Museum, School of Medicine, Trinity College Dublin.
This particular example was created under the instruction of Tübinger University’s Anatomy Professor and obstetrician Dr. Eugene Winternitz.[10] The large foetal heart is dissected to reveal its internal structure at a scale that allowed students attending a class in a lecture theatre to see its form and details. The heart is constructed to easily rotate in its stand and facilitate anatomy demonstrations.
While models, drawings, and diagrams served to illustrate typical anatomy, they were often idealised and couldn’t accurately reflect the organs students and physicians might encounter in the flesh. Anatomy demonstrators carefully dissected and preserved specimens such as this heart of a juvenile to meet that need. Wet or ‘potted specimens,’ as they are called, were preserved in proprietary solutions that, depending on the substances available to them at the time, ranged from alcohol to arsenic, oil of wintergreen, and formaldehyde. This specimen was re-potted in the 1950s, so it is likely to be preserved in formaldehyde or glycerine.[11]
Dissected specimen of the heart of a juvenile, mid 19th century. Courtesy of the Old Anatomy Museum, School of Medicine, Trinity College Dublin
Text: Dr Elizabethanne Boran, Librarian of the Edward Worth Library, and Ms Evi Numen, the Curator of the Old Anatomy Museum, Trinity College Dublin.
Sources
Anon, The Medical News. 30 December 1843 (Philadelphia, 1905). https://archive.org/details/medicalnews79philuoft
Barnes, Elizabeth M., ‘Karl Ernst von Baer’s Laws of Embryology’, Embryo Project Encyclopedia (2014-04-15). ISSN: 1940-5030 http://embryo.asu.edu/handle/10776/7821
Cowper, William, The Anatomy of Humane Bodies (Oxford, 1698).
Kumar Ghost, Sanjib, ‘Johann Vesling (1598–1649): Seventeenth Century Anatomist of Padua and his Syntagma Anatomicum’, Clinical Anatomy, 27 (2014), 1122–27.
Loukas, Marios, et al, ‘History of Cardiac Anatomy: A Comprehensive Review from the Egyptians to Today’, Clinical Anatomy, 29 (2016), 270–84.
Roberts, Wallisa, et al., ‘Across the centuries: Piecing together the anatomy of the heart’, Translational Research in Anatomy, 17 (2019), 1–8.
Schott, A., ‘Historical Notes on the Iconography of the Heart’, Cardiologia, 28, no. 1 (1956), 229–57.
Simmons, J. E., Fluid Preservation: A Comprehensive Reference, (Rowman & Littlefield, 2014).
Simpson Jn, Marcus B., ‘Lower, Richard (1631–1691), physician and physiologist’, ODNB, 2004.
Vesling, Johann, The anatomy of the body of man (London, 1653). This English translation, by Nicholas Culpeper, is not in the Worth Library.
Wellner, Karen, ‘A History of Embryology (1959), by Joseph Needham’, Embryo Project Encyclopedia (2010-06-28). ISSN: 1940-5030 http://embryo.asu.edu/handle/10776/2031
[1] Loukas, Marios, et al, ‘History of Cardiac Anatomy: A Comprehensive Review from the Egyptians to Today’, Clinical Anatomy, 29 (2016), 272.
[2] Ibid., 276.
[3] Kumar Ghost, Sanjib, ‘Johann Vesling (1598–1649): Seventeenth Century Anatomist of Padua and his Syntagma Anatomicum’, Clinical Anatomy, 27 (2014), 1122.
[4] Vesling, Johann, The anatomy of the body of man (London, 1653), p. 42.
[5] Roberts, et al., noted that by Galen’s time the four chambers were recognised but the atria were considered as extensions of vessels leading to the ventricles, rather than as being part of the heart proper: see Roberts, Wallisa et al., ‘Across the centuries: Piecing together the anatomy of the heart’, Translational Research in Anatomy, 17 (2019), 3.
[6] Translation by K.J. Franklin, cited in Schott, A., ‘Historical Notes on the Iconography of the Heart’, Cardiologia, 28, no. 1 (1956), 246.
[7] Schott, A., ‘Historical Notes on the Iconography of the Heart’, Cardiologia, 28, no. 1 (1956), 249.
[8] Wellner, Karen,’A History of Embryology (1959), by Joseph Needham’. Embryo Project Encyclopedia (2010-06-28).
[9] Barnes, Elizabeth M., ‘Karl Ernst von Baer’s Laws of Embryology’, Embryo Project Encyclopedia (2014-04-15).
[10] The Medical news: Transactions of Foreign Societies, 30 December 1843 (Philadelphia, 1905), pp 193-194.
[11] Simmons, J. E. Fluid Preservation: A Comprehensive Reference (Rowman & Littlefield, 2-14).