Part 3

Morgagni's society was called the Academia Inquietorum--"The Academy of the Restless"--the idea of the curious name being that the members were not satisfied to rest peacefully in the knowledge to be gleaned from the older authors, but preferred to get at science for themselves by direct observation and planned experiment. Morgagni's idea in founding the society seems to have been premature. The fate of the Academy of the Restless is involved in some obscurity, but biographers seem to hint that it failed of its purpose. Neither the university nor the times were yet ready for such freedom of thought as this. Even in our own day such a scheme would be considered radical and chimerical. The discouragement met with finally led to the abandonment of the meetings, and Morgagni gave up his attempt to inspire others with his own industry and enthusiasm for original investigation in the physical sciences.

For some years after this he seems to have been absent from Bologna. His time was spent especially at the medical schools of the great universities of Pisa and of Padua. Students who wished to make some special branch of medicine such as physiology, or anatomy, or the, then as yet scarcely known, science of pathology, their prime object in life, had to visit various universities in order to find opportunity and {39} suggestion for study. Morgagni devoted himself so faithfully to his work that his eyesight failed him for a time and very probably his general health also. For some years he returned to his native town to recuperate. Here he took up the active practice of medicine. As so often happens, this period of rest after years of study proved especially broadening in its influence upon Morgagni. After his rest his contemporaries begin to realize his great possibilities as a scientist.

His first publication was a series of notes on anatomy. These were published in the form of collected essays, with the title _Adversaria Anatomica_. The title has a pugnacious sound, but Morgagni did not indulge in controversy and _adversaria_ is only the Latin name for note-books. The first articles thus collected were really communications made by Morgagni to the "Academy of the Restless" during his presidency of that body. This opened his career as a writer, and it is interesting to note that his last book was to be published some sixty-three years later--a period of fecund authorship almost unprecedented.

As the result of the reputation gained by this work he was offered a teaching position at the University of Padua and later was transferred to the chair of the second professorship of anatomy. After a few years he succeeded to the first professorship of anatomy at the university, at that time the most important post in the medical school. This gave him, at the age of about thirty-five, one of the greatest university professorships in the world. Opportunities for research were now amply provided. He was in a position where his communications would be received with due attention and his reputation was secure.

A university professorship in those days was a position of more importance than even in our own, and Morgagni was {40} especially favored in the fact that it had come early in life, so as to enable him to round out his career. His work was eminently congenial to him, and the labor it involved was that which constituted for Morgagni the highest form of recreation. He made many friends among professors and students. The lectures which Morgagni delivered to the university became so popular that his lecture-room was overcrowded and new quarters had to be provided. Many foreign students were attracted to the university by his wide-spread reputation as a great and suggestive teacher. These students came in great numbers especially from the northern countries of Europe. At one time there were over a thousand German students at the University of Padua, and when they organized into a guild for mutual help and social purposes, Morgagni was chosen by them to act as their patron.

Here at the University of Padua Morgagni was to found the new science of pathological anatomy. Normal anatomy had received its development at the hands of the other great masters in the schools of North Italy. To Morgagni was to be given to describe the changes which take place in organs as the result of disease. Needless to say, this is the most important practical branch of modern medical science. The symptoms of disease mean very little unless we know just what organs are affected and what changes have taken place. Morgagni's work on _The Seats and Causes of Disease_ contains the foundation of modern pathology. Modern advances might seem to put it out of date, but the acuity of its author's observations and the truth of his investigations make it an enduring classic.

Of this work of Morgagni's, Professor Benjamin Ward Richardson, said: "To this day no medical scholar can help being delighted and instructed by the study of this wonderful book. To move into it from the midst of a body {41} of current medical literature, is like passing from the periodical flux of current general literature to the perusal of a Shakespearean drama, the _Pilgrim's Progress_, or _Paradise Lost_. It is a transition from the mediocrity of incessant repetition of well-known truths told in long and hackneyed terms, back to descriptions derived direct from nature and fresh from her treasury. It matters not where the book is opened, it is always good and instructive reading, full of suggestion and rich in original narrative."

Some of Morgagni's work in clinical medicine and in pathology, as detailed in these volumes, remains of perennial interest and is often referred to. Many an after-time discovery, proclaimed loudly by its author, will be found, at times only in embryo but often enough in entirety, in its pages. There are frequent surprises to the reader in the anticipation of what are supposedly much later thoughts in medicine. Some of these passages of more general interest I venture to present here.

It was Morgagni who first realized that minute connections between parts of the nervous system might very easily provide the basis for symptoms quite distant from the site of actual disease. He gives, for instance, a detailed account of a curiously interesting case in which the patient, a man somewhat beyond middle life, was annoyed on a number of occasions by violent sneezing. These attacks of sneezing became more and more frequent and finally were accompanied by difficulty of breathing and a sense of pressure over the chest. These symptoms became more and more marked, until finally, during an especially violent attack of sneezing, the man suddenly died.

Up to this time anatomists generally had declared that there was no direct nervous connection between the mucous membrane of the nose and the diaphragm. Sneezing is {42} due to a violent contraction of the diaphragm and is almost invariably caused by the presence of an irritant in the nose. This is, in fact, nature's method of getting rid of irritant material on the sensitive nasal mucous membranes by an explosive expulsion of air through the nose. This expulsion of air is brought about by a convulsive contraction of the diaphragm. It had always been supposed that the sneezing was due to irritation transmitted through the brain to the diaphragm.

Morgagni, in discussing the reason why the diaphragm should be excited into sympathetic reaction by the presence of an irritant in the nose, pointed out a fact that had been forgotten or the significance of which had not been appreciated. The membrane of the nose concerned in smell is supplied by the first pair of cranial nerves, the so-called olfactory nerves. Between this olfactory nerve and the nerve which supplies the diaphragm, the phrenic nerve, which is a cervical and not a cranial nerve, that is to say, comes from the central nervous system through the spinal cord in the neck and not directly from the brain, the older anatomists declared there was no connection. Morgagni pointed out that the mucous membrane of the nose is partly supplied also from the fifth pair of cranial nerves. From the fifth nerve, small branches of connection with the cervical nerves, as low even as the intercostal nerves, had been traced by Meckel. This shows the possibility of a nervous reflex; that is, of a communication of nerve impulses without the necessity for the intervention of the central nervous system.

This was the first direct tracing of distant reflex nervous action in human physiology. The problem of nervous reflexes was to remain obscure for more than a century later, until light was thrown upon it by the investigation of the French physiologist, Claude Bernard. Here, however, was {43} the pregnant suggestion of the explanation of the seeming mystery. In subsequent cases Morgagni looked for the confirmation of his theory in this matter and found it. He pointed out that there was a relationship between the abdominal viscera and the olfactory mucous membrane of the nose. In one of his cases an epileptic seizure was always accompanied by a sense of discomfort in the upper abdominal region and a fetid odor. This odor was entirely subjective; that is, though extremely annoying to the patient it could not be noticed by any one else, even though the patient was close at hand and exhaled his breath at the moment of the observation.

This would seem to point to the fact that Morgagni suspected there were other connections between the special senses and important organs besides those which had been discovered by anatomists up to that time. As a matter of fact the so-called sympathetic nervous system does place all the organs of special sense in direct connection with the other important organs of the body. Morgagni's suspicions were to be confirmed by the discoveries made in this sympathetic system during the succeeding century.

Morgagni first of all seems to have realized what was the mechanism by which alcohol injures the human system. He pointed out that the excitation of the heart due to the action of alcohol was reflected in an overdistention of the arteries. This overdistention gradually led to degenerations in the arterial walls. The loss of elasticity thus induced brought on a disturbance of the circulation in the important organs of the body, and so gave rise to symptoms of wide-spread interference with organic functions.

Morgagni's studies in aneurism, that is, in the dilatation of bloodvessels, show how thoroughly he understood the mechanism of the formation of this serious pathological {44} condition. He pointed out that the first noticeable disease change that occurs is a degeneration of the inner coat of the artery. This leads to the formation of furrows on the inner wall of the vessels and finally brings on weakness of the middle coat of the artery. He realized that the progress of these arterial changes is due to a large extent to blood pressure within the arteries. He felt, too, that blood pressure could be kept from being dangerously high by strict attention to diet limitation. If aneurisms are discovered in early stages the patient's life may well be prolonged by these simple measures. This idea contains the germ of the Tufnell treatment, which has been the most successful therapeutic measure for the treatment of aneurism in the nineteenth century.

The Italian anatomist's acumen led him to appreciate better than ever before in medical history the influence of the mind on the circulation. He pointed out that emotions have a powerful influence on the circulatory system in all its parts. How much the peripheral bloodvessels are affected can be seen in the tendency to blushing during certain forms of excitement, involving shame or embarrassment; on the contrary, pallor in anger, or indignation, or fright. He pointed out, too, that the heart is affected by such emotions and is sometimes strenuously excited and sometimes very much retarded. Morgagni understood that the influence of such emotions in especially excitable individuals leads to wear and tear on the bloodvessels and so to a shortening of lives. He thought of some aneurisms, even those affecting the large bloodvessels, might be caused by sudden intense emotions, and especially by violent efforts to suppress or conceal emotions. We know now, however, that these pathological conditions are due to human passions, but quite other than those which Morgagni had in mind.

It is interesting to note that comparative {45} pathology--that is, the study of the diseases of animals as illustrating corresponding conditions in human beings--had already attracted the attention of the Bolognese school of medicine. Albertini, who had been a professor of Morgagni's, pointed out that aneurisms are rarely found in animals, because brutes were not subject to emotions as are human beings. Morgagni made still further observations in this line to confirm his own conclusions in the matter. For a time in his earlier life he devoted himself to the study of fishes, because they seemed to promise to throw light on certain problems in human anatomy and pathology.

How closely he studied pathological changes in tissues can be gathered from the fact that his observations led him to point out that aneurism of the aorta occurs most frequently at that part of the curvature of the aorta against which blood is constantly projected by the heart. The realization of the importance of this mechanical factor in the production of aneurism is one of the first successful results of carefully applied observation and knowledge of physical laws in the causation of changes in the tissues as opposed to elaborate theories with very little foundation in fact.

Variations in the pulse attracted his attention, and he was among the first to point out that the occurrence of flatulency is liable to cause disturbance of the heart's action and to bring on noticeable cardiac palpitation in the absence of any organic affection of the heart itself. Morgagni also pointed out that intermittence of the pulse may be due to nervous conditions. He showed that severe mental shock or trying emotions may cause irregularity of the heart's action and pulse intermittency. Some of his observations in this matter show an intuition with regard to the nerve supply of the heart that is quite beyond the anatomy of his time, and seems to indicate that he suspected the existence and {46} function of the sympathetic system and also the existence of a special nerve supply to the small arteries.

Perhaps Morgagni's most penetrating evidence of insight in pathology and its relations to clinical medicine is with regard to tuberculosis. Over a century and a half ago he insisted on its contagiousness. He refused to make autopsies on patients who had died of tuberculosis, and his position in the matter was undoubtedly of the greatest service in directing the attention of his contemporaries, and especially those closely in contact with him, to the important question of intimate association with tuberculous patients as a potent factor in the acquirement of the disease, more potent even than heredity which then occupied all men's minds on this subject.

It might be deemed that this advanced position of Morgagni was due rather to intuitive abhorrence of the disease than to the conviction of actual observation, and that his conclusions were the result more of prejudice than of real knowledge. Any such opinion, however, is absolutely contradicted by the fact that he knew and understood better than any one of his generation the pathology of consumption. He pointed out at a time when any chronic affection of the lungs was liable to be considered consumption that there are a number of forms of chronic bronchitis that are not due to pthisis pulmonalis, but to other slow-running conditions within the lungs.

He anticipated very completely the present position of surgery with regard to the treatment of cancer. He advised the operative removal of these malignant tumors whenever possible. As Benjamin Ward Richardson points out, this advice was given evidently not with the idea that the disease could be always thus completely cured, but because early operation gave speediest relief of annoying {47} symptoms and assured the greatest prolongation of life. Many other methods of removal of cancerous growths were suggested in Morgagni's time, as in our own, and many false promises made and false hopes raised by their advocates. He pointed out that the quickest, the safest, the surest and in the end, for the patient, the easiest method of removal is by the knife in the hands of the bold and skilful surgeon. After a century and a half of vauntedly great advance, especially in surgery, we are practically in the same position as when Morgagni's advice was penned, and his opinion remains practically as valuable to-day as then.

In another important point of medicine Morgagni seems to have anticipated the opinion of our own time. It was the custom to practise venesection very freely. On one or two occasions in his own lifetime Morgagni fell ill and venesection was recommended. His biographer says that he constantly refused this method of treatment, adding very naively, "and he who had often cured others by venesection would never allow this remedy to be used upon himself because, as I believe, he had a natural abhorrence to it."

It was an index of thoroughgoing independence of thought in those days to stand out, even for personal reasons, against the overwhelming tradition in favor of blood-letting. But Morgagni had well-grounded doubts as to the remedial efficacy of abstraction of blood, and at least avoided it in his own case.

Besides his skill in practical and theoretic medicine, Morgagni was a man of cultivated taste in art, and he was conversant not only with the literature of his own language, but also of French, Latin and Greek. He was always welcomed in the literary circles of the cities of Northern Italy, and counted among his friends many of the great writers of the time. His success in winning the friendship of rulers was especially {48} noteworthy, and had not a little influence for the advantage of education and science. The patricians of Venice were proud to consider him as a personal friend, and to the Venetian Senate he owed his professorship at Padua. The King of Sardinia, Emanuel III, looked upon him as an intimate acquaintance. All the Popes, five in number, of the second half of his life were on terms of personal intimacy with him, and his advice was asked on many important questions with regard to educational matters in his own day.

Some of these Popes are among the most influential pontiffs that ever occupied the Roman See. The great Benedict XIV, himself a native of Bologna and an intimate friend of the scientist, in his classic work "De Beatificatione Servorum Dei" mentions Morgagni in terms of special commendation. His scarcely less famous successor, Clement XIII, had often consulted Morgagni professionally at Padua before his elevation to the See of Rome. After his election as Pope he assures Morgagni of his continued esteem and friendship, and asks him to consider the Vatican always open to him on his visits to Rome. In an extant letter Clement praises his wisdom, his culture, his courtesy, his charity to God and men, and holds him up as an example to others, since with all his good qualities he had not aroused the enmity or envy of those around him.

Morgagni's life must have been in many ways ideally happy. Rewards for his scientific success began early in life, even before his professorship, and continued all during his long career. The Royal Society of England elected him a fellow in 1724; the Academy of Sciences of Paris made him a member in 1731. In 1735 the Imperial Academy of St. Petersburg conferred a like honor upon him. In 1754 the Academy of Berlin elected him to honorary membership.

His English biographer, Dr. William Cook, says quaintly {49} that all the learned and great who came into his neighborhood did not depart without a visit to Morgagni. He was in correspondence with most of the great men of his time, and the terms of intimate relationship that this correspondence reveals are the best evidence of the estimation in which Morgagni was held, especially by the prominent scientists of his time. Among them were such men as Ruysch, Boerhaave, Sir Richard Mead, Haller and Meckel. This wide acquaintanceship of itself was a great distinction at a time when the means of communication were so much more limited than at present.

It is gratifying to think that Morgagni must have been enviably content in his private life, though, as usually happens when this is the case, very little is said explicitly on this subject. His untiring labor deserved the compensation of a loving domestic circle. During his retirement at Forli, after his graduation from the university and when, from overwork, his health failed him for a time, he married the descendant of a noble family of the town, Paola Vergieri by name, a companion for him who, biographers declare, could not have been surpassed in judgment or in affection. They had a family of fifteen children, eight of whom survived their father though he lived to the ripe age of eighty-seven years. There were three sons, one of whom died in childhood; another became a Jesuit and taught in the famous Jesuit school at Bologna whose magnificent building has now become the municipal museum, the Accademia delle Belle Arte. The third followed his father's profession, married and settled in Bologna, but died before his father, who assumed the care of his grandchildren. All Morgagni's daughters who grew up to womanhood, eight in number, became nuns in various religious orders.

The spirit of science had not disturbed the development {50} of a homely simple faith in the family. The great Father of Pathology, far from being disturbed by the unselfish self-sacrifice of so many of his children, bore it not only with equanimity but even rejoiced at it. His relations to his children were ever most tender. After the suppression of the Jesuits, his son, who had been a member of the order, worked at science with his father at the University of Bologna and not without distinction.

The estimation in which Morgagni was held by his contemporaries can be judged from the fact that twice when invading armies had entered the Emilia and laid siege to Bologna, their commanders, as in old Greek history did the Grecian generals with regard to Pindar and Archimedes, gave strict orders that special care was to be taken that no harm come to Morgagni, and that his work was not to be hampered. Having lived his long life amidst the reverent respect of all who knew him, he died full of day and honors.

Succeeding generations have not been backward in acknowledging Morgagni's merits. I have already spoken of Virchow's tribute to his greatness. The Italians have long considered him as one of their most brilliant names in medicine. One of the best known of the representative Italian medical journals is _Il Morgagni_, published at Milan. To its pages the foreigner seeking to know the progress of Italian medicine turns almost as the first resort. _Il Morgagni_ was founded some fifty years ago, and continues to uphold its reputation as one of the world-known medical periodicals.