Ancient Roman Medicine and Cardiology

Unit 1: The History of Cardiology

• The study of cardiology spans centuries, evolving from ancient beliefs to modern understandings.
• The unit outlines different periods in the history of cardiology, with a focus on the 1st century BCE to the present.
• Key periods include Ancient Times (before the 1st century BCE), the 1st century CE, the 2nd century CE, 3rd-9th centuries CE, the 10th century CE, 12th-15th centuries CE, the 16th century CE, the 17th century CE, the 18th century CE, and the 19th and 20th centuries CE, and the 21st century CE.

1.1: Ancient Times (Before 1st Century BCE)

• Egyptians (c. 3000 BCE):

  • Considered the heart the "seat of life and emotion."
  • Believed the heart was central to thought, emotion, memory, and moral judgment.
  • In their religion, the heart was weighed against the feather of Ma'at (truth and justice) in the afterlife to determine a person's worthiness.

• Egyptians believed the vascular system carried not only blood but also air, water, and other substances, connecting the heart to the body's network of vessels.

• The Ebers Papyrus (c. 1550 BCE) provided some of the oldest descriptions of the heart and vessels. This early medical text described the heart as a pump and mentioned conditions like angina and heart failure, although interpreted through mystical understanding.

• Key people and texts include Imhotep (c. 2600 BCE) and the Ebers Papyrus writers

• Medical practices involved diagnosis through pulse palpation, associated with heartbeat and life force. Treatments involved herbal remedies, spells, and incantations to address health imbalances within the body system.

• Egyptians, while not fully understanding blood circulation, recognized the heart as central and used that knowledge to develop medical practices.

• Limitations and misconceptions included a lack of blood circulation knowledge, believing the heart pumped substances directly to the organs without return flow, as well as misinterpreting air and vital spirits as blood. Diseases were frequently attributed to supernatural causes.

• Legacy: The ancient Egyptians’ focus on the heart as a central organ laid the groundwork for future civilizations. Their belief in the link between the heart and overall health presaged the modern understanding of cardiology’s importance.

1.1.2 Greeks (5th-4th Century BCE)

• The Greeks considered the heart central to life, emotions, and intellect.

• Blood and humoral theory: Blood was seen as one of the four humors (blood, phlegm, yellow bile, and black bile) vital for health and disease.

• Blood was thought to be produced in the liver and consumed by the body, with no concept of circulation.

• Key figures like Hippocrates (c. 460-370 BCE) and Empedocles (c. 495-435 BCE), outlined knowledge about the heart's vital role, but their understanding lacked a mechanistic understanding of blood movement and circulation as we would understand it today.

1.1.3 Hellenistic Period (3rd Century BCE)

• Scholars in the Hellenistic period differentiated between arteries and veins, but did not fully grasp their functions.

• The heart was recognized as the central organ, but knowledge of systemic circulation was limited.

• Key figures include Herophilus of Chalcedon (c. 335-280 BCE) and Erasistratus of Ceos (c. 304-250 BCE), whose work included observations on the circulatory system.

1.1.4 Romans (2nd Century BCE)

• Physicians like Soranus of Ephesus (98-138 CE) and Celsus (25 BCE-50 CE) continued to utilize the knowledge of the previous civilizations to describe heart-related conditions like anatomy and symptoms.
• Romans emphasized hygiene, influenced by engineering advancements like aqueducts.
• Roman physicians relied on Galenic principles and treatments for various ailments.

1.3: 2nd Century (100-200 CE)

• Galen of Pergamon (129-c. 216 CE):
  • Described the heart as a two-pump system, recognizing the right and left ventricles have distinct functions.
  • He believed arteries contained blood, rather than air alone.

1.4: 3rd-9th Centuries (200-900 CE)

• Post-Roman Decline in Western Europe (3rd–6th Centuries): During the fall of the Western Roman Empire, medical knowledge in Europe was largely diminished.

• Rise of the Byzantine Empire (4th-7th Centuries):

  • The Eastern Roman Empire continued as a hub for knowledge preservation. Scholars and physicians continued to build on the work of earlier Greek and Roman thinkers of the body.

• Islamic Golden Age (8th-9th Centuries):

  • Islamic scholars translated and expanded on ancient Greek and Roman medical texts, including those by Galen.

• Key figures during this era like Hunayn ibn Ishaq, Al-Razi, and Ibn al-Nafis, further developed the understanding of medical practices.

1.5: 10th Century (900-1000 CE)

• The 10th century continued as a period of knowledge preservation, particularly in the Islamic world. Al-Majusi (Haly Abbas) detailed descriptions of the heart's anatomy and function.

1.6: 12th-15th Centuries (1100-1500 CE)

• Preservation and Transmission of Knowledge: Translation of Arabic medical texts into Latin expanded understanding, making knowledge accessible to scholars in Europe.

• Critical Reevaluation of Galenic Theories: - Scholars challenged and questioned Galen's theories.

• Anatomical Studies in Europe:

  • The reintroduction of human dissection into medical education in Europe's universities provided a framework for a more accurate understanding of the heart and other organs.
  • Key figures like Mondino de' Liuzzi contributed to systematic works on anatomy.

• The Rise of the Renaissance:

  • The Renaissance (14th to 16th centuries) fostered renewed interest in scientific inquiry and humanism.
    • The invention of the printing press disseminated knowledge further.

1.7: 16th Century (1500-1600 CE)

• Andreas Vesalius challenged Galen's anatomical assertions by conducting human dissections and producing accurate illustrations of the heart.

• Realdo Colombo provided an enhanced understanding of the pulmonary circulation system.

• Important figures like Michael Servetus also offered insights although this was largely overlooked until later discoveries.

1.8: 17th Century (1600-1700 CE)

• William Harvey developed the concept of systemic blood circulation using observation and experimentation
• Marcello Malpighi studied capillaries, connecting arteries to veins.
• Jean Pecquet discovered the thoracic duct, relating the lymphatic system to the blood stream.
• Thomas Willis further refined knowledge of the heart and nerves. And others like Richard Lower expanded this knowledge base further.

1.9: 18th Century (1700-1800 CE)

• Stephen Hales measured blood pressure.
• Albrecht von Haller contributed to understanding the heart’s anatomy and the nervous system’s role.
• William Heberden made early clinical descriptions of angina pectoris, furthering knowledge of heart-related ailments.

1.10: 19th Century (1800-1900 CE)

• René Laennec invented the stethoscope, enabling non-invasive diagnosis of heart sounds.

• Development of the sphygmomanometer (blood pressure cuff).

• Discovery of Purkinje fibers, aiding the understanding of the heart's conduction system

• Link between rheumatic fever and heart disease established.

• Pathologists (like Rudolf Virchow) advanced coronary artery disease understanding.

1.11: 20th Century (1900-2000)

• ECG developed and standardized.

• Cardiac catheterization established by Werner Forssmann.

• Understanding of atherosclerosis, highlighting the significance of cholesterol.

• Discovery of life-saving treatments for heart conditions, and treatments and surgical procedures

• Improvements in the understanding of the heart's disease processes and prevention methods

• Key figures like Clarence Lillehei pioneered open-heart surgery.

• Development of the Heart-Lung machine.

• Major advancements during the latter part of the 20th century included coronary angiography and techniques in pacing therapy.

1.12: 21st Century (2000-Present)

• Minimally invasive techniques—Transcatheter Aortic Valve Replacement (TAVR) became a standard medical practice
• Percutaneous Coronary Interventions (PCI)
• Imaging technologies like 3D echocardiography and sophisticated scans
• Cardiac imaging technologies greatly enhanced and aided diagnosis and treatment
• Genomics and precision medicine, tailoring treatments to specific genetic predispositions.
• AI-supported diagnostic tools aiding early detection and management of heart conditions
• Improvements made to heart failure treatments.

Test your knowledge on the intersections of Roman medicine and cardiology with this quiz. Explore key figures, practices, and misconceptions in the 1st century and beyond. From Galen's influence to early cardiac surgery, see how ancient understanding has shaped modern medical practices.