Areteo di Cappadocia: interpretazioni e aspetti della formazione anatomo-patologica del Morgagni

Giorgio Weber offers a new evaluation of the puzzling medical treatise De causis et signis, attributed by the manuscripts to an ancient physician named Aretaeus of Cappadocia. We know little about Aretaeus. Most scholars believe that he wrote his treatise in the first century a.d., but other researchers have claimed that he lived much later, perhaps as late as the third century a.d.. Even the strange Ionic dialect he used has confused modern scholars. Weber does not try to solve these questions. Instead, he shows beyond a doubt that the person who wrote De causis et signis not only had practiced anatomical dissections on the human body, but had conducted investigations to discover how ailments effected the internal organs of men and women. In other words, Aretaeus had conducted pathologic anatomy. In addition, Weber demonstrates that the acknowledged father of modern pathologic anatomy, the eighteenth-century Italian physician Gianbattista Morgagni, recognized that Aretaeus had performed such dissections and, in fact, drew inspiration from this ancient treatise.

Weber begins by describing the history of De causis et signis after its translation into Latin by the Padovan professor of medicine Julio Paulo Crasso in 1542. As soon as this translation appeared, Aretaeus received high praise from Western medical men, praise that stimulated many subsequent editions in both Latin and the original Greek, as well as translations into several European languages. In the early eighteenth century, the famous clinician Hermann Boerhaave also prepared an edition of the treatise. Subsequently, Morgagni began to study De causis et signis as part of his anatomical studies.

Weber presents several examples to demonstrate that Aretaeus had conducted pathologic dissections. With regard to dysentery, Aretaeus observed different types of intestinal lesions that accompanied dysentery, and established relationships between the appearance and location of these lesions and clinical symptoms such as the feces—the kind of correlation that would have required not only dissection of the intestines, but also careful observations before the patient’s death. Morgagni’s experience confirmed the accuracy of Aretaeus’s observations. Weber also analyzes Aretaeus’s description of ulcers in the respiratory tract and his conclusions regarding the physical appearance of dangerous lesions that led to pneumonia and death. In another section of his treatise, Aretaeus described how kidney stones block the urinary tract and made suggestions as to when surgical intervention would be necessary. Perhaps the most impressive examples of his pathologic anatomy were his discovery of blockages in the veins and arteries, and of lesions on the spinal cord that indicated paralysis.

Weber stresses that Aretaeus’s observations are surprising not only because of their focus on pathology, but also because dissections of any kind were so rare in ancient times. The pre-Christian world of antiquity did not approve of performing anatomical studies on human bodies. Galen himself had to depend on dissections of animal bodies. Only a few early Hellenistic physicians had an opportunity to perform careful autopsies on human bodies. In studying the question of dissection in ancient medicine, therefore, modern scholars need to consider Aretaeus’s De causis et signis.

This is a fascinating study, but Weber has committed a grave oversight, all too frequent among medical historians: he assumes that Aretaeus’s treatise emerged from obscurity only with its discovery by Italian humanist scholars and its translation into Latin by Crasso. He totally ignores the history of the Aretaeus manuscripts in the Byzantine Empire. This question is important, because recent research has shown that medieval Greek physicians not only conducted anatomical studies on human cadavers, but also practiced pathologic anatomy.¹