Friday, June 26, 2009

In our journey into the History of Pediatric Cardiology, we have reached till the contributions of Greek. Lets move to the other parts of Europe now.

The Renaissance in the continent of Europe, more so in Italy in 15th and 16th centuries brought the birth of modern art and science. The architects of the period wanted to reconstruct the knowledge base by scrutinizing the ancient forms carefully. Hence, many ancient works, of those such as Hippocrates and Galen were translated and re-read. Galen's views were unquestionable till then. The Renaissance architects of science decided to study human anatomy by dissection (mostly in secrecy). It was well known that Galen's doctrines were based on animal studies, as human dissection was considered unthinkable in his times. This step helped to understand the real facts of human body better and widened horizons of anatomy to give rise to the concept of pathoanatomy.

The most quotable name of the era was a genius born in AD1452. This multifaceted person, who was probably much ahead of his times even by Renaissance standards, is considered as the one of the most famous artists the world has ever seen. In AD 1513, he described a case of atrial septal defect was sets of brilliant drawings, accurate to present day standards.
He also described the nature and possible functions of the heart. His name was Leonardo da Vinci. His notebooks were studied after his death in AD 1519. Not much was made out of his notebook data, as they seemed to be written in an unknown funny language. Much later, the “da Vinci code” was deciphered! The notebooks had the same language of the Renaissance era, but were, for some reasons, written backwards or in mirror image forms! So much was for the eccentricities of genius, that lesser men took the credit for what he had written centuries back. The recognition of Leonardo da Vinci’s contribution to human anatomy got delayed by few centuries, but nevertheless, credited. Even today, the credit for the accurate description of any congenital heart disease should go to Leonardo da Vinci.

(Ref: Thiene G. The discovery of cirulation and the origin of modern medicine during the Italian Renaissance.Cardiol Young 1996;6:109-119)

If somebody really dared at human dissection, it was Andreas Vesalius. Born in AD 1514, Andreas Vesalius was perplexed at the differences in Galenic hypotheses and real life situations. He decided to look at truth himself and did human body dissections in secrecy. Once he was convinced about the flaws of Galenic hypotheses, he challenged them in open and convinced others to look out for truth by human dissections. In AD 1543, a just 29-year-old Vesalius published the first complete textbook of human anatomy titled De Humani Corporis Fabrica, which liberated the world of age-old shackles of Galen. Vesalius was the first person to scientifically propose the role of heart as the center of the entire vascular network of body. But, he strongly believed that the pulmonary veins carried air from the lungs to the left atrium. This concept was later challenged and disproved by Realdus Colombus few years later. Vesalius taught the scientific anatomy to generations of medical students until his death in AD 1564. This led to a leash of fresh thinking and opened the doors for further refinement of subject. His treatise stands as a medical monument even today.

(Ref: Vesalius A. De Humani Corporis Fabrica. Basel, 1543

Not everything of these changes from ancient acceptance was smooth. Few men of greater ability were not only active in medical front, but also in the issues of Church. One such ill-fated person was a Spanish physician Michel de Villeneuve. He was born in AD 1511 as Michael Servetus, but his religious beliefs and views on the Holy Trinity brought widespread condemnation from Roman Church, forcing him to change his name and flee to Paris. He was famed for his medical abilities, especially his dissection skills. He was first to point that the blood circulated through lungs also. His fame probably prompted him to circulate his views on non-medical issues and he disastrously ended up publishing his views against the doctrine of Trinity. The Church conducted a trail with men as famous as Martin Luther, John Calvin, and Sir Thomas More, who approved his execution. He was burnt to death. The world tragically lost another brilliant man for Godsake!

Next time, I shall dwell upon the other parts of Europe, to see how the science got new turns with each contributor.

On personal note, Dr Pankaj and Dr Ritesh are appearing for their fellowship exit exam. Theory papers are on 1st July and practical on 6th July 2009. Hearty good wishes for their success.

Also, congrats to Mrs Harini, our beloved Echo lab technician!

Our surgeons literally created a record when they operated three neonates with TAPVC (two among them were Infracardiac) in 24 hours duration! A charming visitor from Boston Childrens Hospital was taken aback when she witnessed our PITU, whose capacity is almost 80 beds with more than 80% occupancy on an average. Our volumes must be one of the highest in the World. Any data from other Pediatric Cardiac centers across the globe, anyone? Please mail me.

We came across two infants with DOLV with DORV, one with PS and other with PAH. One infant had DIRV with DORV. Another infant of right isomerism had IVC entering LA; hepatic veins and RSVC entering RA. Few lesions do not seem to have an obvious embryological basis. We had an interesting session of impromptu questions. Dr Shweta spoke on concept of Conus tissue and Dr Amol on embryological basis of DILV and DORV. I had an opportunity to explain the cardiac embryology on the lines of Heckle's biogenetic law (Ontogeny recapitulates Phylogeny). It was quite refreshing to stray away from didactic teaching and to hear the views of budding Pediatric Cardiologists. We hope to have some sessions like this in future.

Please send in your inputs. Let me hear if non-didactic sessions with forums for open discussion need to be increased in number.



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