Cardiovascular Research by Leonardo da Vinci (1452–1519)
2019; Lippincott Williams & Wilkins; Volume: 124; Issue: 2 Linguagem: Italiano
10.1161/circresaha.118.314253
ISSN1524-4571
Autores Tópico(s)Acute Ischemic Stroke Management
ResumoHomeCirculation ResearchVol. 124, No. 2Cardiovascular Research by Leonardo da Vinci (1452–1519) Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBCardiovascular Research by Leonardo da Vinci (1452–1519) Antonio V. Sterpetti Antonio V. SterpettiAntonio V. Sterpetti Correspondence to Antonio V Sterpetti, MD, FACS, FRCS, AV Sterpetti- Policlinico Umberto I, Viale del Policlinico, 00167 Rome, Italy. Email E-mail Address: [email protected] From the Policlinico Umberto I, University of Rome Sapienza, Italy. Originally published17 Jan 2019https://doi.org/10.1161/CIRCRESAHA.118.314253Circulation Research. 2019;124:189–191This year is the 500th anniversary of the death of Leonardo da Vinci (Figure 1; Vinci, Italy [1452] to Amboise, France [1519]). Leonardo is probably the artist and scientist who represents the ideal model of the man of the Italian Renaissance.1–3 The philosopher Pico della Mirandola wrote in 1486, De hominis dignitade, in which he stated that the mission of human beings was characterized by "Intelligence and thinking to understand the beauty of the world created by God."Download figureDownload PowerPointFigure 1. Self-portrait of Leonardo, at the age of 60 years (1510 circa Red Chalk on paper—Biblioteca Reale—Turin, Italy).Leonardo was a painter, sculptor, architect, scientist, mathematician, poet, inventor, astronomer, geologist, historian, and cartographer. In all his activities, he showed fertile imagination, well above the horizons of his times.1–3 He started as a student of Verocchio, a well-known painter in Florence. He was an excellent student, and at the age of 19, he was allowed to start his independent activity. At the age of 20, Leonardo performed studies in humans, including postmortem dissections. Being an artist, he had a special permission to perform human dissections.During the Middle Ages, human dissections were rarely performed for many reasons, including religion and fear of transmission of diseases. To all those facts, we should add the Bulla "Ecclesia Abhorret a Sanguine" (1163) and the Papal Bulla "De Sepolturis" (1299) in which it was practically forbidden to touch bodies after death. In the early Renaissance (1319), Mondino de Liuzzi published the textbook Anhotomia, which represented the only textbook of anatomy accepted in all medical faculties in Europe for almost 200 years. The anatomic theories were the ones supported by Galen, in which the blood forms in the liver and then goes to the periphery where it is consumed by the tissues and that the venous blood goes from the right to the left ventricle through microscopic pores. The public teaching of anatomy was regulated by very narrow rules. A student could not assist in more than 2 dissections during the medical course.The History of His DrawingsIn Pavia (circa 1490), Leonardo met Marcantonio Della Torre, Professor of Theoretical Medicine, who asked for collaboration for a textbook on anatomy.4–6 The knowledge of Marcantonio was based on the classic studies of Galen. Leonardo planned to write his textbook De humanis corpore with many illustrations. He stated "... You can explain for many hours, with much knowledge and many details, the characteristics of an anatomic structure: well, you will never reach the accurateness of a well-done drawing…" He continued this work, with alternating attention, until he was 60 years old. The textbook was never published. In 1623, the drawings were in possession of the agency Thomas Howal of London. Later, they were bought by King Charles II and since then they have been well preserved in Windsor Castle, near London. The drawings were made public almost 300 years later. There is the possibility that the studies by Leonardo were too advanced for his times to be published.Methods of StudyLeonardo performed studies in animals (cows and pigs), and he did more than 30 human dissections.7–14 He accurately analyzed the anatomy of fresh specimen; he also performed in vivo studies on pigs, to analyze the movement of the blood in the beating heart through small metallic tracers. He made several wax casts of the bull heart, and from these casts, he constructed glass models to study the hydraulic characteristics of the blood flowing through the heart and its valves, an in vitro circulation model to mimic the human circulation. Seeds were used to visualize turbulences and blood flow. He studied the dynamics of the water flow in rivers, using colors to show the flow patterns, defining the continuous stress on the lateral walls of the river, "… the water is continuously bouncing against the banks... and as time passes the course of the river gets more and more tortuous…" He determined with different colors the flow characteristics in the center and near the borders of the rivers and translated those findings to the blood flowing in arteries.These methods of study were revolutionary, in times when the heart was reproduced in anatomic drawings with schematic sketches, made by people who never saw an anatomic dissection.Bellhouse15 published in 1969 a series of sophisticated experiments on the mechanics of the aortic valve; a transparent model of the aorta with a flexible valve was perfused by water. Small particles mixed with the water made the flow patterns visible. Robicsek16 commented that Leonardo performed the same sophisticated experiments of Bellhouse,15 450 years before.Heart and Blood CirculationLeonardo moved slowly from the accepted theories learned by Marcantonio de La Torre to his new ideas, based on his own experiments. He writes, "the heart is a muscle which contracts spontaneously." He understands that the aorta provides blood, calor, and energy to all the body through the arterial blood which goes up to the skin trough the capillaries. He examined in detail the bronchi up to their smaller ramifications, noting that each of them is accompanied by a small branch of the pulmonary artery (Figure 2A). On the basis of these observations, he hypothesized that the bronchial arteries receive freshness from the bronchi, full of air, and that the venous blood receives freshness in the lung, before returning to the heart. He studied in detail the anatomy of the coronary artery and veins, coming to the conclusion that the heart feeds itself (Figure 2B).Download figureDownload PowerPointFigure 2. Drawings of the heart by Leonardo. A, The heart. Leonardo described the central function of the heart, overcoming the old theories. The heart provides blood to the tissues, thanks to arteries which become smaller and smaller, until they became microscopic capillaries. B, The heart and the bronchial circulation. Leonardo described the close correlation between the systemic and pulmonary circulation. He noted that the "blood from the heart receives freshness and air in the lungs…" (Drawing and Annotations by Leonardo—1510 circa—Collection Windsor Castle, United Kingdom. Royal Collection Trust/© Her Majesty Queen Elizabeth II 2018.)He noted that both atria contract when the ventricles dilate, explaining the movement of blood from the atria to the ventricles. The right atrium and ventricle are larger than those on the left.Having a special interest in hydraulic engineering, Leonardo studied the anatomy of the cardiac valves which "…are covered by endocardium at the top and muscles on the bottom…" He concluded that all 4 valves should open and close completely, otherwise the heart will not function adequately, with regurgitation of blood in the atria from the ventricles.Interestingly enough, after the collaboration with scientists in Pavia, a series of new theories about blood circulation were elaborated on in that University by Realdo Colombo and Andrea Cisalpino. Those theories were further elaborated by Fabrizio Acquapendente in the neighboring University of Padua and almost kept secret. William Harvey, a young student from Cambridge, studied in Padua, as an assistant to Fabrizio Acquapendente. He graduated in 1602, before returning to London.In 1628, William Harvey published Excercitatio anatomica de motus cordis and sanguinis, which represents the basis of modern cardiovascular physiology. The concept of oxygenation was defined by Marcello Malpighi, Professor of Theoretical Medicine at the University of Bologna, when he published in 1661, De Pulmonibus observations anatomicae; he described the concepts of the oxygenation of the venous blood in the lungs before going back to the heart, completing the previous theory of William Harvey.Why Did Leonardo Not Publish His Work? A HypothesisIn those days, to be innovative was not as simple as today.11–13 In the early 1500s, the Inquisition became more and more severe, to counteract the new thoughts and new ideas coming from Germany, where there was an increasing intolerance for the power of Rome—an intolerance that few years later (1517) brought Martin Luther's presentation of the thesis in Wittenberg against the Indulgences, which officially began the Protestant Reformation.Leonardo was probably not allowed to publish all of his works, even if he had enough time and support to do so. In his annotations, just near the drawings about the heart and blood circulation, he wrote, "… I could tell more, if I was allowed to do so…"William Hunter (1718 to 1783) was able to observe and to study the anatomic drawings and annotations by Leonardo.17 He defined Leonardo as the greatest anatomist of his times and probably of all times. He tried to make public the work by Leonardo, without success.The Interest in Leonardo in Modern TimesLeonardo da Vinci has fascinated and continues to fascinate. It is an indefinable attraction. The majority of people place this attraction in the many intuitions, discoveries, and ideas he had, looking over the horizons of the future. Others are attracted by the mysteries surrounding his personality: he wrote from right to left and his writing in antique Italian can be read only at the mirror and with difficulties. Others are attracted by his paintings. The Last Supper and La Giocanda are the 2 best known paintings in the world. Everybody has his/her known interpretation about the paintings. Experts have analyzed those paintings trying to discover something, without knowing what that something is they are looking for. Movies and books written about the mysteries surrounding Leonardo are immediately best sellers.3,4Freud, the father of psychoanalysis, was fascinated by Leonardo, and tried to define the personality of Leonardo. He found himself in continuous difficulties, lost almost in a jungle of definitions. He wrote an entire essay about the possible meaning behind the painting, Saint Anna and the Holy Mary. He realized at the end that all conclusions were based on the wrong translation of the Italian word Nibbio (a bird of prey).18The reason for the interest in Leonardo is, probably, that we identify ourselves in his search for answers, never clear and well defined.Leonardo wrote that he had a recurrent dream in his childhood of a friendly bird pecking his mouth. He was much interested in the flight of birds, writing more than 1000 annotations and more than 500 drawings about the different characteristics of the flight of birds. He built a flying machine and a helicopter, not too much different from today. He wrote, "… one day flying machines will go from a city to another city… "Leonardo grew up in a small town near the river Arno. He recurrently wrote about the mysteries at the bottom of a river. In adulthood, he made projects draining swamps and deviating the course of rivers. He defined in detail the possibility to explore the seabed with a submarine and with a diving suit, and he described a modern air-filled life belt. He developed a special interest in understanding the mechanisms and functions of the human body. In these studies, he clearly tried to define the origin of life. He performed autopsies to understand why an old man was so calm and happy or why another man was so sad and suffering.Leonardo did not believe in God in his adulthood, and he had a deep disesteem for the clergy. One year before his death, at the end of his studies, he asked for a priest to be converted. He suffered from paralysis of the right arm in the last 2 years of his life. He painted (he was left handed) Saint Giovannino. The saint is represented young, happy, with the right arm raised and strong, indicating the sky, while holding a crux.At the end of his exhaustive studies, Leonardo came to the conclusion that human beings find their meaning and importance in the context of a holy supra natural idea. A message still valid today.DisclosuresNone.FootnotesCorrespondence to Antonio V Sterpetti, MD, FACS, FRCS, AV Sterpetti- Policlinico Umberto I, Viale del Policlinico, 00167 Rome, Italy. Email antonio.[email protected]itReferences1. Burckhardt J. The Civilization of Renaissance in Italy. Middlemore, New Zealand: Trans S.G.C; 1878.Google Scholar2. Burke P. The Italian Renaissance: Culture and Society in Italy. Princeton, New Jersey: Princeton University Press; 1999.Google Scholar3. Santi B. Leonardo" In "Protagonisti dell'Arte Italiana. Florence, Italy: Scala Group Ed; 2001.Google Scholar4. Clayton M. "Leonardo's medicine years"Nature. 2012; 484:314–316.CrossrefGoogle Scholar5. O'Malley CD, Sounders CM. Leonardo on the Human Body: The Anatomical, Physiological and Embryological Drawings of Leonardo da Vinci. New York, NY: Henry Schuman; 1952.Google Scholar6. Vasari G. Lorenzo T, ed. In: Vita Dei Più Eccellenti Pittori, Scultori ed Architettori Italiani, da Cimabue in Sino i Giorni Nostri. Florence, Italy; 1550.Google Scholar7. De Mazzeri SA. Leonardo. L'uomo Ed il Suo Tempo. Mondatori, Milano; 1999.Google Scholar8. Sterpetti AV. Anatomy and physiology by Leonardo: the hidden revolution?Surgery. 2016; 159:675–687. doi: 10.1016/j.surg.2015.10.001CrossrefMedlineGoogle Scholar9. Sterpetti AV. The influence of the stroke suffered by Leonardo on his last paintings. A pioneer of psychoanalysis?Eur J Intern Med. 2016; 33:e7–e8. doi: 10.1016/j.ejim.2016.03.024CrossrefMedlineGoogle Scholar10. Gaddiano A. Manuscript Biblioteca Nazionale di Firenze. 1540.Google Scholar11. Keele KD. Leonardo da Vinci's views on arteriosclerosis.Med Hist. 1973; 17:304–308.CrossrefMedlineGoogle Scholar12. Keele KD. Leonardo Da Vinci on Movement of Heart and Blood. London, UK; 1952.Google Scholar13. Keele KD. Leonardo da Vinci Elements of the Science of Man. New York, NY; 1983.Google Scholar14. Sterpetti AV. The revolutionary studies by Leonardo on blood circulation were too advanced for his times to be published.J Vasc Surg. 2015; 62:259–263. doi: 10.1016/j.jvs.2015.03.036CrossrefMedlineGoogle Scholar15. Bellhouse BJ. Velocity and pressure distribution in the aortic valve.J Fluid Mech. 1969; 37:587–600.CrossrefGoogle Scholar16. Robicsek F. Leonardo da Vinci and the sinuses of Valsalva.Ann Thorac Surg. 1991; 52:328–335.CrossrefMedlineGoogle Scholar17. Kerr JM. William Hunter; his life, personality and achievements.Scott Med J. 1957; 2:372–378. doi: 10.1177/003693305700200907CrossrefMedlineGoogle Scholar18. Freud S. Deuticke F, ed. In: Eine kindheitserinnerung des Leonardo da Vinci. Leipzigund Wien; 1910.Google Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Stutt N, Song M, Wilson M and Scott I (2022) Cardiac specification during gastrulation – The Yellow Brick Road leading to Tinman, Seminars in Cell & Developmental Biology, 10.1016/j.semcdb.2021.11.011, 127, (46-58), Online publication date: 1-Jul-2022. Yadav S and Majumder A (2021) Biomimicked hierarchical 2D and 3D structures from natural templates: applications in cell biology, Biomedical Materials, 10.1088/1748-605X/ac21a7, 16:6, (062001), Online publication date: 1-Nov-2021. Ghosh S, Priya A and Narayan R (2021) Evolution of the fabric of cardiovascular science: Saga of an enduring process of refinement, Annales de Cardiologie et d'Angéiologie, 10.1016/j.ancard.2021.06.002, 70:4, (220-230), Online publication date: 1-Oct-2021. 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January 18, 2019Vol 124, Issue 2 Advertisement Article InformationMetrics © 2019 American Heart Association, Inc.https://doi.org/10.1161/CIRCRESAHA.118.314253PMID: 30653428 Originally publishedJanuary 17, 2019 Keywordsdeathfearhistory of medicineheartblood circulationPDF download Advertisement
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