46007
2015
SRIXXX10.1177/1553350614546007Surgical InnovationTsoucalas et al
Letter to the Editor
Aretaeus of Cappadocia (c. 1st Century BC to 3rd Century AD) and the Origins of Endovascular Catheterization
Surgical Innovation 2015, Vol. 22(3) 322 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1553350614546007 sri.sagepub.com
Gregory Tsoucalas, MD, PhD1, Konstantinos Laios, MD, PhD2, Marianna Karamanou, MD, PhD2, and Markos Sgantzos, MD1 Aretaeus of Cappadocia presents the most prominent and at the same time enigmatic figure in Ancient Greek Medicine, since very little is known about his life, while his work is considered by contemporary medicine as outstandingly significant.1 There is some controversy as to when he lived; with a debate ranging from the 1st century BC to the 3rd century AD. Although the most widely accepted opinion being that he lived in the 2nd century AD, it would be more correct to date him to the 3rd century AD, as a representative of the Eclectic School.2 Aretaeus was a medical writer with vivid descriptions of clinical diseases, including anatomical presentations of various body organs.3 When describing the anatomy of the vena cava in his treatise “On the Acute Diseases,” he considered it to be a binary vessel that begins from the liver and ends in the heart, the superior vena cava, with its second vascular branch to begin again from the liver, crossing the vertebral spine, and ending on the level of the hips, the inferior vena cava (Aretaeus Med. De causis et signis acutorum morborum 2.8.1.1-2.8.9.9). Aretaeus, during an era with absolutely no scientific experience for vascular catheterization, proposed in his writings an endovascular metallic catheter (metallic plate), which could enter endoluminally via the penetration of the upper vena cava toward the heart, or through the inferior vena cava, or even through a continuous penetration of the vertebral spine toward the liver ending upper to the heart (Aretaeus Med. De causis et signis acutorum morborum 2.8.1.12.8.3.1).4,5 His innovative thought, the first tryout of such a procedure, was most probably a demonstrative surgical presentation for didactic purposes during an anatomic lesson and a corpse dissection, human’s or animal’s.6 This was a fatal action unattainable in reality, as such a catheterization would have meant the certain death of the person submitted to it. The use of the conditional syntax inside the ancient fragment of Aretaeus’ text reinforces the view of a hypothetical action in a patient with a blocked blood flow, or a vein trauma, or a heart failure, or simply a means to correct an imbalance of 1 of the 4 humors, according to the homonym theory. Even if his scientific
exaggeration was made to stress the continuum of these vessels and their anastomosis inside the human body, or to imply an invasive surgical method with applications in the future, he should be considered as a pioneer pundit in vessel catheterization, an innovative physician who has been referred to a method with a huge destiny in the medical field. Author Contributions Gregory Tsoucalas: Writing of the letter, collecting data. Konstantinos Laios: Collecting data. Marianna Karamanou: Collecting data. Markos Sgantzos: Supervision.
References 1. Deichgräber Κ. Aretaeus von Kappadozien als medizinischer Schriftsteller. Berlin, Germany: Akademie Verlag; 1971: 1-45. 2. Osler W. Bibliotheca Osleriana: A Catalogue of Books Illustrating the History of Medicine and Science. Montreal, Quebec, Canada: McGill-Queen’s University Press; 1969:31. 3. Winslow F. Physic and Physicians: A Medical Sketch Book. 2 Volumes. London, England: Longman, Orme, Brown; 1839:I, 30. 4. Hude K., ed. De causis et signis acutorum morborum (lib. 1), Aretaeus. 2nd ed. [Corpus medicorum Graecorum, Vol. 2]. Berlin, Germany: Akademie Verlag; 1958:3-35. (Cod: 9,771: Med.) 5. Singer CJ. Studies in the History and Method of Science. Oxford, England: Clarendon Press; 1921:288. The London Medical Dictionary. London, England: Johnson 6. & Davison; 1809:107.
1
University of Thessaly, Larissa, Greece University of Athens, Athens, Greece
2
Corresponding Author: Gregory Tsoucalas, Kononos 62-64 Pagrati, Athens, P.C. 11633, Greece. Email: [email protected]
Downloaded from sri.sagepub.com by guest on November 14, 2015
2015
SRIXXX10.1177/1553350614546007Surgical InnovationTsoucalas et al
Letter to the Editor
Aretaeus of Cappadocia (c. 1st Century BC to 3rd Century AD) and the Origins of Endovascular Catheterization
Surgical Innovation 2015, Vol. 22(3) 322 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1553350614546007 sri.sagepub.com
Gregory Tsoucalas, MD, PhD1, Konstantinos Laios, MD, PhD2, Marianna Karamanou, MD, PhD2, and Markos Sgantzos, MD1 Aretaeus of Cappadocia presents the most prominent and at the same time enigmatic figure in Ancient Greek Medicine, since very little is known about his life, while his work is considered by contemporary medicine as outstandingly significant.1 There is some controversy as to when he lived; with a debate ranging from the 1st century BC to the 3rd century AD. Although the most widely accepted opinion being that he lived in the 2nd century AD, it would be more correct to date him to the 3rd century AD, as a representative of the Eclectic School.2 Aretaeus was a medical writer with vivid descriptions of clinical diseases, including anatomical presentations of various body organs.3 When describing the anatomy of the vena cava in his treatise “On the Acute Diseases,” he considered it to be a binary vessel that begins from the liver and ends in the heart, the superior vena cava, with its second vascular branch to begin again from the liver, crossing the vertebral spine, and ending on the level of the hips, the inferior vena cava (Aretaeus Med. De causis et signis acutorum morborum 2.8.1.1-2.8.9.9). Aretaeus, during an era with absolutely no scientific experience for vascular catheterization, proposed in his writings an endovascular metallic catheter (metallic plate), which could enter endoluminally via the penetration of the upper vena cava toward the heart, or through the inferior vena cava, or even through a continuous penetration of the vertebral spine toward the liver ending upper to the heart (Aretaeus Med. De causis et signis acutorum morborum 2.8.1.12.8.3.1).4,5 His innovative thought, the first tryout of such a procedure, was most probably a demonstrative surgical presentation for didactic purposes during an anatomic lesson and a corpse dissection, human’s or animal’s.6 This was a fatal action unattainable in reality, as such a catheterization would have meant the certain death of the person submitted to it. The use of the conditional syntax inside the ancient fragment of Aretaeus’ text reinforces the view of a hypothetical action in a patient with a blocked blood flow, or a vein trauma, or a heart failure, or simply a means to correct an imbalance of 1 of the 4 humors, according to the homonym theory. Even if his scientific
exaggeration was made to stress the continuum of these vessels and their anastomosis inside the human body, or to imply an invasive surgical method with applications in the future, he should be considered as a pioneer pundit in vessel catheterization, an innovative physician who has been referred to a method with a huge destiny in the medical field. Author Contributions Gregory Tsoucalas: Writing of the letter, collecting data. Konstantinos Laios: Collecting data. Marianna Karamanou: Collecting data. Markos Sgantzos: Supervision.
References 1. Deichgräber Κ. Aretaeus von Kappadozien als medizinischer Schriftsteller. Berlin, Germany: Akademie Verlag; 1971: 1-45. 2. Osler W. Bibliotheca Osleriana: A Catalogue of Books Illustrating the History of Medicine and Science. Montreal, Quebec, Canada: McGill-Queen’s University Press; 1969:31. 3. Winslow F. Physic and Physicians: A Medical Sketch Book. 2 Volumes. London, England: Longman, Orme, Brown; 1839:I, 30. 4. Hude K., ed. De causis et signis acutorum morborum (lib. 1), Aretaeus. 2nd ed. [Corpus medicorum Graecorum, Vol. 2]. Berlin, Germany: Akademie Verlag; 1958:3-35. (Cod: 9,771: Med.) 5. Singer CJ. Studies in the History and Method of Science. Oxford, England: Clarendon Press; 1921:288. The London Medical Dictionary. London, England: Johnson 6. & Davison; 1809:107.
1
University of Thessaly, Larissa, Greece University of Athens, Athens, Greece
2
Corresponding Author: Gregory Tsoucalas, Kononos 62-64 Pagrati, Athens, P.C. 11633, Greece. Email: [email protected]
Downloaded from sri.sagepub.com by guest on November 14, 2015
