The Public Health in G.B. Morgagni. New historical perspectives

The Public Health in G.B. Morgagni. New historical perspectives Abstract The article sheds light on an almost unknown aspect of the activity of G.B. Morgagni. Historians have almost entirely forgotten his work as legal medical expert for the Health Magistrate of the Republic of Venice. His numerous hand-written works well testify his evolution from the Neo-Hippocratic theories to an ante-litteram Hygiene. He surmounts the classical theory of miasma and offers a sort of microbial theory of contagion, long before the microbiological revolution of the end of the 19th century. Morgagni also provides new solutions for the control of air quality and of environmental risks, conceived as measures of Public Health, according to the neo-Hippocratic theories as well as to the Enlightment social medicine ideals. Enlightment social medicine, origins of the Public Health, Public Health in G.B. Morgagni The Public Health in G.B. Morgagni. New historical perspectives Historical-medical literature has often stressed the importance of G.B. Morgagni’s masterpiece De Sedibus et causis morborum (1761), as it represents the birth of the pathological anatomy. But this work also is the expression of a renewed clinical method: according to Neo-Hippocratic theories, Morgagni was searching for a new ‘mechanistic’ theory that could successfully connect causes to pathological effects, therefore identifying the onset of the disease and constructing in-depth nosology.1 Morgagni identifies primary pathological causes in the structural lesions of the internal organs and in their functional impairment, searching for ‘proxies’ or secondary causes following the Neo-Hippocratic approach that explains the origin of the epidemics with environmental factors such as the air and water quality.2,3 Ancient miasmatic theories, explaining the origin of epidemics as a spontaneous corruption of air, were being replaced by the scientific study of possible elements that could contaminate our environment. In 18th century, Iatromechanism, that Morgagni embraced, followed a cospuscolar model to explain several pathological process, even the epidemics, caused by the propagation in the air of pathogenic atoms or particles, derived from a pathogenic matter or from a sick person or animal. The role of Morgagni as a consultant to the Magistratura di Sanità della Serenissima [Health Magistrate of the Republic of Venice] reflects the constant dialogue between jurisprudence and medicine in the Modern Age, shedding new light on Morgagni’s work, as well as his cultural background and medical theories. His forensic opinions, written as an answer to specific questions put forth by the Venetian Health Magistrate,4 show a modern thinking and correspond in many ways to the medical theories of the Enlightenment. Within this context, G.B. Morgagni provides interesting and lesser-known theoretical contributions. His work as legal medical expert clearly demonstrates that we might consider him as and ante-litteram hygienist, interested on Public Health. The authors of this study examined and transcribed numerous hand-written works, often personally penned and signed by Morgagni himself, found today in the Library of his native town, Forlì (Italy, region of Romagna). Some of these works reflect the classical tradition of the 18th century forensic medicine, but there is more relevance and innovation in his work on potential pathological environmental risk factors and studies on the transmission of contagious diseases, which the 17th century medicine had already begun to discuss. Public hygiene policies have often managed through non-medical institutions, from Antiquity to the Early Modern Age. Physicians did not write about environmental remediation plans, urban planning regulations, and workers’ protection until the 18th century. The idea of the impelling need for air quality control belongs to administrative and political institutions: doctors continue for a long time to be faithful to the concept of ‘miasma’. Bernardino Ramazzini (1633–1714), an author who inspired Morgagni’s work, had identified putrefied organic matter as the possible origin of the worse epidemic diseases.5 Morgagni accords with this perspective. Since 1718, Morgagni declares that it is very dangerous to eat the meat of infected animals, as well as to preserve their skins at home or to use them to produce clothes. Furthermore, in 1753 Morgagni reports his expert medical opinion on the risks associated with working in the tanneries6; the same concept is expressed in 1766, when he addresses the issue of workers engaged in cleaning linen clothes or working in fumaroles.7 In two texts, dating 17 318 and 1759,9 he firmly denounces the pathogenic conditions that arise from exhuming corpses that had not yet reach skeletonization, or from digging in old common burials dating back to major epidemics, due to the putrid exhalations. This air, corrupted by the putrefaction, if not contained in a closed environment, can cause epidemic illness in the population. Moreover, Morgagni paid special attention to the health and sanitary conditions in cemeteries, whose danger had been brought to light by contemporary physiology and chemistry. At that time, it was clear both to physicians and politicians that an important role in the safeguarding of health was played by removing possible causes of infection caused by urban burials. Despite the fact that in Italy the conditions of urban burials would be modified only with the Napoleonic occupancy, public opinion had long been formed through a heated debate that concerned the need to change how and where the dead were buried.10 Morgagni was a forerunner of this Italian debate, developed in the 17th century and becoming a topic of the Enlightenment medicine.11 Since the 1730s, he embraced the theory of contamination caused by corpses. This was the hub of a debate that would not only involve doctors but also government authorities, who would later outline sanitary and health plans, including the construction of cemeteries outside of cities as a tool to protect public health.12 The studies and work written for the Health Magistrate of the Republic of Venice highlight Morgagni’s modern thinking—he fully inserts himself among the representatives of the Enlightenment medicine, providing new scientific interpretations and new solutions to the urgent dilemmas that the society of the time was facing, primarily the control of air quality, as a measure of public health. However, Morgagni does not limit his attention to the debate on cemeteries. Epidemics caused by air pollution can also be rooted in factories, often built inside the city centres, because of both industrial processes and the substances used for production. In an expertise written in 1753, he deals with the health conditions of tanneries—one of the most insalubrious manufacturing sectors, as the exhalations produced by the skin of the macerated animals quickly corrupt the air and the surroundings waters.6,7 There is also a Morgagni important study that highlights the author’s true, avant-garde position, when compared to 18th century medical theory. When discussing the health risks caused by the use of infected animal manures, he offers a truly innovative theory of contagion—if compared with contemporary medical thinking. Already in 1546, Girolamo Fracastoro had offered a revolutionary interpretation of the epidemics using the concept of ‘seminaria’,13 invisible non-living particles transmitted from a sick individual to an healthy one. In 17th century, the Pisan group led by Francesco Redi demonstrates that many plant diseases are dependent from insects, and that even the human scabies is caused by mites. With the corpuscular philosophy, physicians used to explain the contagion imaging ‘seeds’, ‘atoms’, ‘particles’ detaching from infected bodies; nevertheless, no medical explanation is clearly founded on the idea that the contagion is caused by microbial agents—simply on the idea of insects, or atoms. Still B. Ramazzini in his De contagiosa epidemia14 (1712) recalled the atomistic model of Fracastoro, following the corspuscolar theory of the iatromechanics. Morgagni embraces the theory of living contagion, writing that ‘minuti, e al nostro senso invisibili animali’ (small animals, invisible to our senses) arise from manure, spreading through the air and infecting humans and animals.15 He therefore overcomes the classical theory of miasma, as well as the contemporary corpuscular theories. His ‘minuti animali’ seem to anticipate the concept of microbial agents. All his scientific production as a legal expert highlights the urgent need to adopt public hygiene and environmental remediation measures to promote public health. In this perspective, Morgagni well represents the Italian side of the Enlightment social history of medicine, from which the 18th century hygienist movement will originate, institutionalizing Public Health as a medical discipline all over Europe. Acknowledgements The authors thank Dr Elio De Angelis for the transcription of some manuscripts of Morgagni, and the librarians of the Municipal Library Aurelio Saffi in Forlì (Italy), who authorized us to explore and study these important literary sources. V.G. has found the hand-written works that G.B. Morgagni wrote as medical legal expert for the Health Magistrate of the Republic of Venice, transcribing and traducing them from Latin. She already published the transcription of some manuscript in 2000. S.M. has developed the study on the social medicine and on the hygienist theories in the illuminist medical thinking as primordial origin of the Public Health. She focused on the theories of G.B. Morgagni, by the analysis of his forensic medical manuscripts Funding The authors declare that the research performed has not been funded by any institution. The study of the hand-written works of G.B. Morgagni had no include employment, research funding or payment for lectures and consultancies. References 1 Lonie I . Hippocrates the Iatromechanist . Medical History 1981 ; 25 : 113 – 50 . Google Scholar CrossRef Search ADS PubMed 2 Conforti M , Gazzaniga V , Marinozzi S . Bernardino Ramazzini tra ippocratismo e sperimentalismo. Per la costruzione teorica di una ‘medicina sociale’ . Medicina nei Secoli 2011 ; 23/2 : 465 – 93 . 3 Ramazzini B . De principum valetudine tuenda. In: Opera omnia medica physica . Londini : P. & I. Vaillant , 1717 : 407 – 52 . 4 Gazzaniga V , De Angelis E . Giovanni BattistaMorgagni. Perizie medico-legali . Roma : Carossi , 2000 . 5 Ramazzini B . De morbis artificum diatriba . Modena : Capponi , 1700 . 6 Morgagni GB . Sulle esalazioni delle concerie delle pelli . Biblioteca comunale di Forlì—Aurelio Saffi, Ms. 1753 ; XXXI : 115r – 117 . and 241r-243v. 7 Morgagni GB . Se gli effluvi che tramandono i lini durante la macerazione possano contribuire all’inquinamento dell’aria . Biblioteca comunale di Forlì—Aurelio Saffi, Ms. 1766 ; XXXI : 139r – 141v . 8 Morgagni GB . Sulle cautele da prendersi per aprire il sepolcro D’Este . Biblioteca comunale di Forlì—Aurelio Saffi, Ms. 1731 ; XXXI : 118r – 125v . 9 Morgagni GB . Sugli scavi nel Camposanto del Pio Ospedale di San Francesco di Padova . Biblioteca comunale di Forlì – Aurelio Saffi, Ms. 1759 ; XXXI : 134r – 6v . 10 Piattoli S . Saggio intorno al luogo del seppellire. Modena: F. Sansoni, 1774 , or Rastrelli, M., Storia delle sepolture antiche e moderneed osservazioni sui nuovi Campi Santi. Firenze: s. e., 1784. 11 Pasini P . Il cimitero moderno: un profilo storico per l’Italia . Ricerche e progetti per il territorio, la città e l’architettura 2012 ; 4 : 191 – 202 . 12 Tommasi G . Per salvare i viventi. Le origini settecentesche del cimitero extraurbano . Bologna : Il Mulino , 2001 . 13 Fracastoro G . De contagione et contagiosis morbis . Venezia : L. Giunta , 1546 . 14 Ramazzini B . De contagiosa epidemia, quae in Patavino agro & tota fere Veneta ditione in boves irrepsit . Padova : Jo. B. Conzatti , 1712 . 15 Morgagni GB . Sui letami di stalle infette e sugli animali che vi si custodiscono . Biblioteca comunale di Forlì—Aurelio Saffi, Ms. 1745 ; XXXI : 53r – 8r . © The Author(s) 2018. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Public Health Oxford University Press

The Public Health in G.B. Morgagni. New historical perspectives

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Abstract

Abstract The article sheds light on an almost unknown aspect of the activity of G.B. Morgagni. Historians have almost entirely forgotten his work as legal medical expert for the Health Magistrate of the Republic of Venice. His numerous hand-written works well testify his evolution from the Neo-Hippocratic theories to an ante-litteram Hygiene. He surmounts the classical theory of miasma and offers a sort of microbial theory of contagion, long before the microbiological revolution of the end of the 19th century. Morgagni also provides new solutions for the control of air quality and of environmental risks, conceived as measures of Public Health, according to the neo-Hippocratic theories as well as to the Enlightment social medicine ideals. Enlightment social medicine, origins of the Public Health, Public Health in G.B. Morgagni The Public Health in G.B. Morgagni. New historical perspectives Historical-medical literature has often stressed the importance of G.B. Morgagni’s masterpiece De Sedibus et causis morborum (1761), as it represents the birth of the pathological anatomy. But this work also is the expression of a renewed clinical method: according to Neo-Hippocratic theories, Morgagni was searching for a new ‘mechanistic’ theory that could successfully connect causes to pathological effects, therefore identifying the onset of the disease and constructing in-depth nosology.1 Morgagni identifies primary pathological causes in the structural lesions of the internal organs and in their functional impairment, searching for ‘proxies’ or secondary causes following the Neo-Hippocratic approach that explains the origin of the epidemics with environmental factors such as the air and water quality.2,3 Ancient miasmatic theories, explaining the origin of epidemics as a spontaneous corruption of air, were being replaced by the scientific study of possible elements that could contaminate our environment. In 18th century, Iatromechanism, that Morgagni embraced, followed a cospuscolar model to explain several pathological process, even the epidemics, caused by the propagation in the air of pathogenic atoms or particles, derived from a pathogenic matter or from a sick person or animal. The role of Morgagni as a consultant to the Magistratura di Sanità della Serenissima [Health Magistrate of the Republic of Venice] reflects the constant dialogue between jurisprudence and medicine in the Modern Age, shedding new light on Morgagni’s work, as well as his cultural background and medical theories. His forensic opinions, written as an answer to specific questions put forth by the Venetian Health Magistrate,4 show a modern thinking and correspond in many ways to the medical theories of the Enlightenment. Within this context, G.B. Morgagni provides interesting and lesser-known theoretical contributions. His work as legal medical expert clearly demonstrates that we might consider him as and ante-litteram hygienist, interested on Public Health. The authors of this study examined and transcribed numerous hand-written works, often personally penned and signed by Morgagni himself, found today in the Library of his native town, Forlì (Italy, region of Romagna). Some of these works reflect the classical tradition of the 18th century forensic medicine, but there is more relevance and innovation in his work on potential pathological environmental risk factors and studies on the transmission of contagious diseases, which the 17th century medicine had already begun to discuss. Public hygiene policies have often managed through non-medical institutions, from Antiquity to the Early Modern Age. Physicians did not write about environmental remediation plans, urban planning regulations, and workers’ protection until the 18th century. The idea of the impelling need for air quality control belongs to administrative and political institutions: doctors continue for a long time to be faithful to the concept of ‘miasma’. Bernardino Ramazzini (1633–1714), an author who inspired Morgagni’s work, had identified putrefied organic matter as the possible origin of the worse epidemic diseases.5 Morgagni accords with this perspective. Since 1718, Morgagni declares that it is very dangerous to eat the meat of infected animals, as well as to preserve their skins at home or to use them to produce clothes. Furthermore, in 1753 Morgagni reports his expert medical opinion on the risks associated with working in the tanneries6; the same concept is expressed in 1766, when he addresses the issue of workers engaged in cleaning linen clothes or working in fumaroles.7 In two texts, dating 17 318 and 1759,9 he firmly denounces the pathogenic conditions that arise from exhuming corpses that had not yet reach skeletonization, or from digging in old common burials dating back to major epidemics, due to the putrid exhalations. This air, corrupted by the putrefaction, if not contained in a closed environment, can cause epidemic illness in the population. Moreover, Morgagni paid special attention to the health and sanitary conditions in cemeteries, whose danger had been brought to light by contemporary physiology and chemistry. At that time, it was clear both to physicians and politicians that an important role in the safeguarding of health was played by removing possible causes of infection caused by urban burials. Despite the fact that in Italy the conditions of urban burials would be modified only with the Napoleonic occupancy, public opinion had long been formed through a heated debate that concerned the need to change how and where the dead were buried.10 Morgagni was a forerunner of this Italian debate, developed in the 17th century and becoming a topic of the Enlightenment medicine.11 Since the 1730s, he embraced the theory of contamination caused by corpses. This was the hub of a debate that would not only involve doctors but also government authorities, who would later outline sanitary and health plans, including the construction of cemeteries outside of cities as a tool to protect public health.12 The studies and work written for the Health Magistrate of the Republic of Venice highlight Morgagni’s modern thinking—he fully inserts himself among the representatives of the Enlightenment medicine, providing new scientific interpretations and new solutions to the urgent dilemmas that the society of the time was facing, primarily the control of air quality, as a measure of public health. However, Morgagni does not limit his attention to the debate on cemeteries. Epidemics caused by air pollution can also be rooted in factories, often built inside the city centres, because of both industrial processes and the substances used for production. In an expertise written in 1753, he deals with the health conditions of tanneries—one of the most insalubrious manufacturing sectors, as the exhalations produced by the skin of the macerated animals quickly corrupt the air and the surroundings waters.6,7 There is also a Morgagni important study that highlights the author’s true, avant-garde position, when compared to 18th century medical theory. When discussing the health risks caused by the use of infected animal manures, he offers a truly innovative theory of contagion—if compared with contemporary medical thinking. Already in 1546, Girolamo Fracastoro had offered a revolutionary interpretation of the epidemics using the concept of ‘seminaria’,13 invisible non-living particles transmitted from a sick individual to an healthy one. In 17th century, the Pisan group led by Francesco Redi demonstrates that many plant diseases are dependent from insects, and that even the human scabies is caused by mites. With the corpuscular philosophy, physicians used to explain the contagion imaging ‘seeds’, ‘atoms’, ‘particles’ detaching from infected bodies; nevertheless, no medical explanation is clearly founded on the idea that the contagion is caused by microbial agents—simply on the idea of insects, or atoms. Still B. Ramazzini in his De contagiosa epidemia14 (1712) recalled the atomistic model of Fracastoro, following the corspuscolar theory of the iatromechanics. Morgagni embraces the theory of living contagion, writing that ‘minuti, e al nostro senso invisibili animali’ (small animals, invisible to our senses) arise from manure, spreading through the air and infecting humans and animals.15 He therefore overcomes the classical theory of miasma, as well as the contemporary corpuscular theories. His ‘minuti animali’ seem to anticipate the concept of microbial agents. All his scientific production as a legal expert highlights the urgent need to adopt public hygiene and environmental remediation measures to promote public health. In this perspective, Morgagni well represents the Italian side of the Enlightment social history of medicine, from which the 18th century hygienist movement will originate, institutionalizing Public Health as a medical discipline all over Europe. Acknowledgements The authors thank Dr Elio De Angelis for the transcription of some manuscripts of Morgagni, and the librarians of the Municipal Library Aurelio Saffi in Forlì (Italy), who authorized us to explore and study these important literary sources. V.G. has found the hand-written works that G.B. Morgagni wrote as medical legal expert for the Health Magistrate of the Republic of Venice, transcribing and traducing them from Latin. She already published the transcription of some manuscript in 2000. S.M. has developed the study on the social medicine and on the hygienist theories in the illuminist medical thinking as primordial origin of the Public Health. She focused on the theories of G.B. Morgagni, by the analysis of his forensic medical manuscripts Funding The authors declare that the research performed has not been funded by any institution. The study of the hand-written works of G.B. Morgagni had no include employment, research funding or payment for lectures and consultancies. References 1 Lonie I . Hippocrates the Iatromechanist . Medical History 1981 ; 25 : 113 – 50 . Google Scholar CrossRef Search ADS PubMed 2 Conforti M , Gazzaniga V , Marinozzi S . Bernardino Ramazzini tra ippocratismo e sperimentalismo. Per la costruzione teorica di una ‘medicina sociale’ . Medicina nei Secoli 2011 ; 23/2 : 465 – 93 . 3 Ramazzini B . De principum valetudine tuenda. In: Opera omnia medica physica . Londini : P. & I. Vaillant , 1717 : 407 – 52 . 4 Gazzaniga V , De Angelis E . Giovanni BattistaMorgagni. Perizie medico-legali . Roma : Carossi , 2000 . 5 Ramazzini B . De morbis artificum diatriba . Modena : Capponi , 1700 . 6 Morgagni GB . Sulle esalazioni delle concerie delle pelli . Biblioteca comunale di Forlì—Aurelio Saffi, Ms. 1753 ; XXXI : 115r – 117 . and 241r-243v. 7 Morgagni GB . Se gli effluvi che tramandono i lini durante la macerazione possano contribuire all’inquinamento dell’aria . Biblioteca comunale di Forlì—Aurelio Saffi, Ms. 1766 ; XXXI : 139r – 141v . 8 Morgagni GB . Sulle cautele da prendersi per aprire il sepolcro D’Este . Biblioteca comunale di Forlì—Aurelio Saffi, Ms. 1731 ; XXXI : 118r – 125v . 9 Morgagni GB . Sugli scavi nel Camposanto del Pio Ospedale di San Francesco di Padova . Biblioteca comunale di Forlì – Aurelio Saffi, Ms. 1759 ; XXXI : 134r – 6v . 10 Piattoli S . Saggio intorno al luogo del seppellire. Modena: F. Sansoni, 1774 , or Rastrelli, M., Storia delle sepolture antiche e moderneed osservazioni sui nuovi Campi Santi. Firenze: s. e., 1784. 11 Pasini P . Il cimitero moderno: un profilo storico per l’Italia . Ricerche e progetti per il territorio, la città e l’architettura 2012 ; 4 : 191 – 202 . 12 Tommasi G . Per salvare i viventi. Le origini settecentesche del cimitero extraurbano . Bologna : Il Mulino , 2001 . 13 Fracastoro G . De contagione et contagiosis morbis . Venezia : L. Giunta , 1546 . 14 Ramazzini B . De contagiosa epidemia, quae in Patavino agro & tota fere Veneta ditione in boves irrepsit . Padova : Jo. B. Conzatti , 1712 . 15 Morgagni GB . Sui letami di stalle infette e sugli animali che vi si custodiscono . Biblioteca comunale di Forlì—Aurelio Saffi, Ms. 1745 ; XXXI : 53r – 8r . © The Author(s) 2018. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

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Journal of Public HealthOxford University Press

Published: Feb 23, 2018

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