15283-B-Blokker

11 General introduction 1 In the early Hellenic world, it was believed that the gods could cure patients in the џӬӣӤӠөӢӞՅӨӦ ( Asklepieion, healing temple) from their diseases. The naturalistic philosophers of later years (±500 BC) did not believe in supernatural powers, but practiced physiology. Their study of nature included anatomy, however, it did not yet correlate anatomy with disease. At the time of Hippocrates (ca. 460-377 BC), the ԻӚӭӪŻŐ ( Iatri , physicians) described external observations of disease (using all five senses), but autopsy on human corpses was probably not performed until the third century BC, when the Greek ruled over Egypt. In Alexandria, the so-called шӨӮӬӞՅӨӦ ( Mouseion , museum) was introduced: a home for arts and sciences, including a library. Here, medical students were enabled to dissect bodies of criminals, and thereby learned how to distinguish normal structures from those changed by disease. It was Erasistratus (ca. 310-250 BC) who at that time discovered the association between diseases and changes in solid organs, and pointed out the relevance of autopsy. For years to come the autopsy procedure was carried out without a clear protocol. According to the ancient documents, physicians often left many organs unexamined, because they finalized the autopsy as soon as they were convinced to have found the cause of death. New developments started with Vesalius, who published the first book on human anatomy 'De Humani Corporis Fabrica Libri Septem' in 1543, based on his own observations taken directly from the many human dissections he performed, and founded a systematic approach for autopsy. In the eighteenth century, autopsy reports became more extensive and sophisticated. Physicians like Morgagni and Boerhaave started paying attention to the clinical history and it’s correlation to autopsy findings (they realised that diseases develop over time); Bichat distinguished different kinds of human tissue through experiments and recognized how they got affected by disease. It wasn't until the nineteenth century, that the autopsy technique itself was subject to improvement: it was Prost who insisted on examining all the organs during a “complete autopsy” that required at least three hours. Later, Rokitansky pointed out how clinical practice could benefit from the knowledge gained from autopsy, and introduced the modern concepts of pathogenesis. In contrast to Rokitansky, who preferably disturbed the anatomical structures as little as possible and examined the organs in situ, it was Virchow who eviscerated all organs from the body one by one, to further dissect and examine them.