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September - December 2005: 
Volume 18, Issue 3

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The lung and respiratory function in Greek medical texts of the 18th and early 19th century
Abstract
Knowledge about lung anatomy and respiratory function appearing in Greek texts of the 18th and early 19th century is presented. It is documented that new knowledge about the critical role of oxygen in the function of respiration was quickly transferred in the Greek region by medical texts translated in the Greek language. Pneumon 2005, 18(3):279-282.
Keywords: lung, respiration, oxygen
Full text

Since the mid 18th century and, in particular, in the two decades preceding the revolution, the number of Greek books of positive-natural sciences, including medicine, was on the rise. Our research has shown that medical books were primarily translations from original European books or a medley of their content;1 in addition, medical knowledge, especially human anatomy and physiology, was also found in non-medical books, i.e. books addressing physics, chemistry, philosophy etc. It would be interesting to present knowledge regarding the anatomy of the lung and the function of respiration found in these books of the pre-revolutionary era, the New-Hellenic enlightenment, that communicated scientific medical knowledge. Furthermore, we will observe the introduction of novel relevant medical terms in Greek by the then scholars.

 

ANATOMY

 

As regards the larynx, authors of that time2 indicated that it consists of five cartilages: the "thyroid", which forms the front part of "Adam's apple", the "cricoid", two "arytenoids", and "epiglottis", a name indicating its position "over glottis, namely the upper opening of the larynx"; epiglottis is attached to the tongue, the thyroid cartilage and the hyoid bone3. In 1757, Nikiforos Theotokis4 presented indeed a preparation of the "larynx and the tracheal artery", noting that the edges of the glottis form the vocal cords, which produce sound as they are hit by the exhaled air. It is worthy of note that the cited terminology regarding the cartilages of the larynx appears in writings of Galen5.

 

Adjacent to the larynx is the so-called "tracheal artery", consisting of an array of cartilages; according to the then writers, these cartilages are ring-form with a front cartilage part and a back muscle part. The muscle part consists of longitudinal and traverse fibers arranged appropriately to allow tracheal movements. After its entrance in the thoracic cavity, the tracheal artery is divided in two major branches, the bronchi, one for each lung, which retain the same structure. The bronchi are further divided to smaller branches to finally end in membranous alveoli, the so-called "blisters" ("φουσκαλίδες") by Ker. Cheretis; or "bubbles" ("φούσκες") by Dim. Darbaris;6 Anthimos Gazis used a variant of the Greek word for blisters ("φυσκαλίδες")7 and added that "a network of blood vessels" extends on their surface. The currently used term "alveoli" ("κυψελίδες") was introduced by Dim. Mavrokordatos in his Anatomy in 1836.8 The branches of the pulmonary artery and vein, the bronchial vessels,9 which nurture the lung, pass between the lobes of the lung along with nerves and "water-carrying vessels" (i.e. the lymph vessels).

 

The membrane that covers the internal surface of the thoracic cavity and the external surface of the viscera is made of the same substance as the peritoneum and is called "πλεύρα" ("plevra") or "πλευρά" ("plevra") by some writers;10 however Kon. Koumas11 used the contemporary Greek term "υπεζωκώς" ("epezokos"; the pleura), which is cited by Galen: "άπασαν ουν εκατέραν του θώρακος υπεζώκασι την ένδον χώραν οι υμένες απλοί την φύσιν υπάρχοντες, ώσπερ αράχνια, καλούνται δε κατά μεν τας πλευράς υπεζωκότες".12

 

RESPIRATORY FUNCTION

 

Until the late 18th century, the predominant view regarding respiration was that the inhaled air provides the lung with an "elastic force" according to Nikiforos Theotokis,13 or the "vital spirit" according to Benjamin Martin (1704-1782), whose book was translated by Anth. Gazis in 1799. The new knowledge introduced by B. Martin in a footnote is that the air constituent that is useful for the human body is oxygen, which was discovered that time by A.L. Lavoisier (1743-1794). In 1791, it was experimentally shown that oxygen is necessary for the function of respiration in humans. To current knowledge, the reference of Anth. Gazis to the vital role of oxygen in respiration is the first entry on the role of oxygen in a Greek writing. By the way, however, it should be noted that at the same time the physician Kerekos Cheretis had not included this knowledge about the vital role of oxygen on respiration in his book published in 1798, one year after his graduation from University, most probably because this experimental evidence had not yet been integrated in the curriculum of the Medical School of Padova.

 

As regards inhaled air oxygen, the physician Theodossios M. Heliades14 wrote further in 1802 that it binds with the blood passing through the lungs, whereas the physician Anastasios Georgiades who later became professor in the newly-founded University of Athens, noted in 1810 that oxygen creates the red color of the blood. The physician Kon. Vardalachos shares the same views stressing that "the function of respiration in animals aims at binding blood with inhaled air" and is intended "to maintain the innate heat in the animal".15 He cites relevant experiments indicating that air oxygen entering the lungs passes in the blood through the alveolar-arterial walls. He distinctively notes that, "according to experimental observations oxygen enters blood through the lateral walls of the vessels". Furthermore, he describes the experiment in which a cyst filled with venous blood was brought in close contact with a cyst filled with oxygen and the venous blood turned to arterial blood". Anastasios Georgiades comments on the observations of G. Dupyutren (1777-1835) published in the "Medicosurgical Paper" of Salzburg in 1808 that critical to the function of respiration are the nerves found in the lungs, i.e. the branches of the eighth cranial nerve and sympathetic nerves forming the anterior and posterior neural plexus of the lung.

 

In an issue of the Greek journal Hermes the Scholar16 in 1816 an article titled "Physiology: On animal heat and respiration" was translated from European journals issued in 1814 and 1815, including Gilbert's Annales des Physik, indicating that scientific knowledge was rapidly communicated in the Greek region. In particular, it is pointed out that oxygen binds with carbon and hydrogen in the blood forming carbonic acid and "water vapors", i.e. water, respectively, compounds expelled with exhaled air, along with "another air constituent, nitrogen". In addition, another article published in Journal de Pharmacie stressed that according to Lavoisier respiration is the single most important chemical process in the human body, since it entails the absorption of oxygen used for the production of heat.

 

As regards body temperature, i.e. the "innate heat", until the late 18th century it was thought that heat, the "fiery material", is produced by the movement of blood in the heart and the vessels, and then blood becomes cold through respiration. However, during the two decades preceding the revolution appears the contemporary knowledge on the physiology of the relationship between blood and respiration that "the vital air changes in the lungs and binds with blood during breathing" ("...μεταβολή του ζωτικού αέρος εν τοις πνευμόνοις και η ένωσις αυτού μετά του αίματος εν τω αναπνέειν"). Literally, the physician Kon. Vardalachos17 notes that "A.L. Lavoisier was the first to suggest that heat originates from the oxygen in the air. Undoubtedly, when oxygen binds with carbon or hydrogen to form carbonic acid or water, respectively, it inevitably releases an amount of heat in the lungs where the afore-mentioned binding occurs; this heat is continually diffused in the blood and accounts for innate heat". Similarly, Anast. Georgiades18 points out that the binding of oxygen with carbon or water creates "heat" ("θερμαντικόν"), which is then transported through circulation in the whole body and maintains the body temperature ("ζωώδη θερμότητα").

 

As a conclusion to this work, we will cite the recommendation of the physician Kon. Vardalachos not to rely on assumptions but to proceed to experiments to test specific scientific hypotheses: "Anyone who wishes to verify the Lavoisier's views on the respiratory system should carry out a lot of experiments to this end and not just make assumptions as we have been doing till now" ["Εάν θέλωμεν να βεβαιώσωμεν το του Λαθοϊσιήρου (Lavoisier) περί της αναπνοής σύστημα, πρέπει να κάμωμεν περί ταύτης πολλά πειράματα, και όχι να υποθέτωμεν, καθώς εκάμνομεν έως τώρα"].

 

REFERENCES

 

1. D. Karamperopoulos, European medical knowledge in the Greek region, pp. 1745-1821, Athens, History of Medicine Library, Nr. 1, 2003, pp. 33.
2. Κ.Μ. Κoumas, Series of fundamentals of mathematical and physical dissertations, Vol. 8, Vienna, 1807, p. 26; Kerekos Cheretis, Manual of animal economy, Vienna, 1798, p. 16; Kyr. & Man. Kapetanakis, Iconology for children, Vol. 6, 1812, Nr. 49, where a relevant color anatomy picture is included.
3. "Hyoid... named after its shape, resembling the Greek letter υ (ypsilon)", Rufus from Efessos, "On the names of human structures", ed. Ch. Daremberg & Emile Ruelle, Paris, 1879, p.. 155.
4. Nikiforos Theotokis, Elements of physics, Vol. Β΄, 1767, p. 192.
5. Galen, "On the necessity of human body structures", Word VII, Chapter XI, ed. G.C. Kuehn, Cl. Galeni, Opera Omnia, Vol. 3, Leipzig, 1822, reprint Georg Olms Verlag, Hildesheim-Zurich-New York, 1997, pp. 551-557.
6. Dim. Darvaris, Epitome of Physics, 1813, Vol. C, p. 135.
7. Anthimos Gazis, Grammar of philosophical science or a brief assay on experimental philosophy, Vol. Β΄, Vienna, 1799, p. 554.
8. Dim. Mavrokordatos, Anatomy of the human body, ¬Athens, 1836, p. 554.
9. Ker. Cheretis, Manual of animal economy, Venice 1798, p. 19, where the term "bronchial vessels" appears maybe for the first time. See Dim. Karamperopoulos, The european medical knowledge ..., see above, p. 230. See also Koumanoudes, Introducing new terms, Athens 1900, (reprint Hermes, Athens 1980), p. 229, where reference is made to later medical texts.
10. The terms "πλεύρα" and "πλευρά", cited by some writers, are probably unedited translations of the French term "plevre" or the Italian term "pleura", respectively.
11. Κ.Μ. Koumas, Series of fundaments ..., see above, Vienna, 1807, p. 25.
12. Galen, On anatomical operations, C.G. Kuehn, Colle¬cted works of Galen, Vol. 2, Leipzig 1821, reprint 2001, p. 522.
13. Nikiforos Theotokis, Elements of physics, Vol. Β΄, Leipzig 1767, p. 192.
14. Theodossios M. Heliades, Chemical Philosophy, Vienna 1802, p. 166. Anast. Georgiades, Antipanacea ("Αντιπα¬νάκεια"), Vienna 1810, p. 190, where the French term "oxygene" is translated as "οξυγένιον".
15. Kon. Vardalachos, Physical experimentics, Vienna 1812, p. 279.
16. Hermes the Scholar ("Ερμής ο Λόγιος"), Vienna 1816, p. 82-87, 1818, p. 220.
17. Kon. Vardalachos, Physical experimentics, Vienna 1812, p. 279.
18. Anast. Georgiades, Antipanacea, Vienna 1810, p. 192.

References