The lungs, wrote the second century Greek physician and philosopher Galen, had “all the properties which make for easy evacuation; for it is very soft and warm and is kept in constant motion.” He also assumed that arteries carried the purest blood to higher organs such as the brain and lungs from the left ventricle of the heart, while veins carried blood to the lesser organs such as the stomach from the right ventricle. In order for that theory to be correct, some sort of holes were needed to interconnect the ventricles, and so in the spirit of Galen’s time, he claimed he had found them. So paramount was Galen’s authority that for 1400 years, anatomists claimed to have seen these holes as well.1
Not wanting to dispute Galen when he couldn’t find those holes, Vesalius imagined that it diffused through the unbroken partition between the ventricles. When he published his 1543 book De humini corporus fabrica, pointing out that Galen had based some of his theories on the dissection and observation of dog and monkey cadavers rather than human ones as he himself had, Vesalius was met with such opprobrium that he vowed never to write again, and lived out his life as a court physician. It took a royal intervention to save him from burning at the stake.2
It didn’t turn out as well for Michael Servetus, a colleague of Vesalius, who published that blood flowed from one ventricle to the other through the lungs, contradicting Galen’s assertion that blood “sweated” from the right ventricle to the left through invisible pores in the interventricular system. Servetus was thereafter burned atop a mound of his own books by order of John Calvin, although probably as much for his revisionist religious views as for his insult to the established theories of Galen.3
Less than a hundred years later, William Harvey had published On the Circulation of the Blood, which further described the significance of the lungs. In his Lectures on the Whole of Anatomy (1653), he said: “Pre-eminence [of the lung]: nothing is especially so necessary, neither sensation nor aliment. Life and respiration are complementary. There is nothing living which does not breathe nor anything breathing which does not live.” Further disputing Galen, Harvey concluded: “The lungs make the spirits and indicate the nourishment, wherefore more worthy than the liver if honor is judged by benefit.”4
Although he ultimately lived to see the majority of reputable anatomists acknowledge the validity of his work, Harvey himself initially experienced resistance within the medical community. In fact, he is remembered as saying, “You know very well the storm my previous research caused. It is often better to grow wise in private at home than to publish what you have amassed with infinite labor, to stir up storms that may rob you of peace and quiet for the rest of your days.”5
Fortunately, scientists interested in the pulmonary system chose not to grow wise in private, and continued to pursue knowledge of the lungs and the circulatory system – but it would be another century and a half before scientists began to understand the physiology of respiration and the importance of oxygen. Joseph Priestly identified the presence of oxygen in air, but was unaware of its chemical and physiologic importance. Antoine Lavoisier named Priestley’s gas and defined the role of oxygen in combustion, chemical reactions, and respiration. Though probably France’s greatest chemist ever, Lavoisier lost his head to the guillotine during the French revolution.6
Fortunately, it’s much safer to practice pulmonary and critical care medicine today. These two specialties are inexorably linked. The connecting theme, of course, is that patients who are critically ill invariably have difficulty breathing for themselves, and require the assistance of a mechanical ventilator. It was the experts in lung physiology in the 20s, 30s and 40s who developed the technology that made the ventilator possible. After mechanical ventilation was introduced, it morphed into other aspects of critical care: blood pressure control, sepsis, infection, etc.
The three physicians on the cover of this issue of Hampton Roads Physician represent three separate specialties that have evolved within the umbrella of pulmonary and critical care medicine: the relatively new field of sleep medicine, lung disease and the ICU.
Dr. Delp Givens of Riverside Pulmonology/Sleep Center has seen the number of patients with sleep disorders skyrocket to such a degree that in 2017, he will transition his pulmonary/critical care practice to sleep medicine entirely to accommodate their needs.
Dr. Melhem Imad, who practices interventional pulmonology with Bayview Physicians, Pulmonary Medicine of Virginia Beach and at Chesapeake Regional Healthcare, focuses the majority of his work caring for lung cancer patients.
Dr. Paul Marik, Professor of Medicine and Chief of Pulmonary and Critical Care Medicine at
Eastern Virginia Medical School, sees patients in the office and spends the bulk of his time in the ICU when he’s not authoring papers and giving lectures.
We are very pleased to honor these three physicians for their previous and future contributions to the field of pulmonary and critical care medicine.
References:
1. The History of the Lungs, https://web.stanford.edu/class/history13/earlysciencelab/body/lungspages/lung.html
2. The Martyrdom of Andreas Vesalius, http://www.ncbi.nlm.nih.gov/pubmed/2208869
3. A thousand years of pulmonary medicine: good news and bad, J. F. Murray, European Respiratory Journal 2001 17: 558-565
4. The History of the Lungs, https://web.stanford.edu/class/history13/earlysciencelab/body/lungspages/lung.html
5. Famous Scientists: the Art of Genius
6. A thousand years of pulmonary medicine: good news and bad, J. F. Murray, European Respiratory Journal 2001 17: 558-565
