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September 23, 2017
Infective Endocarditis Giovanni Morgagni

Giovanni Battista Morgagni (1682-1771)

De sedibus, et causis morborum per anatomen indagatis libri quinque. 2 vols. Venetiis, typog. Remondiniana, 1761.

Giovanni Morgagni
Portrait of Giovanni Morgagni
Portrait of Giovanni Morgagni


Cesalpino Andrea

During the first half of the 18th century, Lancisi and Vieussans described aortic valve lesions which were compatible with infective endocarditis. It was, however, Morgagni who gave the best pathological description of aortic valve endocarditis during the second half of the same century.

Giovanni  Battista Morgagni was an Italian physician and anatomist and is considered one of the greatest physicians of the 18th century. He is recognized as the founding father of anatomo-pathology.

Morgagni published his most important work, "De sedibus, et causis morborum per anatomen indagatis," in 1761, when he was 79 years old. This monumental work was written over a period of 20 years.  After Vesalius' De fabrica and Harvey's De motu cordis, Morgagni's De sedibus is viewed as the third most important publication in the history of medicine. This outstanding work regroups about 650 observations with a detailed clinical description followed by postmortem examination. The originality of this work was the systematic attempt to correlate the clinical symptoms with pathological findings introducing the anatomical concept of the disease and laying the foundation for the field of anatomo-pathology. Morgagni was convinced that postmortem autopsy examination was indispensable to the understanding of a disease.

 De sedibus was divided into 5 sections:

  1. 1) Diseases of the head

  2. 2) Diseases of the thorax

  3. 3) Diseases of the abdomen

  4. 4) Diseases of a general nature and diseases treated by surgery

  5. 5) Supplement

In the section two on the diseases of the thorax, Morgagni described several clinical observations of major significance covering the entire spectrum of cardiovascular disorders. He recorded several accounts of aortic and mitral valve diseases including one case of aortic valve endocarditis.

In this observation, Morgagni reported the case of a 36 year-old male who presented with "dropsy of the thorax." The patient had a slow pulse with swollen legs and virulent gonorrhea and died very rapidly.
The autopsy examination showed:

"...Some whitish polypous concretions, some of which kind were also in the vena portarum and the inferior cava,...no concretion of this kind being found in the other cavities of the heart,...,except in the valves of the great artery,..., All these valves, on the upper part of their border, and on the neighbouring part of that surface, with which they look upon each other, swell'd out into short and unequal excrescences; by the load of which being weigh'd down , they were all brought so near together by this means, as to leave but a very narrow passage betwixt each other through which the blood might pass out.  But when I examined each valve in particular, I saw that the right had its border much shorter than usual, or was become less transversely; and that the left was ruptur'd through the middle, from the border quite to the lower part; and that from the very lips of this rupture other excrescences were protuberant.  The substance of all these valves was in part lax and flaccid, so that it might be very easily pull'd away by the fingers and by the nails; and yet it was partly harder than usual, also; so that when you rubbed it betwixt your fingers, you would perceive some particles to be mix'd with it, which approach'd, in some measure, to the nature of a cartilage."

In this observation, Morgagni described a case of aortic valve disease from rheumatic origin which was complicated with infective endocarditis. This is the first case of infective endocarditis in which clinical presentation and pathological findings are provided with great detail. 

The complete text of this historical observation is reported in Latin and French.

Latin Version                                                                                                  French Version

Cesalpino Andrea Cesalpino Andrea Image Place Holder



REFERENCES

Morgagni GB. The seats and causes of diseases. Translated by Benjamin Alexander,3 Vols. London, Johnson and Payne, 1769

Morgagni GB. Recherches anatomiques sur le siege et les causes des maladies. Traduit par Desormeaux A et Destouet P, 10 Vols. Paris, Chez Caille et Ravier, 1820-1824


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