Anatomy of the Heart

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The structure of the heart has intrigued scientists since ancient times. Different interpretations of the anatomy of the heart reflect changing notions of its function. In ancient art, the heart is pictured according to society’s concept of its function. The ancient Egyptians believed that the heart contained the soul, and that it would be weighed by Anubis after death. If it was heavier than a feather the soul was damned. Note that even in this early depiction the chambers of the heart are visible.

The early Greek anatomical writers, including Aristotle and Hippocrates, regarded the heart as the source of innate heat and this concept remain unchallenged for a thousand years. Greek surgeon, physician and philosopher – Claudius Galen (AD 129 – 199/217) incorporated these ideas in his anatomical texts. Galen also believed that the flow of blood through the heart required the existence of passages, or pores, between the ventricles.

Early anatomical texts from Greece and Rome were not illustrated with diagrams. In 16th century medical schools, Galens’ work was still being read aloud during demonstration dissections so students could verify the accuracy of his descriptions. Ecclesiastical approval is made clear by the sacred monogram in the title page of this 1643 edition of Galen’s Epitome.

The advent of woodblock printing meant that diagrams could be reproduced. The first to appear were depictions based on medieval manuscripts where symbols were used rather than naturalistic representations. This anatomy textbook, by Johannes de Ketham, used in Vienna in the 15th century, employs the playing card symbol of the heart. The artist has tried to visualise Galens’s first century anatomical descriptions. Contrary to Galen’s text, however, the heart is shown on the right hand side of the body and it is not clear how blood reaches the heart. How medical students reconciled these discrepancies we cannot know.

Some professional anatomists entertained doubts about specific Galenic details, and in 1543, Flemish anatomist - Andreas Vesalius (1514 –1564) published an extraordinary illustrated textbook based on his careful dissections of numerous human bodies. It revolutionised medicine because it provided detailed and accurate pictorial representations based directly on dissected specimens. Vesalius was one of a line of pioneering Professor’s of Anatomy at Padua University, where dissection was undertaken in the famous Anatomy Theatre under the protection of the Venetian state during the inquisition. (The Vesalian Theatre in the Anderson Stuart Building is named in his honour).

The illustration of the heart in Vesalius’s Fabricia showed the interventricula pores as described by Galen but explicitly deny the connection between the ventricles. Vesalius’ guarded comments reflect the risk that doubting Galen might amount to heresy.

The septum of the ventricles, composed of the thickest substance of the heart abounds on both sides with little pits impressed in it. Of these pits, none , so far as least as can be perceived by the senses , penetrate through from the right to the left ventricle., so we are driven to marvel at the handiwork of the Almighty, by means of which the blood sweats form the right to the left ventricle through passages which escape human vision.

The great Italian Rennaissance artist and scientist, Leonardo Da Vinci (1452-1519) had also dissected over 100 bodies and produced many anatomical drawings in preparation for a great anatomical atlas. This project was never completed or published his drawings were lost to both medicine and art for centuries. Some of these drawings appeared in A Treatise on Painting, published in 1580, but by then Vesalius’ work was already well known. Hundreds more were discovered in his now famous notebooks.

Vesalius’ successor as Professor of Anatomy at Padua, Realdo Colombo (1516-1559) described the heart valves and, on the basis of animal vivisection, the nature of the pulmonary circulation.

English physician William Harvey (1578 – 1657) was to study at Padua a century later and Colombo’s work on the heart and pulmonary circulation was a key element in formulating his own theory of circulation of the blood.

Another English physician, Richard Lower (1631-1691) showed that the chambers of the heart were impervious to blood and proposed that the heart muscle was supplied by the coronary arteries, not from the ventricular blood. This radical idea is the foundation of our understanding of ischaemic heart disease.

Galen’s early concepts of the structure of the heart were made obsolete in favour of the new anatomy of Vesalius and his successors. Since that time, anatomical representations of the heart in textbooks still record the same basic features. Further advances in understanding came with the development of the microscope.

Contents

Discussion Points

  • As a medical student, what different types of representations of the anatomy of the heart have you seen?
  • How does each of them contribute to your knowledge of the structure of the heart?

References

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Suggested Further Reading

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