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The First Printed Treatise in Pathology

Keywords: history of pathology, history of autopsy, Theophilus Boneti, Marcellus Malpighi

Theophilus Boneti or Bonetus (1620–1689), a Swiss physician, collected records and notes of hundreds of postmortem examinations that were performed by his contemporaries or earlier physicians. In 1679 he published the collection in 2 volumes, containing 1706 pages [1].

Boneti and his associates continued to add cases during the ensuing years and by the time he died they had accrued 2806 cases. Most cases were from the 16th and 17th centuries. The prosectors were illustrious physicians: Bartholinus (1616–1680) of Denmark; Eustachius (1524–1574) of Rome; Fallopius (1523–1563) of Modena; Fernel (1497–1558) of France; Glisson (1597–1677) of England; Malpighi (1623–1694) of Rome; Meibomius (1638–1700) of Germany; Paracelsus (1493–1541) of Switzerland; Peyer (1653–1712) of Switzerland; Vesalius (1514–1564) of Belgium; and Willis (1621–1675) of England. A few cases recorded by Hippocrates (460–375 BC) of Greece and Galen (130–200) of Rome were included. Boneti added several of his own cases to the collection. His closest associate, Johannes Jacobius Mangentus, augmented the series with 31 cases from his practice.

In 1700, 11 years after Boneti’s death, the amassed material was published as a treatise in 3 volumes [2] containing 2260 over-sized (9 x 15 inch) pages, including an index of 65 pages at the end of the third volume. The volumes are divided into 4 books: diseases of the head, chest, abdomen, and miscellaneous conditions. The books are subdivided into sections and the sections consist of case reports, ranging from just a few to over 100 per section.

In the 23 sections that concern diseases of the head, most cases were autopsied after chronic headache, apoplexia, lethargia, delirium, loss of memory, epilepsy, tremor, convulsion, and hydrocephalus, as well as some ear, nose, and oral problems.

Chest diseases are divided into sections on dyspnea, suffocation, bloody sputum, empyema, phthisis, palpitation, irregular pulse, and syncope.

Abdominal cases comprise the largest number of sections and related autopsies. They are categorized according to premortem signs and symptoms: dysphagia, abnormal thirst, wasting, epigastric pain, nausea and vomiting, dysentery, diarrhea, cholera, abdominal pain, icterus, cachexia, gastric tumors, back pain, oliguria, profuse urination in diabetes, urinary incontinence, abnormal color and consistency of urine, pain in the right hypochrondrium, hemorrhoids, anal fistula, groin and scrotal hernias, testicular pain, uterine prolapse, uterine bleeding, extrauterine pregnancy, abortion, and intrauterine death.

The last book contains 12 sections. The main topics are: fever, tumors, trauma, wounds, fractures, ulcers, arthritis, lues, poisoning, snake bite, skin infection, tobacco abuse, and death by hanging.

Each of the 2806 autopsy reports begins with the highlighted final pathological diagnosis and the proximate cause of death. Next are the clinical history and autopsy findings. There are no microscopic examinations in any cases. The reports range from a few printed lines to several pages.

There are 184 cases of death due to violent headache and apoplexia. The final pathologic diagnoses are almost invariably massive intracranial hemorrhage. There are 335 cases listed as death after chronic dyspnea and phthisis (tuberculosis). At autopsy, the main findings are recorded as purulent pneumo-pleural inflammation.

With few exceptions, postmortem examination of the bodies of 128 patients who had a longstanding history of vomiting and gastric pain showed perforated gastric ulcer, pyloric stenois, or scirrhous tumor (carcinoma) of the stomach, with or without hepatic metastasis. Pain in the right hypochrondrium was commonly associated with enlarged liver, firm pancreas, and icterus. In almost all 90 cases, the cause of palpitation and abnormal pulse was linked to polyp (thrombus) in the right side of the heart with pulmonary extension. Several cases of ruptured aneurisms are recorded with sudden backache and chest pain, but no pathologic findings are noted in any of the cases with clinical history of angina.

Rectovesical, uterovesical, and rectovaginal fistulas were common autopsy findings in conjunction with urinary and pelvic problems. There were 7 deaths due to extrauterine pregnancy. Six patients died of brain abscess following pain in the ear. Five deaths were due to intestinal perforations as complications of cholera. Death was caused by utero-pelvic tumors in 3 patients after years of uterine bleeding. One patient died after suffering multiple fractures. At autopsy encephaloid (soft) cancer was found in tubular and flat bones.

This review would not be complete without translation of part of an obstetric case (p. 276, vol. 2). The patient was a 28-yr-old para 3 gravida 4 who presented at 8 mo of gestation with headache, vision problems, and abdominal cramps. Within days she developed convulsions and she received antiepileptic clysters (enemas) for 4 days and underwent blood-letting. The cervix was not dilated when she suddenly died. At autopsy, bloody fluid was found in every organ and all body cavities. A healthy looking fetus with head presentation was dead in the uterus. The placenta was large and hemorrhagic but was not detached from the uterus. The final diagnosis was recorded as Puerperal Convulsion Lethalis (ecclampsia). The immediate cause of death was listed as massive bleeding.

It would be a disservice to medicine and the history of medicine not to mention autopsy number XIII (p. 143, vol. 1). The autopsy report records the postmortem findings on dissecting the body of Marcellus Malpighi who died at age 71 in December 1694. He had cerebral apoplexia and his right side was paralyzed. At autopsy his cranium was filled with blood and blood clot. The prosector was Georgio Baglivio, a medical doctor, of Rome.

Readers will not need to be reminded who Malpighi was. However, even the most informed medical historians did not know, prior to the publication of this review, that the transcript of Malpighi’s autopsy with clinical history is one of 2806 cases in Boneti’s treatise. This oversight may be ascribed to the fact that Boneti’s treatise has never been translated from the original Latin.

Equally puzzling is who Boneti was. What did he do beyond collecting records of postmortem examinations? We are uninformed. History is completely mute.

View larger version (134K): [in this window] [in a new window]   Fig. 1. Title page of Boneti’s treatise in volume 1 of the 1700 publication [2]. The frontispiece shows Boneti in his study.

	References

Top References

1. Boneti T. Sepulchretum Sive Anatomia Practica ex Cadaveribus Morbo Denatis. 2 vols., Chouet, Geneva, 1679.
2. Boneti T. Sepulchretum Sive Anatomia Practica ex Cadaveribus Morbo Denatis Proponens Historias et Observationes, 3 vols., Cramer & Perachon, Geneva, 1700.

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