The Ancient World

Investigations into blood, blood-related diseases and what we now call the 'circulation' date back to antiquity. Anning (1957) and Dickson (2004) note that pathological haemostasis was described in China in about 2650 BC. From the many references to 'drinking blood' in ancient testaments, it could seem that the ancients had discovered techniques for anticoagulation. 'Whipping', which removes coagulable material, was perhaps the most likely method. The earliest known European writings to mention blood coagulation were those of Greek philosophers in the 4th and 3rd centuries BC. In particular, Plato (428-347 BC) asserted that the blood contained fibres that caused it to congeal when it cooled after leaving the warmth of the body, and his view was not refuted until the end of the 18th century. Hippocrates distinguished arteries from veins and may have recognised venous thrombosis in relation to venous ulcers. Diocles of Carystus, an early successor of Hippocrates, appears to have recognised a condition he called 'inflammation of the veins', but it is not known whether he meant phlebitis in the 'infected' sense, or what we now call thrombosis (i.e. 'phlebitis' in the sense used by Cruveilhier in the

3 During the course of the book we shall discuss other issues of terminology, and many of them bear the same relationship to the 'rival' approaches as the clot/thrombus distinction.

4 These errors do not, however, include 'vitalism' in the sense of evocation of a 'vital force'. We shall discuss this point more fully in the following pages and the appendix. Mechanists ('reductionists') who regard proponents of the pathophysiological ('holistic') approach as 'vitalists' are guilty of sloppy thinking, and sometimes of ignorance.

19 th century). Studies of arteries and veins in Alexandria during the later centuries BC, notably by two pioneers of vascular surgery, Herophilos and Erasistratos, culminated in the work of Galen during the 2nd century AD. Galen used venesection to treat ulcers and varicose veins. His mainly accurate anatomy, and his mainly fanciful physiology, remained virtually unquestioned until the 16th century; we shall say more about this in Chapter 8. In 1452, Leonardo da Vinci produced superb anatomical drawings that included illustrations of superficial limb veins. These were important precedents for the revolution in anatomy that was to take place a century later in the school of Vesalius and his successors in Padua.

Another major influence on mediaeval medicine was the encyclopaedic al-Tasrif (Art of Healing) of Abu'l-Qasim, written around AD 1000. Abu'l-Qasim, known in Europe as Albucasis, was the most famous surgeon of the Middle Ages, and his work influenced European medicine for half a millennium. Among other things, al-Tasrif contains what is perhaps the earliest clear description of haemophilia.

Venous thrombosis was described in a European text around AD 1400 (Dickson 2004). However, the first recorded attempt to account for its aetiology was by Wiseman (1686). Wiseman, surgeon to Charles II, apparently attributed the phenomenon to 'coagulation of the serum ... or the obstruction of a vein ...', roughly identifying two of the elements of 'Virchow's triad'. He wrote in the aftermath of Harvey's celebrated publication, and at the time of the early microscopists; an appropriate era in which to begin our historical survey.

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