The Functional Unit in Action
“The best teaching is that taught by the patient himself.”
Sir William Osler
An elderly European patient complains he has been unable to pass a bowel motion lately…
Now get your head inside a functional unit – complete the topics that follow…
A 40yr old man presents with yellowing of the eyes. Apply the sieve to the following
‘functional unit of jaundice’.
Another patient says she is becoming unsteady and doesn’t feel very safe walking any more. Can you complete a functional unit for something as complex as walking.
Morgagni was exposed to death early – his father died when he was only seven, and his two older brothers also died at an early age. He also narrowly escaped early death himself – at age 13 he was saved in a narrow brush with drowning. An aspiring poet, he wrote a poem to the man who had saved him. In later life, he also paid the man a pension.
Morgagni took his medical degree and doctorate of philosophy from Bologna at 19 years of age and took an interest in anatomy. When he began to show potential, he was invited to be a professor at Padua University and soon published several volumes of fine work, including a description of the anal columns that now bear his name.Morgagni then did not publish again until 42 years later. When he was 79 years of age he bequeathed to the world one of the finest medical works ever known. This magnum opus – “The seats and causes of disease” – was to revolutionise medicine. A weighty tome, it contained the results from 640 meticulously conducted post-mortem examinations. Each case was presented along with pre-mortem clinical detail, thorough review of the literature and penetrating commentary – and together they revolutionized pathology and medicine. He was so thorough that his index alone took 78 pages, which made the work of great practical use to students. In one case he verified the observation that lesions on one side of the brain cause symptoms of paralysis on the other.
In producing his famous work, Morgagni established the use of the ‘clinicopathological correlation’ as the fundamental tool of medical research. The great European clinicians of the 18th and 19th centuries continued this tradition to build clinical medicine as we know it today.
Besides being a brilliant medical investigator, Morgagni was a student of the classics, a philosopher and historian, as well as an archaeologist of wide renown. He died of ‘ruptura cordis’, aged 99.Men [and women] will not take time to get to the heart of a matter.
Thoroughness is the most difficult habit to acquire, but it is the pearl of great price, worth all the worry and trouble of the search.