“I Miss My Liver.” Nonmedical Sources within the Historical past of Hepatocentrism

Summary

Till the seventeenth century, the liver was believed to be the origin of blood. This was primarily based on a false impression of Greco‐Roman physiology, primarily originating from Galen (c. 129‐216), who described this organ as heat and moist, the “supply of the veins and the principal instrument of blood manufacturing.”(1) A number of historical students assumed {that a} hearth perpetually burned within the liver, main them to contemplate it the seat of the human soul. This concept was generally often known as hepatocentrism as a result of the liver was thought of the middle of the entire organism and the origin of life. These beliefs had continued for nearly 4,000 years, from the third millennium Earlier than Christ (BC) till the seventeenth century, when new anatomic and physiologic research demystified the position of the liver in blood manufacturing and raised consciousness on the significance of the center in systemic circulation.(1)

The historical past of hepatocentrism could be analyzed all through nonmedical sources, significantly literature and the wonderful arts. It’s attention-grabbing to notice that most of the medical info revealed by nonmedical inventive works are lacking from medical manuscripts of the identical period; this highlights the significance of contemplating these within the historical past of drugs. Collectively, these theories have raised dialogue amongst tutorial researchers, detailed investigation of which can provide attention-grabbing contributions not solely to students with an curiosity within the historical past of drugs but in addition to practising clinicians. The intention of this paper is to guage the altering concepts and beliefs relating to the position and performance of the liver by analyzing references to it in essential literary and inventive works (nonmedical sources) all through historical past.

Hepatocentrism in Etymology

In 2011, Riva et al.(2) gave proof that the etymology of phrases generally used to point the liverin fashionable languages would possibly present vital info on the importance attributed to this organ in previous populations. The time period “hepa,” which is the idea of the scientific phrases used to explain objects associated to the liver, comparable to “hepatitis” and “hepatology,” derives from the Historic Greek phrase “hèpar” (η′παρ), which in accordance with Tiniakos et al.(3) might come up from the phrase “hedoné” (‘ηδονη′), which means “pleasure.” In being one of many key feelings skilled by the human soul, “pleasure” alludes to this preliminary perception that the liver housed the human soul with its advanced feelings. Certainly, as aforementioned, Galen described the liver as a heat and moist organ that held the hearth that burned perpetually within the human physique. So, in historical physiology, the warmth of the liver was considered the origin of the human spirit that travelled into the mind by the use of the center.(1) The connection between liver and heat is properly evidenced within the Latin time period “iecur.” Intimately, historical Romans indicated the liver with this phrase, which Isidore of Seville (560‐636) related to a different Latin phrase, “ignis” (i.e., hearth).(2) In line with the speculation of the 4 components by the Greek thinker Empedocles (c. 490‐c. 430 BC), hearth was principally current within the yellow bile, which was mentioned to reside within the liver. It must be talked about that the Latin phrase “iecur” has now disappeared in fashionable Romance languages; certainly, the time period “fegato” (Italian), “foie” (French), and “higado” (Spanish) derive from the Latin adjective “ficatum,” used to point the liver of an animal fattened with figs.(2) Lastly, the English time period “liver” appears to derive from the Anglo‐Saxon phrase “lifere.” Comparable phrases to point the liver could be present in different Northern European languages, comparable to German (“Leber”), Icelandic (“lifur”), Dutch, Swedish, Danish, and Norwegian (“lever”). All of those phrases, together with the Anglo‐Saxon phrase “lifere,” appear to carefully resemble the English verb “to reside,” underscoring the relation of the liver to life in populations influenced by the Celtic tradition.(4) In conclusion, etymologic evaluation of the phrases utilized in fashionable languages to point the liver appears to verify the significance of this organ in previous cultures and the central position that populations attributed to it within the life of people.

Hepatocentrism in Historic Populations

Hepatocentrism was initially developed within the Mesopotamian populations the place the liver was thought of the central organ of the human physique, the venue of life, soul, feelings, and intelligence.(2) Among the many Babylonians, curiosity on this organ elevated with the event of a sort of divination, known as haruspicy, which was primarily based on the inspection of the viscera, particularly livers (hepatoscopy), of sacrificed animals. The liver was chosen for inspection as a pure consequence of the idea that the human soul resided in that organ. Certainly, the liver gave the impression to be the organ that was largest and most considerable in blood in the entire physique, and for that reason it was extra steadily analyzed. The Etruscans have been additionally well-known for the apply of divining beside the entrails of sheep. Positive arts can verify this historical apply; clay or bronze fashions of sheep livers utilized by clergymen have been found in Mesopotamia in addition to in Italy.(2) The liver was additionally an vital organ amongst Historic Egyptians who eliminated it from the corpse previous to mummification. They positioned this organ in canopic jars embellished with the determine of the god Imsety, whose position was to guard the liver itself and to help the revivification of the corpse. Not like the traditional civilizations, Egyptians believed that the center was the seat of the soul (cardiocentrism) and due to this fact left it contained in the corpse after the mummification in order that it could assure the passage of the spirit to the afterlife, conserving the particular person alive eternally.

The Hebrews have been very conversant in haruspicy, as evidenced in some passages of the Bible: “For the king of Babylon stands on the parting of the highway, on the fork of the 2 roads, to make use of divination: he shakes the arrows, he consults the photographs (terâphîm), he seems on the liver” (Ezekiel 21:21). It comes as no shock that the Mesopotamian tradition influenced their beliefs on the liver in the course of the Babylonian exile (sixth century Earlier than Widespread Period). The phrase “kâbhêdh” (), indicating the liver, is etymologically associated to the thought of “weight” as a result of anatomically the liver is the heaviest organ within the human physique. It was seen because the seat of life as properly, evidenced in one other passage of the Bible describing the metaphorical destiny of 1 lured by a harlot, “until an arrow struck his liver” (Proverbs 7:23). It was additionally the seat of all of the feelings, as clearly appeared on this passage: “Mine eyes do fail with tears, my bowels are troubled, my liver is poured upon the earth, for the destruction of the daughter of my folks” (Lamentations 2:11).

Mesopotamian tradition additionally influenced the Greco‐Roman world, which inherited the idea of hepatocentrism, as could also be famous by analyzing different nonmedical sources, such because the well-known delusion of Prometheus and his immortal liver.(3, 5) In line with Hesiod (eighth century BC) and Aeschylus (fifth century BC), Prometheus was a legendary gigantic creature, a Titan, who helped humankind by initiating it within the arts and science. Prometheus stole the hearth from Zeus’ safekeeping and gave it again to the mortal people. As punishment, Zeus banished him to Mount Caucasus and condemned him to being chained whereas an eagle devoured his liver all day (Fig. ). Prometheus’ liver had the power to regenerate each night time, thus enabling everlasting torture. Primarily based on this delusion, a number of authors assumed that the traditional Greeks knew in regards to the liver’s regenerative powers.(6, 7, 8) Actually, the immortality of this Titan’s liver could be interpreted as being derived from the idea that it held his immortal soul.(2) Historic Greeks couldn’t have recognized about liver regeneration as a result of their anatomic and physiologic data was primarily based on hepatoscopy, which centered solely on the liver’s floor look. Observing the form, construction, and coloration of the liver was clearly inadequate to find out about its regenerating capability, which was found solely by nineteenth‐century scientists by means of superior data of anatomy and microscopic research.(9) Subsequently, it appears unlikely that the selection of liver because the eagle’s goal was primarily based on the conception that it was in a position to regenerate however moderately as a result of it was believed to be the seat of life; as a result of Prometheus was immortal, so was his liver.

Atlas holding up the sky and Prometheus certain with an eagle choosing out his liver, c. 555 BC, Arkesilas Painter, (fl.c. 565‐555 BC), Vatican Museums and Galleries, Vatican Metropolis.

As well as, the much less recognized Tityus’ delusion can as soon as once more show Historic Greece’s conception of the liver’s immortality. Tityus was a big legendary creature who was born from Zeus and Elara, the daughter of King Orchomenus.(3, 5) The god determined to cover the pregnant mom deep contained in the earth in order that his spouse Hera wouldn’t study of his infidelity. There, Tityus was born and nursed by the earth itself. His eagerness for energy led him to forcibly occupy the traditional metropolis of Panopeas in Phocis. There he assaulted the Olympian goddess Leto, trying to rape her, whereas she was on her strategy to the oracle in Delphi. Leto known as for assist from her two kids Apollo and Artemis. Each got here to her rescue and tried to kill Tityus. As he was immortal, Zeus was compelled to impose on him a punishment. Tityus was certain to Hades, the place each new moon two vultures would feed on his liver, which was able to regenerating, thus implementing infinite struggling.(3, 5) By the way, it must be talked about that the thought of vultures, famend for feeding solely on lifeless animals, consuming the flesh of a residing particular person seems to be misguided.

Nonetheless, the idea of liver because the seat of life additionally occurred a number of instances within the epic poem “Iliad,” historically attributed to Homer. The Greek poet described a number of struggle wounds in hanging particulars; it comes as no shock that each one liver accidents he described have been deadly. For example, the Greek hero Achilles slit open Tros’ liver “that spurted free, gushing with darkish blood […] and his life breath slipped away” (Iliad, XX, 530‐533). Furthermore, in the identical poem, Hecuba, queen of Troy, declared that in revenge for the homicide of her son Hector, she would possibly be capable of devour Achilles’ liver (Iliad, XXIV, 209‐213).(10) As well as, in accordance with the Greeks, one mortally wounded is commonly outlined as “struck within the liver” as a result of it was thought of the venue of life.(11)

The liver additionally appears to be associated to the idea of life within the Arab tradition, as demonstrated by the a lot‐mentioned story of Hind bint ‘Utbah. She was an Arab lady who lived within the late sixth and early seventh centuries Widespread Period and accused of cannibalism as a result of she ate the liver of Hamza, the uncle of Islamic prophet Muhammad. This episode exhibits cannibalistic rituals in pre‐Islamic Arabia primarily centered on the liver because it was the seat of life. The Arab tradition influenced Islamism, so prophet Muhammad was mentioned to make use of the time period “moist liver” to seek advice from the soul.(12) On an event of nice sorrow, the prophet is alleged to have wept all night time “as if his liver would crack,” in the identical method as right this moment we’d say “as if his coronary heart would break.”(11) Moreover, among the many Berbers of North Africa, a real depth of affection or emotion is expressed in the course of the ritual betrothal dance by saying, “You’re my liver,” which means “you’re the neatest thing about me, probably the most treasured one.”(13) As talked about by Reuben, even in fashionable North Africa, a preferred Arabic expression is “Istahisht kibdati” (“I miss my liver”), which means “I miss my baby.”(13)

Lastly, the position of the liver in historical cultures and folks exterior the Mediterranean Basin deserves to be remembered. In historical Chinese language drugs, the liver was thought of the seat of anger and tear formation, whereas the gallbladder was mentioned to be the seat of braveness.(14) Equally, in Persian and Urdu conventional drugs, the liver was the seat of braveness and need.(15) In populations of Mesoamerica, the liver was the seat of certainly one of three parts of the human soul (‘ihiyotl’ within the liver, ‘tonalli’ within the head, and ‘teyolia’ within the coronary heart). Ihiyotl held ardour and aggression, whereas the opposite parts of the soul have been associated to consciousness (teyolia), willpower, and intelligence (tonalli).(16) The liver was related to Mictlan, the underworld, and was related to Mictlantecuhtli, the god of the lifeless in Aztec mythology. The latter is dramatically represented with flesh extensive open under his chest; popping out of the open flesh within the abdomen, an amazing liver seems.(16)

The Central Position of the Liver within the Center Ages

Students seem to have uncared for the evaluation of the liver within the Center Ages. Throughout these centuries, the inventive illustration of the Crucifixion, crucial image of Christianity that exhibits the redemption of all the humanity by means of Jesus’ sacrifice, recurrently incorporates a refined reference to hepatocentrism, i.e., the wound in Christ’s flank. In line with the Gospel of John, the Romans deliberate to interrupt Jesus’ legs, a apply often known as crurifragium, which was a technique of hastening demise throughout a crucifixion.(17) They really realized that Jesus was already lifeless and there was no motive to interrupt his legs. A soldier stabbed him within the aspect to ensure that he was lifeless: “one of many troopers pierced his aspect with a lance, and instantly there got here out blood and water” (John 19:34). The phenomenon of blood and water was perceived as a miracle. Within the allegorical interpretation, blood symbolizes the humanity of Christ and water His divinity; Jesus was each true God and true Man. This idea can be underlined in the course of the Catholic Mass when the priest pours a small quantity of water into the wine earlier than the consecration. This act symbolizes each Christ’s humanity and divinity, recalling the manufacturing of each blood and water from Christ’s aspect on the cross. The Gospel didn’t point out the aspect the place Christ was wounded, however custom locations the harm between the eighth and ninth ribs of the correct aspect, which can be represented in numerous artistic endeavors throughout the centuries. The crucifixion iconography seems to be deeply influenced by contemporaneous hepatocentrism such that the liver, thought of the origin of life in Greco‐Roman drugs, appears to be the goal of the Roman soldier. Within the “Crucifixion” (c. 1368‐1370) by the Florentine painter Jacopo da Cione (1325‐1399), the wound is depicted within the decrease a part of the correct hemithorax the place it could be inferred to have an effect on the liver. The identical depiction is repeated by extra famend and prestigious artists, comparable to Giotto (c. 1270‐1337), the place the identical level is stabbed, for instance, within the “Crucifix” of Santa Maria Novella (c. 1290‐1295) (Fig. ). This iconography is true not solely within the work of Italian artists but in addition those that got here from Northern Europe, as proven within the “Diptych with Calvary and Final Judgement” (1430‐1440) by the Flemish painter Jan van Eyck (c. 1390‐1441). The custom of this explicit place continued all through the Center Ages such that it may be present in all probably the most well-known Renaissance artists, comparable to Andrea Mantegna (1431‐1506) in his “Crucifixion from the excessive altar of San Zeno” (1457‐1459) and Masaccio (1401‐1428) within the “Crucifixion from the Pisa Altarpiece” (1426). Through the Baroque interval, Caravaggio (1571‐1610) supplied additional particulars on the wound within the liver of Christ. In his “The Incredulity of Saint Thomas” (1600‐1601), Caravaggio represented the apostle Saint Thomas placing his finger inside resurrected Christ’s wound (Fig. ). A noteworthy element is the orientation during which the finger enters the wound; this offers us an concept of the course of the stab, not obliquely and superiorly towards the center however virtually perpendicular to the physique’s floor, in a transverse course pointing to the liver. Even when Caravaggio didn’t characterize a classical crucifixion scene, his work confirmed the situation of Christ’s wound as being centered on the liver.

“Crucifix” (c. 1290‐1295) (element) by Giotto, Santa Maria Novella, Florence, Italy.

See Also

On The Expertise of Being Poor-ish, For Individuals Who Aren’t

“The Incredulity of Saint Thomas” (1600‐1601) (element) by Caravaggio, Bildergalerie, Potsdam, Germany.

The connection between liver and soul in Christianity is also evidenced within the metaphor of the “thirsty dropsy.”(18) The tragically ironic correlation between fluid overload and unquenchable thirst, which was noticed by historical physicians, was utilized in nonmedical literary works as a metaphor for greed within the depiction of ethical and philosophical issues relating to the human soul. In his “De Scripturis,” the bishop Augustine of Hippo (354‐430) in contrast greed, a illness of the soul, and dropsy, a illness of the flesh; what the sufferer desires, respectively, cash or water, solely aggravates their situation.(18) This metaphor is maintained all through the centuries and could be notably discovered within the determine of Mastro Adamo, in “The Divine Comedy” by the Italian poet Dante Alighieri (1265‐1321). Impressed by the parallel between thirst and ascites present in classical antiquity, Dante describes his assembly, throughout his fictitious journey to hell, with the counterfeit Mastro Adamo who suffers from “dropsy.”(19, 20) The Italian poet describes the unquenchable thirst of this character who himself acknowledges that consuming water worsens his edema (“ché s’i’ ho sete e omor mi rinfarcia,” Inferno, XXX, 126). Regardless of the literal bodily illness described, Dante makes use of Mastro Adamo to embody and symbolize avarice. In line with Smith, he suffers from everlasting “thirsty dropsy” as punishment for his sins as a forger of cash.(21)

The Fashionable Age Dethrones the Liver

As was described earlier on this article, Galenists had lengthy believed that venous blood was produced within the liver from meals absorbed within the digestive system and used up within the physique.(1) Across the 1650s, anatomists, comparable to William Harvey, made key discoveries in medical anatomy and physiology, together with the existence of the lymphatic and systemic circulatory methods.(22, 23) These vital realizations led to the unequivocal rejection of the longstanding concepts relating to the position and performance of the liver, which have been thereafter attributed to the center (cardiocentrism).

This milestone within the historical past of drugs is described within the seventeenth‐century portray “Il Fegato” (“The Liver”), which right this moment is held on the Museo Storico Nazionale dell’Arte Sanitaria in Rome and is believed to have belonged to Giovanni Guglielmo Riva (1627‐1677), one of the distinguished Italian surgeons of that point.(1) This portray exhibits a person with an open stomach that has been dissected to indicate the liver; the person is holding a parchment with an ode retired on an anatomic stage the place Liver and Coronary heart struggle for the glory of being king among the many human organs, the one which produces blood. Not solely does this portray recount the developments in medical physiology on the time, it additionally offers us an allusion to the emotionally charged ambiance surrounding this alteration in opinion within the scientific group, which is as regular translated to the inventive world.

It’s attention-grabbing to notice how regardless of this irrevocable discovery relating to the position of the center and liver, the liver was nonetheless extremely regarded and didn’t completely lose its declare to be the seat of the human soul in common myths and infamous literature work. Within the fairy story “Snow White” (“Schneewittchen” in German), written by Jacob (1785‐1863) and Wilhelm Grimm (1786‐1859) in 1812, the evil queen calls for the huntsman kill Snow White and convey her lungs and liver to undoubtedly verify her demise.(24) Within the acclaimed 1937 Disney film “Snow White and the Seven Dwarfs,” primarily based on this fairy story, the evil queen calls for Snow White’s coronary heart. With right this moment’s medical data, this is sensible as the center is central to people’ speedy survival. The unique model by the Brothers Grimm exhibits that in the course of the nineteenth century, common drugs held that the human spirit was housed within the liver, which was believed to play a job in sustaining life.

One other noteworthy instance of how the liver considerably maintained its significance in common drugs after the invention of systemic circulation could also be present in a distinguished literary piece within the fashionable period. In his masterpiece “Moby Dick” (1851), the American author Herman Melville (1819‐1891) used the liver to represent human feelings. Intimately, the expression “white liver” is used within the e-book to explain somebody who lacks braveness.(25) This expression doesn’t appear to be instantly related to the anatomic and physiologic discoveries relating to the liver on the time (nineteenth century), moderately it’s most probably a mirrored image of the idea within the Classical period that the liver housed one’s blood, therefore braveness.

Certainly, an identical expression (“lily‐liver”) could be discovered in the course of the seventeenth century when William Shakespeare (1564‐1616) described the concern and cowardice of a servant, defining him as “Lilly‐liver’d Boy” (“Macbeth,” Act V, scene 3, 20). The English poet used the identical metaphor in “The Service provider of Venice,” when Bassanio acknowledged “have livers white as milk” (Act III, scene 2, 86). It’s attention-grabbing to notice that fashionable society nonetheless makes use of the liver to specific human emotion and traits, because the French expression “avoir les foies blancs” (“to have the white liver”) to suggest cowardice or the Italian “avere fegato” (“to have liver”) to point braveness. Equally, references to liver and bile additionally seem in lots of different languages (e.g., Estonian, Japanese, and Chinese language) as a metaphor for bravery, anger, conceitedness, and different feelings and moods.(13, 14) Curiously, Mellinkoff postulated that the connection between braveness/cowardice and liver in numerous cultures and populations may very well be associated to the bitter style of bile.(14)

Conclusions

On this transient journey by means of historical past, from the Classical Age to right this moment, we’ve got mentioned the evolution of beliefs regarding the position and features of the liver by analyzing nonmedical sources.

Within the historical past of artwork, the liver, thought of the seat of soul in Medieval and Early Fashionable Age drugs, as influenced by the Greco‐Roman physicians, was represented because the goal of the Roman soldier’s lance within the illustration of the crucified Christ. His aspect wound alludes to the myths of Prometheus and Tityus, whose livers have been eternally destroyed in the course of the day and regenerated every night time; this symbolized immortality, which was within the energy of the liver, seat of the soul. It ought to come as no shock that Renaissance and Baroque artists have been fascinated by the myths of Prometheus and Tytius, as proven by “Tytius in Chains” by Gregorio Martìnez (1547‐1598), by “Prometheus Certain” by Peter Paul Rubens (1577‐1640), and by “The Punishment of Tythus” by Titian (c. 1488‐1576). When medical data on the liver and its features modified and hepatocentrism concept declined, society began to change its beliefs and convictions and artists modified the illustration of the crucifixion episode. Subsequently, the sundown of hepatocentrism coincided with the lower in artists’ curiosity in Christ’s aspect wound, which fully disappeared within the crucifixion iconography. As an alternative, consideration shifts to a concentrate on the injuries in his fingers and toes, as properly evidenced in “Crucifixion” (1880) by the American painter Thomas Eakins (1844‐1916). For the reason that 1600s, the event of cardiocentrism in drugs has additionally influenced the non secular cult, as testified by the Catholic devotion to the “Sacred Coronary heart,” already developed within the Center Ages however fostered in that interval by the bishop of Geneva Francis de Gross sales (1567‐1622) and by the nun Margaret Mary Alacoque (1647‐1690). The painters appear to neglect the liver, which disappears from their works in fashionable instances, whereas the center (and its relationship with love) seems to develop into a extra enticing topic for artists. In fashionable artwork, solely the Armenian‐American painter Arshile Gorky (1904‐1948), one of many fathers of Summary Expressionism, centered on the liver in certainly one of his works (“The Liver is the Cock’s Comb,” 1944) (Fig. ).

“The Liver is the Cock’s Comb” (1944) by Arshile Gorky, Albright–Knox Artwork Gallery, Buffalo, New York.

Within the historical past of literature, the idea of the liver because the seat of feelings and keenness has continued all through the centuries. Certainly, this idea could also be discovered within the Center Ages (Dante) and Early Fashionable Age (Shakespeare) and likewise in nineteenth‐century writers (Brothers Grimm, Melville). The affect of contemporary hepatology on literature could be evidenced within the “Ode to the Liver,” written by the Chilean Nobel laureate poet Pablo Neruda (1904‐1973). As talked about by Arrese, Neruda composed the ode after an encounter with liver researcher Hector Orrego; it was printed in 1956 in a e-book entitled “Nuevas odas elementales” (New Elemental Odes).(26) Orrego defined the trendy data on the physiology of the liver to Neruda, and the poet reported this in his ode. He praises his liver as a “noiseless equipment,” realizing that if “one tiny cell / be in error / or one fiber be worn / in your labor / and the pilot flies into the unsuitable sky / the tenor collapses in a wheeze / the astronomer loses a planet.” On the finish of the ode, the creator underlines the tight relationship between life and the liver’s operate: “I like life: Don’t betray me! Work on! / Don’t arrest my music.”(26) The ode seems to be a contemporary model of the aforementioned seventeenth‐century portray “Il Fegato” in Rome.

In conclusion, the liver is likely one of the largest human organs, and its dimension, related to its richness in blood, undoubtedly influenced common beliefs throughout centuries and civilizations on its important position in human life. Historic myths in cultures as numerous as Assyrian and Babylonian, Greco‐Roman, Hebrew, Aztec, and Chinese language confirmed that the liver was seen because the seat of life and human ardour, thereby influencing the event of hepatocentrism in artwork and literature in addition to in drugs. The event of cardiocentrism in drugs in the course of the seventeenth century appears to have restricted the significance given to the liver in favor of the center within the wonderful arts, in literature, and consequently, extra broadly in tradition. This might lead to much less consideration towards liver illness in comparison with cardiovascular pathologies in fashionable society. Subsequently, the shift from hepatocentrism to cardiocentrism must be appreciated not solely by historians but in addition by training clinicians and scientists who wish to enhance public consciousness of the liver and its illnesses.

Notes

Potential battle of curiosity: Nothing to report.

References