Unit 12 - Contemporary Medicine:The Role Model of Physicians as Medical Humanists The Case of Grigore T. Popa
UNIVERSITY GRIGORI T. POPA OF MEDICINE AND PHARMACY (RO)
In his memoirs Grigore T. Popa argues that “a scientific work can be valuable by the new data it discovers, by the original working methods it establishes, or by the movement it produces in the field of the specialty to which it belongs (or even in more distant fields). In general, no scientific breakthrough is fully confirmed forever (even the first ranks make no exception in this regard). But that scientific work can be considered solid, of which something remains, and which impels new research. That is why the best criterion for judging some works is the resonance they had in the world of specialists and the degree of interest they aroused.”
Popa’s contribution to the field of neuroanatomy is outlined in a monograph, which, the author argues, contains:
“the results of an uninterrupted series of research are included to elucidate the meaning of the hard cranial mater. The fibrillar structure of the dura, known only from a diffuse aspect, was described by me in detail and was recognized as an ordered structure, always the same, representing a well-defined type. I described the fiber groups; I individualized them both in humans and in the other vertebrates. Using the principle emitted by Roux, after which the conjunctival fibril is a result of traction and which sits in the direction of this traction, I sought the genesis of the dural structure. Since the factors that impress the skull were discussed beyond its hard parts, I was forced to review the known data on the structure of the skull.
Through another series of research, conducted on the human skulls and on the skulls of other vertebrates, I came to establish a special appearance of the bone thickening, thus modifying the classic schemes of Félizet. Then, finding a strict interdependence between the skull and the hard, we analyzed the genetic factors of the whole system, subjecting each one to a personal critique and experimentation: craniomotor, mastication, gravity, pulsation and brain weight, cranial bone growth and external pressures.
Along with the main issue, and based on a rich material available, we have issued some hypotheses, which concern the mechanical genesis of the Pacinian corpuscles, the pituitary body genesis, the crista gall apophysis genesis, the clinoid apophysis genesis, the sphenoid square blade genesis. From the structure of the walls of the hard mater sinuses, we have issued a new hypothesis on their functioning. By means of the forms I first established and described, my research has contributed to a rich literature and numerous personal observations in the field of human anatomy, comparative anatomy and pathological anatomy.”
As far as cerebro-stimuline is concerned, Popa confesses that he discovered it by accident:
“We were working in the Anatomy Laboratory of the University of Cambridge (England) in the summer of 1936 and wanted to see if we could find (as some authors have stated) the melanophore hormone in the cerebrospinal fluid. For this purpose we were brought to the laboratory with heads of sheep from slaughterhouses to have the cerebrospinal fluid taken directly from the brain cavities. Since the melanophoric reaction was not constant, we had the idea of injecting the cerebrospinal fluid into the brain cavities of the frog instead of injecting it under the skin. And so from time to time I noticed an extremely curious phenomenon: the animal began to tremble, screaming and contracting all the muscles; finally it fell into drowsiness. At first I thought that the simple distension of the brain cavities or maybe some impurities in the injected fluid could be the cause of this reaction. The control experiments that we had done showed that in fact the cerebrospinal fluid was an exciting substance (or more) for the nerve centers, and the substance was in effective concentration only in the third ventricle of the brain and especially at the pituitary recessus, where the pituitary stem continued with the infundibula. Concentrating the cerebrospinal fluid in bain-marie I found that the excitatory substance existed everywhere in the liquid only that it was more diluted than in the tubal lobe. Because the substance excited the whole brain and was very concentrated in the pituitary recess, I called it "cerebro-stimuline", by analogy with the other substances produced by the pituitary and which excited the activity of the various organs (gonado-stimuline, thyroid-stimulating hormones etc.).”
With respect to the developments in the study of the hypothalamus, pituitary gland and the vascular connections between them, Grigore T. Popa briefly presents the story of his famous discovery together with researcher Una Fielding:
“In 1914, when I entered Professor Rainer's laboratory in Iasi, he was describing a new gland with internal secretion, which he called “glandula insularis cervicalis”, and made me control his work on guinea pigs, and one time asked me to gather brains from these animals. I was a beginner and I was just learning the technique, but like any young man I had the zeal and imagination. I started to work, but the progress was slow; in the meantime, a German author, Schiefferdecker, proved that Pende's gland was not a gland, but simply fat lobes! I then remained with the brains of guinea pigs that I continued to tighten and remove the pituitary gland from them until I began to slowly destroy the base of the skull and I gained a true ability to keep the organ intact in its connections with the brain.
Then I saw on the pituitary stalk a number of vessels that impressed me with the fact that they were perfectly parallel between them. I had never seen this orderly arrangement in the vascular field. I showed Professor Rainer what appeared to me as a mere morphological curiosity. He examined the pieces and was of the opinion that these vessels were vessels of pia-mater that enveloped the pituitary stalk and also added: "I would be curious to see if they are human."
In the autopsies he did afterwards, he searched with me, and saw that these vessels were also human. But at no cost did he want to believe that they were nothing more than vials and, thinking that they went around the stem with the pia-mater, he baptized them with the name of the "puffer stem".
That was the problem for a while. So little importance did Professor Rainer give to the vessels that when he was asked to suggest a thesis topic, Mr. Radu, a colleague of mine from the laboratory came up with "Modifications of the pituitary during pregnancy" and he did not even think of more thorough research on the vessels. Several times I tried to talk about the mantle of vessels that I kept dissecting, but I was left with the urge to gather material. During our transfer to Bucharest, among five other issues that had to be followed, he advised me to investigate further the "mantle of vessels", which I also did. I performed series sections, coloured the preparations and made hundreds of drawings with the Edinger machine. My impression was that, after a while on the pituitary stalk, the vessels entered the hypothalamus; but how important this fact could have been, I confess that I had no idea. I showed my preparations to Professor Rainer several times, seeking to prove that these vessels resembled accessory portal veins on the abdominal wall, but he never allowed himself to be convinced, objecting to various imperfections of technique and a beginner’s clumsiness. Seeing that I had no results and that my teacher did not give any importance to this subject, I left him and continued with the study started at the same time, on the functional structure of the cranial dura mater (between 1922-1925).
In 1925 I went to America as a Rockefeller Foundation Scholar, where I stayed for one year. In 1927 I came to England, in the same quality, where I began to work under the leadership of Professor G. Elliot-Smith, renowned anthropologist and brain researcher. In 1928, Miss Una Fielding, who was working in the same room as me, gave me to examine some of her preparations, in which she had seen some nerve cells in direct contact with the vessels. I immediately recognized my portal vessels. Nor did she attach much importance to these vessels, being interested in figuring out the purpose of the cells. While we were talking, Professor Elliot-Smith came, and when I told him that I could demonstrate the existence of vessels connecting the pituitary to the brain, his eyes suddenly lit up. He asked me details, what I needed to prove it, and he said, <<this fact is so important, if it is true, that you have to put everything aside and complete its demonstration>>.
Together with Ms Una Fielding, I started a two-year work, doing series of sections through pituitary + hypothalamus: in children, in human beings, in adults, in dogs, mice, guinea pigs, rats and pigeons. More than forty series were executed and examined by Una Fielding in London and myself in Iasi. Upon my return to London in 1930, the demonstration could be done in full on our material and the results were presented at the Anatomy Congress of Great Britain and Ireland. The discussion was attended by G. Elliot-Smith and Sir Arthur Keath, and the existence of the portal vessels was recognized by this high scientific forum and Harvey Cushing, to whom I demonstrated on his microscopic preparations in the laboratory at University College of London. The first notes came out in 1930 and 1935 when I published the work in extenso at the Romanian Academy; I mentioned the role of Professor Rainer and what he meant to me: just a role model urging me to continue the work I had started in the laboratory.”