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In 1761 Cotugno gave the first reliable account of ventricular and subarachnoid fluid.1 Until Cotugno, anatomists had found empty spaces around the brain and cord and thought that in life they were filled by vapour. Willis said the ventricles were empty spaces, or served the “vile duty of a sewer. In the dead they may be filled with water…if the serous fluid in the blood is too abundant.”2 Albrecht von Haller’s famous textbook3 (at the same time as Cotugno’s studies) describes:
“As in the pericardium…a thin humour constantly exhales from the arteries into the ventricles of the brain and is constantly drawn back through the veins…so often the collected moisture turns into water and even distends the ventricles…A great abundance of water has been found in the ventricles of apoplectics, the soporose, convulsives, paralytics, and victims of epidemic fevers; hydrocephalus even more.”
Cotugno studied 20 adult male bodies. He established the free circulation between the cranial and spinal dura of cerebrospinal fluid (sometimes referred to as liquor Cotunnii). His lucid description indicating its formation and absorption from blood vessels is contained in his work on sciatica.4
“Not only does this water contained in the tube of dura mater ensheathing the spinal marrow [cord] from the occiput to the os sacrum, surround the marrow constantly, but it also abounds in the hollow of the skull and fills all the spaces found between the brain and the encompassing dura mater… It seems to be a human law that the space around the spinal marrow that is filled with water increases with man’s age…Hitherto anatomists have not observed this large collection of water in the spine and around the brain because of the ridiculous method usually employed for the dissection of bodies…they cut off the head with the neck…all the fluid collected around the brain and spinal marrow is at once lost… and the anatomist is misled by the appearance of empty spaces…It seems beyond all doubt that the spinal fluid, as well as that which humectifies all other cavities of the body, constantly oozes from the extremities of the smallest arteries and, finally is absorbed through very small inhaling veins, so that there is a continual state of renovation.”
Further, he noted the incoagulability of CSF in health, but like urine in nephritis, which he observed some 50 years before Bright, it clouded on boiling, only in disease. This work was overlooked until Magendie reprinted it in 1827.
In this crucial work, Cotugno, an astute observer and clinician, differentiated sciatic nerve pain from arthritis of the hip, probably for the first time. The eponym Cotugno’s syndrome was subsequently applied to unilateral sciatic neuralgia. He also wrote about typhus and gave a fine description of the pathology of smallpox pustules.5
DOMENICO FELICE ANTONIO COTUGNO (1736–1822)
Near the heel of Italy lies the town of Ruvo Pugliese, the birthplace (29 Jan 1736) of Cotugno. Most of his life he spent in Naples. His family were poor and hardship was his constant companion in his formative years. After medical training in Salerno, he worked in the University of Naples and the Ospedale degli Incurabili. Cotugno surmounted serious illness while resident at the hospital. He became an assistant at the Ospedale degli Incurabili. In 1766 he became professor of anatomy, the leading physician in Naples, and director of the Ospedale. By the age of 31 he was widely acclaimed for his excellent publications,6 including two books.
When he was only 25, in 1761, his dissertation, Aquaeductibus auris humane internae, predated the work of Hermann von Helmholtz. In it he described6 the vestibule, semicircular canals, and cochlea. He demonstrated the labyrinthine fluid, and considered mechanisms of resonance, sound transmission, and hearing. He depicted the columns in the bony spiral lamina of the cochlea known as Cotunnius’ columns. His description of the nasopalatine nerve, and its role in sneezing anticipated Antonio Scarpa’s work.
In 1765 he visited Rome and northern Italy, and was befriended by Morgagni. Notable success in practice led to appointment as physician to Ferdinand IV, King of Naples, accompanying his travels to Austria and Germany.
He was a dedicated doctor, but was also a student of art, architecture, Latin, and antiquities. A greatly esteemed physician, local lore was that nobody in Naples could die without a passport from him. He was renowned for his devotion to medicine and scientific investigation. He stopped teaching in 1814 but continued to attend his hospital daily. In 1818 he had a cerebral embolism that eventually caused his death on 6 October 1822.
The generous son of a poor father, he left 100 000 ducats to the Ospedale degli Incurabili.
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