Subspecialisation in surgery, centralisation of pathologies, dedicated doctors to a small part of surgery, all are actual concepts accepted as good and necessary to the advance of medicine. Are they true?
This month it was published in National Geographic Magazine an article dedicated to a very important person who died 500 years ago, but who is still moulding our mind. Leonardo Da Vinci is that genius person.
Leonardo was not only a painter, he dedicated is life studying botany, geology, architecture, military engineering, hydraulics, geometry, optics, anatomy. He was a thinker ahead of his time. According to Martin Clayton (responsible for Leonardo’s drawings of the Royal Collection Trust) Leonardo’s drawings show us how he could change easily from one topic to another, showing us how fascinating was his mind and capabilities. Leonardo is fascinating. Specialists of each area, including medicine, to better understand and acquire new knowledge about their own present work, are now studying some pages of Leonardo’s notebooks.
Leonardo could change easily from one topic to another.
Leonardo Da Vinci was a pioneer in the study of human anatomy, performing over 30 dissections and putting them on paper like no other man has done till our days. For about 20 years he observed birds and bats to understand the dynamics of flying, and projected several flying machines like the glider. Projected and built war machines. Created theatrical ornaments. Projected a swivel bridge that could rotate 90º in its axis. Designed and built the “areal screw” (in 1489) for a party, concept that was use to build helicopters. To reduce friction during motion transfer he projected bearings (in 1497). Because he understood that the surrounding air influences a bullet trajectory, Leonardo created oval projectiles. Amazing how one man’s work and mind can influence so many different areas of knowledge.
Da Vinci used in art the principles of science (observation, hypothesis, experience). He was moving between the two “worlds” taking lessons from one to apply in the other. He was able to link different knowledges, and he used that to create outstanding things. Anatomy was a great example, putting on paper not only fantastic drawings with great detail, but also which muscles and nerves could be responsible for facial expressions.
In painting he was the master of sfumato, a technique used to improve tree-dimensional perspective. It is present in his masterpiece “Mona Lisa”. The study of geometry and optics were crucial to paint incredible perspectives like the one we can see in “The Last Supper”. Here again he brought knowledge from science to art.
He was able to link different knowledges, and he used that to create outstanding things.
Leonardo Da Vinci also projected a device to allow people to breath underwater. Although his device was primitive, it anticipated diving gear that is now being used by military forces. His drawing was the starting point…
You are wrong if you think Leonardo gave to medicine only anatomical drawings. Dr J Calvin Coffey, surgeon from Irland, studied the mesentery and was Leonardo that gave him the light. Represented in Gray’s Anatomy as a combination of several structures, the mesentery was designed by Leonardo in 1508 as an uninterrupted structure, like Dr Calvin Coffey was trying to demonstrate. Leonardo’s drawing was so important that Dr Calvin Coffey used these drawings in 2015 when publishing his conclusion about the mesentery. 500 years ago Leonardo was right!
How would our world be if Leonardo had dedicated himself to one single area?
There is more. Leonardo also shook Dr Wells, cardiovascular surgeon from Cambridge, in 1977. Da Vinci dissections allowed for the first atherosclerosis description, and to understand the anatomy and dynamics of heart valves. He even built one valve in glass. The details described by Leonardo were only definitely confirmed in 1960. Impressive is that Leonardo's description of heart valve and studies of how they function were necessary to change how Dr Wells repairs a valve. “Was a paradigm shift!”, Dr Wells in National Geographic Magazine.
Lastly, in 2009 the polish pianist Slawomir Zubrzychi built a musical instrument called “viola organista” designed by Leonardo. Da Vinci is still giving us music…
So… If Leonardo Da Vinci had dedicated himself to one single area, the world would be a worse place. All the different projects presented above have only one thing in common: the same author! Andrea Clarke, responsible for an exposition to celebrate the 500 years of Leonardo’s death, stated: “the three notebooks show how Leonardo Da Vinci was a dynamic thinker and how he was able to make connections between different phenomena and disciplines.” This is only possible if you study different areas.
Why should it be different in surgery? Why should we dedicate ourselves to one single and small area of surgery? Why can’t we take lessons from one area to make other area better? There is already specialisation in medicine. Is specialisation of specialisation (subspecialisation) really necessary and good? Will it narrow and limit our skills? Will it “close” our surgical mind? I think it will.
Be like Leonardo Da Vinci. Be open-minded. Study different areas and link them all to be better. There are no frontiers in knowledge and between different knowledges.
References:
Claudia Kalb. Leonardo: Um génio à frente do seu tempo. National Geographic Maio 2019.
by by Dr Carlos Eduardo Costa Almeida
General Surgeon