LEGACY
HEROPHILUS OF CHALCEDON: A PIONEER IN NEUROSCIENCE
Feridun Acar, M.D.
Department of Neurosurgery,
Gulhane Military Medical Academy,
Ankara, Turkey
Sait Naderi, M.D.
Department of Neurosurgery,
Dokuz Eylul University School of
Medicine, İzmir, Turkey
Mustafa Guvencer, M.D.,
Ph.D.
Department of Anatomy,
Dokuz Eylul University School of
Medicine, İzmir, Turkey
Uğur Türe, M.D.
Department of Neurosurgery,
Ondokuz Mayis University School
of Medicine, Samsun, Turkey
M. Nuri Arda, M.D.
Department of Neurosurgery,
Dokuz Eylul University School of
Medicine, İzmir, Turkey
A REVIEW OF the history of ancient medicine reveals that most of the knowledge is concentrated in the studies of a few scientists. The best-known names include Hippocrates, Rufus of
Ephesus, Celsus, and Galen. The survival of their works throughout the ages has been the most
important factor contributing to their popularity. However, there are other scientists who made
great contributions to science, but whose writings have been lost or destroyed over the course
of time. As a result, their names are not as well known as those of others and the value of their
contributions is not appreciated. With the improvement of communication technology in the
past 50 years, links between the studies of ancient science can be made more effectively and
scientists who have remained hidden under the shade of time have begun, after thousands of
years, to receive the appreciation they deserve. In the field of neuroscience, the historical
record focuses on Galen of Pergamon. But, when his marvelous works are carefully studied, it
is interesting to note two names he frequently referenced: Herophilus (335–280 BC) and
Erasistratus (310–250 BC). These two scientists were the first to place scientific value on the
dissection of the human body. Herophilus is considered the father of scientific anatomy, and
Erasistratus was the first experimental physiologist. Attracted by the prospect of material
advancement and eminent students, both migrated from their homes in Asia Minor to Alexandria. The works of Herophilus and Erasistratus have been lost entirely, but some details of
their teachings may be recovered from the writings of Galen. In this study, we focus on
Herophilus, a master of ancient medicine, whose important discoveries about the human body
formed the basis for positive science and the foundation for neuroscience.
KEY WORDS: Alexandria, Chalcedon, Herophilus, History of medicine, Neuroscience
Neurosurgery 56:861-867, 2005
Reprint requests:
Sait Naderi, M.D.,
Department of Neurosurgery,
Dokuz Eylül University School of
Medicine, İnciraltı, İzmir, Turkey.
Email: [email protected]
Received, February 8, 2004.
Accepted, November 1, 2004.
DOI: 10.1227/01.NEU.0000156791.97198.58
H
erophilus (335–280 BC) (Fig. 1) was
born in Chalcedon, a small town on the
Asiatic side of the Bosphorus (now
Kadıköy, İstanbul, Turkey). We have no knowledge of his childhood. As a teenager, he moved
to the island of Cos, an important center for
medical faculty, to study medicine. Hippocrates,
the ancient master of medicine, had already
been dead for 65 years when Herophilus was
studying medicine in Cos, but his medical philosophy and knowledge remained powerful influences. Herophilus’ education by Praxagoras
was greatly influenced by this strong Hippocratic philosophy. After he completed his education as a medical doctor, Herophilus worked
in Athens for a short time before moving to
Alexandria in 300 BC to practice his profession
(2, 6, 8, 11, 12, 15, 18, 20) (Fig. 2).
HISTORICAL BACKGROUND
With its wonderful natural resources and
agriculture, Egypt found itself under the in-
NEUROSURGERY
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fluence of many cultures throughout the ages.
Until 525 BC, Egypt was controlled by the
Saite reign. A weak political situation starting
in the 7th century BC led to a rapid increase in
foreign populations in Egypt. Soon, Syrians,
Jews, and Greeks became a majority. To suppress opposition within Egypt, Psammetichus
I hired legionnaires from Ionia and Karia, and
the number of Greek soldiers in Egypt slowly
increased. Greece’s technical and economical
power was supported by this military presence. They settled in colonies–one of which
was Naucratis, established by a group who
had emigrated from Miletus in 600 BC–on
valuable agricultural land near the Nile River.
During the 4th century BC, wars among the
Greek colonies created suitable conditions for
the Persians to invade Egypt. In 350 BC, Philip
II, the father of Alexander the Great, established military and economical stability in
Macedonia. He succeeded in unifying the
Greek colonies in Asia Minor, making Greece
a strong competitor of the Persians.
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FIGURE 2. Map depicting the migration of Herophilus through the Mediterranean region.
works are explicitly ascribed to Herophilus by ancient sources,
including: 1) Anatomy, 2) On Pulses, 3) Midwifery, 4) Therapeutics, 5) Dietetics, 6) Against Common Options, and 7) On Eyes. In
this study, we have collected Herophilus’ contributions to
neuroscience from the testimonies of other authors, including
Celsus, Galen, Vindicianus, Theophilus, Rufus, and Theodoretus, and we present them to provide detailed insight into the
work of Herophilus.
FIGURE 1. Portrait of Herophilus by Joseph Doeve of The Netherlands in the
collection of the Houston Academy of Medicine–Texas Medical Library.
In 322 BC, the Macedonian king, Alexander the Great, conquered Egypt and became king and pharaoh of that land. His
successors, Ptolemy I and Ptolemy II, made efforts to improve
Alexandria. They established the Alexandrian museum and
library complex, where they welcomed noble scientists of the
ancient world (1). It was during the reigns of Ptolemy I and
Ptolemy II that Herophilus and other scientists had the opportunity to dissect human bodies, mostly prisoners held in the
jails, with royal permission. For a period of 40 years, human
dissection and possibly vivisection were permitted in the ancient world (9).
In the 3rd century BC, Alexandrian and Hippocratic medicine embraced the remnants of Assyro-Babylonian medicine
and spread into Mesopotamia and eventually into Syria,
which became a crossroad of Greco-Alexandrian, GrecoRoman, Oriental, and Medieval medicine. Greek medical texts
were often translated into Syrian, then Arabic and Hebrew,
and eventually Latin (14).
The original manuscripts written by Herophilus were lost
over the course of time, but it is possible to trace his contributions through the works of other famous authors of the
ancient world, such as Galen of Pergamon, Rufus of Ephesus,
Soranus of Ephesus, Celsus, and Pliny (4 ,6, 10, 20). Eleven
862 | VOLUME 56 | NUMBER 4 | APRIL 2005
ON DISSECTION AND VIVISECTION
Herophilus, the first to perform systematic dissection of the
human body, was one of the most important figures of ancient
medicine. After Herophilus, few physicians performed human
or animal dissections. Vivisection, the dissection of live specimens, was reportedly performed only by Herophilus and
Erasistratus (23, 24). This was the focus of ethical discussion
among the ancient authors. Regarding vivisection, Tertullianus states:
Herophilus cut up innumerable persons [six hundred
people] in order to examine their nature, who hated
humans, in order to have knowledge, explored their
internal parts, but he probably did not explore all of
them clearly, since death itself changes what has been
alive, especially a death which is not a simple one but
one which is an error in the minds of the artificial
process of dissection. (24)
Similarly, Cornelius Celsus reports:
Herophilus and Erasistratus did dissection in live
criminals out of prison, received from kings. And while
breath still remained in these criminals, they inspected
those parts which nature previously had concealed, also
their position, color, shape, size, arrangement, hardness,
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HEROPHILUS
softness, smoothness, connection, and the projections
and depressions of each, and whether anything is inserted into another thing or whether anything receives a
part of another into itself . . .. Nor is it cruel, as most
people maintain the remedies for innocent people of all
times should be sought in the sacrifice of people guilty
of crimes, and of only a few people at that . . .. (23)
Although only the aforementioned two authors reported
vivisection performed by Herophilus, this remained a universally accepted fact for several centuries.
ON ANATOMY: HEAD AND BRAIN
A review of the studies written by authors on ancient medicine reveals that Herophilus performed dissections of the
head, ventricles, choroid plexus, venous sinuses, cranial
nerves and their foramina, and other neuroanatomic structures. He also categorized neuroanatomic structures according
to their shape, including the brain (encephalon), cerebellum
(parencephalon), torcular herophili, calamus scriptorius, and
choroid plexus.
Vindicianus described the anatomy of the head and cranial
sutures, and mentioned that Herophilus also wrote about the
cranium. Citing Herophilus, Vindicianus describes the cranium as follows:
The skull, the “helmet,” which the Greeks used to call
crane, is placed underneath and it coheres with a membrane, on which placed is the skin. The skin has hair, not
for the sake of ornament, but to protect our brain against
heat and cold. The temples then lie below the skull and
are adjacent to the pneumatic veins of the brain. And
above them the eyebrows are placed, adorned with hair
. . .. (19)
Herophilus’ contribution to the anatomy of the brain, cerebellum, and ventricles was described by Galen in De usu
particum. Before stating the results of the anatomic dissections
performed by Herophilus, the “psychic pneuma,” the accepted source of life upon which ancient medicine was based,
should be explained. There existed disagreement regarding
the origin of the psychic pneuma. The brain, ventricles, meninges, and the point between the two eyebrows were all
suggested as the body’s command center by different authors.
The psychic pneuma travels through the ventricles and
reaches outward through the foramina. It seems that Galen
agreed with Herophilus regarding the origin of the psychic
pneuma. He stated his agreement and reported that Herophilus suggested the brain as encephalon and the cerebellum as
parencephalon. Galen reports this fact as follows:
Now since all the nerves of the body below the head
grow either from the cerebellum [parenkephalis] or from the
spinal marrow, the ventricle of the cerebellum had to be of
quite a considerable size and had to get a share of the
psychic pneuma which was previously prepared in the
NEUROSURGERY
OF
CHALCEDON
front ventricles [lateral ventricles of the brain]. Consequently there must be a passage from those ventricles into
the ventricle of cerebellum. The latter [ventricle], then, also
appears large, and the passage entering into it from the
anterior ventricles is very large indeed; it alone does a
connection between the cerebellum [parenkephalis] and cerebrum [enkephalos] exist. These, you see, are the names
Herophilus and his followers are in the habit of giving its
two parts. The anterior part was called by this name of the
whole on account of its size. For, although it is double in
nature, as was mentioned, each of its two parts is much
bigger than the entire cerebellum. The posterior part [cerebellum], by contrast, got its name because the anterior
part had been the first to expropriate the name of the
whole [enkephalos] for itself, and therefore it was no longer
possible to find a different, more just a name for the
cerebellum than it now has . . .. (7)
There is also some information regarding Herophilus’ studies in the field of lateral and fourth ventricle anatomy. Rufus
of Ephesus, in De nominatione partium hominis, reported that
“the tunic covering the ventricles of the brain on the inside”
was called the “choroid meninx” by Herophilus (13). According to Galen, however, “Herophilus calls it ‘choroid twisted
clusters’” (3). On the other hand, describing the fourth ventricle anatomy in De anatomicis administrationibus, Galen tried to
explain the meaning of calamus scriptorius as follows:
Next pay attention to how, when it [the vermiform
process, the woodworm-shaped process lying on the
aqueductus cerebri] is bent forward, the result is that the
posterior ventricle, the fourth, is exposed, and, when it
is moved backwards, that the larger part of the ventricle
is covered and only that part is visible which Herophilus
likened to the carved out groove of a pen (kalamos) with
which we write [kalamos scriptorus]. You see, it really is
like a pen, since it has a hollow, like an incision [posterior median sulcus], in the middle, and on either side of
this each of the two lateral parts [eminentia facialis]
extends up to as great a height as they rise in pens from
the line in the middle. Particularly in Alexandria they
carve out the pens with which we write in this way, and
since Herophilus lived there, it is likely that when he
was dissecting, he applied this name being induced to
do so by the similarity of the image . . .. (3)
Herophilus also described venous sinuses. His followers
accepted his descriptions and names. Writing about the venous sinuses, Galen cites Herophilus as follows:
At the crown of the head the folds of the membrane
[sinus transversus] that conduct the blood come together into a common space like a cistern, and for this
very reason it was Herophilus’ custom to call it “wine
vat” [torcular herophili]. From this point, as from some
acropolis, they [sinuses] send forth canals to all the parts
lying below them . . .. (7)
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ON ANATOMY: NERVES
Herophilus, in association with Erasistratus, described the
sensory and motor nerves. It is important to note the common
belief that the nerves carried the psychic pneuma. Rufus of
Ephesus cites Herophilus’ philosophy of nerves as follows:
Nerve [neuron] is a simple, solid body, the cause of
voluntary motion, but difficult to perceive in dissection.
According to Erasistratus and Herophilus there are
nerves capable of sensation, but according to Asclepiades not at all. According to Erasistratus there are two
kinds of nerves, sensory and motor nerves; the beginning of the sensory nerves which are hollow, you could
find in the meninges of the brain, and those of the motor
nerves in the cerebrum [enkephalos] and in the cerebellum [parenkephalis]. According to Herophilus on the
other hand, the neura that make voluntary motion possible have their origin in the cerebrum [enkephalos] and
spinal marrow, and some grow from bone to bone,
others from muscle to muscle, and some also binds
joints together . . .. (13)
The works of Herophilus on cranial nerves and foramina
have been cited by many physicians. Some addressed the
controversies between Herophilus and Marinus, emphasizing
their disagreement about the number of cranial nerves proceeding from the brain. Galen, in Hippocratis Epidemiarium,
states:
. . . I say this nerve, of which Hippocrates speaks here
branches off from the brain near the start of the spinal
marrow. In addition to this pair of nerves only one other
pair proceeds from the brain, running through the beginning of the spine . . .. This is the pair which Marinus,
after Hippocrates, designated the six pairs of nerves
proceeding from the brain. People believed that Marinus and Herophilus disagreed on them . . .. (12)
Herophilus suggested that facial nerve did not reach to the
exterior. As a result, Herophilus and his supporters named
this the “blind foramen” (3). Herophilus also called the optic
foramen “porus.” It can be understood from the texts of Galen.
For example, in De libris proprii, he reports:
In Book 19 [of his twenty anatomic books, Marinus
writes] about the nerves that grow from the brain, about
smell and from what source its perceptual organ begins,
and about the nerves that go to the eyes, which Herophilus as well Eudemus call “passages” [poroi] . . .. (17)
Also, in De symptomatum causis, Galen states:
The nerve which proceeds down from the brain to the
eye—which Herophilus and his followers in fact also
call a “passage” [poros], because its perforation alone is
clearly visible—seems to me to exist a pathway for
sensory pneuma . . .. (17)
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ON NEUROPHYSIOLOGY
AND PATHOLOGY
There were a variety of opinions regarding the body’s center of command. Theodoretus Cyrrhensis addressed this fact
in Graecarum affectionum curatio. According to Theodoretus
Cyrrhensis:
It is easy to discern all the disagreements they [the
pagan Greeks] had with each other concerning the location of the command center. For, while Hippocrates,
Democritus, and Plato said that it is seated in the brain,
Strato in the space between eyebrows. But Erasistratus,
the physician, said it is in the area in the meninx of the
brain, which he calls “on the skull” [epikranis]. Herophilus, in the ventricle of the brain . . .. (22)
According to Galen:
Herophilus assumed that the ventricle in cerebellum
[parenkephalis] exercises most control . . .. (7)
Galen reports:
Herophilus recognized correctly that the nerve-like
and not the arterial class serves the voluntary movements . . .. (17)
Table 1 lists the neural structures found by Herophilus, and
Table 2 includes the structures named by Herophilus.
TABLE 1. Neural structures found by Herophilus
The difference between nerves and arteries
The difference between cerebrum and cerebellum
Meninx of brain
Arachnoid of brain
Dural venous sinuses
Brain being the center of nerves and intellect
Cranial nerves, such as optic, oculomotor, trigeminal, facial,
auditory, and hypoglossal
Functions of medulla spinalis
Control of motor function
Ventricles of brain
Optic nerve and its entrance to brain
Difference between motor and sensory nerves
Difference between cranial and spinal nerves
Difference between arteries and veins
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HEROPHILUS
TABLE 2. Structures named by Herophilus
Neuron
Prostate
Torcular herophili
Chorion
Duodenum
Facial canal
Calamus scriptorius herophili Cornea, retina, choroid, and iris
Retina
Rete mirabile
DISCUSSION
For the first time in human history, the systemic dissection
and vivisection of the human body were performed by
Herophilus and Erasistratus in Alexandria during a period of
40 years. After this period, there is no written evidence of
human dissection for approximately 1800 years (2, 11, 15). The
dissection and vivisection of animals was performed by Alcmaeon in 5th century BC. Aristotle also performed dissections
on animals, but never on humans. In Corpus Hippocraticum,
there is no clear evidence of human dissection.
Claudius Galen had knowledge of human anatomy and
discussed it in his writings (4, 16). He served as the physician
responsible for the gladiators in Pergamon. In this role, he
performed many surgeries on extremities, but his experience
with abdominal and thoracic surgery and with neurosurgery
was limited. As a great scholar, he possessed the writings of
his forerunners, including Hippocrates, Herophilus, and Erasistratus (17). To these writings, he added his own contributions and formed a valuable treatise. However, his anatomic
studies were on North African baboons with an anatomy
similar to that of humans. He presented his studies as he
completed them on humans. Despite the similarities, however,
there were several minor variations between human and baboon anatomy. Andreas Vesalius realized these points 1300
years after Galen’s death. It is clear that Herophilus was the
scientist responsible for the genuine work on human anatomy.
There are several reasons that Alexandria was the center for
science and dissection in the ancient world under the reign of
Ptolemy I and Ptolemy II. In most published articles, authors
emphasize the blending of Greek and Egyptian culture in
Alexandria. However, when this is investigated further, it is
apparent that Egyptian medicine included important knowledge of remedies and the care of wounds. Egyptians also had
some anatomic knowledge of the human body as a result of
mummification. But, this knowledge was limited, and medical
application was more ritualistic and spiritualistic in reality.
There was little interaction between Greek and Egyptian physicians in Alexandria. Therefore, it is more reasonable to say
that it was the ambition of the Ptolemy reign that made
Alexandrian medicine unique. Ptolemy I and Ptolemy II gave
royal support to scientists and even gave permission to take
the prisoners out of jail for use in vivisections to make Alexandria a forerunner in science (9, 17).
NEUROSURGERY
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In opposition to Aristotle, Herophilus gave the brain precedence over the heart as the center of the nervous system. It is
true that Alcmaeon had anticipated this, but the Aristotelian
tradition was definitely in favor of the heart being seat of the
intellect. According to Galen, “Herophilus places the dominant principle of the ‘soul’ in the ventricles of the brain” (5).
The testimony of Aristotle on human cadavers opened the
road to dissection:
A cadaver cannot form fear and debate more than a piece
of wood, stone or bronze. Pneuma has gone away. To name
cadaver as a human is a great linguistic failure. (21)
In addition to his writings on neuroanatomy and neurophysiology, Herophilus made important contributions to
other areas of medicine. His treatise On Eye Diseases may be
the foundation of modern ophthalmology. He divided the
liver into lobes in the same fashion used today and he described the pancreas gland in detail. He described the uterus
and the broad ligaments and reported for the first time that the
ovaries produced the “human egg.” He wrote about the formation and transportation of spermatozoa through the male
genital system and described the prostate gland, the salivary
glands, the duodenum, and lymphatic circulation. Many of his
findings form the basis of our modern medical philosophy.
After his death at the end of the reign of Ptolemy II, the
empiricists gained power and traditional Greek ethics prohibiting the exploration of the human body reached a new height
in Alexandria. It was believed that everything had been explored, and a retrograde evaluation of old antiquities began.
The charge of having practiced vivisection on humans was
brought against Herophilus and Erasistratus in ancient times.
The evidence on which this charge was based comes from
Celsus (AD 30) and Tertullianus (AD 155–222). Interestingly,
neither was a physician (8). Celsus states that members of the
Methodist School:
. . . think it is necessary to dissect dead bodies and examine their viscera and intestines; and they think that
Herophilus and Erasistratus had taken by far the best
method for attaining that knowledge, for they procured
criminals out of prison by royal permission, and dissecting
them alive contemplated, while they were even breathing,
the parts which nature had before concealed (24).
Celsus decided that such practices were both cruel and unnecessary. From his further remarks in the same passage, it is evident that, in his time, a certain section of medical opinion maintained that dissection of a dead subject was as unnecessary as it
was disgusting. Tertullianus repeats the charge in the next century, and although his language is not quite so definite, his
meaning is clear according to the natural interpretation of the
words. After calling Herophilus a “butcher” who dissected six
hundred persons so he might scrutinize nature—a passage
which probably refers only to dissection of the dead—he continues, “death in his hands was not simply death, but led to error
from the very process of cutting up.” This seems to be a repeti-
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tion of the empirical contention that, since death changes the
appearance of the organs, all dissection is useless. But, we may
understand that Tertullianus meant to at least imply, even if he
did not absolutely state, that the bodies cut up were living. It is
strange, however, that Galen makes no reference to this supposed practice. On this account, many modern authorities have
doubted the authenticity of this claim. Galen was an openminded writer who thought very highly of Herophilus, although
he differed from and severely criticized Erasistratus in many
details. At the same time, Galen pointed out the mistakes of the
former and gave the latter full credit for those parts of his work
of which he approved. If he had known of the practice of human
vivisection by Herophilus or Erasistratus, it is inconceivable that
he would not have referred to it, either in praise or rebuke.
Galen’s silence on this subject leads us to wonder whether it was
not simply a charge trumped up by partisan writers who, like
some people of modern times, disapproved of dissection in any
form so strongly that, consciously or unconsciously, they confused dissection of the dead with dissection of the living (5).
CONCLUSION
Although his possible participation in human vivisection is
against medical ethics, the great contributions of Herophilus
and his followers should be recorded in our literature. As the
founder of neuroanatomy and neurophysiology, Herophilus
paved the way for neurological surgery and should be given
the recognition he deserves. Thousands of years after his
death, he should be remembered by future generations for his
contributions to the medical world.
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COMMENTS
T
his article puts into perspective some of the contributions
made by pre-galenic philosophers and investigators, one
of whom was Herophilus. A strong case is made for an individual medical philosophy derived from the teachings of
Herophilus and focused on certain aspects of neuroscience, in
particular related to the anatomy of the brain and nerves. This
anatomy and some of the physiology found their way into
galenic and later teachings, and there seems to be no doubt
that Herophilus made some important fundamental discoveries, which are nicely listed in the tables. It is also interesting to
note how individuals such as Herophilus enhanced their education and their influence by traveling widely throughout
what was then the civilized world.
Edward R. Laws, Jr.
Charlottesville, Virginia
H
erophilus of Chalcedon is a name familiar to medical
students and neurosurgeons, primarily because of the
calamus scriptorius and the torcular herophili, both of which
we learned in our first year of medical school. However, what
is not well known is the significant contribution this anatomist
made to our early anatomic literature, particularly in the neurosciences. As the authors have clearly pointed out, there are
no known writings left by this great figure, so one is left to
search out the writings of the contemporary and later writers,
and that was done quite skillfully here. Also included in the
article is a nice historical review of the period and the question
of performing vivisection. It seems that one had to be quite
adventurous at that time if one wanted to perform anatomic
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HEROPHILUS
dissections, but that apparently did not dissuade Herophilus
from doing so; for this, he was called a “butcher” by some.
Reading the original descriptions of the torcular herophili and
the calamus scriptorius brought these anatomic figures to life.
Also not often appreciated by modern scholars is the contribution that Herophilus made to the understanding of the function
of the brain as being the seat of the soul and higher cortical
function, this in contradistinction to the Aristotelian view of the
heart as being the cardiocentric control of higher functions. Unfortunately, Herophilus put the function within the ventricular
system, leading to the development of the long-standing cell
doctrine, which remained with us until the 17th century, at
which point the function was appreciated to be in the brain
substance. Despite this last error, it is clear from reading this
article that Herophilus was, and remains today, one of our great
figures in the history of the neurosciences, and after reading this,
all of us will be even more enlightened on his contributions.
OF
CHALCEDON
tered in the acquisition of knowledge throughout history. In
my opinion, the Alexandrian School was the greatest school of
that era, and Herophilus of Chalcedon was the father of modern anatomy (2). Herophilus and Erasistratus were the bestknown physicians of the Alexandrian School. Herophilus described and named the rete mirabile, the calamus scriptorius,
the torcular herophili, and the choroids (1). Herophilus wisely
sought and received the permission of the administration for
his research, which provided him the unique opportunity of
vivisection of 600 subjects. As a result, he was able to present
many previously unexplored topics and anatomic structures.
It is indeed regrettable that most of the collections of the
Alexandrian libraries were destroyed over the years. Nevertheless, the preserved materials, although insufficient, stand
as a testament to the importance of his work.
Yücel Kanpolat
Samanpazari, Turkey
James T. Goodrich
Bronx, New York
T
his is a very important historical article about Herophilus
of Chalcedon. As participants in the knowledge and information society, we are well aware of the difficulties encoun-
1. Clarke E, O’Malley CD: The Human Brain and Spinal Cord. San Francisco,
Norman Publishing, 1996, pp 10–12.
2. Singer C, Underwood EA: A Short History of Medicine. Oxford, Clarendon
Press, 1962, pp 48–49.
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NEUROSURGERY
VOLUME 56 | NUMBER 4 | APRIL 2005 | 867