The Journey of Discovering Skull Base Anatomy in Ancient Egypt and the Special Influence of Alexandria

Ali M. Elhadi, M.D.; Samuel Kalb, M.D.; Luis Perez-Orribo, M.D.; Andrew S. Little, M.D.; Robert F. Spetzler, M.D.; Mark C. Preul, M.D.


Neurosurg Focus. 2012;33(2):e2 

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Rufus of Ephesus: AD 80–150

Rufus of Ephesus, a Greek physician, was thought to have been born in Ephesus, on the west coast of Asia Minor. In his later years he returned to Ephesus, from which he takes his moniker. However, the young Rufus studied and practiced medicine in Alexandria ([10] Unlike his contemporary Soranus or later Galen, Rufus never lived in Rome. Instead, he spent a considerable amount of time in Egypt, where he continuously wrote about life there. He described several of its endemic diseases such as filariasis and other worm infestations and commented on the general state of health of the Alexandrian citizenry. According to historians, Rufus wrote most of his anatomical books while in Egypt, where he received anatomical training. He was convinced that studying anatomy was crucial to understanding diseases. More than 90 medical works are attributed to him. A few of his works were preserved in Latin. However, the legacy of his studies originates from the translation of most of his books into Arabic. The fate of his works and reputation is bound up with that of Galen and Galenism. In typical fashion, although praising him, Galen does not refer to Rufus directly and took direct issue with him only rarely. To gauge the contribution of Rufus, one must access the compilers of later Greek medical encyclopedias, Oribasius, Aetius, and Paul of Aegina, all of whom often cited Rufus at length. For the Byzantines, Rufus was one of the four great names in their medical literature. In medieval literature, Rufus was subsumed under the reputation of Galen, even to the extent that his philosophy, studies, and writings were credited to Galen. Recent interest in the Arabic sources has vindicated and reinvigorated knowledge of his contributions.

Rufus contributed greatly to the anatomical nomenclature, especially in his book On Naming of the Parts of the Body. During his life, unlike those of Herophilus and Erasistratus,[33] dissecting the human body was no longer permitted in Alexandria. It is rumored that Rufus was disappointed with the prohibition on dissecting human bodies. He therefore dissected monkeys and pigs instead. Alexandria must still have been a center of medical and anatomical education during his lifetime. He was a contemporary of Statilius Criton, who was chief physician and procurator to the emperor Trajan (AD 98–117). In his prologue to the Canterbury Tales, Geoffrey Chaucer (1342–1400) named Rufus among the great physicians.

Although Rufus explained the brain much like his predecessors Herophilus and Erasistratus, he was the first to introduce the fact that the brain, spinal cord, and nerves are composed of the same substance, while simultaneously distinguishing them as separate anatomical entities. Previously, it was thought that they were connected together:[14]

The marrow [spinal cord] arises from the brain and escapes through the hole of the cranium at the occiput [foramen magnum] and descends as far as the base of the spine through all vertebrae; it is not a special substance but an extension from the brain; it is called the marrow of the back. Nervous channels [nerves] which are distributed to sense arise and emerge from the brain: for example, to the ear, to the nose, and to other sensory parts. One of these processes comes off in front from the base of the brain, is divided into two branches [optic nerves], and inclines towards each of the eyes in the part called the basin or cavity of vision, in the form of a fossa, and which is found on each side of the nose.

To permit such comparisons, the tissue he studied must have been relatively fresh. Rufus described the optic nerve in more detail than previous anatomists. He was a very well-respected physician and anatomist who named many body parts. In terms of skull base anatomy, he described the color of the brain and mentioned that two layers covered the brain: a freely mobile outer layer and an inner layer fixed to the brain. His writings mention the carotid vessels and explain that the name, carotid, was bestowed by a previous anatomist and signified karoein: "when it is compressed the individual goes to sleep."[38]


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