His life

Antonio Maria Valsalva was born on February 17, 1666, in Imola, Italy (Fig. 1) [1]. Pompeo Pini, a jeweler, was his father, and Catarina Tosi was his mother [2]. The name Valsalva, on the other hand, originated from the place where his grandfather’s family home was located. Valvalsa grew up in an upper-middle class family. At the age of 43, he married Elena Lisi, the 17-year-old daughter of a noble Bologna senator. They had six children, half of whom died in childhood. Valsalva died of apoplexy in Bologna on February 2, 1723, at the age of 57 [3].

Fig. 1
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The great Italian anatomist Antonio Maria Valsalva (1666–1723)

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As a child, he was sent to a Jesuite school to study the humanities, mathematics, and natural sciences [1, 3]. Interested in anatomy and physiology, Valsalva continued his education at the University of Bologna and graduated at the age of 21 [2]. At this University, he was a student of Marcello Malpighi (1628–1694), known as the discoverer of microscopic anatomy [1]. By the time he graduated, a plague epidemic in Bologna spread throughout the city. Therefore, as soon as he graduated, he was appointed as an inspector of public health services in Bologna. While performing this duty, he treated many important people, including the governor of the city, with his clever clinical judgment [1, 3]. Afterwards, the academic community appreciated his achievements and declared him Professor of Anatomy, and he became president of Bologna’s Academy of Sciences. Valsalva saw the medical profession as a humanitarian duty and did not do it for money. He always provided help by examining and treating people in bad condition free of charge [1].

Career and achievements

Valsalva worked for 25 years at Ospedale degli Incurabil, a hospital complex located on Via Maria Longo in the center of Naples, Italy [4]. The hospital was established in the sixteenth century mainly to care for patients affected by syphilis.

He worked in ophthalmology, rhinology, vascular, and tumor surgery and also performed organ grafts on animals [1].

In the field of surgery, he was recognized as an outstanding surgeon by his contemporaries and introduced many new operations and surgical instruments. He worked hard in the lab and was successful in removing the spleen and kidney from animals. It is thought that the probability of performing these processes in humans is high [1].

In otohynolaryngology, he was the first to define the three regions of the ear (outer, middle, and inner). However, Valsalva’s area of expertise was the middle and inner ear [1]. Therefore, he made detailed dissections covering the anatomy of these regions. Additionally, he described the structure and function of the Eustachian tube, named after the Italian anatomist Bartolomeo Eustachi (1501–1574) who discovered it [1, 3]. He studied the mechanisms and functions of the tympanic membrane, middle ear ossicles, and semicircular canals (Fig. 2 and Cover) [1, 3].

Fig. 2 and Cover
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Table I, III, VII, and VIII of the De Aure Humana Tractatus (1704). Drawings by Francesco Cavazzone (1559–1612), an Italian painter, showing the anatomy of the external and middle ear

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His landmark book De Aure Humana Tractatus (The Treatment of the Human Ear) was published in 1704 (Fig. 3). This book was accepted as the a standard educational resource throughout Europe for more than 150 years [1,2,3].

Fig. 3
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De Aure Humana Tractatus (1704), the best-known written work of Antonio Maria Valsalva

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Valsalva maneuver

He described the Valsalva maneuver in detail in this book (Fig. 3). The Valsalva maneuver is a movement performed by trying to exhale at medium strength while the airway is closed. It is a simple method used to unclog the ears by balancing the external pressure and internal pressure. The Valsalva maneuver is also used in patients experiencing paroxysmal tachycardia, as it also stimulates the vagus nerve, which innervates the lungs, as well as slowing the heart rate [1, 3, 5].

Cardiology and sinus of Valsalva

Valsalva was also deeply interested in the physiology and anatomy of the heart valves. He detailed the work of the anatomist Giulio Cesare Aranzi on the aortic valves [1]. He described nodules in the form of small protrusions in the center of each valve, allowing complete closure of the aortic valve. He described pocket-like enlargements between the aortic wall and the valves, known as the sinuses of Valsalva. Although Valsalva discovered the Valsalva sinuses, it was reported after his death by his collaborator and student, Giovan Battista Morgagni [1].

Morgagni

Valsalva was also an adviser to many notable scientists, such as Giovanni Battista Morgagni (1682–1771) (Fig. 4) [2, 3].

Fig. 4
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The scientists Giovanni Battista Morgagni (1682–1771)

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He left all of his medical notes to his student, Morgagni, when he died. After Valsalva’s death in 1740, Morgagni was in charge of editing all of his writings and biography. The works of Valsalva were included in many of Morgagni’s publications [3].

Health problems

Since his early adulthood, he had suffered from recurrent bouts of bronchitis and pneumonia, as well as abdominal pain. There was a possibility that Valsalva suffered from diabetes mellitus [1]. Valsalva dissected cadavers almost every day. Because there was no knowledge of the existence of microorganisms at the time, he did not take any precautions while performing the dissections. As a result, he was vulnerable to infection in this manner [1].

As diagnostic tests were not available at the time, Valsalva tasted fluids from patients and cadavers in dissections and said, “The gangrenous fluid tastes bitter and leaves an unpleasant feeling on your tongue” [1]. Consequently, he lost his sense of smell, forcing him to perform dissections in more difficult circumstances [1].