Massa versus Haller: Priority of the Cerebrospinal Fluid Discovery.

The commonly accepted practice in recognizing the scientific priority of a discovery requires finding a hitherto unknown phenomenon, publishing it to other scholars and doing it for the first time. And this is what happened regarding the discovery of the intracranial fluid presence by the Venetian anatomist Massa in 1536. This finding fulfills all the conditions necessary for the recognition of the scientific discovery.

Paraphrasing the saying of Lord Acton that the history of scientific discoveries is the most important thing for a scientist, I analyzed the text entitled, “Research into the Physiology of Cerebrospinal Fluid Reaches a New Horizon: Intimate Exchange between Cerebrospinal Fluid and Interstitial Fluid May Contribute to Maintenance of Homeostasis in the Central Nervous System” written by Mitsunori Matsumae, Osamu Sato, Akihiro Hirayama, Naokazu Hayashi, Ken Takizawa, Hideki Atsumi and Takatoshi Sorimachi and released in Neurologia medico-chirurgica volume 56 in 2016.[1)]

In the first historical section of this paper, the authors discussed in detail major contributors to cerebrospinal fluid discovery throughout the ages. They stated that Albrecht von Haller was the first who had described cerebrospinal fluid within the brain ventricles in 1747 in “Primae lineae physiologiae in usum praelectionum academicarum.”[2)] The authors emphasized it especially as Domenico Felice Cotugno himself—as authors noticed—had credited von Haller for cerebrospinal fluid discovery. Indeed, in his work “De Ischiade Nervosa commentaries” published in 1764, Cotugno cited “Nullu attamen dubito; quo nuperrime acredidit Vir summus Hallerus (q),” where the reference “q” stands for Haller’s work “Elementa Physiologiae… .”[3)] Coming back to Haller’s manuscript, in section “De Cerebro” chapter CCCLVI on page 177, there was written that the water is secreted within the brain ventricle—see Fig. 1. In the same place, von Haller described that there were no such anatomical experiments to confirm this statement. But analyzing the further works of this anatomist and physiologist, and carefully examining especially the Latin paper “Elementa Physiologiae…” edited in 1762, von Haller—while describing intracranial fluid—referred to Massa’s research in 16th century.[4)] Probably, over almost 20 years between “Primarae lineae physiologiae…” and “Elementa Physiologiae…,” von Haller found among the past researches the right one by Massa. In Chapter XIX entitled “Aqua ventriculorum” of his “Elementa Physiologiae…,” von Haller mentioned on page 43 several greatest anatomists who had been involved in similar experiments and N. Massa took the first place. Thus, von Haller was fully aware of his predecessor’s discovery. In 1536, a Venetian physician, Nicolo Massa, had indicated the existence of fluid within cerebral ventricles in his “Liber Introductorius Anatomiae” in Chapter XXXVIII on page 84.[5)] In English translation of Massa’s Latin work, Lind clearly explained this phrase (in Fig. 2 beginning with the Latin word “Vide”): “Examine also in these cavities the watery superfluity [cerebrospinal fluid] deposited there by other parts of the brain which is purged through a certain foramen which comes from the ends of these ventricles.”[6)] Lind added an explanation in brackets so that there were no doubts what kind of fluid in the ventricles it was. And later on, as Massa had pointed out “But what is more worthy of note is the fact that I have always found these cavities full, or half-full, of the aqueous substance just mentioned” (see Fig. 2 beginning with the Latin word “Sed”).

Fig. 1.

The page 177 of Haller’s “Primae lineae physiologiae”[2)]with a breakthrough statement about the presence of fluid in the brain’s ventricles (marked in red color).

Fig. 2.

The most important fragment of the page 84 of Massa’s “Liber Introductorius Anatomiae” with description of intraventricular water (marked in red color).

Apart from omitting important facts referring to discovery of cerebrospinal fluid, the authors did not adequately reference one of the figures. The title page of Haller’s work “Primae Lineae Physiologiae…” presented by Matsumae et al. in Fig. 1 came from English translation, not the first Latin translation of his work as authors suggested. This English edition was released 20 years later, in 1767, by G. Drummond in Edinburgh.[7)]

It is clearly evident, that Massa anticipated the modern anatomists, describing the presence of fluid intracranially. Because this work was original, the evidence accurate and based on autopsy observations and what is more other scientists cited his work, thus we have to recognize Massa’s scientific priority for this discovery.[8,9)] This great anatomical discovery is widely recognized as a milestone in the development of neuroanatomy and neurophysiology.