The ethical and legal implications of the Human Tissue Amendment Act 2020 (Vic)

The Human Tissue Act 1982 (Vic) has recently been amended by the Human Tissue Amendment Act 2020(Vic). In an effort to better reflect the modern practice of organ donation, the intention of the amendment is to include a process for the authorisation of ante-mortem procedures in patients being considered for organ donation after circulatory determination of death(DCDD). As part of this process, the amendment introduces a new requirement for consent for such ante-mortem procedures, and specifies that: A designated officer for a hospital must not give an authority … in respect of a person unless, where the respiration or the circulation of the blood of the person is being maintained by artificial means, two registered medical practitioners, neither of whom is the designated officer and each of whom has been for a period of not less than five years a registered medical practitioner, have each certified in writing — ​ that the practitioner has carried out a clinical examination of the person while the respiration or the circulation of the blood of that person was being maintained by artificial means; and that, in the practitioner’s opinion, at the time of examination, death of the person would occur as a result of the withdrawal of the artificial means of maintaining the respiration or the circulation of the blood of the person.

‘To practice medicine with a safe conscience’

Chapter 18, ‘To practice medicine with a safe conscience: rational therapeutics’ summarizes both parts of Pharmaceutice rationalis (1674, 1675), The London practice of physick (1685), A plain and easie method for preserving those that are well from the infection of the plague (1691) and Dr Willis’s receipts for the cure of all distempers (1701). The analysis emphasizes that the theme running through these treatises is Willis’s concept that vitality is dependent on healthy nutrition, adequate respiration, fermentation and circulation of the blood, and excretion. His therapies target one or other of these processes, usually in combination. The point is made that although most of the ingredients are no longer favoured, Willis’s pharmacopoeia is rational in the context of his ideas. His advice on lifestyle with botanical remedies and the products of chemical laboratories are described. In addition to surgical manoeuvres such as bleeding and the cutting of issues and fontanels, details are provided of innovative procedures including oesophageal stenting and drainage of pleural fluid. {150 words}

Logic, geometry and visualisation of the body in Acquapendente’s rediscovered Methodus anatomica (1579)

The article provides the first description and analysis of the recently rediscovered manuscript titled Methodus anatomica by Girolamo Fabrici da Acquapendente (1533–1619). Acquapendente was one of the most important anatomists in late sixteenth-century Europe and played an instrumental role as Harvey’s teacher in Padua towards the latter’s discovery of the circulation of the blood. The manuscript provides first-hand testimony as to how anatomy was administered in Padua in the post-Vesalian era and sheds light on a number of otherwise unknown aspects of the development of the anatomical method. Chiefly among these is the attention devoted by Acquapendente to historia, as a way to order sensory data in a consistent way, which draws widely from the geometrical method and from the contemporary debate on the discretisation of continuous quantities.

Descartes’ Man Under Construction: The Circulatory Statue of Salomon Reisel, 1680

This paper studies the “human circulatory statues” which Salomon Reisel designed in the 1670s in order to demonstrate the circulation of the blood and its effect on the brain. It investigates how Reisel intended this project to promote Descartes’ philosophy, and how it relates to contemporary diagrammatic schematizations of the blood circulation system. It further explores Reisel’s claims concerning the epistemological and practical advantages of working with a three-dimensional model and argues that Reisel intended his statua to address the concerns of his fellow physicians and, more specifically, to help in diagnostics. I consider the background, strategy and legacy of the essays in which Reisel presented his devices, as well as their relevance to the general project of the scien­tific journal – one of the earliest – in which they appeared, the Miscellanea Curiosa. Reisel was a leading physician who acted throughout his life as a mediator between the Royal Society and the Academia Naturæ Curiosorum. His articles, the paper argues, have much to tell us much about the role played by the recently established scientific academies and their journals in shaping the transmission of early modern science and medicine, in terms both of theories and of the knowledge embodied in scientific instruments.

A Mouse Model for Infection with Enterovirus A71 in Small Extracellular Vesicles

ABSTRACT Enterovirus A71 (EV-A71) is the major pathogen of hand, foot, and mouth disease (HFMD); in some severe cases, it could develop into central nervous system (CNS) disease such as aseptic meningitis, encephalitis, and neurogenic pulmonary edema in children under 5 years. The EV-A71 pathogenesis which is involved with the CNS is unclear due to the lack of a simple and reliable mouse model thus far. Most clinical EV-A71 isolates could not effectively infect the neonatal mouse, which used to be an EV-A71 infection model. The small extracellular vesicles (sEVs) released from clinical EV-A71 isolate-infected cells were infectious in cell lines and could cause a high viral replication in mice. Neonatal ICR mice were injected intraperitoneally with these infectious sEVs and showed more weight loss and higher mortality than those mice injected with the clinical EV-A71 isolate. By using these sEVs, we provided a simple and effective method by which we can generate a stable and valuable animal model for the studies of EV-A71 pathogenesis and therapy. IMPORTANCE EV-A71 was supposed to infect the CNS through the neural pathway and the circulation of the blood in previous studies. Reverse axon transport had been confirmed as an important pathway for EV-A71 to infect the CNS; however, it is still unknown how EV-A71 infects the CNS through the circulation of the blood. Combined with the infectivity of sEVs secreted from EV-A71-infected cells and the characteristic that sEVs could cross the blood-brain barrier, we considered that sEVs may play a vital role in EV-A71 pathogenesis of the CNS.

BLOOD FLOW IN ARISTOTLE

Modern readers view ancient theories of blood flow through the lens of circulation. Since the nineteenth century, scholarly work on the ancient understanding of the vascular system has run the gamut from attempting to prove that an ancient author had in fact, to some extent or another, pre-empted Harvey's discovery of the circulation of the blood or towards attempting, often with some empathetic embarrassment, to explain the failure on the part of an ancient author to notice something that seems so obvious to the modern eye. Thus C.R.S. Harris's 1973 book The Heart and Vascular System in Ancient Greek Medicine, which remains the standard on the topic, opens with a sentence in which he marvels at how the otherwise admirable ancient Greek physicians could have ‘failed entirely to arrive at any conception of the circulation of the blood’. This modern vantage point has had an unfortunate effect. In the case of Aristotle in particular, understanding of his cardiovascular system has been diminished by a tendency to define it in contradistinction to our own modern understanding of circulation. By deliberately uncoupling from the framework of modern physiology, this paper will offer a richer and more accurate picture of his views.