Aloys Martin (1818–1891), „Wegbereiter der Anästhesie”

Objectives: Aloys Martin has recently been called ”a pioneer of surgical anaesthesia in Germany” [41]. This gave rise to an investigation into further aspects of his professional and private biography and the social as well as political context. Methods: Documents in archives and relevant medical and historical literature relating to the objectives were surveyed and analyzed. Results: In 1848 the anaesthesiological articles Martin had been contributing came to an end. He then worked as a university lecturer and professor at the University of Munich, as an official forensic and charity physician as well as in medical practice in Munich. Among other things, he published diverse articles on the schematism of Bavarian civilian and military physicians, on infectious diseases and edited scientific journals. As a founder and editor of the Bayerisches ärztliches Intelligenzblatt (Bavarian Medical Information Newspaper), renamed the Münchner Medizinische Wochenschrift (Munich Medical Weekly Journal) in 1886, he guided the publication to a central position in a medical community just developing professional status. Martin was also the founder and for many years the chairman of societies for voluntary medical assistance to the poor and the Froebel kindergartens in Munich. Although he himself was of lower class origin and under pressure from conservative circles at the university and ministery due to his liberal political views, his life and works bear witness to his own effective emancipation and rise into the ”Bildungsbürgertum” (educated class) of the 19th century. Conclusions: Aloys Martin is a historical figure in anaesthesiology. In his function of promoting the professionalization of the whole Bavarian medical community, he also ranks highly. In view of his self-abnegating medical service devoted to the common good, he may still today be considered an example.     

Richard Caton (1842-1926): pioneer electrophysiologist and cardiologist

Richard Caton is recognized as the discoverer of the waves of electrical potential which today form the basis of electroencephalography. He reported his finding in three communications, two in the British Medical Journal and one to the Ninth International Congress of Medicine at Washington, DC. After defending his priority in having made this discovery, he did no further work on the brain: his family and colleagues were unaware of his discovery for many years after his death. This was possible partly because of many other things that he did in his long life but also because, in his later years, he took deliberate steps to hide the fact that he had worked on the brain. The most important of these other activities was a practical study of the treatment of rheumatic heart disease. The basis of his treatment--complete rest in bed--is still in use today.     

The circumcision of Jesus Christ

PURPOSE: We study the controversies manifested in religious writings, art, sculpture and music as well as the theological disputes surrounding the circumcision of Jesus Christ. MATERIALS AND METHODS: Data are derived from relevant historical and theological articles. RESULTS: Jesus Christ was circumcised as a Jew on the 8th day after his birth. Until 1960 the Catholic church celebrated the day as Circumcision Day. In medieval times the holy foreskin was worshipped in many European churches. CONCLUSIONS: Christianity never condoned the ritual of circumcision and established the sacrament of baptism in its place.     

Robert Lich, Jr., M.D.: innovator in pediatric and adult urology

PURPOSE: Dr. Robert Lich, Jr. (1909 to 1987) advanced the foundation of knowledge in many areas in the field of urology. He is best known for his contributions to our understanding and management of vesicoureteral reflux. MATERIALS AND METHODS: We reviewed the many articles published by Dr. Robert Lich, Jr., focusing on his work with vesicoureteral reflux. We describe the contributions made by a pioneering urologist who helped advance the foundation of knowledge concerning the etiology of vesicoureteral reflux and its surgical management. We discuss his novel ideas within the framework of surgical techniques of his time, and relate personal experiences from his colleagues and his wife. RESULTS: Doctor Lich was a pioneer in adult and pediatric urology. He is remembered most for his innovative ureteral reimplant technique for the surgical management of vesicoureteral reflux. CONCLUSIONS: Doctor Lich enriched the fields of adult and pediatric urology through a lifelong pursuit of scientific investigation and refinement of surgical practice. It is appropriate to review his innovative contributions to the management of vesicoureteral reflux as we experience yet another paradigm shift in our understanding and management of this condition.     

W. W. Keen and the dawn of American neurosurgery

Before the turn of the century, W. W. Keen was the most celebrated neurosurgeon in the United States. During the Civil War he served as a surgeon in the Union Army. He collaborated with Mitchell and Morehouse in clinical studies that culminated in their publishing Gunshot Wounds and Other Injuries of Nerves. In 1887, he was the first surgeon in the Americas to remove a benign brain tumor. He perfected a technique for ventricular puncture, devised operations for spasmodic torticollis, microcephalus, and tic douloureaux, and introduced many European neurosurgical techniques to the United States. An astute clinician and excellent teacher, Keen had no research interests other than anatomical and pathological dissections. He published over 50 papers on neurosurgical topics, in addition to articles on numerous other subjects. Although recognized as a pioneer in neurosurgery, he is not usually considered a founder of neurosurgery in the United States because of his failure to develop the specialty further than his contemporaries in the remainder of the neurosurgical world. This failure related not to his abilities, but probably to the fact that he was elderly before it became technically possible to perform safe and effective intracranial procedures.     

Mildred Codding: an interview with Cushing's medical artist. Interview by Matthew R. Moore, John Shillito Jr., Eugene Rossitch Jr.

Mildred Codding was Dr. Harvey Cushing's medical illustrator and was closely involved with many of his original articles and books. From a recent interview with her we gained many insights into life as a medical artist for the father of modern neurosurgery, both in and outside of the operating room. The artistic drawing techniques of Miss Codding and Dr. Cushing are compared.     

The free fascial forearm flap

The unpleasant appearance of the donor site after harvesting a forearm flap limits its use in many centers. In this paper, the author records his experience with a modification of the standard fasciocutaneous forearm flap. Such modification involves the utilization of the fascial component of the flap sparing the skin of the forearm, which is closed as a longitudinal line. This fascial forearm flap (FFF) was used as a free flap in eight cases. All the flaps survived well, and the donor site appearance was excellent. The fascial forearm flap advantages and limitations are discussed with recommendations for further utilization of other fascial flaps.     

John Collins Warren: Master educator and pioneer surgeon of ether fame.

John Collins Warren (1778-1856) represented the apex of surgery and medicine of the first half of nineteenth century Boston. Educated at Harvard College where he obtained a Bachelor of Arts in 1797, he contemplated the idea of a business career prior to setting sail for a traditional medical education at Europe's finest universities. From 1799 to 1802, he attended prestigious medical and surgical lectures in London, Edinburgh, and Paris. Warren received an honorary MD from Scotland's St. Andrews University in 1802. He then returned to Boston and joined his father's practice.In 1815, he followed his accomplished father as the Hersey Professor of Anatomy and Surgery at Harvard Medical School. He held this position with great distinction until 1847 when he retired as professor emeritus. From 1816 to 1819 he served as Harvard Medical School dean and received an honorary medical degree at the end of his term.John Collins Warren had numerous surgical accomplishments during his illustrious career. Clinically, he was active and varied in his practice, operating on strangulated hernias, tumors, and cataracts, in addition to performing vascular surgery and amputations. He published many articles and books of widespread circulation. Professor Warren also performed the first reported case of ether anesthesia administered by William T. Morton on October 16, 1846.Outside the operating theatre, Doctor Warren and his colleagues were revered for founding the Massachusetts General Hospital in 1821, and years before, in 1812, Warren and his associates established the New England Journal of Medicine and Surgery. In light of his varied contributions, John Collins Warren is remembered as a dedicated and innovative surgeon, as well as a committed medical educator, able administrator and effective leader.     

Times of life: A tribute to Dr James TK Lau

Background: The historically unprecedented severe acute respiratory syndrome crisis saw eight Hong Kong health care workers sacrificing their lives in the line of duty – Dr James TK Lau was the first one. The reviewer looks back at a specific time in the life of this colleague's outstanding career from the end of 1980 to mid‐1984. A Medline search showed that during this short time, Dr Lau published 22 articles in international prestigious journals as first author, as well as being a co‐author for many papers (as well as several local papers). These articles, ranging from experimental study (one), randomized controlled study (one), clinical observations (six), case reports (three) to new techniques (11), reflect the author's inquisitiveness, ingenuity, resourcefulness and most importantly, incessant quest for technical perfection through meticulous attention to detail. Of note, many of the innovative techniques have stood the test of time and have been assimilated into everyday practice. Authoring 21 paediatric surgery papers in international journals over a short span of time was truly remarkable, and also, unprecedented locally. This could not have happened without one most memorable attribute – total devotion – that was clearly evident at all times of his life, and in particular, the final times of his life.      

Franz von Leydig (1821-1908), pioneer of comparative histology

Franz von Leydig, a German histologist and zoologist, is known to every student of human or animal anatomy because of the testicular testosterone-producing cells carrying his name. However, he made many contributions to our knowledge of the fine structure of animal tissues, including more than 200 scientific articles and several books. His most important work, the book Lehrbuch der Histologie des Menschen und der Thiere, established him as a pioneer if not the founder of comparative histology. Leydig taught at three different universities (Würzburg, Tübingen and Bonn) and received many honours from scientific organizations worldwide, including the Royal Society. He died in Rothenburg ob der Tauber, the town of his birth, aged 86 years.     

Sir William Hingston

Sir William Hingston was one of Canada’s most illustrious surgeons in the second half of the 19th century. Not only was he a very innovative surgeon but he was an excellent teacher and wrote many medical articles during a career that spanned over 50 years. Active as he was medically, he found time to serve a term as mayor of Montreal and was on the board of directors of various banks and companies. As recognition of his many talents, he was knighted by Queen Victoria in 1895. He died in 1907 at the age of 78 years.     

Dr. Henry Head and lessons learned from his self-experiment on radial nerve transection

In this paper the authors aim to review Dr. Henry Head's famous and dramatic nerve sectioning experiment. They discuss the implications of his experimental approach as well as the effect his experiment had on the field of neurology. Henry Head was a prominent British neurologist who contributed greatly to the understanding of the sensory examination through an experiment in which he had his own radial nerve transected. Head carefully documented the sensory changes following the sectioning. He hypothesized the existence of two separate sensory systems: protopathic and epicritic. Head was one of the first scientists to speculate on sensory dissociation, and his writings generated both enthusiasm and controversy. Although the ethical issue of self-experimentation was raised by his bold experiment and many aspects of his investigations and conclusions have been criticized, Head undoubtedly contributed important clinical lessons to neurology. Arguably, Henry Head's greatest contribution was the realization that the neurological portion of the sensory examination was anything but straightforward.     

The colorectal adenoma-carcinoma sequence

BACKGROUND: It is widely accepted that the adenoma-carcinoma sequence represents the process by which most, if not all, colorectal cancers arise. The evidence supporting this hypothesis has increased rapidly in recent years and the purpose of this article is to review this evidence critically and highlight its clinical significance. METHODS: Medline searches were used to identify recent key articles relating to the adenoma-carcinoma sequence. Further pertinent articles were obtained by manual scanning of the reference lists of identified papers. RESULTS: The evidence supporting the adenoma-carcinoma sequence can be classified as epidemiological, clinicopathological and genetic. The most recent and largest body of data relates to molecular genetic events and their cellular effects; however, many other approaches, such as cytogenetics, molecular cytogenetics and cytometry, have also yielded valuable information. CONCLUSION: Recent work continues to support the adenoma-carcinoma sequence, but there is a paucity of data on the interrelationship between different genetic mutations and on the relationship between molecular and other types of genetic abnormalities. The clinical utility of the observations described has yet to be fully realized and global genetic analysis of colorectal tumours may prove to be central in rational adenoma management.     

Misconceptions About Mandible Reduction Procedures

Mandible reduction procedures are currently very popular in Asian countries. But many misconceptions or differences in concepts about these procedures still exist, mainly because of preconceived ideas and restriction in communication. The author reviewed articles and found some misconceptions about these procedures. Also, the author added some opinions regarding new ideas about these procedures (i.e., minimal incision technique and botulinum toxin), as well as logical backgrounds of associated concepts. The intraoral approach is the safest and most effective procedure. The sagittal split ostectomy is the most important procedure for mandible reduction.     

Systematic Review of Postgraduate Surgical Education in Low- and Middle-Income Countries

Surgical care is recognized as an important component of public health, however, many low- and middle- income countries (LMICs) are faced with a shortage of trained personnel. In response to this unmet need, many countries have developed local postgraduate training programs in surgery. This study aims to characterize general surgery postgraduate education in LMICs. PubMed, EMBASE, and Global Index Medicus databases were searched for articles related to postgraduate general surgery education in LMICs. Studies in other surgical specialties and those published prior to 1990 were excluded. Data were collected on the characteristics of postgraduate training programs. Sixty-four articles discussed postgraduate surgical education in LMICs. Programs in 34 different countries and 6 different regions were represented. Nine countries were low-income, 12 were low-middle-income, and 13 were upper-middle-income countries. Sixty-four articles described aspects of the local postgraduate training program. Prior to postgraduate training, residents complete an undergraduate medical degree with 19 programs describing a pre-training experience such as internship. Surgical curricula were broad-based to prepare trainees to work in low-resource settings. At the completion of postgraduate training, examination formats varied including oral, written, and clinical exams. Postgraduate general surgery programs ranged from 2.5 to 7 years. Postgraduate surgical education is one mechanism to increase surgical capacity in LMICs. Different strategies have been employed to improve surgical education in LMICs and learning from these programs can optimize surgical education across teaching sites.     

Treatment selection in acute anterior cruciate ligament tears

Traumatic hemarthrosis associated with rupture of the anterior cruciate ligament is one of the most common ligament injuries encountered in sports medicine today. Its management is difficult because of the combination of presenting pathology as well as the multitude of patient profiles encountered. Crucial to the decision on proper management of a particular patient is the accumulation of data concerning the patient's social and sporting life as well as a detailed physical examination. When doubt exists, the physician can use other tests, including arthrograms, examination under anesthesia, or arthroscopy, to confirm and expand his diagnosis. Generally, the patient will be easily categorized into one of three areas: those who require surgery and reconstruction, those who do not, and those whom a decision is not clear. In the treatment of rotatory instability of the knee, no single approach has proved to be a panacea. The multiple procedures available attest to the complexity of the situation. It is not easily decided who will do well with conservative treatment and who will not, although data show that many individuals with mild or moderate instability can be treated effectively this way. The patient must be involved in the decision process, although it is clearly the physician who brings his bias to bear. The key factor in the successful management of the knee with rotatory instability is the patient's individual ability and willingness to modify his activities and select those sporting events compatible with his level of instability and general coordination. Rehabilitation is important for optimal results in both the conservatively and operatively treated groups and involves the four principles of (1) protection during the healing phase, (2) prevention of reinjury, (3) achievement of previous performance levels, and (4) postponement of late degenerative changes. The role of the physician is to guide and support the patient in learning to accept his knee disability. The best medical management and advice are ever-changing. Future technologic breakthroughs may provide optimal solutions for knees with rotatory instability and may create surgical and rehabilitative techniques that will prove desirable to those patients who presently are unwilling or unsuited to take the risk of major surgical reconstruction and the long rehabilitative process associated with it.     

Soft Tissue Tumors of the Hand. 1. Benign

Soft tissue tumors of the hand arise from skin, subcutaneous tissue, tendons, nerve, and blood vessels. Many of these lesions occur on other parts of the body; however, the hand remains a unique site because these tumors have symptoms, appearances, treatments, and prognoses that may be quite different than when on other parts of the body. Their characteristics and the severity of symptoms vary markedly depending on the exact location, size, and type of tumor-and many of these tumors can have multiple forms of presentation. Two articles are intended to provide an overview of benign (this article) and malignant tumors (subsequent issue) of the hand. The rarer and more deleterious tumors are discussed in detail while the common tumors and epidermal lesions with which practitioners are familiar are briefly overviewed. At the completion of these review articles, participants should be able to identify and diagnose various benign and malignant hand tumors as well as understand the accepted current treatment of these growths.     

William Harvey, 1. That incomparable invention of Dr. Harvey's

Harvey's discovery of the circulation had its roots far back in his early studies in medicine at the University of Padua where he was a pupil of the famed anatomist Fabricius, who was very interested in the valves of the veins. The difference between his teacher and Harvey was Harvey's dedication to the modern concept "scientific method". Other influences on his findings included the earlier work of Erasistratus and Galen. Harvey, after a long period of experimentation, published his findings on the circulation of the blood in his famous treatise De Motu Cordis in 1628. It is noteworthy that Harvey as a clinical practitioner failed thereafter to apply his discoveries to his work as a physician. The first of two articles on Harvey, this is concerned with his work as a scientist and discoverer. The second article is devoted to his work as a medical doctor.