Adam Brown Kelly and his operating chair.

BACKGROUND: Adam Brown Kelly, well known for lending his name to Paterson-Brown Kelly syndrome, is steeped in the early history of otolaryngology. To date, little light has been shone on his contributions to the specialty in that exciting period and to his home town of Glasgow. METHOD: A historical review of his life and times was undertaken based on surviving accounts of his life, published work and archived memoirs. RESULTS: This article summarises his life and connections, with particular reference to his unique chair that has survived to this day. CONCLUSION: Brown Kelly remains a pioneer of modern otolaryngology, and deserving of prominence within the medical history of Glasgow.

Ambroise Paré: His Contribution to the Future Advancement of Neurosurgery and the Hardships of His Times Affecting His Life and Brilliant Career.

Ambroise Paré was celebrated surgeon of the 16th century whose practical accomplishments, books, and ideas transformed surgery and was a precursor for the later development of neurosurgery. He developed many surgical innovations related to wound management, arterial ligation for the prevention of hemorrhage during limb amputations, and the treatment of war-related head and spine injuries. He maintained that a surgeon should operate gently to reduce pain and improve outcome, and he dedicated his career to the wounded, sick, and poor. He also served 4 consecutive French monarchs-Henri II and his 3 sons François II, Charles IX, and Henri III. As a Huguenot (a Reformed Protestant) by faith, he lived in an environment dominated by Catholicism. Hence, his practice and life were sometimes hindered by political circumstances and religious prejudice. In this historical vignette, we will discuss the professional accomplishments of Ambroise Paré that influenced the future development of neurosurgery, including his descriptions of phantom-limb pain and peripheral nerve injury, his innovations in neurotraumatology, and the saws he invented for use in skull surgery. We will also highlight Paré's broad neurosurgical contributions to the field. Finally, we will discuss his personal life during the difficult and dangerous political circumstances of 16th century France.

Supplementing the neurosurgical virtuoso: evolution of automation from mythology to operating room adjunct.

A central concept of scientific advancement in the medical and surgical fields is the incorporation of successful emerging ideas and technologies throughout the scope of human endeavors. The field of automation and robotics is a pivotal representation of this concept. Arising in the mythology of Homer, the concept of automation and robotics grew exponentially over the millennia to provide the substrate for a paradigm shift in the current and future practice of neurosurgery. We trace the growth of this field from the seminal concepts of Homer and Aristotle to early incorporation into neurosurgical practice. Resulting changes provide drastic and welcome advances in areas of visualization, haptics, acoustics, dexterity, tremor reduction, motion scaling, and surgical precision.

[First medical museum of Russia (150-anniversary of the Surgical museum of the Imperial Medical-Surgery Academy)].

The opening in 1863 of the Surgical museum of the Imperial Medical-Surgical Academy was the sign of a new age in the development of medical science. It became the first medical museum in our country. It was the period when similar museums appeared in Europe and America. Thus all over the world were formed the first museums that amassed their collections, the later basis of modem medical museums.

Jan Mikulicz-Radecki (1850-1905): a fundamental contributor to world surgery; surgeon of the head, neck, and esophagus.

We present some of many valuable and unique achievements of Jan Mikulicz-Radecki with special regard to his contribution to laryngology. He constructed esophagogastroscope, and was one of the first to perform endoscopy of esophagus and ventricle. He published several papers describing new approaches to maxillary sinus through inferior meatus, surgical management of tonsillar cancer via lateral pharyngotomy, correction of post-traumatic nasal deformations, and the use of iodophorm in healing wounds. Among Mikulicz's many celebrated scientific achievements, the most important remains the development of asepsis and creation of a surgical school, which was a modernized continuation of Langenbeck-Billroth achievements.

Development of intraoperative MRI: a personal journey.

The initial attempts at intraoperative image guidance and imaging dates back to early 1980s. Since then Neuronavigation and intraoperative imaging technologies were developed in parallel. This works aims at summarizing the developments and giving an insider's view into the beginning stage of these technologies. The successes and obstacles encountered in the first few decades are relayed from the angle of one of the initial developers.

History of cervical disc arthroplasty.

Enthusiasm for cervical disc arthroplasty is based on the premise that motion-preserving devices attenuate the progression of adjacent-segment disease (ASD) in the cervical spine. Arthrodesis, on the other hand, results in abnormal load transfer on adjacent segments, leading to the acceleration of ASD. It has taken several decades of pioneering work to produce clinically relevant devices that mimic the kinematics of the intervertebral disc. The goal of this work is to trace the origins of cervical arthroplasty technology and highlight the attributes of devices currently available in the market.

What is surgery?

Progress in surgical science has been characterized by a continuous cycle of innovation from bedside to bench to bedside. Beginning 30,000 years ago with the first bone needles to surgical lasers and robotics of today, each quantum leap has resulted from the convergence of technical advances and creative surgeons, but always defined by an attitude of care toward the sick. One of the most innovative pediatric surgeons, Dr. Mark Ravitch, elucidated some simple yet profound principles in the precise answer to the question "What is Surgery?" This section outlines some simple concepts summarized as "Ravitch's Rules," which provide a useful framework for clarity in understanding the past and illuminating the road ahead. Surgeons must be thoughtful in how they define themselves and their craft, ignoring technological advances at their own peril.

The Spencer Wells forceps.

This is the first of a six-part biographical series tracing the lives of the people behind some of today's most commonly used surgical instruments. Surely the most recognisable 'name behind the instrument' must be that of Sir Thomas Spencer Wells (1818-1897), whose ratchet haemostatic forceps represented a simple but important advance in surgical instrument technology.

The chain saw--a Scottish invention.

The prototype of the chain saw familiar today in the timber industry was pioneered in the late 18th Century by two Scottish docors, John Aitken and James Jeffray, for symphysiotomy and excision of diseased bone respectively. The chain hand saw, a fine serrated link chain which cut on the concave side, was invented around 1783-1785. It was illustrated in Aitken's Principles of Midwifery or Puerperal Medicine (1785) and used by him in his dissecting room. Jeffray claimed to have conceived the idea of the chain saw independently about that time but it was 1790 before he was able to have it produced. In 1806, Jeffray published Cases of the Excision of Carious Joints by H. Park and P. F. Moreau with Observations by James Jeffray M.D.. In this communication he translated Moreau's paper of 1803. Park andMoreau described successful excision of diseased joints, particularly the knee and elbow. Jeffray explained that the chain saw would allow a smaller wound and protect the adjacent neurovascular bundle. While a heroic concept, symphysiotomy had too many complications for most obstetricians but Jeffray's ideas became accepted, especially after the development of anaesthetics. Mechanised versions of the chain saw were developed but in the later 19th Century, it was superseded in surgey by the Gigli twisted wire saw. For much of the 19th Century, however, the chain saw was a useful surgical instrument.

W. James Gardner: pioneer neurosurgeon and inventor.

W. James Gardner, a skillful neurosurgeon and inventor, is best remembered for his cervical tongs and hydrodynamic theory of syringomyelia. A pioneer of modern neurosurgery, Gardner trained under Charles Frazier in Philadelphia, and in 1929 he moved to Ohio where he became chief of neurosurgery at the Cleveland Clinic, a position he was to hold for the next 33 years. A large surgical practice made it imperative for Gardner to develop surgical methods that were quick, effective, and advantageous for patient and surgeon. He was an early proponent of the sitting position for patients undergoing cranial surgery, which led to the development of a neurosurgical chair with a head fixation device. To reduce the risks of hypotension and air embolism when the patient is in the sitting position, Gardner invented the clinical G suit. He was the first to advocate and use induced arterial hypotension for intracranial surgery and the first neurosurgeon in the US to publish his experiences performing lumbar discography. He converted an operating table so that he could induce hypothermia during aneurysm surgery and then applied pneumatic cuffs to occlude the major arterial supply to the brain. His pioneering work has been documented in many other areas such as hemifacial spasm and trigeminal neuralgia, for which he performed the first vascular decompression, in cervical sympathectomy for treatment of various ailments, and in the use of intrathecally delivered steroid drugs for sciatica. During his career, he authored 256 publications and one book on the dysraphic states. Many of his contributions to the discipline of neurosurgery are now taken for granted.