Saving private W. H.: The surgical experiences of Dugald Blair Brown (1847-1896): Lieutenant-Colonel, FRCS, Edin., AMD.

Dugald Blair Brown, a military surgeon and Fellow of the Royal College of Surgeons, Edinburgh, published twelve papers containing 77 case studies of gunshot wounds that he had treated in the Anglo-Zulu War of 1879 and in the First Anglo-Boer War of 1880-1881. Brown devised a "conservative" method of surgery, the early development of which had been influenced by Thomas Longmore (1816-1895), Joseph Lister (1827-1912), F. J. von Esmarch (1823-1912), and Carl von Reyher (1846-1890). During these conflicts, Brown reacted to surgical practices unsuited to the battlefield and not in the interest of the wounded. One such practice was "expectant" surgery, the practitioners of which dangerously substituted natural healing for immediate wound resection. Brown also criticized "operative" surgeons who, when faced with gunshot wounds of the extremities, expeditiously amputated limbs. Viewing each case as diagnostically unique, Brown tried to salvage limbs, to preserve function, and to accelerate recovery. To achieve these objectives, he used debridement, antisepsis, drainage, nutrition, and limited post-operative intervention.

Charles Hewitt Moore, FRCS (1821-1870): Medical innovator.

Charles Hewitt Moore, a Fellow of the Royal Society of Medicine, practiced at Middlesex and St. Luke's Hospitals and was administratively active in The Medical and Chirurgical Society. From 1851 to 1868, he demonstrated expertise in general surgery and the lymphatic system; on pelvic deformity and disease; on the vascular system and aneurisms; on the etiology of cancer; and on the neurophysiology of sleep. He subscribed to two principles of medical investigation: anomalies can reveal new information; and the propagation of untested theory inhibited medical learning and practice. Translator of the German edition of Rokitansky's Handbook (vol. 3, 1851), Moore wrote twelve papers, three chapters for Holmes' System of Surgery (1860-1862), and two treatises. Renowned in vascular and cancer surgery, he combined ablation with ZnCl2 against cutaneous and breast cancer. Theorizing that ganglionic nerve tissue was involved in the sleep cycle, he anticipated modern investigations into the sleep-related activity of basal ganglia, the only nerve tissue of that kind in the brain.

Sir Marc Armand Ruffer, MD: The early years, 1878-1896.

A founder of paleopathology, the study of disease in ancient human remains, Sir Marc Armand Ruffer, MD (1859-1917) served in Egypt, from 1896 to 1917, as a public-health administrator, epidemiologist, and pathologist. He was professor of Bacteriology at the Cairo Medical School, President of the Sanitary, Maritime, and Quarantine Council, member of the Indian Plague Commission, and author or co-author of 40 papers in palaeopathology. However, little is known of his early professional life, which encompassed his education, medical training, and research in England and France. The pre-Egyptian period, 1878 to 1896, was a time of extraordinary activity. Acquiring four academic Degrees at Oxford University and clinical experience at the University College Hospital, London (1878-1889), he was the clinical assistant of Louis Pasteur during the anti-rabies campaign (autumn 1889), interim President of the British Institute of Preventive Medicine (1893-1896), and immunology researcher (1890-1895), in London and Paris, under the guidance of Élie Metchnikoff (1845-1916). Ruffer developed the diphtheria antitoxin in Britain. In addition to a dissertation on hydrocephalus, he composed or co-authored 34 papers. A prolific writer, linguist, clinician, and administrator, he explored several medical sub-disciplines before concentrating on palaeopathology.

Frederic E. Mohs, MD, and the history of zinc chloride.

The history of zinc chloride therapy before and including Frederic E. Mohs' (1910-2002) early contributions to dermatologic oncology is presented. In 1932, Mohs devised a method of cutaneous surgery that employed zinc-chloride paste to devitalize basal or squamous cell carcinoma. Because zinc chloride coagulates malignant tissue without destroying cellular architecture, he described the surgery and its preservative effect as the fixed-tissue method. This method involved the serial removal of devitalized malignant tissue and the freezing and histologic examination of each layer; the process was continued until a cancer-free plane was reached. In 1953, a modified version of the micrographic system, the fresh-tissue method, was introduced. For improved efficiency, Mohs retained the systematic mapping of a neoplasm but eliminated the chemical escharotic. Although the fresh-tissue method has become the preferred treatment mode, zinc-chloride paste therapy remains in use today. Although the history of Mohs micrographic surgery is well documented, its background has not received sufficient attention. This paper surveys the chemical synthesis of zinc chloride, the formulation of zinc-chloride paste as a cutaneous escharotic, and the extent to which Mohs' method compares with those of 19th and early 20th century predecessors.