Evidence of the Earliest Thyroid Cancer Operation Performed Successfully.

Thyroid surgery appears early in history, even though the anatomic description and the function of the thyroid gland was not understood [...].

Trepanations in the ancient Greek colony of Akanthos: Skull surgery in the light of Hippocratic medicine.

OBJECTIVE: The study presents seven new cases of trepanations on four individuals from the ancient Greek colony of Akanthos (5th - 1st c. BC) and juxtaposes the paleopathological observations with the Hippocratic treatises. MATERIALS: A meta-analysis of 42 published trepanations on 27 individuals from Greece. METHODS: Trepanations from Akanthos were observed macroscopically, stereoscopically and by computer tomography. The meta-analysis considers the demographic, geographical and temporal distribution, the techniques, associated pathology, and survival rate. RESULTS: Trepanations were observed on four females in Akanthos. Three trepanations were performed with scraping and four with drilling. Two individuals exhibited significant signs of healing, and two survived shortly after the operation. In two cases, trepanation was practiced for treating cranial injuries. In Greek antiquity trepanation was performed predominantly in males, principally as a surgical treatment of cranial injuries. The survival rate was 62.9 %. Scraping was the oldest, most frequent and successful technique. CONCLUSIONS: Trepanation performed systematically in Greece since the Bronze Age (ca. 2,000 BC). Hippocrates who rationally conceived medicine, codified the pre-existing empirical knowledge. The trepanations from Akanthos show technical similarities but also discrepancies from the Hippocratic recommendations, confirming the mental and technical readiness of the ancient surgeon. SIGNIFICANCE: The synchronous to Hippocrates trepanations from Akanthos, provide the opportunity to compare physical evidence with the written sources. LIMITATIONS: The frequency of trepanations is affected by the representativeness and the state of the skeletal preservation. SUGGESTIONS FOR FUTURE RESEARCH: Trepanations published in previous decades, need to be reassessed with new imaging modalities. A standard recording methodology is fundamental for data comparison.

Votive Reliefs of Lower Extremities Disorders: A Brief Review.

The purpose of this paper is to present a series of votive reliefs from Graeco-Roman antiquity related to disorders of the lower extremities, in order to comprehend the importance of anatomical offerings as gifts of gratitude to healing gods such as Asclepius. The selected offerings cover disorders such as varicose vein disease and deformities of the lower limbs and provide significant information on medical treatments in ancient Greece, as well as the importance of religious practices in the healing process.

Dimitrios Mavrokordatos Disproving the Hemostatic Myth of Aqua Binelli.

"Aqua Binelli" or "Aqua Balsamica Arterialis" was a hemostatic compound invented by the Italian Fedele Binelli in 1797. Its hemostatic properties were viewed as the solution to treating hemorrhage in cases of wounds and surgical operations. Those who opposed the compound were persuaded of its total lack of effectiveness, supporting the view that hemostasis could be achieved by exerting pressure on, stitching, and ligating a vessel. The publications of Karl Ferdinand von Gräfe, Professor at the University of Berlin and fervent advocate of Aqua Binelli, helped spread the use of the compound in Europe. In 1832, however, one of his students, a young Greek named Dimitrios Mavrokordatos, who became the first Professor of Anatomy and Physiology in the newly established University of Athens in 1837, published in Würzburg his dissertation titled Observations on the Potency of Aqua Binelli (Weitere Nachrichten über das Binellische Wasser), where a completely different picture emerged relating to those applications of the compound that von Gräfe considered successful. The case of Mavrokordatos' dissertation was a typical 19th-century scientific controversy between a young student and his teacher who enjoyed the support of his associates. Eventually, the myth of the hemostatic activity of Aqua Binelli was debunked.

The ancient history of dementia.

OBJECTIVE: This paper presents dementia, as studied in the ancient Greek and Byzantine bibliography, aiming at clarifying whether there was an early differentiation between dementia and senile dementia. METHODS: Numerous references of the terms morosis, delirium (παραλήρηµα) or "leros" (λήρος), and anoia were found in the writings of authors from the seventh century BC up to the fourteenth century AD. The references were studied and those referring to everyday use of the words were eliminated from the corpus, which is, thus, formed solely by the terms with medical connotations. RESULTS: The ancient history of dementia may be separated in two periods: before and after Posidonius, who differentiated two medical ontologies relating to dementia: dementia appearing due to old age called λήρος and dementia appearing due to other reasons called morosis. During the first period, we mainly have authors referring to dementia due to old age or due to cold black bile, defined as a deterioration of memory and reasoning. In all cases, the etiology and the clinical manifestations are presented while we make an attempt to correlate the ancient descriptions to modern medical entities. CONCLUSIONS: The study of the ancient texts proves that dementia was distinguished from senile dementia early in history. This differentiation was manifested even with a shift in the use of specific terminology. Finally, the attempt to correlate modern medical entities with dementia-related issues results in interesting hypotheses.

Insights in the history of pancreas: Restoring the true meaning of "kallikreas".

BACKGROUND/PURPOSE: This paper investigates the history of pancreas in classical and late antiquity with the intent to correlate it to the modern medical knowledge. Furthermore, an attempt is made to understand the true meaning of the term "kallikreas". METHODS: Only primary textual sources are used in the transcription of ancient references of "pancreas" and/or "kallikreas". All of the references are analyzed and interpreted under a modern prism for better understanding the ancient anatomy proposed. RESULTS: The ancient references describe the actual organ, its position and the blood vessels related to it. An attempt if made to correlate the ancient physiology of the organ to the modern one. Finally, the problematic issue of the ancient terminology is studied. CONCLUSIONS: Textual proofs are offered that the knowledge that exists and that travelled through the ages concerning the identification of pancreas with "kallikreas", from which the hormone kallikrein took its name, is erroneous and that the term refers instead to the mesentery.

Liver abscess in ancient Greek and Greco-Roman texts.

OBJECTIVE: This paper presents liver abscesses, as studied in the ancient Greek and Greco-Roman bibliography. METHODS: Numerous references concerning this entity can be found in the writings of the Hippocratic doctors (5th cent. B.C.), Archigenes of Apamea (1st cent. A.D.), Galen (2nd cent. A.D.), Aretaeus of Cappadocia (2nd cent. A.D), Oribasius (4th cent. A.D.), Theophilus Protospatharius (7th cent. A.D.), and Paulus Nicaeensis (7th-10th cent. A.D.). RESULTS: In most cases the clinical manifestations, the prognosis and the method of treatment are presented. In all ancient writings we studied, the rupture of a liver abscess is also part of the main theme. In specific, the path that the fluid would follow after a rupture was considered to be a main prognostic factor, i.e. if the fluid "coursed into the stomach", the patient would definitely die. CONCLUSIONS: In this work, an attempt is also made to correlate the ancient descriptions to modern medical entities, such as amebic or pyogenic liver abscess.

The ancient surgical bloodletting method of arteriotomy.

Methods of bloodletting were widely known in antiquity and were used for the cure of numerous illnesses and symptoms, caused mainly by the supposed excess of blood in the body. This article presents and discusses arteriotomy, a surgical method of bloodletting, appearing after the 1st century AD in the texts of Celsus, Galen, Antyllus, and Severus. The texts were studied either in their primary language or in a translation. Secondary references were only used for comparing the ancient technique to modern surgical methods.

Galen on "syncope".

This paper studies the Galenic views on syncope. According to Galen, syncope is a sudden prostration of the vital powers, without suspension of the respiration and it is usually a sign or complication of fever. He believed that "cardiac syncope" was a primary illness of the mouth of the oesophagus or of the stomach that affected the heart "by sympathy", meaning secondarily. The aetiology, the clinical manifestations and the treatment are presented, along with a special section referring to the connection between "marasmus", which was supposed to be a wasting of the organism of the elders due to "dryness", and syncope. Numerous authors before and after Galen treated the subject of the famous "cardiac affection": Hippocrates (4th-5th century BC), Asclepiades (2nd-1st century BC), Celsus (1st century AD), Aretaeus (2nd century AD), Soranus of Ephesus (2nd century AD), and Caelius Aurelianus (5th century AD) all see cardiac syncope as a distinct disease. Based on the Galenic descriptions, several modern medical conditions may be identified, such as congestive heart failure, hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia, congenital long QT syndrome or anomalies of the coronary arteries.

The manifestation of "gangrene" in the Hippocratic corpus.

We trace the early historical references concerning "gangrene," specifically in the treatises of the Hippocratic corpus. The term "gangrene" today refers to the necrosis, or death, of tissues resulting from prolonged ischemia, bacterial invasion, and subsequent putrefaction. Apart from the name "gangrene," another term, "sphacelus," exists in the corpus, referring to similar decay. An effort is made to correlate cases of "gangrene" and "sphacelus" described in the Hippocratic texts and related bibliography. In this study we retained only references to "sphacelus" that have the same end points as "gangrene." References to necrosis of the skull, the brain, the teeth, the jaw, the extremities, the ribs, and some resulting from "ulcers" were isolated. Their clinical manifestations, prognosis, and treatment are presented, together with general comments on the disease's etiology.

The ancient technique of "gastrorrhaphy".

OBJECTIVE: The paper describes "gastrorrhaphy," deriving from the Greek words "gastir" meaning "abdomen" and "rhaphy" meaning "suturing," which was a technique used for the treatment of abdominal wounds. METHODS: The technique is described in detail in the texts of Celsus (first century A.D.) and in those of Galen (second century A.D.). Furthermore, references were found in Oribasius' texts (fourth century A.D.) and in the writings of two veterinarian doctors of the same period. We provide our drawings in order to elucidate the different techniques of suturing. RESULTS: Celsus described one method of "gastrorrhaphy" while Galen presented two different methods for this procedure. All three methods agree on the processes required: replacement of the prolapsed viscera, cleaning of the wound, and suturing. The difference in methods is in the way of suturing the wound; Celsus suggests stitches in layers. While Galen's first method refers to stitching of the peritoneum with the abdominal wall, his second method refers to stitching of similar structures, meaning peritoneum to peritoneum and abdominal wall to abdominal wall. CONCLUSIONS: Celsus' method strongly resembles stitching in layers with cross-sutures, while both of the Galenic techniques of gastrorrhaphy are versions of the full-thickness sutures used nowadays. It should be stressed out that Galen's methods of "gastrorrhaphy" were used by Andreas Vesalius and Ambroise Paré many centuries later.

Management of obesity in the writings of Soranus of Ephesus and Caelius Aurelianus.

Caelius Aurelianus (5th century AD) is famous for translating the writings of Soranus of Ephesus (2nd century AD) into Latin. In his book On acute and chronic diseases, Caelius gives an almost complete edition of the works of Soranus, while adding some of his own and other writers' material. Obesity was even at that time considered to be a disease and the authors treat the subject extensively. The nature, etiology, the clinical manifestations of obesity are described, although treatment covers the greatest part of the material. Infliction of perspiration, very low caloric intake diet, exercise, and diuresis are proposed, and one cannot overlook the strong similarities of some of the treatments with those used nowadays as secondary aids for weight loss.

"Empyemas" of the thoracic cavity in the Hippocratic Corpus.

Thoracic "empyemas" appear often in the Hippocratic Corpus and with detailed descriptions of their etiology and clinical manifestation. To find the precise thoracic location suffering from "empyema," the physician asks the patient to turn on one side and inspects there for pain. The Hippocratic physicians give a very detailed description of "empyemas" caused by "peripneumonia," which is an illness resembling today's pneumonia. The proposed therapeutic method in this case, thoracostomy and drainage of the empyema, constitutes a cornerstone of our surgical heritage, appearing for the first time in the Hippocratic texts.