"Heroic" medicine in neurology: A historical perspective.

BACKGROUND AND PURPOSE: Repetitive bloodletting, promoting profuse diarrhoea and vomiting, the formation of artificial ulcers, and other aggressive treatment methods based on humoral theory and Brunonian medicine were used for patients with nervous system (NS) diseases until the end of the 19th century. These methods are also termed "heroic" medicine by modern medical historians. METHODS: I analysed doctoral dissertations on the subject of NS diseases, clinical reports from 1806 to 1842 from the Vilnius University clinics, and other primary sources. This study was conducted in the vein of a historical-medical analysis and synthesis of primary sources, using comparative analysis, analogy, descriptive methods, and the method of retrospective diagnosis. RESULTS: Copious bloodletting, purgatives, leeches, cupping therapy, and other potentially harmful methods were frequently employed as habitual treatments for patients with NS diseases. Calomel was used as a purgative and an anti-inflammatory drug, and acidum borussicum was prescribed for patients with hydrophobia. After analysing three clinical cases, I revealed how principles of desperate, "heroic" medicine were applied to treat severe NS diseases with the "strongest" drugs, described in the scientific literature of the time. CONCLUSIONS: My work was not intended to judge or criticize historical treatment methods but to demonstrate on what contemporary scientific theories they were based. We should not rule out the idea that some aggressive treatment methods used nowadays, although they eradicate or reduce the burden of a NS disease, or even prolong patients' lives, may offer exceptional examples of 21st century "heroic" medicine for future generations.

Descriptions of Apoplexy by Joseph Frank in the Beginning of the Nineteenth Century in Vilnius.

In the beginning of the 19th century, apoplexy was understood to be a disease of the cerebral blood vessels, manifesting with a sudden weakening or extinction of sensation and the patient's inability to move. In this study, we examined the situation of neurology in the beginning of the 19th century in Vilnius through the perspective of a nervous system disease - apoplexy. Case reports and descriptions of apoplexy in the textbook and memoirs by Joseph Frank (1771-1842), descriptions of patients with apoplexy from the proceedings of Vilnius University Clinic were analysed. It was identified that the main cause of apoplexy was not an imbalance of the four humours but the pathology of cerebral blood vessels. However, following ancient tradition, the principles of recreation and moderation were thought to be important for the prevention of apoplexy, and bloodletting and diet were believed to be essential for the treatment.

From brain cytoarchitectonics to clinical neurology: Polish Institute for Brain Research in Vilnius, 1931-1938.

The Polish Institute for Brain Research was established in Warsaw in 1928 to support scientific research on the brain and its functions. The director of the institute was Maksymilian Rose (1883-1937), a distinguished Polish neurologist and neuroanatomist, a disciple of Oskar Vogt and Korbinian Brodmann. In 1931, the Institute was moved from Warsaw to Vilnius. The Institute was well-known in Europe at the time because of the research in the fields of neuroscience, clinical neurology, and psychiatry, as well as the cytoarchitectonic analysis of social activists' brains-a fashionable, neophrenological way to link the mental functions of deceased geniuses with the cellular composition of their central nervous systems. In 1939, the work of the Institute was interrupted by World War II; some of the preparations and materials were moved from Vilnius to Warsaw, some were stored in Vilnius, and some were lost. In this article, we analyze the primary and secondary sources, some of which were obscure for over 80 years, and evaluate the most important scientific achievements of the Polish Institute for Brain Research, as well as its legacy in the early period of modern neuroscience and neurology in interwar Vilnius.

Chronotypes and their relationship with depression, anxiety, and fatigue among patients with multiple sclerosis in Vilnius, Lithuania.

Background: Approximately half of patients with multiple sclerosis (PWMS) experience sleep disorders or changes in the circadian rhythm, that may further promote the pathogenesis of multiple sclerosis. As the prevalence of chronotypes among PWMS remains unclear, we aimed to evaluate the prevalence of chronotypes among Lithuanian PWMS; to assess the relationship of chronotypes with depression, anxiety, and fatigue symptoms; and to compare these results with those of healthy controls. Methods: We enrolled 101 PWMS and 100 healthy controls. We included 130 (64.7%) and 71 (35.3%) women and men, respectively. The median age of all respondents was 39 [interquartile range (IQR) 20.75] years. Participants were assessed using general questionnaire, Horne-Östberg Morningness-Eveningness Questionnaire (MEQ), Hospital Anxiety and Depression Scale (HADS), and Shortened Fatigue Questionnaire (SFQ). Chronotypes were identified based on the total MEQ score. Results: The average MEQ scores of the PWMS and control groups were 54 (IQR 15.0) and 53.5 (IQR 13), respectively, which indicated the intermediate chronotype. There was no significant between-group difference in the prevalence of chronotypes (p = 0.893). In both groups, individuals with moderate evening and intermediate chronotypes showed higher average HADS depression scores (p = 0.022). Further, in both groups, the individuals with the evening chronotype showed the highest average HADS anxiety scores (p = 0.001). The PWMS group had a higher average SFQ score than the control group (p < 0.001). High SFQ scores were more common among PWMS who had the intermediate (p < 0.001) and morning chronotypes (p = 0.011). The fatigue level was higher among healthy individuals with the evening chronotype (p < 0.001). Conclusion: The most common chronotype for PWMS and healthy controls was the intermediate chronotype. Further, in both groups, higher HADS depression and anxiety scores were associated with the evening chronotype. Fatigue was more commonly found in healthy controls with the evening, and in PWMS - with intermediate and morning chronotypes.

Hildegard of Bingen (c. 1098-1179) on sleep and dreams in her Causae et curae and Physica: a historical perspective.

Saint Hildegard of Bingen (c. 1098-1179) was a 12th century Benedictine abbess, a visionary, a composer, a poet, a healer, and one of few medieval women who produced treatises on medicine. In her medical writings, Causae et curae and Physica, the abbess described, among other topics, physical functions and mechanisms of sleep, dreams and waking, emphasizing the importance of sleep for the human body. She regarded sleep as both a passive and an active process. Hildegard warned her readers about sleeping too little or too much, evaluated possible causes of insomnia and nightmares, and discussed potential treatments for these sleep disorders. In this paper, we analyze Hildegard's writings in the context of Greco-Roman physiological theories, which were held to the end of the Middle Ages and later. We also discuss questions concerning the abbess's putative education, the originality of her works, and the significance of her writings in the context of current knowledge on sleep medicine.

Stephanus Bisius (1724-1790) on mania and melancholy, and the disorder called plica polonica.

Stephanus Bisius (1724-1790) was a physician of Italian descent and a graduate of the University of Pavia. He was invited to the Polish-Lithuanian Commonwealth in the early 1760s and became head of the Faculty of Medicine at Vilnius University in 1781. In 1772, Bisius had authored the first original study on nervous and mental diseases in the Grand Duchy of Lithuania. In his 35-page booklet, written in Latin and Polish, Bisius characterized mania and melancholy as diseases of the brain, explaining that the organs that feed the human soul are affected, not the soul itself. He introduced the principles of humoralism and solidism to readers, and recognized that autopsies had failed to reveal reliable findings concerning mania or melancholy. Bisius also described the origins of the challenging disorder called plica polonica, a strange condition associated with tufts of matted hair. As a physician during the medical Enlightenment, Bisius criticized metaphysical speculations in medicine and stated that plica was only a result of superstitions. Even though he proposed antiphlogistic treatments for patients with mania and melancholy, he maintained that time and faith in God might help some patients overcome their infirmities.

Ludwig Heinrich Bojanus (1776-1827) on Gall's craniognomic system, zoology, and comparative anatomy.

Most of what was known about Franz Joseph Gall's (1758-1828) organology or Schädellehre prior to the 1820s came from secondary sources, including letters from correspondents, promotional materials, brief newspaper articles about his lecture-demonstrations, and editions and translations of some lengthier works of varying quality in German. Physician Ludwig Heinrich Bojanus (1776-1827) practiced in Vienna's General Hospital in 1797-1798; attended some of Gall's public lectures; and, in 1801-1802, became one of the first physicians to provide detailed reports on Gall's emerging organology in French and English, respectively. Although Bojanus considered the human mind to be indivisible and did not entirely agree with Gall's assumption that the brain consists of a number of independent organs responsible for various faculties, he provided valuable information and thoughtful commentary on Gall's views. Furthermore, he defended Gall against the charge that his sort of thinking would lead to materialism and cautiously predicted that the new system would be fruitful for developing and stimulating important new research about the brain and mind. Bojanus became a professor of zoology in 1806 and a professor of comparative anatomy in 1814 at Vilnius University, where, among other accomplishments, he established himself as a founder of modern veterinary medicine and a pioneer of pre-Darwinian and pre-Lamarckian evolutionism.

Detection of aquaporin-4 antibodies for patients with CNS inflammatory demyelinating diseases other than typical MS in Lithuania.

OBJECTIVES: Neuromyelitis optica (NMO) is frequently associated with aquaporin-4 autoantibodies (AQP4-Ab); however, studies of NMO in Lithuania are lacking. Therefore, the main objective of our study is to assess positivity for AQP4-Ab in patients presenting with inflammatory demyelinating central nervous system (CNS) diseases other than typical multiple sclerosis (MS) in Lithuania. MATERIALS AND METHODS: Data were collected from the two largest University hospitals in Lithuania. During the study period, there were 121 newly diagnosed typical MS cases, which were included in the MS registry database. After excluding these typical MS cases, we analyzed the remaining 29 cases of other CNS inflammatory demyelinating diseases, including atypical MS (n = 14), acute transverse myelitis, TM (n = 8), acute disseminated encephalomyelitis, ADEM (n = 3), clinically isolated syndrome, CIS (n = 2), atypical optic neuritis, ON (n = 1), and NMO (n = 1). We assessed positivity for AQP4-Ab for the 29 patients and evaluated clinical, laboratory, and instrumental differences between AQP4-Ab seropositive and AQP4-Ab seronegative patient groups. RESULTS: AQP4-Ab test was positive for three (10.3%) patients in our study, with initial diagnoses of atypical MS (n = 2) and ADEM (n = 1). One study patient was AQP4-Ab negative despite being previously clinically diagnosed with NMO. There were no significant clinical, laboratory, or instrumental differences between the groups of AQP4-Ab positive (3 [10.3%]) and negative (26 [89.7%]) patients. CONCLUSIONS: AQP4-Ab test was positive for one-tenth of patients with CNS inflammatory demyelinating diseases other than typical MS in our study. AQP4-Ab testing is highly recommended for patients presenting with not only TM and ON but also an atypical course of MS and ADEM.

The reception of Gall's organology in early-nineteenth-century Vilnius.

Much has been written about the development and reception of Franz Joseph Gall's (1758-1828) ideas in Western Europe. There has been little coverage, however, of how his Schädellehre or organology was received in Eastern Europe. With this in mind, we examined the transmission and acceptance/rejection of Gall's doctrine in Vilnius (now Lithuania). We shall focus on what two prominent professors at Vilnius University felt about organology. The first of these men was Andrew Sniadecki (1768-1838), who published an article on Gall's system in the journal Dziennik Wilenski in 1805. The second is his contemporary, Joseph Frank (1771-1842), who wrote about the doctrine in his memoirs and published an article on phrenology in the journal Bibliotheca Italiana in 1839. Both Frank and Sniadecki had previously worked in Vienna's hospitals, where they became acquainted with Gall and his system, but they formed different opinions. Sniadecki explained the doctrine not only to students and doctors but also to the general public in Vilnius, believing the new science had merit. Frank, in contrast, attempted to prove the futility of cranioscopy. Briefer mention will be made of the assessments of Johann Peter Frank (1745-1821) and Ludwig Heinrich Bojanus (1776-1827), two other physicians who overlapped Gall in Vienna and went to Vilnius afterward. Additionally, we shall bring up how a rich collection of human skulls was used for teaching purposes at Vilnius University, and how students were encouraged to mark the organs on crania using Gall's system. Though organology in Vilnius, as in many other places, was always controversial, it was taught at the university, accepted by many medical professionals, and discussed by an inquisitive public.