HEALTH REFORM INITIATIVES IN THE INTERWAR ERA: THE CASE OF GREECE AND THE ROLE OF THE LEAGUE OF NATIONS HEALTH ORGANISATION

During the Interwar period (1918-1939), financial aid and technical assistance were given to countries worldwide by the League of Nations Health Organisation (LNHO) in an attempt to reform public health systems, address population health problems, and control infectious diseases. Greece was one of the countries that received this aid, and in 1928 cooperation with the LNHO was initiated. The aim of this alliance was an integrated health reform plan entitled "Collaboration with the Greek government for the sanitary reorganization of Greece" and had a dual purpose: a) the reorganisation of the health services and b) the establishment of a unified public health system that provided comprehensive healthcare for all citizens. The current article discusses the collaboration between Greece and the LNHO and their endeavour to reorganise the health system during the Interwar period. More specifically, it investigates the significant legislative and policy initiatives and their impact on the health system's evolution. In addition, it aims to explore the factors that affected the outcome of LNHO's reform plan. It is also argued that the proposed health reform plan was not fully implemented due to intense political and social conflicts that resulted from the institutional measures taken to address public health problems as well as financial and technical constraints.

WHEN QUARTAN FEVER RELIEVED DEPRESSION: THE INCEPTION OF PYRETOTHERAPY IN THE GRECO-ROMAN ANTIQUITY.

OBJECTIVE: The aim: This paper explores the documentation of the effect of quartan fever on, the ancient Greek equivalent of conditions falling nowadays under the spectrum of depression, in Greco-Roman medical sources. PATIENTS AND METHODS: Materials and methods: The authors searched original medical texts written in Greek by physicians who lived and practiced Medicine in the broader Mediterranean region from the 5th century BC to the 7th century AD for records related to quartan fever and neuropsychiatric diseases. CONCLUSION: Conclusions: Quartan fever was used as a treatment for neuropsychiatric conditions until the middle of the 20th century. Although malaria can have severe neuropsychiatric sequelae, the neuroimmunological underpinnings of the effect of fever and heat on depression warrant further investigation.

HYSTERICAL APNEA IN THE WORK OF GALEN (CA 129 - 199 AD): GENDER EQUITY IN THE HISTORY OF PSYCHOSOMATIC MEDICINE.

OBJECTIVE: The aim: To presents clinical, epidemiological and pathophysiological aspects of the disease described by Galenos of Pergamon during the 2nd century AD and discusses its implications on contemporary discourse on gender equity and gender - based discrimination. PATIENTS AND METHODS: Materials and methods: The authors searched original medical texts written in Greek language and attributed to Galenos for records related to hysterical apnea. CONCLUSION: Conclusions: Galen attempted to interpret hysterical apnea by combining clinical and epidemiological observations with anatomical and functional lesions. His approach denounced the anatomically unsound notion of the wandering womb and availed the knowledge of his period in a rational manner. Investigating gender - related aspects of contemporary psychosomatic conditions related to fertility and pregnancy can help address gender - based discrimination in modern societies.

Periscyphismus and Section of the Temporal Vessels: Two Byzantine Surgical Remedies for Headache Relief.

Headache is a prevalent clinical symptom and condition, whose management has been challenging from the antiquity to the 21st century. Physicians in the Greek, Roman and Byzantine antiquity employed surgical techniques to treat headache in patients presenting with persistent symptoms that were not alleviated with conservative means. A survey in the medical literature of the period reveals that two surgical procedures, periscyphismus and section of the temporal vessels, were developed for this purpose. The present study describes the techniques presented in the sources of the period and elaborates on their evolution and influence across different historical periods and contexts.

Anorexia and bulimia in late antiquity and early Byzantine period in the eastern Mediterranean region.

OBJECTIVE: The purpose of this study is to identify clinical manifestations of eating disorders in the Eastern Mediterranean region from the first century AD until the seventh century AD and evaluate relevant awareness among the physicians of the era. METHOD: The authors searched original medical texts written in Greek by physicians practicing in the Eastern Mediterranean region from the first century AD to the seventh century AD. The search focused on passages that include possible references to clinical entities analogous to anorexia nervosa (AN) and bulimia nervosa (BN) as described in the DSM-5 and the contemporary literature. RESULTS: Descriptions of conditions that resemble AN or BN can be found in the work of Galen, Oribasius, Aetius of Amida, Leon Philoumenos, Alexander Trallian, and Paul of Egina. Successive physicians confirmed the observations of their predecessors and add to the description of the clinical presentations and their etiology. DISCUSSION: This research provides evidence of awareness of presentations resembling currently defined eating disorders in the Eastern Mediterranean region during a period with different norms and values. Observations from the period can serve as a point for reflection about the characteristics and etiology of AN and BN in the 21st century.

Surgery in antiquity: the origin of the Trendelenburg position revisited.

INTRODUCTION: The Raised Pelvic Position, also known as Trendelenburg position, consists of the elevation of the pelvis above the horizontal plane in the supine position with the head lowered. The position is named after Friedrich Trendelenburg, a German surgeon, who flourished in Berlin at the end of the nineteenth century. Although modern studies trace the position's principle back to the first century BC, we herein present even earlier descriptions, dating back to the fifth century BC. MATERIAL AND METHODS: The whole ancient Greek literature was digitally searched. All relevant references were analyzed from the original sources. RESULTS: We found at least nine references to the Raised Pelvic Position in the ancient Greek literature from the following physicians: Hippocrates (fifth century BC), Soranus of Ephesus (first century AD), Aetius of Amida (fifth century AD) and Paulus Aegineta (seventh century AD). DISCUSSION AND CONCLUSION: All references presented, describe clearly the Raised Pelvic Position, as part of a strategy to repair uterine pathologies, mainly prolapsed uterus, but also instability, bleeding, tumors and infertility. We conclude that ancient Greek writers were aware of the usefulness of the head-down position, as reflected from the numerous existing descriptions dating back to the fifth century BC.

Surgical treatment of polydactyly and syndactyly during the 4th century AD.

INTRODUCTION: Polydactyly, or polydactylism, is a common congenital disorder of the limbs, consisting of any digit duplication beyond the normal five. The term syndactyly refers to fused digits. We herein present a thorough description of these diseases together with their surgical treatment, provided by Oribasius, a Byzantine physician of the 4th century. To our knowledge, this is the earliest description of supernumerary and fused fingers and their surgical management. MATERIAL AND METHODS: We conducted a thorough study of Oribasius' work. RESULTS: The 15th chapter of the 47th book of Oribasius' work is devoted to finger abnormalities (i.e. polydactyly and syndactyly) and their surgical treatment. DISCUSSION: With regard to the extensive medical knowledge of the 4th century as survived in Oribasius' work, these descriptions comprise, to the best of our knowledge, the earliest written references to the surgical treatment of polydactyly and syndactyly.

Paul of Aegina's surgical instruments: a complete surgical instrumentarium in the seventh century AD.

BACKGROUND: Although current progress in surgical instruments is oriented towards stapler devices, minimally invasive instrumentation and advanced cautery tools, it definitely seems intriguing to determine what instruments were used in antiquity and to appraise their use. Most adequate information can be retrieved from manuscripts of early medical authors, of whom Paul of Aegina (AD 625-690), also being a most important surgeon, is the most recent. The aim of this study is to present surgical instruments used in his practice. METHODS: Surgical instruments mentioned in the original Greek text of his monumental work named Epitome of Medicine were sought using computer software. Further, similar research was performed on other significant manuscripts of earlier Greek medical writers to determine whether some of the instruments were exclusively mentioned by Paul of Aegina. RESULTS: In total, 121 different surgical instruments were identified and described in detail in the Epitome of Medicine. Thirty-three instruments (27%) were exclusively reported by Paul of Aegina. CONCLUSIONS: In antiquity a large number of surgical instruments were already being used. Paul of Aegina described in detail a large variety of fine, as well as a substantial number of, original surgical instruments, which he himself used in a wide spectrum of surgical operations.

Popliteal cyst before William Baker: first report in the Galenic Corpus.

INTRODUCTION: A popliteal cyst, also known as Baker cyst, is a benign fluctuant swelling of the gastrocnemius-semimembranosus bursa in the popliteal fossa at the back of the knee. The cyst is named after William Morrant Baker, who is considered to have first described this fluid collection with new sac formation outside of the knee-joint in 1877. We herein present a short description contained in the Galenic Corpus that appears to match to what we now call the Baker cyst. MATERIAL AND METHODS: Α thorough survey of Kühn's Galenic Corpus was performed. RESULTS: The 14th book of Kühn's edition contains a brief review of all the anatomical structures and pathologies. In the 17th chapter of this treatise, devoted to skin lesions, the author states that steatomas appear in the popliteal fossa. However, it is no more believed to reflect the Galenic teaching and is ascribed to Pseudo-Galen. DISCUSSION: With regard to the descriptions survived and the anatomy knowledge in the post-Galenic era time, the brief report of the ancient text of unknown origin, appears to match what we now describe as popliteal cyst.

Trichiasis in ancient times.

Trichiasis, recognized since the time of Hippocrates, is a cause of ocular irritation that may result in scarring of the cornea and threaten sight. We have reviewed the original Greek medical texts made from the 1st to the 7th century ce and present the existing medical knowledge relating to trichiasis, including its clinical picture, cause, diagnosis, and treatment. Recognition of trichiasis as a stage of trachoma and its distinction from pseudotrichiasis gave the impetus for physicians of the era to use a significant number of pharmaceutical and surgical treatments.

Management of penile tumours during the Byzantine period.

While conventional treatment of penile cancer consists of total penile amputation and bilateral lymphadenectomy, recently a more conservative strategy comprising penile-preserving surgery and selective lymphadenectomy has been applied in order to preserve the penis and to minimize unnecessary inguinal lymphadenectomy. A thorough literature survey was performed to see what was already known of the surgical treatment of penile tumours in ancient times. In the Byzantine period, surgery appeared to have been highly developed, as one may conclude from the surgical material included mainly in the works of Oribasius of Pergamus and Paul of Aegina. Being aware of cancer, they described in their medical encyclopaedias malignant and benign tumours of the prepuce and glans penis, as well as their surgical and non-surgical management. After local excision of malignant tumours, they strongly recommended burning to prevent relapse, whereas they discouraged simultaneous removal of external and internal preputial lesions, because of the risk of perforation of the prepuce. These surprisingly detailed descriptions prove that Byzantine surgery had reached a higher level than commonly supposed. Penile-preserving treatment, which has recently become the therapeutic strategy of choice, was already accomplished in ancient times by using adjuvant thermal or chemical burning after local tumour excision.

On the history of modern tonsillectomy: the contribution of Nikolaos Taptas.

The earliest reports on removal of the entire tonsil using a method of careful dissection came in the early 1900 s by American and British otorhinolaryngologists. These descriptions are credited as the first of the so-called modern tonsillectomy. In this report we present a technique of tonsillectomy conceived by Nikolaos Taptas, a Greek physician and citizen of the Ottoman Empire, which was introduced at the same period with the ones previously mentioned. Taptas practiced his technique in the very early 1900 s. He used his own instruments and reported excellent post-operative results with very few complications. He should therefore be considered among the pioneers of modern tonsillectomy.

Gynaecomastia and scrotal rhacosis: two aesthetic surgical operations for men in Byzantine times.

BACKGROUND: Nowadays, as in the past, much attention is paid to aesthetic operations in women, while only infrequently have such operations been referred to in males. Generally, male aesthetic surgery was introduced to surgical practise during the 19th century. In this study, we analysed the practise of such operations in Byzantine times and in other ancient cultures with surgical knowledge, i.e. ancient India and China METHODS: The sixth book of Paul of Aegina's "Epitome of Medicine" was studied for description of aesthetic operations in males in the Byzantine period, since this book is completely devoted to surgery and is generally considered to be the most important reference for surgery in Byzantine times. The original text and its excellent translation by Francis Adams were used. References concerning aesthetic operations for males were identified. Accordingly, historical work and reviews on plastic surgery in ancient India and China were studied. RESULTS: Mainly, two aesthetic surgical procedures for males in the Byzantine period were identified. These two procedures comprise gynaecomastia and rhacosis (scrotal relaxation). Two different techniques were reported for the surgical management of gynaecomastia, through sub-mammary or supra-mammary access. Two procedures were noted for rhacosis, for which Paul of Aegina reproduced the respective chapters from Leonides' and Antyllus' works. Evidence supporting male aesthetic surgery in ancient India and China or elsewhere was not found. CONCLUSIONS: Despite the dubious aesthetic result, the existence of different aesthetic surgical techniques in males substantiate the advanced level of surgery achieved by physicians in the Byzantine period.

Conception, complicated pregnancy, and labour of gods and heroes in Greek mythology.

Pregnancy and labour are holy moments in a woman's life. Even in Greek mythology we can find descriptions of them. We searched in the Greek myths to find descriptions of labours of ancient heroes and gods. We identified descriptions of extracorporeal fertilization, superfecundation, ectopic pregnancy, preterm labour, prolonged pregnancy and Caesarean section. The use of imagination could help the reader to find similarities in present or future developments in the field of obstetrics. It could be concluded that various aspects of modern obstetrical practice are described in Greek mythology.