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.

Cross-sectional study on awareness and knowledge of torture investigation and documentation among Greek doctors and senior medical students.

Doctors in Greece face the possibility of encountering a person that has suffered torture, especially since the high rates of refugees' and migrants' inflows that took place over the last years. In order to assess the awareness and the knowledge of doctors and senior medical students in Greece regarding a manual on effective investigation and documentation of torture such as Istanbul Protocol (official United Nation document since 1999), a cross-sectional study was conducted using a structured anonymous questionnaire. The sample was doctors practicing in public hospitals in Greece, doctors volunteering at a non-governmental organization (NGO) and undergraduate medical students in their final year of studies in the Medical School of National and Kapodistrian University of Athens. The data were analyzed using IBM SPSS version 23, using descriptive statistics and statistical significance tests.In a total of 289 participants, the mean total score of Istanbul Protocol knowledge was 4.43 ± 1.104 (the maximum possible score was 10) and the mean total score of Istanbul Protocol awareness was 2.04 ± 1.521 (the maximum possible score was 10). The most important conclusion was that among doctors and senior medical students, there seem to be knowledge, awareness, and information deficit about Istanbul Protocol and several issues relating to torture. The overall research outcome highlights the need for the development of a relevant informative/educational program, in order to cover the corresponding existing needs of the population of doctors in Greece.

The Innovated "Closed Chest Drainage System" of William Smoult Playfair (1871).

During the 19th century, the addition of the water-seal system to a closed chest drain was a major turning point in the history of thoracic surgery. German physician Gotthard Bülau seems to have invented and used his own closed chest drainage device with a liquid-seal system in 1875, and published it in the year 1891. But, in 1871, British physician William Smoult Playfair seems to have thought of the subaqueous drainage and used such drainage to treat the thoracic empyema in children. The British physician stresses in his texts the effectiveness of his method of fully draining the thoracic empyemas while simultaneously preventing air from entering the pleural cavity. An appropriate honor must be attributed to Playfair, who used a subaqueous chest drainage system and appears to be the first to publish such a method.

Medical and Social Aspects of Syphilis in the Balkans from the mid-19th Century to the Interwar.

The current study presents some aspects of syphilis in the Balkan Peninsula from the 19th century until the Interwar. Ever since the birth of modern Balkan States (Greece, Bulgaria, Turkey and Serbia), urbanization, poverty and the frequent wars have been considered the major factors conducive to the spread of syphilis. The measures against sex work and sexually transmitted diseases (STDs) were taken in two aspects, one medical and the other legislative. In this period, numerous hospitals for venereal diseases were established in the Balkan countries. In line with the international diagnostic approach and therapeutic standards, laboratory examinations in these Balkan hospitals included spirochete examination, Wassermann reaction, precipitation reaction and cerebrospinal fluid examination. Despite the strict legislation and the adoption of relevant laws against illegal sex work, public health services were unable to curb the spread of syphilis. Medical and social factors such as poverty, citizen's ignorance of STDs, misguided medical perceptions, lack of sanitary control of prostitution and epidemiological studies, are highlighted in this study. These factors were the major causes that helped syphilis spread in the Balkan countries during the 19th and early 20th century. The value of these aspects as a historic paradigm is diachronic. Failure to comply with the laws and the dysfunction of public services during periods of war or socioeconomic crises are both factors facilitating the spread of STDs.

The "Endura" of The Cathars' Heresy: Medieval Concept of Ritual Euthanasia or Suicide?

The aim of the study is to explore the medieval concepts on the voluntary death of severely sick people, as they emerge through the endura (endurance) of the heresy of the Cathars in France (twelfth to fourteenth centuries). The endura was the prerequisite act of repentance that would allow the fallen soul to return to heaven. The endura was a necessary act of repentance, after the performance of a ceremonial purification of the soul (consolamentum), and consisted of the patients' voluntary abstention from vital food. The consolamentum and endura could be performed in the final stage of a disease with the consent of the patients or their relatives. The role of the Cathar physician was only to determine the severity of the disease and the forthcoming death of the patient. The physician was not allowed to take steps that would deprive the life of the patient, and the performance of the ritual endura was duty of the spiritual leaders of the community. The modern ethical approach to this subject is dictated by the medieval belief on the salvation of the soul and tries to answer the question of whether the endura could be seen as a medieval concept of a ritual euthanasia or fell within the theological sin of suicide.

Biological Warfare Plan in the 17th Century­the Siege of Candia, 1648­1669.

A little-known effort to conduct biological warfare occurred during the 17th century. The incident transpired during the Venetian­Ottoman War, when the city of Candia (now Heraklion, Greece) was under siege by the Ottomans (1648­1669). The data we describe, obtained from the Archives of the Venetian State, are related to an operation organized by the Venetian Intelligence Services, which aimed at lifting the siege by infecting the Ottoman soldiers with plague by attacking them with a liquid made from the spleens and buboes of plague victims. Although the plan was perfectly organized, and the deadly mixture was ready to use, the attack was ultimately never carried out. The conception and the detailed cynical planning of the attack on Candia illustrate a dangerous way of thinking about the use of biological weapons and the absence of reservations when potential users, within their religious framework, cast their enemies as undeserving of humanitarian consideration.

Dromokaition Psychiatric Hospital of Athens: from its establishment in 1887 to the era of deinstitutionalization.

Dromokaition Psychiatric Hospital opened its doors in 1887, following the donation made by Zorzis Dromokaitis from the island of Chios. Private donations and all forms of charities had contributed to a large extent in the establishment of hospitals across Greece, during the late 19th and the early 20th century. Dromokaition was one of them but it was also unique, as it was the first psychiatric hospital in Athens, admitting patients from every part of the country. This paper aimed at highlighting the long service of the institution through the different historical periods the country went through. We present the chronicle of its foundation, the development of its inner structure, and the medical and organizational influences which it received, along the way. The therapeutic methods used during the first decades of its operation reflected the corresponding European standards of the time. As a model institution from its foundation, it followed closely the prevailing European guidelines, throughout its historical path, either as an independent institution or as an integrated one within the National Health Service.

Infectious disease control in the Ionian Islands during the British Protection (1815-1864).

This review presents the medical and social role of British military doctors in the formation of the British sanitary campaign in the Ionian Islands during the period 1815-1864. They were the core of a health system based on the old sanitary model of the Venetian Republic, which was the former ruler of the region. The British innovation and reorganisation of the old lazarettos (a quarantine system for maritime travellers), the new marine sanitary procedures, the determination of quarantine duration for major infectious diseases along with the introduction of the vaccination system resulted in a satisfactory defence against epidemics in Greece during the 19th century. The British military physicians applied and established West European medical ideas, as well as the principles of preventive medicine, for the first time in the Greek territory and this is a historical example of a successful sanitary campaign based on the experience of military physicians and their collaboration with civilian physicians.

Pioneers in the anti-malaria battle in Greece (1900-1930).

The aim of the study is to present the efforts of the Greek physicians to introduce a malaria control and eradication program in Greece. It is based on the proceedings of the Greek Anti-Malaria League and on medicohistorical studies. Due to political, economic and military reasons the Greek State seemed weak to develop a dedicated plan to eradicate malaria. Hence, the Greek Anti-Malaria League in 1905 was founded by a group of eminent citizens who took the initiative to organize a campaign against the disease. Constantinos Savvas, Professor of Hygiene and Microbiology and President of the League, as well as the pediatrician Dr. Ioannis Kardamatis were among the most influential personalities in the Greek society at that time. Due to the massive use of quinine the burden of the disease decreased significantly. But, the national disaster of 1922, however, during the Greek-Turkish War and the wave of one million Greek refugees from Asia Minor to Greece modified the epidemiological map of malaria. The heritage of the epidemiological studies undertaken by the League was the basis for the new campaign undertaken during the 1930s by the Greek State and the Rockefeller Foundation. The new structure of the Sanitary Services, the legacy of the League's experience and the knowledge of the Greek trainees of the Rockefeller Foundation, served as the starting-point for the final eradication of malaria after World War II.

Rescue medical activities among sea migrants and refugees in the Mediterranean region: lessons to be learned from the 2014-2020 period.

BACKGROUND: Since 2014, the number of migrants and refugees crossing the Mediterranean towards Europe has risen significantly due to various reasons. Both state agencies and non-governmental organizations (NGOs) have launched rescue missions in the Central Mediterranean in accordance with international legal obligations for search and rescue (SAR) operations for those under distress at sea. Our aim is to summarise the specific qualifications needed for maritime SAR in the Mediterranean both in terms of the population at risk, the equipment and the medical support required, especially during the coronavirus disease 2019 (COVID-19) pandemic and the operational legal framework. MATERIALS AND METHODS: This article aims to summarise the key points of SAR efforts from a medical perspective as depicted in the relevant literature during a specific timeline period (2014-2020) in a specific part of the Mediterranean Sea (Central Mediterranean route). Only papers published in English and whose full text was available were included in this study. The inclusion criteria were: a) articles referring to sea rescue operations between 2014 and 2020, b) research that focused on medical preparedness and assistance during rescue operations in the Central Mediterranean route, c) studies concerning demographic and clinical features of the rescue population, d) guidelines on the rule of conduct of persons and states participating in rescue activities. The exclusion criteria were: a) studies describing SAR operations in different regions of the world and b) studies focusing on routes, demographics and medical support of migrants/refugees on land. RESULTS: Three major themes were identified: a) characteristics of the population in distress at sea: country of origin, age groups, presence of communicable and non-communicable diseases were identified in the relevant literature. Our research shows that dermatological and respiratory issues were the major concerns among sea migrants, coming from different countries of both Africa and Asia, being relatively young and mostly males; b) medical preparedness and equipment needed for rescue: according to current guidelines, revised during the COVID-19 pandemic, infrastructure needed during SAR operations includes both equipment for resuscitation, personal protective equipment, deck adjustments, medical personnel trained to function in an austere setting and able to handle vulnerable patient groups such as children and pregnant women; c) medico-legal implications of SAR operations: knowledge of the legal framework encompassing SAR operations seems necessary, as European Union and state led initiatives seem to withdraw from proactive SAR, while criminalising NGO led rescue efforts. Operating with the imperative to save lives seems to be the only way of respecting international law and human values, thus, a summary of what the law dictates was made in an effort to keep medical workers participating in such operations updated. CONCLUSIONS: Investigation aims to shed light on the special clinical features of sea migrants, the skills, equipment and organizational structure needed by medical workers participating in SAR operations as well as the legal framework under which they will be asked to operate. Special consideration will be given to the difficulties that emerged due to the COVD-19 pandemic.

Controversies and lessons from the history of smallpox: the case of massive vaccination in British Corfu (1852).

The study presents an anti-vaccination action in the 19th century involving both scientific and political motivation. The research is based on an unpublished archive, namely the registries of the British Executive Police during the massive vaccination campaign in Corfu, the capital of the British possession in the Ionian Islands-Greece (1815-1864), after the smallpox outbreak of 1852. The archival material provides information about the number of vaccinated people, namely their sex, age, nationality, the year of the previous vaccination, along with the last year when a citizen "had smallpox". The records indicated 40,858 citizens and of these, a total 21,845 (53.46%) were vaccinated. Despite the impressive organization, the vaccination project caused a great controversy at both the scientific and political level between the British authorities and the Greek Ionian Assembly. The archival material gives a diachronic message in the fields of public health, infectious disease control, and health crisis management. The lack of control by a State or local authority, combined with political instability and the public's ignorance or distrust of scientific matters, are the main factors behind the failure to prevent, restrict or eradicate infectious diseases even nowadays.

Lessons from a historic example of diving safety rules violation: the case of Greek sponge divers.

This study presents a historical example of systematic safety rules violations by professional sponge divers in Greece during the early 20th century. In light of absolute unaccountability in favour of economic competition and in the absence of state oversight, the profession of sponge diving had developed into a deadly undertaking. The study is based on a report compiled by Professor of Hygiene and Microbiology Konstantinos Savvas, which was addressed to the Ministry of Marine Affairs. Savvas' report rested on data concerning hospitalised divers derived from the medical records of warship 'Kriti' (Crete), which escorted groups of Greek fishing vessels to four of their expedition in the Mediterranean over the period 1900-1903. Although the events explored herein took place at a time much different from the modern era with its numerous advancements in hyperbaric medicine, enhanced divers' professionalism and the establishment of labour rights and strict safety regulations, we should not overlook the human factor of professional exploitation that leads to the violation of safety rules. On the other hand, supervisory authorities entrusted with the responsibility of overseeing professional activities ought to be vigilant on a constant basis, especially in times of economic crisis that may lead to lax state functioning.

The Red Sea and the port of Clysma. A possible gate of Justinian's plague.

The aim of this study is to present the sea and land commercial routes of the Byzantine Egypt and their role in the dissemination of the plague bacteria Yersinia pestis from the Red Sea to Mediterranean ports. The Mediterranean port of Pelusium was considered as the starting point of the first plague pandemic, according to the historical and archaeological data; the port of Clysma in the Red Sea, however, can also be assumed as possible entrance gate of the Yersinia pestis. Indeed, it is proposed that the port of Clysma is most likely to have been the gateway of Yersinia pestis in the Byzantine Egypt when the epidemic broke out, given its geographic position and close trade relationship at the time of the epidemic in Pelusium.

Reflecting upon the humanitarian use of unmanned aerial vehicles (drones).

Nine years after the earthquake in Haiti and the appearance of the concept of “humanitarian drones”, it remains a poorly discussed yet highly controversial issue. Emergency mapping and light cargo deliveries to inaccessible areas are only some of the most popular ways in which drones are currently used for post-disaster relief and health crisis management by first responders around the world. On the other hand, every single successful use for drones is always followed by controversy about the problems caused by that very same, initially successful, use. However, examples of good practices will contribute to the investigation, study and analysis of the ways in which new, cutting-edge technologies such as drones can be implemented and adapted to meet the needs and requirements of humanitarian organisations and local communities affected by disasters. The issue is how and under what circumstances drone use can potentially fulfil humanitarian functions, particularly in the aftermath of a disaster, and how this type of technology could be deployed in non-violent, ethically desirable ways as part of the humanitarian response. In conclusion, it is questionable whether the benefits of using drones outnumber the moral obstacles they raise, and whether they will eventually be considered an inseparable part of humanitarian aid as well as a cutting-edge technological toy.

Potassium loss with tissue potassium deficiency in rats during hypokinesia.

BACKGROUND: This study aims at showing the effect of hypokinesia (HK) on tissue potassium (K(+)) loss with different tissue K(+) depletion and tissue K(+) deficiency with different K(+) intake. To this end, tissue K(+) content, plasma K(+) level, and K(+) loss with and without K(+) supplements during HK were measured. METHODS: Studies were conducted on male Wistar rats during a pre-experimental and an experimental period. Animals were equally divided into four groups: unsupplemented vivarium control rats (UVCR), unsupplemented hypokinetic rats (UHKR), supplemented vivarium control rats (SVCR), and supplemented hypokinetic rats (SHKR). SVCR and SHKR were supplemented daily with 2.50 mEq potassium chloride (KCl). RESULTS: Gastrocnemius muscle and right femur bone K(+) content reduced significantly, whereas plasma K(+) level and urine and fecal K(+) loss increased significantly in SHKR and UHKR compared with their pre-experimental values and the values in their respective vivarium controls (SVCR and UVCR). Bone and muscle K(+) content decreased more significantly, and plasma K(+) level and urine and fecal K(+) loss increased more significantly in SHKR than in UHKR. CONCLUSIONS: The greater tissue K(+) deficiency with higher than lower K(+) intake shows that the risk of higher tissue K(+) deficiency is directly related to K(+) intake. The higher K(+) loss with higher tissue K(+) deficiency and the lower K(+) loss with lower K(+) tissue deficiency shows that the risk of greater K(+) loss is directly related to tissue K(+) deficiency. Tissue K(+) deficiency increases more when the K(+) intake is higher and K(+) loss increases more with higher than lower tissue K(+) deficiency indicating that, during HK, tissue K(+) deficiency is due to the inability of the body to use K(+) but not to K(+) shortage in the diet.

Magnesium loss in magnesium deficient subjects with and without physical exercise during prolonged hypokinesia.

OBJECTIVE: To show the effect of hypokinesia (HK; diminished movement) on magnesium (Mg2+) loss in Mg2+ deficient subjects and the effect of physical exercise and on Mg2+ deficiency with and without physical exercise: Mg2+ balance, serum Mg2+ concentration and Mg2+ loss were measured. METHODS: Studies were conducted on 30 healthy male volunteers during a pre-experimental period of 30 days and an experimental period of 364 days. They were divided equally into three-groups: unrestricted active control subjects (UACS), continuous hypokinetic subjects (CHKS) and periodic hypokinetic subjects (PHKS). The UACS group ran average distances of 9.3 +/- 1.2 km.day-l; the CHKS group walked average distances of 0.9 +/- 0.2 km.day-l; and the PHKS group walked and ran average distances of 0.9 +/- 0.2 km and 9.3 +/- 1.2 km.day-l for 5-and 2-days per week, respectively. RESULTS: Mg2+ deficiency, serum Mg2+ level, fecal and urine Mg2+ loss increased (P < 0.05), in the PHKS and CHKS groups compared with their pre-experimental values and the values in the UACS group. However, serum Mg2+ concentration, urine and fecal Mg2+ loss and Mg2+ deficiency increased more (P < 0.05) in the PHKS group than in the CHKS group. CONCLUSIONS: Mg2+ deficiency is more evident with than without physical exercise and Mg2+ loss is exacerbated more with higher than lower Mg2+ deficiency. This indicates that Mg2+ deficiency with and without physical exercise and Mg2+ loss with higher and lower Mg2+ deficiency is due to inability of the body to use Mg2+ and more so when physically healthy subjects are submitted to prolonged periodic than continuous hypokinesia.

The Saint George Quarantine Station of Piraeus, Greece (1865-1947)

For centuries, the marine quarantine system was the major protection of the public health against serious infectious diseases around the world. The present study reconstructs the history of the Quarantine Station of Piraeus, one of the largest Mediterranean ports, known as the "Lazaretto of Saint George", as a vital element in the maritime sanitary protection of Greece. Our research will investigate the impact left by this institution on public health, as well as on the economic life of the port of Piraeus and the adjacent capital city of Athens. With regard to the first issue, we will seek to evaluate its role in relation to major outbreaks in the capital, as well as the arrival of 1.3 million Greek refugees after the Greco-Turkish War of 1922. The opening of Suez Canal (1865) was a great challenge and the institution was problematic at administrative and sanitary levels. During 20th century, the station complied with the national public health legislation and the international sanitary conventions. Until the Second World War, the Lazaretto of Saint George played a key role in both the protection of public health in general, but also in the economic and industrial progress of Piraeus and Athens.

The Knights Hospitaller of Rhodes and the Black Death of 1498: a poetic description of the plague.

The study is a presentation of the sole written testimony of the great plague epidemic that struck the island of Rhodes in 1498, at the time when the Order of the Knights of St. John was settled there. The Greek poem "The Thanatikon (i.e., plague) of Rhodes", which was written by Emmanuel Georgillas Limenitis in the late 15th century and recounts the terrible events of the epidemic, was used as a source of information. Among the 644 verses of the poem, elements like the place, time, duration and how the epidemic spread can be identified. Within the historical context of the era, evaluation and analysis of the data reveal the correlation between human activities and the physical history of the disease in the Mediterranean during the 15th century. The Plague of Rhodes confirms the value of non-medical sources in the medico-historical and historico-epidemiological study of the evolution of the disease caused by Yersinia pestis while highlighting an enduring intrinsic weakness of surveillance systems. Despite modern means of epidemiological surveillance, the risk of relaxation of a health system after a long period of absence of an infectious disease constitutes a major factor for future resurgence of the specific disease.

Time to Rethink Refugee and Migrant Health in Europe: Moving from Emergency Response to Integrated and Individualized Health Care Provision for Migrants and Refugees.

In the last three years, the European Union (EU) is being confronted with the most significant influx of migrants and refugees since World War II. Although the dimensions of this influx-taking the global scale into account-might be regarded as modest, the institutional response to that phenomenon so far has been suboptimal, including the health sector. While inherent challenges of refugee and migrant (R&M) health are well established, it seems that the EU health response oversees, to a large extend, these aspects. A whole range of emergency-driven health measures have been implemented throughout Europe, yet they are failing to address adequately the changing health needs and specific vulnerabilities of the target population. With the gradual containment of the migratory and refugee waves, three years after the outbreak of the so-called 'refugee crisis', we are, more than ever, in need of a sustainable and comprehensive health approach that is aimed at the integration of all of migrants and refugees-that is, both the new and old population groups that are already residing in Europe-in the respective national health systems.