Baron Dominique-Jean Larrey (1766-1842): innovator of the triage.

BACKGROUND: During times of war, it is common for some of the most valiant physicians to practice their skills at the battlefields. Only few of them, however, manage to excel. Among those physicians who seemed like the battlefield was their natural environment, was the military surgeon of the French army, Baron Dominique Jean Larrey (1766-1842). He studied medicine and served in the French Navy. Baron Larrey was one of the most significant medical innovators. METHODS: International literature was digitally searched. DISCUSSION: Larrey optimized a variety of procedures, even early neurosurgical ones. He also wrote medical treatises and most importantly invented the world famous 'flying ambulance'. During his 53-year service in the army he became the symbol of protection of the French warrior. That is why he was widely known as the 'protector of the soldier'. Nevertheless, his most eminent invention was the formation of the new 'triage' method. Due to Larrey's priceless impact in the domain of surgical innovation, a notable NATO award was created that is named after him. CONCLUSION: All references presented describe clearly Baron Larrey's contribution to medicine. His innovations in the sphere of the medical science renovated radically the medical ideas of his era.

The Hellenic surgical School for treatment of neuralgias and dystonias as presented in 19th-20th centuries in Greece.

BACKGROUND: This article examines the surgical techniques used for the treatment of neuralgia and dystonia in Greece during the late 19th to the middle of the twentieth century. It emphasizes on the Greek contribution to neurosurgery. METHODS: The aim of this study is achieved by examining unpublished archives as well as historical documents collected from both the National Library of Greece and the Library of the Hellenic Parliament. RESULTS: Greek medicine of the nineteenth century emerged through the practice of Greek physicians who have studied abroad. Many important figures on surgery, like Theodoros Aretaios, Nikolaos Taptas and Konstantinos Mermigas attempted myotomies, neurectomies, trasoraphies, and injections according the European protocols, though introducing some variants on well established procedures. This article also refers to the early stereotactic neurosurgery in Greece, especially in the treatment of Parkinson's Disease and extrapyramidal syndromes by Aggelos Karakalos, ultimately contributing toward a better understanding of the evolution of Greek surgery, highlighting its pivotal role in the international development of neurosurgical techniques. Greek school of surgery avoided brutal operations like trephination and proved worthy among most advanced school of the 19th and 20th centuries. CONCLUSION: Neuralgias and dystonias constituted for the physicians of the past a riddle connected with the mystery of the central and peripheral neural system. Surgical procedures were proposed, finding ways of implication mainly in the cases of neuralgias. Gradually drug administration of simple substances like alcohol demonstrated some results. The study of Greek medical archives dated back to 19th and early twentieth century allow us to have a comprehensive idea about the therapeutical approaches and especially the operative ones used by the Greek physicians of the time to fight dystonias and neuralgias unveiling their capabilities and theoretical medical knowledge.

The history of esophageal surgery.

BACKGROUND: Esophageal surgery has always been considered extremely demanding, given the surgical experience and skills required, due to the anatomic location of the esophagus as well as the impact of such extensive operations on patients' homeostasis. The intention of the present study is to review all historical time points of esophageal surgery, from its inception to the modern era of minimally invasive esophageal surgery. METHODS: The first clear description of esophageal surgery is dated back to 1738, in an attempt to remove a foreign body from the thoracic esophagus. However, the high morbidity and mortality rates of esophageal surgical operations led to the invention and application of less invasive surgical procedures. RESULTS: Esophageal surgery has evolved from extensive surgical operations to minimally invasive esophagectomies, aiming exclusively to reduce perioperative morbidity and mortality, while maintaining surgical effectiveness. Despite the fact that benign esophageal pathologies were the main stimulus for this evolution, minimally invasive esophageal surgery is now applied even in patients with esophageal cancer, with outcomes comparable to those of traditional surgical approaches. CONCLUSION: It would be interesting to see how all these new surgical techniques may evolve, altering further the current status of esophageal surgery in the future.

Medical education challenges and innovations during COVID-19 pandemic.

COVID-19 pandemic has undoubtedly disrupted the well-established, traditional structure of medical education. Τhe new limitations of physical presence have accelerated the development of an online learning environment, comprising both of asynchronous and synchronous distance education, and the introduction of novel ways of student assessment. At the same time, this prolonged crisis had serious implications on the lives of medical students including their psychological well-being and the impact on their academic trajectories. The new reality has, on many occasions, triggered the 'acting up' of medical students as frontline healthcare staff, which has been perceived by many of them as a positive learning and contributing experience, and has led to a variety of responses from the educational institutions. All things considered, the urgency for rapid and novel adaptations to the new circumstances has functioned as a springboard for remarkable innovations in medical education,including the promotion of a more "evidence-based" approach.

John Watson (1807-1863) and his Pioneer Work On the Surgery of Esophagus.

Backround. John Watson (1807-1863) was the first surgeon in USA who performed and published his results on esophagotomy. Methods. His pioneer surgical work was a gold standard reference for the later surgeons. Results. Watson was a devoted surgeon and his innovative operating techniques secured him a place in the hall of fame of the history of medicine.

Gottlieb Burckhardt (1836-1907): 19th-Century Pioneer of Psychosurgery.

Gottlieb Burckhardt was a 19th-century Swiss psychiatrist who introduced the psychosurgical method known as topectomy as a means to relieve the symptoms of aggression and agitation in individuals diagnosed with mental disease. Specifically, he performed topical excision of part of the cerebral cortex on 6 patients with chronic schizophrenia. Most of these patients became more approachable and easier to manage, but they also showed signs of aphasia or seizures, and 2 died soon after the surgery. Burckhardt's presentation of the results of his surgical procedures to the Berlin Medical Congress in 1890 caused an enormous controversy within the European medical community and resulted in his ostracism from it. He continued practicing, however and dispensing advice in his role as a mental hospital director, though he soon gave up his surgical endeavours. His innovative theory of higher cerebral functions anticipated the lobotomy procedure that was developed nearly half a century later by the neurologist Egas Moniz (1874-1955).

An innovative hippocratic cranial intervention for amaurosis in classical Greece.

BACKGROUND: Amaurosis is the sudden and acute loss of sight. Followers of Hippocrates in ancient Greece described amaurosis as a symptom of several ophthalmological pathologies, such as tumours or trauma. To treat it, surgery often was performed. METHODS: The Corpus Hippocraticum, edited by Littré, was thoroughly studied. RESULTS: The Corpus Hippocraticum describes the surgical treatment for amaurosis, which involves drilling with specialized tools (i.e. trephines) into the affected area of the temporal bone. It was believed that this procedure would help release demonic spirits and balance the bodily humours. Physiology of the era assumed that fluids in the head sometimes exerted high pressure on the optical nerve and that this fluid needed to be alleviated. CONCLUSIONS: Ancient Greeks studied cranial anatomy and understood the main principals of internal bleeding and inflammation. They treated some of the neurological symptoms that resulted from these conditions with surgery.

Theophrastus Bombastus Von Hohenheim: Theological Reformer, Philosopher and Physician.

Theophrastus Bombastus Von Hohenheim (1493-1541), known as Paracelsus, was a German-Swiss Renaissance man. His interests included alchemy and medicine. During the early 1500s, he worked as a physician, introducing mineral-based therapies to treat ailments. He is credited with developing the first recipe for laudanum, a powerful opium-based pain medication. He had radical beliefs, claiming that supreme knowledge could be reached by observing nature, not by reading books. He expressed rebellious opinions on religious topics and, though devoted Christian, criticized the Catholic Church, preaching that the spirit of Christianity dwells in the human soul and not within the church walls. Paracelsus' efforts to "renovate" the expression of the Christian faith by limiting the ritual and augmenting the spirituality among believers are presented.

Paul of Aegina (ca 625-690 ad): Byzantine Surgeon and Pioneer of Surgical Management of Congenital Atresia of the External Auditory Canal.

Diseases of the ear have been recorded and treated since ancient times. Ex-votos have been offered to heal deafness. Noninvasive treatments have evolved into minor, and later more advanced, surgical techniques to treat head and neck issues. Paul of Aegina (ca 625-690 ad) perfected his medical skills in the School of Alexandria in Egypt. His medical encyclopedia, Medical Compendium, described a broad series of surgical operations, including a chapter "On the atresia of the auditory canal," which vividly described a surgical technique to open the ear canal. This surgery is particularly interesting, as it exceeds the limits of resection and amputation known at that time and describes a novel surgical technique. His innovative methods paved the way for future surgeons.

William Cheselden (1688-1752): 18th-Century Pioneer of Lateral Lithotomy and Iridectomy.

William Cheselden (1688-1752) was a British surgeon and anatomist who was famous for his rapid and skilful techniques. He emphasized learning through dissection and introduced lateral lithotomy as an effective approach for the removal of bladder stones. Medical practitioners throughout Europe adopted his techniques. Cheselden also has been credited with the first known case of full recovery from blindness using iridectomy. Moreover, a milestone in his career was his indirect instigation for the separation of surgeons from barbers. He is considered the founder of modern British surgery.

Andreas Vesalius of Brussels (1514-1564): his contribution to the field of functional neuroanatomy and the criticism to his predecessors.

Until the fifteenth century, the knowledge about anatomy and function of the nervous system had been significantly influenced by theological notions. Andreas Vesalius of Brussels (1514-1564), based on human cadavers' dissections, criticized his predecessors and contributed to the construction of the current knowledge about functional neuroanatomy. Although he did not avoid mistakes, he successfully demonstrated the high value of human cadavers' dissection in anatomical teaching.

Praxagoras of Cos (4th Century BC) and His Innovative Method of a Diverting Enterocutaneous Fistula to Relieve Small Bowel Obstruction.

Born in an island with huge medical tradition in ancient Greece, Praxagoras of Cos became an esteemed medico-philosopher and surgeon. The evolution made by the Hippocratic School of Medicine further boosted his talent and helped him perform surgical operations, which were believed impossible for his era. Praxagoras introduced an innovative surgical technique to confront small bowel obstruction, by creating an enterocutaneous fistula. This historical review connects all available data to present the life and work of an important medical figure of the ancient Hellenic School.

Pierre Franco (1505-1578): An Innovative Surgeon of the 16th Century in the Treatment of Hernia and Lithotomy.

Pierre Franco (1505-1578) was a brilliant surgeon of the Renaissance, a contemporary of Ambroise Paré. He made an impact on the history of surgery with his innovative approaches in the treatment of hernia, lithotomy, and the use of the suprapubic incision. The purpose of this study is to present a detailed account of his work, innovations, and achievements as well as the impact he made on the surgery of the Renaissance.

Antoine Ferrein (1693-1769)-His Life and Contribution to Anatomy and Physiology: The Description of the Vocal Chords and Their Function.

The purpose of this study is to summarize the life and work of the French anatomist and surgeon Antoine Ferrein (1693-1769). Ferrein made an impact in the history of anatomy and physiology through his work and especially with the description of phonation, renal anatomy, and liver and biliary structure. He also made an impact on ophthalmology with the description of the eyelid and its diseases. After a thorough review of the literature, we present in this review his life and his main discoveries with special emphasis on the anatomic description of the vocal chords resembling the chords of a violin tempered by the air exhaled from the lungs and how the physiology of phonation and the surgery of the larynx were revolutionized after that.

Hallmarks of amputation surgery.

PURPOSE: To highlight the most important innovations and milestones in the historical evolution of amputation and disarticulation surgery through the ages, from the early antiquity until the modern era. METHOD: A thorough search of the literature was undertaken in PubMed and Google Scholar as well as in physical books in libraries to summarize current and classic literature on the hallmarks of the history of amputation surgery in the course of medical history. RESULTS: Amputation of a limb is one of the oldest surgical procedures. Initially, it was fraught with complications and dismal outcome of the patients because of hemorrhage and infection. Due to lack of analgesics and narcotics the operation had to take only a few minutes. Obtaining experience, the surgeons evolved the operative technique and refined the procedure, anesthesia and perioperative analgesia was introduced, instruments were developed, and rehabilitation has enabled functional and social reintegration of amputees. CONCLUSION: From the Hippocratic era until currently, the surgical approach to amputation has changed little. However, the indications for amputations have changed a lot and had been refined, especially in diabetic patients and in those with severe chronic peripheral vascular disease. An exponential decrease in mortality for an operation once fraught with complications was due to the development of the tourniquet, proper vessel ligation and repair, antisepsis, and anesthesia.

Abulcasis (936-1013): his work and contribution to orthopaedics.

AIM OF THE STUDY: The purpose of this historic review is to summarize the life and work of Abulcasis (936-1013) and his contribution to surgery and orthopaedics. METHOD: We conducted an extensive search in libraries as well as online in PubMed and Google Scholar. RESULTS: Abulcasis in his work combines the knowledge of ancient Greek and Roman physicians and surgeons with the extensive knowledge of Arabic medicine and pharmacology. He also pioneered surgical technique with the invention of numerous surgical instruments and with several revolutionary surgical techniques. CONCLUSION: Abulcasis made an impact with his medical writings in which he summarized the works of ancient Greek and Roman physicians like Hippocrates and Galen with the influence of medieval authors and the knowledge of the Arabic medicine and pharmacology. His descriptions and innovations in his work remained a work of reference in the West and East for many centuries to come.

Spine deformities and trauma in Avicenna's Canon of Medicine.

AIM OF THE STUDY: The purpose of this historic review is to summarize the life and work of Avicenna (980-1037) and his contribution to the diagnosis and treatment of spinal deformities and trauma. METHOD: We conducted an extensive search in libraries as well as online in Pubmed and Google Scholar. RESULTS: Avicenna in his work Canon of Medicine combines the knowledge of ancient Greek and Roman physicians and surgeons and he combines them with the extensive of Arabic medicine and pharmacology. CONCLUSION: Avicenna made an impact with his medical writings in which he summarized the works of ancient Greek and Roman physicians like Hippocrates and Galen with the influence of medieval authors and the knowledge of the Arabic medicine and pharmacology. His descriptions and comments in his work Canon of Medicine summarize and comment the work of his predecessors and it remained a work of reference until at least the sixteenth century.

The Hippocratic Doctrine of "the Acute Brain Suffering" as the Brain Stroke.

BACKGROUND: The ancient Greek term "apoplexy" as is repeatedly mentioned by the Hippocratic School of Medicine, included a cluster of diseases, mainly those concerning the central nervous system. The term was wrongfully infiltrated in Western European medicine as synonymous to what is called today a "stroke" of the brain. OBJECTIVE: While in "Corpus Hippocraticum" the definition of the stroke was rather ambiguous; our study aims to unveil those fragments referring to it, in order to compose the Hippocratic theory of what it stood for "Acute Brain Suffering" (Greek: Οξείες Οδύνες του Εγκεφάλου) during the Classical era of ancient Greece. METHOD: A bibliographic research of the "Hippocratic Collection" was conducted during our study in order to connect all fragments from the original ancient Greek text, and reconstruct the "Hippocratic Stroke Theory". Three editions have been used as reference. French edition by Littré, and two Greek ones by Kaktos and Pournaropoulos. RESULTS: The "Acute Brain Suffering" seems to be the entity we call "Stroke" in modern clinical practice. Edema (collection of fluids-humours theory) was considered to be the most significant element which though could have been addressed by a cranial decompression for the symptoms to improve. The symptoms in question were, acute brain pain, diplopia, vertigo, ataxia, saliva, and urine loss as well as feces incontinence. CONCLUSION: Both therapeutic approach and symptomatology exhibited significant similarities with the modern concept of the stroke. The Hippocratic School was a scientifically advanced sect of medicophilosophers who promoted global medicine.

Vesalius criticism on Galen's musculoskeletal anatomy.

Galen of Pergamum (129-216/217 AD), an important Greek physician, influenced the history of medicine for more than 1400 years. However, Andreas Vesalius (1514-1564), after performing dissections of human cadavers, remarked that Galen made several mistakes due to the fact that his dissections were on animals, particularly on apes. The current study summarizes the main points in which Vesalius criticized Galen in terms of the musculoskeletal anatomy.

The Hippocratic Method of Surgical Cauterization for the Tumescence Spleen in the Rare "Spetses Syndrome".

Spleen in antiquity was considered by the Hippocratic medicine as a viscerous organ of spongy character, which could clear human body of the black bile. According to the Hippocratic doctrine of the 4 humors, black bile could cause a series of diseases. Both the anatomical position and shape of the spleen were also recognized. In the case of a splenic hardening, with simultaneous augmentation of its dimensions and dermal ulceration and/or splenic abscess, some interventions were proposed. Thus, herbal medicine, phlebotomy, and minimal surgery with local cauterization were applied for treatment, to confront a disease that was considered serious but not fatal. The Hippocratic physicians encountered various spleen diseases and among them they most probably confronted a rare splenic pathological entity, named centuries later as "Spetses syndrome," a rare type of thalassemia of the Spetses island of Saronikos Gulf. Although the approach seems in modern terms rather primitive, the ancient Greek medico-philosophers most likely understood the significance of the spleen.