Adolphe Gubler (1821-1879) or Parisian neurology outside La Salpêtrière in the age of Jean-Martin Charcot.

Adolphe Gubler (1821-1879) is a typical example of a 19th century hospital physician in Paris. Head of a medical unit at Beaujon hospital in 1855, he was nominated to the treatment and pharmacognosia Chair in 1868. He trained many students who became his disciples and remained very close to him. Gubler published prolifically in all areas of medicine. His most well-known work is clearly his contribution to the study of vascular accidents affecting the brain stem, which Auguste Millard worked on simultaneously; hence the eponymous Millard-Gubler syndrome, an example of crossed hemiplegia. Following a brief biography, we will present Gubler's main publications in the area of neurology: on migraine, neurological damage during acute rheumatic fever, aphasia, and the autonomic nervous system. Much of this work was carried out through student theses that Gubler directed. The fame of his contemporary Jean-Martin Charcot (1825-1893) eclipsed that of Gubler, even though the latter was well known and respected among Parisian professors. By tying together the diverse threads of his work, we hope to renew interest in this 19th century neurologist.

Stroke in Ancient Mesopotamia.

INTRODUCTION: More than 6000 years ago, the cradle of civilization, Mesopotamia, grew-up in what is known today as Iraq. The history of cerebrovascular diseases in Mesopotamia is insufficient to supply scholar needs. Therefore, the goal of this review is to highlight some remarkable points in the history of what we may coin as "stroke medicine" during the ancient Mesopotamian eras and to explore the knowledge and expertise of ancient healers. The neo-Sumerian period (2112-2004 BCE) documented, through clay tablets, many medical records about two kinds of medical specialists; the asipu (exorcists) and the asu (physician-priests). METHODS AND FINDINGS: The information herein was gathered through literature review using online resources, such as NCBI, Google Scholar, PubMed, UCLA, and HINARI. Initially, most of the knowledge we have got was acquired mainly from two well-known transliterated cuneiform texts. Both tablets had clearly addressed stroke. One tablet, part of the "diagnostic" series is currently in the Louvre Museum in Paris, while the other one is in the British Museum in London and is part of the "therapeutic" series. The Mesopotamians had noticed and documented vascular disorders of the brain and some pertinent diseases. The asu and the asipu demonstrated an observational knowledge of anatomy and but no knowledge of the nervous system, the concept of pathology, or physiology as we call them today. Not all paralysis cases were viewed as a curse or an impact incurred by a supernatural deity. Physical treatment was mentioned to the patients. The familial occurrence of stroke was a well-known trait in that ancient period. CONCLUSION: This descriptive review tells us that the history of stroke in the medical practice was well-encountered in the first half of the second millennium BCE and that physicians were keen observers to describe stroke presentation and prognosis.

Management of stroke as described by Ibn Sina (Avicenna) in the Canon of Medicine.

Stroke or cerebrovascular accident (CVA) is caused by a disturbance of the blood supply to the brain and an accruing loss of brain function. The first recorded observations were in 2455 BC and it has been studied intensely by ancient physicians throughout history. In the early medieval period, Ibn Sina (980-1025 AD) called stroke sekteh and described it extensively. Some of Ibn Sina's definitions and his etiology of stroke are based on humoral theories and cannot be compared with medical current concepts, but most of his descriptions concur with current definitions. This review examines the definition and etiology, clinical manifestations, prognosis, differential diagnosis, and interventions for stroke based on Ibn Sina's epic work, Canon of Medicine. The pharmacological effects of medicinal herbs suggested by Ibn Sina for stroke are examined in light of current knowledge.

Translating new knowledge into practices: reconceptualising stroke as an emergency condition.

OBJECTIVES To examine how the new concept of stroke as an emergency condition led to the development of new clinical pathways for stroke patients in Newcastle Upon Tyne, implemented through protocols which were then rapidly adopted across the UK and further afield. METHODS Historical analysis using health policy documents, published papers and correspondence on stroke alongside 17 interviews with stroke clinicians and managers in the UK and the US. RESULTS The challenges of implementation stemmed from organisational and professional barriers rather than scientific or technological difficulties. Stroke's historical status as a non-treatable illness was a barrier to the adoption of acute treatments. Building new pathways for stroke patients by developing protocols for paramedics and emergency room staff originated as a local solution to a local problem but were taken up widely. DISCUSSION Understanding the clinical response to the reconceptualisation of stroke as a treatable disease contributes to our understandings of the relations between clinical research and practice. These findings have implications for how we understand the translation of new knowledge into practice and its transfer across different clinical communities and settings. Protocols are shown to be a particularly valuable tool, bridging knowledge between communities and manifesting a new identity for stroke.

Interpretación popular del ictus en la Galicia antigua: el mito del dragón / The popular interpretation of strokes in ancient Galicia: the dragon myth

Introducción. La gran prevalencia y morbimortalidad del ictus ha favorecido una consecuentemente amplia representación en la medicina precientífica del pueblo gallego. Presentamos una interpretación no estudiada hasta el momento, y que está, por otra parte, ligada al fenómeno jacobeo: el ictus como resultado de la influencia maligna de un dragón. Otro dragón aparece citado en el Códice Calixtino como impedimento a la traslación apostólica. Desarrollo. En el libro tercero del Códice Calixtino, donde se narran los hechos de la traslación de los restos del apóstol Santiago el Mayor desde Palestina hasta Santiago de Galicia, encontramos la principal referencia escrita de la figura del dragón del Pico Sacro. El símbolo pagano del dragón permanece acantonado en la medicina popular gallega, transmitida de forma predominantemente oral, como causante directo de procesos morbosos como el ictus. Conclusiones. En la medicina popular gallega, la patología ictal se atribuye mayoritariamente a un subtipo del llamado ‘aojamiento’ o ‘mal de ojo’. Por vez primera, hasta donde sabemos, se revela el símbolo del dragón como explicación mágica directa de una patología vascular cerebral. Por otra parte, la interpretación precientífica del ictus en Galicia encuentra,en el mito del dragón, un puente de unión con el relato legendario de la traslación del apóstol Santiago a Galicia. Tal relación apoya la veracidad del relato de la traslación del Códice Calixtino, en detrimento de reelaboraciones posteriores (AU)

Introduction. The high prevalence and mortality of stroke has consequently brought about a wide presence of this pathology in the Galician pre-scientific folk medicine. A new interpretation of stroke, linked to the local tradition around the figure of Saint James the Apostle, is presented in this paper: stroke is considered to be the result of the evil influence of a dragon. In the Codex Calixtinus, a xii century manuscript containing various materials around the figure of Saint James, a dragon is also mentioned as an obstacle for the translation of the apostolic body. Development. The third book of Codex Calixtinus containing the narration of the translation of the dead body of James the Greater from Palestine to its likely current location in Santiago de Compostela (Galicia, Spain), also holds the major written record of the dragon of the Pico Sacro mountain. The pagan symbol of the dragon has remained in the orallytransmitted Galician folk medicine as a direct cause for neurological diseases such as stroke. Conclusions. For the first time, in our knowledge, the symbol of a dragon as the magical explanation for cerebral vascular disease has been described. Moreover, this mythical explanation, found only in the Galician folk medicine, is strongly linked to the legend of the translation of James the Apostle to Galicia. Such a link supports the originality of the narration in the Codex Calixtinus as opposed to other versions of the apostolic translation which can be found in other manuscripts (AU)

Historical aspects of critical care and the nervous system.

The appropriate starting point for a history of neurocritical care is a matter of debate, and the organization of facts and conjectures about it must be somewhat arbitrary. Intensive care for neurosurgical patients dates back to the work of Walter Dandy at the Johns Hopkins Hospital in the 1930s; many consider his creation of a special unit for their postoperative care to be the first real ICU. The genesis of neurocritical care begins in prehistory, however. This article gives a predominantly North American history, with some brief forays into the rest of the world community of neurointensivists.

Dr John Rankin; his life, legacy and the 50th anniversary of the Rankin Stroke Scale.

Dr John Rankin (1923-1981) is one of the many distinguished alumni of the former University Department of Materia Medica and Therapeutics, Stobhill Hospital Glasgow. While his varied international career encompassed pulmonary physiology, occupational medicine and public health, he remains best remembered in the United Kingdom for his early stroke publications. In a series of articles published 50 years ago in the Scottish Medical Journal he described early rehabilitative stroke medicine using a novel grading system. Half a century on Rankin's eponymous stroke scale has become the endpoint of choice in acute stroke trials. This paper describes Rankin's remarkable career and the legacy of his work, with a particular focus on his stroke research and grading system.

[Company centredness in the rehabilitation system of the German Democratic Republic, GDR]. / Die Betriebszentrierung im Rehabilitationssystem der DDR.

This article describes major aspects of the rehabilitation system of the former German Democratic Republic, GDR. Based on presentation of the actors in the medical and occupational rehabilitation system, differences are pointed out in comparison to the notion of rehabilitation in the former Federal Republic of Germany, FRG. The article focuses on the system of rehabilitation after stroke, which is outlined with relevant scientific literature. The health and rehabilitation system of the GDR was company-centred. Patients in rehabilitation received comprehensive care and guidance, and especially the companies played an integrative part and adjusted the occupational activity of the patients in rehabilitation to their physical and mental abilities in order to avoid early retirement. On account of the political and social transformation process as well as transfer of the health and rehabilitation legislation of the old FRG, the company-centred rehabilitation system of the GDR was replaced, implementing West German rehabilitation structures in East Germany as well.

[The development of the cognition and treatment of apoplexy in traditional Chinese medicine].

Surveying the developmental history of the cognition and treatment of apoplexy in traditional Chinese medicine, it could be divided into 3 phases, viz. the phase of "exogenous wind" before the Tang and Song dynasties, the phase of contention of "endogenous wind" during the Jin, Yuan and Ming dynasties, and the phase of compromising of traditional Chinese and consulting of western medicine of "equal importance of exogenous and endogenous wind" after the Qing dynasty. Through the development of these three phases, the cognition of cause of disease and pathogenesis of apoplexy was deepened continuously, and the method of treatment, prescription and materia medica were enriched further. Especially, with the introduction and usage of modern scientific technology, the diagnosis and treatment of apoplexy were more standardized, and the effect was improved constantly, reflecting the characteristic and superiority of traditional Chinese medicine.

Benjamin Franklin, electricity, and the palsies: on the 300th anniversary of his birth.

Benjamin Franklin was involved not only with the nature of electricity but with its possible medical utility. He conducted electrical experiments on people with palsies, notably those caused by stroke, to see if electricity from machines could restore movement. Franklin recognized that electricity was not the miraculous cure it was hoped to be, and he presented his findings in 1757 as communication to the Royal Society. Although he did not provide names or individual case studies in this communication, subsequently published in 1758, his personal letters reveal that he treated at least two important colonists: James Logan, William Penn's secretary and a prominent public official in Pennsylvania, and Jonathan Belcher, governor of several provinces. Franklin's private letters shed light on how he conducted his clinical "tryals" and why he drew the conclusions he did in his report to the Royal Society.