[Neisser and the clap]. / Neisser en de druiper.

In 1879, during his specialization in dermatology, Albert Ludwig Sigesmund Neisser (1855-1916) discovered the bacterial cause of gonorrhoea. The gonococcus - Neisseria gonorrhoea - would, however, not bear his name until 1933. Neisser's early research focused primarily on venereal diseases, syphilis in particular, and on leprosy. Later, as a hygienist, he became a passionate advocate of public clinics for venereal diseases, regulated prostitution, and health education. In 1916, Neisser died of sepsis after lithotripsy for nephrolithiasis. His scientific inheritance includes many publications on a variety of venereal and skin diseases and public health-related topics, and textbooks such as Ikonographia dermatologica and Stereoskopischer Medizinischer Atlas.

[Kolff and the artificial kidney]. / Kolff en de kunstnier.

Willem Kolff (1911-2009), son of a physician, studied medicine in Leiden and specialised in internal medicine in Groningen. It was there that he started attempts to apply the phenomenon of dialysis in patients suffering from renal failure. He built the first prototypes of dialysis machines after his appointment as an internist in the municipal hospital in Kampen, during the Second World War. Indeed, in the first 15 patients he managed to decrease urea levels, resulting in temporary clinical improvement, but eventually they all died. It was not until after the war that dialysis helped a patient survive an episode of acute glomerulonephritis. After 1950 he continued his work on artificial organs in the United States (first in Cleveland and later, after 1967, in Salt Lake City). Although most of his work from then on revolved around the development of an artificial heart, he also contributed to the design of a compact, disposable apparatus for dialysis, the 'twin coil'. Haemodialysis also became feasible for patients with chronic renal failure after the 'Scribner shunt' (1960) provided easy access to the circulation. Peritoneal dialysis is another option. Excess mortality, mainly from cardiovascular disease, is still a largely unsolved problem.

[Boerhaave and his syndrome]. / Boerhaave en zijn syndroom.

Herman Boerhaave (1668-1738), professor of botany, medicine and chemistry at the University of Leyden, attracted students from across Europe, thanks to his didactic qualities, reinforced by bedside teaching. His published writings, often unauthorised, were mainly theoretical and systematic. The more remarkable is the extensive and 'atrocious' case history he published about the 51-year-old nobleman Jan Gerrit van Wassenaer. As courtier and admiral of the Dutch fleet Van Wassenaer was a regular attendant at copious banquets, but at home he used to eat sparingly and sometimes he resorted to emetics. One day, having taken several bowls with an extract of Blessed Thistle (Carduus benedictus) and trying to vomit, he was seized by excruciating pain in the chest. The pain continued unabated until his death, the next day. Boerhaave, called to his bedside in the middle of the night, was unable to make a diagnosis from the history and physical examination. Post mortem examination showed the oesophagus had been torn off in the chest. Later generations have linked Boerhaave's name with spontaneous rupture of the oesophagus.

[Riva-Rocci and blood pressure]. / Riva-Rocci en de bloeddruk.

Scipione Riva-Rocci (1863-1937) was educated in Turin as a physician and later as a doctor of internal medicine. In 1896 and 1897 he published a series of four articles (in Italian) on a new method for measuring blood pressure. Previous non-invasive methods were all based on compression of the radial pulse, in keeping with centuries of medical tradition, but they were cumbersome and unreliable. Riva-Rocci's innovation consisted in compressing the brachial artery instead, at the level of the upper arm. For this purpose he devised an inflatable rubber tube, which was rigid on the outside. Disappearance of the radial pulse on palpation indicated the systolic arterial pressure, as Riva-Rocci confirmed by calibration experiments in animals and with human cadavers. His instrument was introduced world-wide after a chance visit by the American neurosurgeon Harvey Cushing (1869-1939). The Russian surgeon Nikolai Korotkoff (1874-1920) was the first to apply auscultation of the artery below the cuff (in 1905), a method that allowed determination of diastolic arterial pressure. Riva-Rocci was Chief of Medicine at the municipal hospital in Varese from 1900 to 1928, where he developed a special interest in paediatrics.

[Ranke and modern surgery in Groningen]. / Ranke en de moderne heelkunde in Groningen.

Hans Rudolph Ranke (1849-1887) studied medicine in Halle, located in the eastern part of Germany, where he also trained as a surgeon under Richard von Volkmann (1830-1889), during which time he became familiar with the new antiseptic technique that had been introduced by Joseph Lister (1827-1912). In 1878 he was appointed head of the department of surgery in Groningen, the Netherlands, where his predecessor had been chronically indisposed and developments were flagging. Within a few months, Ranke had introduced disinfection by using carbolic acid both before and during operations. For the disinfection of wound dressings, he replaced carbolic acid with thymol as this was less pungent and foul-smelling. The rate of postoperative infections dropped to a minimum despite the inadequate housing and living conditions of the patients with infectious diseases. In 1887, at the age of 37, Ranke died after a brief illness - possibly glomerulonephritis - only eight years after he had assumed office. A street in the city of Groningen near its present-day University Medical Centre has been named after him.

[Hoogendoorn and the medical registry]. / Hoogendoorn en de medische registratie.

Dirk Hoogendoorn (1914-1990) was a solo general practitioner in the village of Wijhe (eastern part of the Netherlands) from 1941, during the time of the German occupation, until 1971. From the very beginning, he combined his practice with the recording of disease patterns. He first concentrated on infectious diseases, especially whooping cough, which was the subject of his doctoral thesis. He later set up registries in two regional hospitals. When his initiative expanded to a national organisation, he became its advisor. He nonetheless continued to produce statistics on a variety of disorders as well as on surgical procedures, even more so after his retirement. The subjects ranged from traffic accidents and tonsillectomies to the discrepancy between increased body height and the unchanging height of the tennis net, but he had the most affinity with the practice of obstetrics. He stirred up much emotion by showing that a decrease in perinatal mortality was proceeding slower in the Netherlands than in other European countries, especially by suggesting a causal relationship between this lag and the high rate of Dutch home deliveries. This debate has continued to this day.

[Papanicolaou and the cervical smear]. / Papanicolaou en het uitstrijkje.

George N. Papanicolaou (1883-1962) was born in Kymi (on the island of Euboea, Greece). He studied medicine in Athens but chose not to join his father's practice in Kymi. Instead, he obtained his doctoral degree at the Zoological Institute in Munich (1910) and - after a brief return and marriage in Greece - went to work at the Oceanographic Institute in Monaco. Recalled in 1912 by the death of his mother and the Balkan Wars, he and his wife emigrated a year later to New York. After some difficulty, he found work as a research biologist at the Cornell University Department of Anatomy. Papanicolaou concentrated on vaginal cells right from the start, initially from guinea pigs. His real goal was to harvest egg cells for the study of sex differentiation; he succeeded in finding the right time by recording the cyclic changes in genital epithelium. These same changes appeared to occur during the human menstrual cycle. It was by chance that he encountered cancer cells in a human specimen in 1928. More than 10 years would pass before he took up the subject of cancer again, in collaboration with the gynaecologist Herbert F. Traut (1894-1963). After their first publication in 1941, Papanicolaou gradually fine-tuned the technique of cytological diagnostics in a variety of organs. In 1961, he moved to Miami Beach as head of a new cancer centre, but suddenly died a few months later.

[Behçet and his triad]. / Behçet en zijn trias.

Hulusi Behçet (1889-1948) was an internationally oriented Turkish dermatologist. He was closely involved in establishing the Istanbul Faculty of Medicine, where he later became a professor. In addition, Behçet was a scientist and an editor of the German professional journal, Dermatologische Wochenschrift. In articles published in this journal, he had written about 3 patients who suffered from an inexplicable triad of symptoms: eye problems, oral en genital ulcers. This oculo-urogenital syndrome now bears his name: 'Behçet's disease'.

[Quincke and his oedema]. / Quincke en zijn oedeem.

Heinrich Irenaeus Quincke (1842-1922), the son of a physician, was born in Frankfurt but was educated in Berlin where he also completed his medical studies in 1864. After a 'grand tour' that took him to Paris, Vienna and London, he was trained in Berlin, first in surgery and later in internal medicine, under Von Frerichs (1819-1885). In 1878, he became a professor of internal medicine in Berne; from 1883 he held the chair of medicine in Kiel, which he would hold for the next 30 years. In 1882, he published a synthesis of several observations of 'acute, circumscribed oedema of the skin'. Quincke accurately described the clinical features and distinguished the familial from the sporadic forms. He was correct in attributing the condition to increased vascular permeability, but he surmised the causal factors were neurogenic rather than humoral, according to current insights (excess of bradykinin due to external factors or hereditary deficiency of C1-esterase inhibitor). Quincke not only contributed to several other clinical observations, but also pioneered the lumbar puncture, initially not for diagnostic purposes, but to relieve headache in hydrocephalic children.

[Moleschott and materialism]. / Moleschott en het materialisme.

Jacques Moleschott (1822-1893), born into a Dutch Roman Catholic family, attended secondary school in Cleve (Germany). There he became captivated by Hegelian philosophy and lost his faith. After medical studies in Heidelberg and a brief spell as physician in Utrecht, where he struck up a life-long friendship with the physiologists Franciscus Donders (1818-1889) and Izaak van Deen (1805-1869), he returned to Heidelberg as lecturer in physiology. In his textbooks and particularly in his book for the general public, 'The circulation of life' (in German), he attested to a strict physicochemical view of biological phenomena, in opposition to contemporary notions of vitalism and teleology. When the atheistic implications had caused a conflict with the authorities in Baden, he moved as professor of physiology to Zürich (1854) and subsequently to the emerging nation of Italy, as professor in Turin (1861) and finally in Rome (1878), where he became a senator.

[Kocher and goitre]. / Kocher en de krop.

Emile Theodor Kocher (1841-1917) studied and spent his entire career as surgeon (since 1866) and professor (since 1872) in his native Berne, apart from a 'grand tour' of surgical institutions in Europe. The discipline of surgery rapidly expanded, not least through the introduction of anaesthesia and antisepsis. Kocher's expertise ranged from ankle fractures to hypophysectomy; he wrote an authoritative textbook on surgical technique. He became most famous through his treatment of goitre, an endemic condition in the mountainous parts of Switzerland. Kocher developed a meticulous technique for thyroidectomy, without major haemorrhage or damage to the recurrent nerve. The 'Kocher clamp' was developed for haemostasis. On discovering that patients might develop cretinism or 'cachexia' many years after total thyroidectomy, he took care to leave part of the gland intact. As the relation with myxoedema became clear, he experimented with thyroid transplantations and attempted to find biochemical function tests. In 1909 he was awarded the Nobel prize for Physiology or Medicine. Five years later thyroxin was isolated.

[Van Helmont and gas]. / Van Helmont en het gas.

Johan Baptista van Helmont (1579-1644) was born in Brussels, around the time the Southern Netherlands ceased their resistance against the Spanish rule. He studied a variety of disciplines in Louvain and made a 'grand tour' in Europe, but remained dissatisfied with traditional knowledge, which he regarded as empty phrases and sophistry. His spouse being wealthy, he devoted himself to studying nature anew, unencumbered by prejudice, as Paracelsus (1493-1541) had done before him. Yet in his attempts to explain living and inanimate matter he could not avoid making basic assumptions. Among these was his view that there were only two elements: water and air. Water might carry elementary seeds from which a variety of substances could develop. When a substance was consumed by fire, an ethereal essence would remain, which he called 'Gas' (a term perhaps derived from Paracelsian 'chaos', perhaps from 'Geist'). Today 'gas' is defined as the volatile state of a given substance, but in Van Helmont's view it was mainly a metaphysical characteristic. Most of Van Helmont's work was published only after his death, through a verdict of the Spanish Inquisition.

[Snellen and his optotypes]. / Snellen en zijn optotypen.

Herman Snellen (1834-1908) studied medicine in Utrecht and wrote a thesis under the guidance of Franciscus Donders (1818-1889). In 1858 he became assistant and a few years later first physician at Donders' newly-founded eye hospital. In 1862 he published his optotypes, letters of different sizes, constructed in squares with 5 x 5 subdivisions. For each row of letters of a given size there is an indication of the distance D at which a normal eye can just distinguish these (corresponding with 5 minutes of arc). If the eye of the subject being examined can just make out letters of a given size at distance d, the visual acuity V for that eye is d/D. Snellen was a gifted surgeon for a variety of ophthalmologic disorders. In 1877 he was appointed Professor of Ophthalmology at Utrecht and in 1884 he succeeded Donders as director of the eye hospital.

[Thomas Hodgkin and his disease]. / Hodgkin en zijn ziekte.

Thomas Hodgkin (1798-1866), born into a family of Quakers, would remain faithful all his life to the principles and rules of the 'Society of Friends'. He studied pharmacy and medicine in London, Edinburgh and Paris. As curator for the museum of pathological anatomy of Guy's Hospital (1825-1837) he introduced modern, organ-based, medicine in England, together with the clinicians Richard Bright and Thomas Addison. In 1832 Hodgkin reported autopsy findings of seven patients who had shown swollen lymph glands and an enlarged spleen, without evidence of tuberculosis, purulent inflammation or cancer. Later the diagnosis 'Hodgkin's disease' would be restricted to lymphomas with giant, multinucleated Reed-Sternberg cells on microscopic examination. Especially in his later years, Hodgkin devoted much time and effort to the emancipation of oppressed or destitute minorities, especially abroad. He died of dysentery on a journey to Palestine and lies buried in Jaffa.

[Willis and his circle]. / Willis en zijn cirkel.

Thomas Willis (1621-1675) grew up in Wiltshire and studied medicine in Oxford, at a time when the city was besieged and then occupied by Parliamentarian troops. He started his career as a country doctor while concurrently taking part in informal gatherings with other scientists (William Petty, Christopher Wren and, later on, Robert Hooke, Richard Lower and Robert Boyle). They performed physical and chemical experiments and carried out a variety of tests on animals. After the restoration of the monarchy in 1660 Willis combined his practice with academic teaching. From then on he focused his studies on the structure and function of the brain, dissecting brains after removal from the skull and fixation in 'spirit of wine'. In his 'Cerebri anatome' of 1664, illustrated by Wren, he drew attention to the arterial circle at the base of the brain, including its physiological advantages. This arterial circle had been incompletely described by others in the past and fully, but only in writing, by Wepfer in 1658.

[Van den Spiegel and his line]. / Van den Spiegel en zijn lijn.

Adriaan van den Spiegel or Spigelius (1578-1625) was born in Flanders to protestant parents. His father was court surgeon to William, Prince of Orange. Adriaan studied medicine in Leiden and obtained a doctoral degree in Padua. In 1616, after a period as physician to the German-Dutch student community in Padua and as court physician in central Europe, he was appointed professor of anatomy and surgery, succeeding Fabritius (1533-1619) and Casserius (1552-1616). He planned to publish a modern atlas of anatomy with etchings from the legacy of Casserius, to replace Vesalius' De humani corporis fabrica libri septem of 1543. Unfortunately he was cut short by death, like his predecessor. Eventually his pupil Bucretius published the atlas in 1627, with 78 of Casserius' illustrations and 20 new ones. In the text Spigelius calls attention to the aponeurotic fascia of the transverse and oblique abdominal muscles, on either side of the rectus abdominis muscle. He proposes the name linea semilunaris, now the official term.

[Virginia Apgar and her scale]. / Virginia Apgar en haar score.

Virginia Apgar (1909-1974), born in New Jersey, managed to continue medical school despite the financial crisis of 1929, continued for a brief time in surgery and subsequently became one of the first specialists in anaesthesiology. In 1949 she was appointed to a professorship, the first woman to reach this rank at Columbia University in New York. She then dedicated herself to obstetric anaesthesiology and devised the well known scale for the initial assessment of newborn babies, according to 5 criteria. From 1959 she worked for the National Foundation for Infantile Paralysis (now March of Dimes), to expand its activities from prevention of poliomyelitis to other aspects of preventive child care, such as rubella vaccination and testing for rhesus antagonism. She remained single; in her private life she enjoyed fly fishing, took lessons in aviation and was an accomplished violinist.

[Falloppius and his uterine tubes]. / Falloppius en zijn tuba uterina.

Gabriele Falloppio (1523-1562) was initially educated as a priest in his native Modena, Italy. He subsequently became a physician and professor of anatomy in Pisa, and later in Padua on the post Vesalius (1515-1564) had occupied not long before him. In 1561, Falloppius published a collection of anatomical observations to supplement, and sometimes correct, Vesalius' great De humani corporis fabrica libri septem of 1543. Among Falloppius' observations was a description of the female 'semen-conveying ducts', as they were then called, in which he emphasized their gradual widening towards the female 'testes', to which they were only loosely attached by fringe (fimbriae) or 'shreds of worn clothes'. When this fringe was folded back, the resulting opening resembled that of a brazen trumpet (tuba). Vesalius published a courteous riposte in which he still denied the existence of such an opening. The tubes Falloppius had described were eventually named after him.

[Wenckebach and his rhythm]. / Wenckebach en zijn ritme.

Karel Frederik Wenckebach (1864-1940) showed an aptitude for research even as a medical student in Utrecht. After graduation and a thesis on the bursa of Fabricius he worked as an assistant in the physiological laboratory. Following a stint as general practitioner in a mining community (1891-1896) he returned to Utrecht, where he could combine his practice with physiological studies, especially disturbances of the heart rhythm. In 1899, with no other recording instruments than a sphygmomanometer for tracing the radial pulse and a tuning fork for chronometry, he described the 'rhythmic arrhythmia' phenomenon: a missed beat after a given number of regular beats (mostly between three and six), followed by an intermission shorter than the interval between two regular beats. The Wenckebach rhythm is now also known as type I second-degree atrioventricular block. Wenckebach subsequently became a professor of medicine in Groningen (1901), Strasbourg (1911) and Vienna (1914-1929).

[Mathijsen and plaster casts]. / Mathijsen en het gipsverband.

In 1851, Antonius Mathijsen (1805-1878), a Dutch military surgeon, developed a practical method for immobilizing limb fractures with plaster casts. Previous attempts had been made by using soluble material for moulding casts to replace the traditional methods of traction or splinting. Disadvantages included the long drying-time required (e.g. with glue) or the requirement for hot water plus the resultant skin irritation (e.g. with gutta-percha). Plaster of Paris had occasionally been tried but proved unwieldy. Mathijsen used plaster of Paris in various different ways, the most successful being cotton bandages impregnated with plaster in powder form to which water had been added. His method was adopted worldwide within a decade. Mathijsen never married and spent his old age with relatives in the south of the Netherlands.