George Hogarth Pringle and the mystery of the first antiseptic operation in Australia.

EARLY LIFE: George Hogarth Pringle, later an associate of Joseph Lister, was born in Kintail, Scotland in 1830. In 1854, he worked as a dresser at the Royal Infirmary, Edinburgh with Joseph Lister. After serving in the Crimean War, he settled in New South Wales and began practice in Parramatta. PRINGLE AND ANTISEPTIC SURGERY: In October 1867, Pringle performed the first operation in Australia using the antiseptic principles advocated 6 months previously in the first of a series of articles published in The Lancet by Joseph Lister. Mystery surrounds how Pringle was able to adopt Lister's principles so quickly. Lister and Pringle had been friends in Edinburgh and previous writers have hypothesized that the two men corresponded whilst another has suggested Pringle was using antiseptic principles prior to Lister's work being published. Both these scenarios are unlikely. The Lancet appears to have been available in Australia within 4 months of publication. CONCLUSION: The conjunction of an appropriate case and the arrival of a recent copy of The Lancet highlighting Lister's work is the likely source of Pringle's decision to apply antiseptic principles.

Robotic Head and Neck Surgery: History, Technical Evolution and the Future.

The first application of robotic technology in surgery was described in 1985 when a robot was used to define the trajectory for a stereotactic brain biopsy. Following its successful application in a variety of surgical operations, the da Vinci® robot, the most widely used surgical robot at present, made its clinical debut in otorhinolaryngology and head and neck surgery in 2005 when the first transoral robotic surgery (TORS) resections of base of tongue neoplasms were reported. Subsequently, the indications for TORS rapidly expanded, and they now include tumours of the oropharynx, hypopharynx, parapharyngeal space, and supraglottic larynx, as well as obstructive sleep apnoea (OSA). The da Vinci® robot has also been successfully used for scarless-in-the-neck thyroidectomy and parathyroidectomy. At present, the main barrier to the wider uptake of robotic surgery is the prohibitive cost of the da Vinci® robotic system. Several novel, flexible surgical robots are currently being developed that are likely to not only enhance patient safety and expand current indications but also drive down costs, thus making this innovation more widely available. Future directions relate to overlay technology through augmented reality/AR that allows real-time image-guidance, miniaturisation (nanorobots), and the development of autonomous robots.

Differentiating between rhinosinusitis and mastoiditis surgery from postmortem medical training: A study of two identified skulls and hospital records from early 20th century Coimbra, Portugal.

Differentiating between medical procedures performed antemortem, perimortem or postmortem in skeletal remains can be a major challenge. This work aims to present evidence of procedures to treat rhinosinusitis (RS) and mastoiditis, suggest criteria for the diagnosis of frontal sinus disease, and frame the individuals described in their medical historical context. In the International Exchange collection, the skull (878) of a 24-year-old male, who died in 1933 due to frontal sinusitis and meningitis, presents evidence of a trepanation above the right frontonasal suture, and micro/macroporosity on the superciliary arches. The available Coimbra University Hospitals archives (1913-1939) reported that 46 females and 59 males (aged 15 months-84 y.o., x̄=35.33) underwent surgery to treat RS, primarily by trepanation (94.3%). In a search for similar evidence in the collection, the skull of a 42-year-old female (85), who died in 1927 due to sarcoma in the abdomen, shows four quadrangular holes located above the right supraorbital notch, right and left maxilla, and left mastoid process. The number/location of the holes and cut marks point to postmortem medical training (possible dissection). This paper discusses the value of information from historical contexts to differentiate between surgery and medical training in the paleopathological record.

A 1842 skull from Dupuytren's museum of Paris: an original artifact of Joseph Gensoul first maxillectomy technique.

Joseph Gensoul was a pioneer of ENT surgery. In 1827, he performed the first total maxillectomy on 17-year-old boy. His work inspired many surgeons, who were previously unwilling to remove maxillary tumours. A paleopathological study performed in the Dupuytren museum allowed us to identify a skull from the early 19th century, with a large maxillar tumour. There were indications that this skull was operated according to Gensoul's technique. The aim of this study is to confirm that this patient had, in fact, received this surgical treatment. This is a historical and descriptive paleopathological study of a skull of the early 19th century of Dupuytren Museum in Paris. The historical research was conducted in collaboration with the French Academy of Medicine and the Museum of Medicine History (Paris). Bones mark cut studies allowed us to confirm that the patient was operated according to the method described by Gensoul in his "Surgical letter" in 1833. Our historical research has allowed us to understand the perspectives of surgeons in the 19th century and the intellectual processes that led to this discovery. At a time when the robotization and industrialization dominate our art, it is interesting to look to our past, our origins, and our history. The study of ancient humans remains and allows us to understand the origin of our specialty and pay tribute to these pioneering surgeons. Their intellectual approach and boldness should be acknowledged and applauded, especially as it is also the key to our success.

Observations on a set of Greco-Roman eye, ear, nose, and throat surgical instruments.

The tools described in this article are verified to be Greco-Roman medical and surgical instruments for the eye, ear, nose, and throat. They include three myrtle leaf-shaped scalpels, three ear spoons, a "Q-tip," a forceps, a needle, and two arrow-pointed scalpels. One of the arrow-pointed scalpels is nearly identical to a Juerger keratome, suggesting that in Roman times, cataracts were extracted, not just "couched" into the posterior chamber. The description presented here goes beyond traditional archeological claims, because as a head and neck surgeon, I evaluated these instruments from a surgeon's point of view. For example, nonsurgeon medical historians have claimed the myrtle leaf-shaped items were used as handles or for blunt dissection, which I feel is mistaken. Review of the literature reveals the Greco-Roman surgeons were doing tonsillectomies, tracheotomies, and cataract extractions, and recognized that swimming in dirty water could cause ear infection. However, it is clear that with poor or no anesthesia, the pain from blunt dissection would have been intolerable, and unnecessary tissue planes would have been opened increasing wound infection risks. Therefore, there would have been no need for the myrtle leaf-shaped blade if it were just a handle. Laryngoscope, 2016 127:354-358, 2017.

[Georg Schlöndorff-the father of computer-assisted surgery]. / Georg Schlöndorff - Vater der "computerassistierten Chirurgie".

Georg Schlöndorff (1931-2011) developed the idea of computer-assisted surgery (CAS) during his time as professor and chairman of the Department of Otorhinolaryngology at the Medical Faculty of the University of Aachen, Germany. In close cooperation with engineers and physicists, he succeeded in translating this concept into a functional prototype that was applied in live surgery in the operating theatre. The first intervention performed with this image-guided navigation system was a skull base surgical procedure 1987. During the following years, this concept was extended to orbital surgery, neurosurgery, mid-facial traumatology, and brachytherapy of solid tumors in the head and neck region. Further technical developments of this first prototype included touchless optical positioning and the computer vision concept with three orthogonal images, which is still common in contemporary navigation systems. During his time as emeritus professor from 1996, Georg Schlöndorff further pursued his concept of CAS by developing technical innovations such as computational fluid dynamics (CFD).

Pharyngeal pouch management: an historical review.

BACKGROUND: Management of the pharyngeal pouch has evolved enormously since the first description by Ludlow in 1764 and the first case series by Zenker and Von Ziemssen in 1877. With the introduction of antibiotics, and the advancement of surgical technique with the advent of endoscopic surgery and lasers, current management is vastly different to that in the nineteenth century. OBJECTIVES: This paper traces the history of pharyngeal pouch management, and discusses the various treatment options and opinions recorded during the nineteenth and twentieth centuries, comparing these with techniques popular today. RESULTS AND CONCLUSION: Pharyngeal pouch surgery has been associated with significant morbidity, both because of the elderly age of patients typically affected by the condition and because of the surgery itself and potential post-operative complications encountered. The historical development of pharyngeal pouch management and the understanding of pharyngeal pouch pathophysiology are discussed.

Surgical treatment of head and neck cancers in the ancient world.

OBJECTIVE: This paper attempts to chart the history of head and neck cancers and their surgical treatment, starting from ancient Egypt and concluding with Galen. CONCLUSION: The ancient Egyptians appear to have treated head and neck cancers with local applications. The ancient Greek corpus contains a reference to treating pharyngeal carcinoma with cautery, but the description is too vague to establish the diagnosis conclusively. The ancient Romans moved away from surgical treatments, with Galen establishing a prejudice against surgery that would last through the Middle Ages.

[Dr. Moshe Sherman--the first otolaryngologist in Eretz-Israel: 100 years since his arrival].

On 4.8.1911 Dr. Moshe Sherman landed at the port of Jaffa. He was the first otolaryngologist in Eretz-Israel and for one year he was the only specialist in the country. Dr. Sherman was born in Nikolayev (Russia) in 1881. He started his medical education in Odessa, continued in Berlin, graduated in 1907 at the University of Dorpat (Estonia) and pursued postgraduate studies in otolaryngology at Moscow University. He settled in Jaffa, started a private practice and soon became a famous specialist. He volunteered at the Jewish hospital in Jaffa--"Shaar Zion", and twice a year spent several weeks in Jerusalem seeing patients and performing small operations. On January 1912 Dr. Sherman, together with another 5 physicians, laid the foundations for the first doctors' organization in Israel: "The Medical Society of Jaffa and Jaffa district". In 1918 Dr. Sherman was elected consultant at the Hadassah Hospital in Tel Aviv, and in 1932 a department for ear, nose and throat diseases was established there under his management. He was the founder and first chairman of the Ototaryngology Society in Eretz-Israel, and in 1935 was elected the chairman of the Jewish Medical Association in Eretz-Israel (later--its honorary president). He was the initiator and founder of the "World Fellowship", and the Editor in Chief of 'Harefuah' and "Michtav Lachaver". Dr. Sherman was the author of numerous papers related to his specialty and to the history of Jewish organizations in Eretz-Israel and, later, in the State of Israel. Dr. Sherman died in Tel Aviv on July 17th 1969.

[The otorhinolaryngological achievements of Wladyslaw Orlowski (1835-1889)]. / Otorynolarngologiczne dokonania Wladyslawa Orlowskiego (1835-1889).

The professional and scientific activities of Wladyslaw Orlowski (1835-1889), an eminent Varsovian surgeon are presented widely. Orlowski was a versatile surgeon. Orlowski's successful surgical treatment of many otorhinolaryngological diseases (such as complications of the inflammation of the middle ear, carcinoma of face and nose, tumor of nose, tuberculosis of nose, abscess of cheek, probably actinomycosis of jaw, carcinomas of tongue and others) are described in some more detail. He was a good surgical therapist of many different otorhinolaryngological diseases.

[Andrzej Franciszek Ksawery Dybek (1783-1826) and rhinolaryngology]. / Andrzej Franciszek Ksawery Dybek (1783-1826) a rynolaryngologia.

The professional and scientific activities of Andrzej Franciszek Ksawery Dybek (1783-1826), an eminent Varsovian physician, the military doctor, the professor of surgery of Warsaw Royal University, and the member of many scientific societies are presented with full particulars. The activity of Surgery Clinic of Warsaw Royal University is depicted widely. Dybek's successful treatment of rhinolaryngological diseases (such as traumas of cranium, syphilitic ulcerations of throat and face, polypus of nose, disease of maxillary sinus, cancer of lip) are presented in some more detail.

[The Józef Czekierski's (1777-1827) otorhinolaryngological connexions]. / Józefa Czekierskiego (1777-1827) otorynolaryngologiczne zwiazki.

The professional and scientific activities of Józef Czekierski (1777-1827), an eminent Varsovian surgeon on the turn of the 18th century are described widely. He was the head of surgical and obstetricial departments in Warsaw. He was also the head of the first Surgical Clinic in Warsaw. In the four-part textbook "Surgery" published in 1817-1818 Czekierski presented surgical treatment of such otorhinolaryngoogical diseases as wounds of ear and tongue, traumas of nase, diseases of parotis, the foreign bodies at respiratory tract and at the upper part of alimentary canal with full particulars. He described such rhinolaryngological operations as plastic reconstruction of the nase, tracheotomy, conicotomy, oesophagotomy in some more detail.

[Professor Waclaw Kusnierczyk (1908-1997)--Pro Memoria in the century of birthday]. / Profesor Waclaw Kusnierczyk (1908-1997)--Pro Memoria w 100-lecie urodzin.

Waclaw Kusnierczyk was born in 1908 in Sniatyn. He received the degree in medicine at Jan Kazimierz University in Lwów in 1932. He did his PhD degree under Professor Zaleski supervision in 1938 at Jan Kazimierz University. At that time he concentrated his scientific activity on research on tuberculosis. In 1953 he obtained the title of second degree specialist in ear, nose and throat diseases. He became a chief of Otolaryngology at Urban Hospital No 4 in Katowice in 1960. Since then this eminent physician was working on tumours located in upper respiratory tract and the possibility of its endoscopic diagnosis at Silesian Academy of Medicine in Katowice. As one of the first he pointed out the negative influence of smoking cigarettes on cancer of larynx. It was Waclaw Kusnierczyk who implemented new priorities for integrated programs in patient care, research, education and cancer prevention. He has published widely in peer reviewed journals and has edited or contributed to many books. He has given many major lectures and is the recipient of numerous prestigious awards for his scientific accomplishments. The achievement of Professor Kusnierczyk were the valuable source of information for the physicians. In 1997, on the 31st of January he died in Katowice.

A historical vignette (14). The anatomo-clinical method applied to ENT at the time of Jean Cruveilhier.

This paper evokes the personality of Jean Cruveilhier, presenting an overview of ENT pathology as reconstructed on the basis of his atlas: "The pathology of the human body" (1829-1842). We look at the anatomo-clinical method and paint a broad picture of medicine as practised in Paris during the first half of the 19th century (Figures 1,2).