Instances of Biowarfare in World War I (1914-1918).

During World War I (WWI), also referred to as 'The Great War,' Germany implemented a pioneering biowarfare program as part of a broader military strategy to undermine Allied forces by targeting their logistical and supply capabilities. This initiative, unprecedented in its systematic and strategic application, utilized a variety of pathogens, primarily targeting animal populations, to disrupt support systems without contravening international laws, specifically the 1907 Hague Convention. The operations, shrouded in secrecy and largely led by the German General Staff, included sophisticated sabotage actions against both enemy and neutral states. The allegations and usage of bioweapons increased the interest of the Great Powers in further developing their own biowarfare program.

Early Infirmaries in Methoni During the Venetian Occupation.

INTRODUCTION: In the High Middle Ages, Venetian sovereignty was recognized in Methoni and Koroni (in Greece). It helped lay the foundations for the prevalence of democracy in Venice in the Eastern Mediterranean. The development of these two decadent regions of Messinia, had to be supported by social welfare infrastructure. Today, the search for these social welfare infrastructures in Venetian Methoni at the beginning of the conquest turns mainly to the monasteries of the Latin monastic orders that settled there during that time. These spiritual institutions, which provided shelter, hospitality, and even medical care to those in need, have not been identified to date. OBJECTIVES AND METHODS: The goal of this paper is to propose two possible locations based on bibliographic and on-site research. With the help of bibliographies, Venetian files, and relevant wills from the time, an effort was made to identify these ruins. On-field research was carried out to consolidate the findings that arose from the analysis of bibliographic references, the evidence arising from them, as well as local tradition. RESULTS AND CONCLUSION: The monastery of the Cistercian nuns shows that, in the context of charity, medical care was provided to those in need. The monastery in Paliomothoni was one of the earliest infirmaries in Venetian Methoni. The location of the first infirmary of Venetian Methoni within the Cistercian monastery of Paliomothoni is highly probable. Additionally, it was found to be operating there by Dominican monks at a later time.

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.

Morbidity During the Early Interwar Period (1923-27): A Historical-Epidemiological Study of 15,146 Cases Treated at the "Agios Dimitrios" Hospital in Thessaloniki, Greece.

Background and objective The period spanning 1923-1927 was a turbulent period in Greek history following the catastrophic defeat of the Greek army in September 1922, known as the "Asia Minor Catastrophe". The massive settlement of refugees in Thessaloniki, Greece, entailed massive economic, public health, and social challenges. The present historical-epidemiological study aims to evaluate the diseases of individuals hospitalized at the "Agios Dimitrios" Hospital in Thessaloniki during the aforementioned period. Materials and methods This study involved 15,146 consecutive patients (January 1923-March 1927) treated at the hospital. Data were collected from the General Hospital of Thessaloniki "Agios Dimitrios" and were manually entered into a pre-coded database. Descriptive statistics were calculated. In addition, the case fatality rates (CFR) were calculated; the respective 95% confidence intervals (CI) were estimated. Results The most frequent causes for admission to the hospital were as follows: normal delivery/delivery without disclosed sequalae (n=1915, 12.7%), followed by tuberculosis (n=1514, 10.0%), malaria (n=1438, 9.5%), injuries/falls/fractures (n=1394, 9.2%), pneumonia/pleuritis (n=1010, 6.7%), appendicitis (n=623, 4.1%), dysentery/enterocolitis/typhoid (n=489, 3.2%), salpingitis/salpingo-oophoritis (n=358, 2.4%), soft tissue abscesses (n=309, 2.0%), hernias (n=295, 2.0%), rabies (n=239, 1.6%), metrorrhagia/menorrhagia (n=233, 1.5%), ocular cataract (n=225, 1.5%), postpartum infections/endometritis (n=181, 1.2%), uterine discomfort/uterine pain (n=162, 1.1%), nephritis/uremia (n=157, 1.0%), miscarriage (n=155, 1.0%), skin infections/inflammations excluding abscesses (n=152, 1.0%), otitis/mastoiditis/labyrinthitis (n=96, 0.6%), and peptic ulcer (n=93, 0.6%). Tuberculosis was particularly associated with high CFR (49.5%, 95% CI: 47.2-52.3%), followed by nephritis/uremia (CFR: 37.6%), dysentery/infectious enterocolitis/typhoid (CFR: 24.3%), peptic ulcer (CFR: 22.6%), pneumonia/pleuritis (CFR: 16.1%), postpartum infections/endometritis (CFR: 15.5%). Conclusions Infections predominated in the disease spectrum of the hospitalized population. The documented fatality rates were high; poor outcomes may reflect the socioeconomic adversities and limited medical means and resources available at that time.

The Hospital of Medieval Venetian Methoni.

In medieval Venetian Methoni, the provision of medical care could be roughly divided into two phases. During the first phase, Venice provided medical care solely to the staff, the garrison, and the Venetian citizens residing in Methoni. Medical care to the rest of the population was offered by the solitary orders that had settled in the area after the conquest of Methoni, in the context of charity. In the second phase, when trade with the East and also the pilgrimages to the Holy Places increased, the Senate took over medical care, initially by subsidizing the local monasteries and later, according to a decision made by the Senate of Venice since 1423, by taking over the provision from its own hospital, which was located in the residential area of the castle, dedicated to Saint Johannes the Theologian (Evangelist).

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.

The Plague in Crete During the 19th Century.

The plague is one of the most dangerous infectious diseases that can affect mankind. The disease has caused countless pandemics over the centuries in many parts of the world, mainly Asia, Africa, and Europe, and has caused over 200 million deaths, making it one of the greatest scourges of mankind throughout the ages. Similar to the rest of Greece, Crete was affected for many years by the plague during the 19th century, which caused significant mortality, both in the cities and the countryside. The lack of doctors, the absence of organized health systems, the ignorance of the origin and modes of transmission, and the belief of the island's Muslim conquerors in destiny and God-given diseases made the spread of the plague very easy, while simultaneously making its control, with measures to protect public health, extremely difficult. This led to the repeated decimation of the island's population, with immeasurable social and economic consequences for its progression and future development.

Alexander the Great (356-323 BC) and His Injury in Kyropolis Reconsidered.

Purpose: To reconsider Alexander the Great's injury in Kyropolis. Methods: Historical sources were compared with modern neurosurgery. Results: Earlier interpretations were focused on the transient blindness Alexander the Great presented after the injury, but according to our point of view we should rather focus on his dysarthria which lasted almost two months. Conclusion: We propose the hypothesis that Alexander the Great developed a posttraumatic delayed cerebellar syndrome after the injury.

Comparative study of pandemics and their impact on children and adolescents: COVID-19 and Spanish Flu.

Overview: Pandemics are characterized by an abrupt and sudden outburst and absence of preparation for its management. The focus during pandemics is on the medical aspect of the disease and not on its impact on the citizens' or vulnerable groups' psychosocial wellbeing. Aim: The purpose of this study was to highlight the impact of the pandemics of the Spanish Flu and COVID-19 on children and adolescents as well as to recognize their short and long-terms effects on children's and adolescents' physical and mental health. Materials and Methods: The material of this review constituted of publications regarding the impact of the Spanish Flu and COVID-19 on children and adolescents via relative search through valid databases and websites of trustworthy organizations. Results: The main finding of the present review was that pandemics negatively affect children and adolescents undermining their mental and physical health. The factors that negatively impact on this population's normal development include parental death, financial hardships, restrictive measures, disruption of daily routine and absence of social contact. The short-term effects include anxiety, depression, aggressive behavior as well as fear and grief. Mental disorders, disability, poor academic performance and low socioeconomic level are among the long-term effects of the two under study pandemics. Conclusions: Children and adolescents constitute a vulnerable group amidst pandemics and there is a need for coordinated worldwide and national actions to prevent and timely manage a pandemic's impact.

The History of Anthrax Weaponization in the Soviet Union.

In this paper, we reveal the anthrax weaponization in the Soviet Union and its impact on biowarfare research, technology, and public health that resulted in the development of the first Soviet Anthrax vaccine and the subsequent vaccination of animals and humans en masse. We assume that there are cases that a biowarfare technology was incorporated into the civilian industry and benefited public health. However, the legacy of bioweapons today still poses an asymmetric threat to public health and safety.

Chemical Warfare in Ancient Greek Ionia: Mass Intoxication With Hecate's Deleterium.

The rich land of Erythrae in the coast of Asia Minor attracted the attention of the Ionian king Codrus. An oracle demanded the presence of the murky deity Hecate for him to conquer the city. Priestess Chrysame was sent by Thessalians to set the strategy of the clash. The young sorceress poisoned a sacred bull who turned mad, later to be released toward the camp of Erythraeans. The beast was captured and sacrificed. In the feast that followed, all ate a piece of his flesh and went crazy, stimulated by the poison, an easy prey for the army of Codrus. The deleterium used by Chrysame is unknown, but her strategy shaped the origin of biowarfare.

Medicinal plants in the treatment of urinary tract malignancies during the Araboislamic period (7th- 14th century AD).

Arabic medicine, or Arab-Islamic, mainly refers to all developments achieved in the Age of Khalifs, or the Golden Age of the Arab-Islamic civilization (ca 7th-14th centuries AD). Arab scholars adopted ancient Greek medicine and soon understood the essence of the fatal disease known as cancer. They introduced various new types of cancer, distinguishing other entities like infection and proposed new methods of treatment, both surgical and non-invasive. Herbal medicine after Dioscurides and Galen bloomed in the Arabic world. Malignancy of the urinary tract was identified and a plethora of herbs were used to slow down its expansion. Moreover, herbal drugs were introduced to alleviate cancerous symptomatology. Avicenna introduced Hindiba, while known scholars like Abulcasis and Rhazes noted the benefits of garlic, onion, black seeds, pomegranate, olive oil as well as leaf and bread wheat. Arabian herbal medicine may still be beneficial in anticancer fight and mainly in the palliative medicine. It should be emphasized that almost 50% of the drugs administered today have their point of origin in the plants used in antiquity.

The Manchurian pandemic of pneumonic plague (1910-1911).

China's winter of 1910-1911 was one of its most difficult. A deadly airborne pneumonic plague, believed to have originated from tarbagan marmots, broke out in October 1910 in a northeastern Chinese province commonly known by the exonym Manchuria. The disease had a near 100 percent mortality rate, affecting mainly the lower socio-economic classes and eventually killing more than 60,000 people over six months. By April 1911, the epidemic was suppressed, in large part due to the efforts of a Western-educated Chinese physician, Wu Lian-Teh. Similar to the recent COVID-19 pandemic, the Great Manchurian Plague outbreak highlighted the importance of personal protective equipment, such as face masks, and a quick and efficient international medical response.

Mathieu Joseph Bonaventure Orfila (1787-1853): The Founder of Modern Toxicology.

Mateu Joseph Bonaventura Orfila i Rotger was a prominent Spanish chemist and scholar of the 19th century whose experimental work has enormously contributed to the progress of toxicology. Being a pioneer with his research on the effects of toxins and antidotes on live animals, he established basic principles of modern medicine and pharmacology. Orfila improved the accuracy of several chemical techniques such as the Marsh test. He served as an expert and well-known scientific investigator in important legal trials involving alleged poisonings with arsenic and other chemical substances. In 1840, he was asked to investigate the notorious case of Charles Lafarge's death, whose wife had been accused with murder by poisoning his food with arsenic. After four failed chemical analyses, Orfila was finally able to detect arsenic in the victim's body, leading the court to convict Madame Lafarge. Due to his overall contribution to the field, Orfila is considered the father of modern toxicology.

The Anti-tuberculosis Battle in Greece in the 1800s and 1900s.

Tuberculosis is an infectious disease that mainly affects the lungs (known as pulmonary tuberculosis). Mycobacterium tuberculosis is a species of pathogenic bacteria in the family of Mycobacteriaceae and the causative agent of tuberculosis; it was discovered by Robert Koch in 1882. From about 1918 to 1939, tuberculosis in Greece was characterized as a social disease because it seemed to spread among the lower social classes, including displaced people living in refugee camps. The battle against tuberculosis involved private initiatives aimed at educating people on hygiene and establishing anti-tuberculosis institutions, such as sanatoria and preventoria.

Hospital Agios Dimitrios: The General Public Hospital of Thessaloniki.

The purpose of this article is to highlight the history of Hospital Agios Dimitrios, the General Hospital of Thessaloniki. During the early 20th century, many refugees settled in the Greek city of Thessaloniki. To address the growing public health needs of the city's inhabitants, the Greek government established a health agency to offer medical care and respond to infectious disease outbreaks and epidemics. This initiative resulted in the construction or renovation of various hospitals. The Hospital Agios Dimitrios in Thessaloniki was completed in 1903. Its innovative architecture includes kiosks and wards designed to provide better ventilation and prevent the transmission of infectious diseases.

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.

Constantinos Michael (1751-1816): 19th Century Doctor and Medical Philosopher.

Objectives: During the 18th and 19th centuries, many books about science were published. Constantinos Michael (1751-1816), the first medical historian to write in Greek, contributed to this literature. Born in Kastoria, Greece, Constantinos Michael lived and studied medicine and philosophy in Vienna. His book Dietetics describes how lifestyle and diet can benefit or harm human health. Though not well known, Constantinos Michael made substantial contributions to medical scholarship and the promotion of Greek history and Hellenic culture, as described in this study. This is the first such study of Constantinos Michael and his medical treatise, Dietetics.

Alexandra General Hospital in Athens: Historical Connections to the Greek Royal Family.

Princess Alexandra of Greece (1870-1891), the eldest daughter of King George I of Greece (1845-1913), was known as the "beloved daughter of the Athenians". Her death at the age of 21 in 1891 due to a pregnancy complication caused nationwide grief. To honour her, the Alexandra Maternity Hospital in Athens was named in her memory. Affiliated with the University of Athens, Alexandra Maternity Hospital researches pregnancy and newborn care, including complications and maternal mortality. Today, the hospital contains various clinical and laboratory departments providing patients with exceptional health care.

Joseph Lister (1827-1912): A Pioneer of Antiseptic Surgery.

Joseph Lister was a prominent British surgeon and medical scientist who established the study of antisepsis. Applying Louis Pasteur's germ theory of fermentation on wound putrefaction, he promoted the idea of sterilization in surgery using carbolic acid (phenol) as an antiseptic. His method reduced the incidence of wound sepsis and gangrene, which, in turn, reduced the need for amputation. By showing how germs could be prevented from entering the wound, Lister increased the safety of surgical operations and laid the foundations for all subsequent advances in the field.