Historical impact to drive research in peptic ulcer disease.

The story of gastric acid secretion began with early ideas on gastric secretion (Spallanzani and de Réaumur, 17th century) and with first descriptions of food digestion (Dupuytren and Bichat, Beaumont, early 18th century), followed by proof that gastric juice contained acid (Prout, early 18th century). The research continued with first descriptions of gastric glands as the source of gastric acid and its changes upon digestive stimulus (Purkinje and Golgi, mid and late 19th century). The theory of 'nervism' - the neuro-reflex stimulation of gastric secretion by vagal nerve (Pavlov, early 20th century) was contrasted by a histamine-mediated concept of gastric secretion (Popielski and Code, mid 20th century). Thus, gastric acid and pepsin (Schwann, early 19th century) were found to be essential for food digestion and studies also pointed to histamine, being the most potent final common chemostimulator of oxyntic cells. The discoveries in etiopathogenesis of mucosal injury were marked by the famous dictum: 'No acid, no ulcer' ('Ohne saueren Magensaft kein peptisches Geschwür', Schwarz, 1910) that later induced the term of 'mucosal defense' and the notion that the breaking of 'gastric mucosal barrier' represents the initial step in the process of mucosal injury (Davenport, Code and Scholer, mid 20th century). The prostaglandins were shown to influence all major components of gastric mucosal barrier, described with the term 'cytoprotection' (Vane, Robert and Jacobson, 1970s). Beginning in the latter half of 19th century, the studies on gastric bacteriology that followed enabled the discovery of association between Campylobacter (Helicobacter) pylori and peptic ulcers (Warren and Marshall, 1980s) that led to worldwide major interventions in treating peptic ulcer disease. The surgical approach to peptic ulcer had been outlined by resection procedures (Billroth, Pean, Moynihan, late 19 century) and vagotomy, with or without drainage procedures (Jaboulay, Latarjet, Dragstedt, mid 20th century). Antacids, protective agents, anticholinergics, and later gastrin antagonists and prostaglandins were used for decades in the treatment of peptic ulcer, with differing effects. The advent of the concept of H(2)-receptor antagonists (Black, 1970s) and the discovery of acid (proton) pumps in parietal cells (Ganser, Forte and Sachs, late 1970s) paved the way for potent (H(2) antagonists) and profound acid inhibition (proton pump inhibitors) that revolutionized the treatment of acid-related disorders, including peptic ulcer disease. Worldwide, peptic ulcer and its complications remain the cause of significant morbidity, especially in older age groups, representing a major burden for ambulatory and hospital healthcare resources.

"I am living in my own corpse"--the experience of tuberculosis in poems by A B Simic.

This paper focuses on seven poems dealing with various aspects of his experience of tuberculosis and uncovers different shades of poetic self within his verses: the notions of self transforming from a helpless child to a ghostly, transparent creature in the secluded world of a hospital ward, and to decaying flesh and "living in a cadaver" are pinpointed. Poetry as creation is the opposite of physical demise; in poetry Simic finds escape not from the inevitable end, but from suffering. These poems are not confessions of a sick young man; they are relevant works of art touching readers' sensitivity and imagination. They may be relevant for medical professionals in enabling them to view disease-in this case tuberculosis-in a wider context and to be open to the many and different ways in which the experience of illness can be expressed.

Beauty: soul or surface?

It is proposed that beauty can be external or internal or both. External or physical beauty is immediately visible. Internal or inner beauty is not always immediately visible. Ideally both types of beauty are connected and spring from one another. The opposite situation, in which only one exists while the other is suppressed, is exemplified in this paper, using a tale from 19th century Croatian literature as a model. The main character is Tena. Initially physically beautiful, she is later disfigured by smallpox. Consequently her psyche metamorphoses through illness, distress and destitution, and she discovers an inner self that allows her full personality to develop. The story of Tena illustrates how love based only on outer appearance may end in unhappiness. Perhaps true love depends more on soul than surface. Endless quests for external beauty are part of medical practice today more then ever before. Skin is the paradigm of this. The dermatologist needs many clinical skills, including an understanding of psychology, when addressing skin-related problems--appearance-related problems in particular. Sometimes the humanities (e.g. literature, poetry, etc.), may help broaden our perspective of such a complex phenomenon as beauty.

The image of a leper (?): a paradigm of hidden fears of contagious diseases (exemplified in a wall painting of Saint Elizabeth of Hungary).

This is a brief study on the popular ideas about leprosy based on an 18th century wall painting in north-western Croatia portraying Saint Elisabeth healing a sick man, possibly a leper. The analysis uses examples from the history of medicine, semantics, toponymy and iconography.

The image of a leper (?): a paradigm of hidden fears of contagious diseases (exemplified in a wall paitung of Saint Elizabeth of Hungary)

This is a brief study on the popular ideas about leprosy based on an 18th century wall painting in north-western Croatia portraying Saint Elisabeth healing a sick man, possibly a leper. The analysis uses examples from the history of medicine, semantics, toponymy and iconography.

Introducing death: a 15th century Croatian Glagolitic literary text.

We explored the notions of life and death as perceived and presented in a 15th century Croatian literary text, Slovo Mestra Polikarpa, in which master Polikarp, a well-learned man of medieval times, engages in a lengthy dialogue with Death itself. This contrast/debate is a rare piece of medieval literature, not only by its Old Croatian language, but also by the angular Glagolitic script in which it was written. As a part of Croatian cultural heritage, it is deeply rooted in and clearly belongs to the common context of Western European medieval views on life, health, ailing, and death. A medieval perspective on such issues might be interesting to broad readership and, in many aspects, to medical professionals, whose everyday practice necessarily involves not only practical and scientific, but also moral, philosophical, and religious deliberations about life and death.

Cazenave, Kaposi and lupus erythematosus. A centennial and a sesquicentennial.

A review is presented calling attention to the first naming and publication of the term 'lupus erythematosus' and to the dermatologist (M. Kaposi) who first detected the systemic nature of this disease.

Mal de Meleda: from legend to reality.

Luca Stulli of Dubrovnik (Ragusa), 1772-1828, was one of the first to make epidemiologic studies of heritable skin disorders. His treatise of what became the 'mal de Meleda' on the Adriatic island of Mljet (Meleda) is a classic in the dermatologic literature. The present study documents his life, his birth record, his portrait and recalls his original publication (in Italian).

The chair of dermatovenerology at Zagreb School of Medicine. On occasion of the 80th anniversary of its foundation (1921-2001).

The development of dermatovenerology in Croatia parallelled more or less this process in other parts of the Austro-Hungarian Monarchy throughout the 19th century. The foundation of the first specialized hospitals as well as the establishment of dermatovenerological units and their transformation into academic departments and chairs in the early 20th century was a slow growth provoked by the spread of syphilis and Skrljevo disease. A group of Zagreb physicians were instrumental in this regard. Based on archival sources, this paper illustrates the chronology and circumstances of the foundation of the first chair, on the occasion of its 80th anniversary.

The sacred disease and its patron saint.

Although the Hippocratic natural theory of epilepsy as a brain disorder originated around 400 bc , it did not begin to take root until the 18th and 19th centuries, leaving the intervening centuries dominated by mostly supernatural concepts. This article provides historical insight into human behavior when afflicted with disease: supplication to a patron saint, Saint Valentine, a cult that spread throughout Europe.

100 years of Japanese dermatology: a perspective from abroad.

The development of Japanese dermatology is reviewed from the times of the founding fathers and Keizo Dohi to today. Tribute is paid to the heroes of the first hour. Thereafter, an evaluation of Japanese-authored papers in the leading journal of the field (JID) over four decades is presented, taking a triennial slot in each. The contribution of Japanese- authored papers has increased substantially over this period.

Giovanni Alessandro Brambilla (1728-1800) and the Imperial Infantry Regiment #22 ("Lacy"). On occasion of the bicentennial of his death.

Giovanni Alessandro Brambilia (1728-1800) was the Chief Surgeon of the Imperial Austrian Army and the first director of the newly founded medico-surgical academy in Vienna (1785). He died in Padua in late July 1800 (29th?), en route from his estate in Lombardy to Vienna, and the chiostro della magnolia in the Santo displays a memorial plaque commemorating his demise. On account of his merits for the education of (military) surgeons and the development of surgery in Austria, this short article shall serve to briefly recall his life and related facts.

Mirko Drazen Grmek: the genesis of scientific fact and archaeology of disease.

Professor Mirko Drazen Grmek (Krapina 1924--Paris 2000) was one of the most prominent Croatian scientists. Work in history of science directed him to the crossroads of various fields placing his approach in anthropological perspective. Two models will serve as illustrations of his main theories. The historical reconstruction of scientific discovery (mostly on examples of 17th century) will be presented as well as Grmek's ideas on a concept of disease. The introduction of the term "memoricide" within his activities during aggression on Croatia is mentioned.