[The private society 'Utrechtsch Geneeskundig Gezelschap Matthias van Geuns' as a source of history and inspiration]. / Het besloten Utrechtsch Geneeskundig Gezelschap Matthias van Geuns als historie- en inspiratiebron.

The Utrechtsch Geneeskundig Gezelschap [Utrecht Medical Society] Matthias van Geuns (1793 to the present) is the oldest still active local medical society in the Netherlands. Membership is select and limited to only one local representative from every medical specialty. Proceedings of the medical meetings have never been published, neither was a prize offered for a best essay. The minutes of the meetings, however, have been preserved. They give a fascinating insight into the way this small society reacted to the developments in medicine during two centuries. Infectious diseases, for example cholera, abdominal typhus and tuberculosis, and newly introduced surgical procedures like anaesthesia and antisepsis or asepsis were discussed. The lectures had to be attended by all members and were meant to be aimed at a general medical audience. The society members were expected to prepare themselves and take part in the discussion afterwards, everyone from his own point of view. This procedure was both instructive and stimulating. The minutes of the Utrechtsch Geneeskundig Gezelschap Matthias van Geuns are a valuable source for scientific research on medical developments in the Netherlands, particularly in Utrecht.

['A sad and painful heart'--Andreas Vesalius as cardiologist]. / 'Een droef en pijnlijk hart' Andreas Vesalius als cardioloog.

One needs courage to dissociate oneself from ideas maintained for ages and put forward by authorities. How laborious this process has been for Vesalius concerning the heart, is obvious when we compare the information of an eye-witness with both editions of the De Humani Corporis Fabrica (1543 and 1555). He must have come hesitantly to the conclusion that the views on the permeability of the septum cordis, as they were supported by Galen, Mondino and Johann Winther, a professor at Louvain, could not be defended. However, they had been essential in the considerations about the blood-flow. Although Vesalius demonstrated by vivisection-experiments that a relation exists between the pulse and the heart contractions, he was not an experimenting cardiophysiologist. In this respect, he stood far behind his contemporary Leonardo da Vinci, who made experiments on heart ntractions and the bloodstream along the heart valves. Vesalius was an anatomist! And a morphologist! But he was also a physician. In this respect, he also was interested in the pathological aspects of anatomy. So he recalled in, his last book, Anatomicarum Gabrielis Fallopii Observationum Examen (1564) some cardiologically interesting patients, a.o. the courtier van Immerseel, with a very unequal pulse and "a sad and painful heart" (tristi in corde, sensu doloreve), by whom a heart abnormality was found post mortem, that in modern terms we could call "an old heart infarction with thrombus formation." According to Schenk von Grafenberg, Vesalius was dreaming of a big book about anatomo-pathology, but alas, he never wrote it. Undoubtedly he would have trusted more his eyes and less Galen: "non solum ex Galenis testimonio, sed etiam oculis ipsis perspexeris".

Angiosarcoma of the heart presenting as pulmonary disease.

A 23-year-old man died from the pulmonary manifestations of cardiac angiosarcoma. The absence of all cardiac signs and symptoms was an unusual feature. The clinical outcome was rapidly fatal. Apparently, the presence of cardiac symptoms in a patient with primary cardiac angiosarcoma is not obligatory.

Pott's disease before Pott.

Pott's disease, i.e. caries of the spine with gibbosity, psoas abscesses and palsy, has been known since antiquity, its relation with tuberculosis suspected, as is seen in the Hippocratic writings. In the 18th century cases were studied in France and England; in the Netherlands by Hovius, Camper, Bonn and Coopmans. The most lucid descriptions however were those of SIR PERCIVALL POTT (1779). An annotated Dutch translation by DU PUI (1779) called attention to the treatment of this disease which was on the increase. In retrospect the eponym 'Pott's disease' seems well deserved.

Compression as a treatment of cancer, a historical survey.

Compression in medicine goes far back in history. In ancient Rome and during the Renaissance compression by means of leaden plates was a well-known treatment of cancer. Compression flourished particularly in the first half of the 19th century, in Great Britain encouraged by the publications of Young and Arnott and Walshe, in France especially by the work of Récamier. Around 1850 this treatment fell into discredit: on the one hand because of improved surgical possibilities, on the other because not all the alleged cures concerned true malignancies. The results were, on the whole, disappointing. Quite recently, compression re-appeared as a treatment of carcinoma of the urinary bladder.

Early Dutch contributions on Peyronie's disease.

Long before De la Peyronie's description of three cases of plastic induration and curvature of the penis (1743) the disorder was already known. The Ephemerides (1687) and the rather scabrous booklet, Venus minzieke gasthuis (Venus Hospital for the lovesick)(1688), contain short remarks on this condition. Two extensive Dutch contributions -- not mentioned in the literature on this subject -- were written by Nicolaas Tulp (1593--1674) and Fredrik Ruysch (1638--1731). The first one is a case history, the second one is more general discussion with a fine engraving added. Treatment varied according to the various early authors. The therapeutic successes claimed must be seen in the light of the natural history of this disease: spontaneous improvement occurs not infrequently. To change the eponym 'Peyronie's disease', however, seems unjustified. It is an homage to François Gigot de la Peyronie (1678-1747) surgeon to King Louis XV and founder of the French Académie de Chirurgie.

Sweat gland tumour of the eyelid with conjunctival involvement.

An 87-year-old woman presented with a rapidly growing tumour at the nasal side of the upper eyelid. The clinical diagnosis was basal cell carcinoma. During surgery, the impression of malignancy was accentuated by the finding that even the conjunctiva had been invaded. Histological examination revealed an eccrine acrospiroma with, indeed, many mitoses but, on the other hand, a completely benign aspect. Besides, there was no recurrence after 1 year.