A pioneer in two worlds: Thomas Keith (1827-1895) photographer and surgeon.

Thomas Keith, an Edinburgh surgeon, was an early and successful exponent of the operation of ovariotomy (ovarian cystectomy). He published detailed accounts of all of the patients on whom he carried out this procedure and his published success rate proved to be amongst the best in the world. The leading American surgeon J Marion Sims, who visited Keith to determine the reasons for this success, concluded that Keith's achievement resulted from meticulous attention to detail and his emphasis on the cleanliness of the instruments and the operating field, before this was generally adopted. His friendship with Joseph Lister led to his early use of Listerian antisepsis, which further improved these results. Yet, his medical colleagues and his obituarists seemed unaware of his other significant pioneering contribution, as a gifted photographer and pioneer of the waxed paper technique of photographic processing. That same attention to detail resulted in photographs of the highest quality whose significance has since been appreciated by photographic historians.

Augustus Bozzi Granville (1783-1872): Pioneer obstetrician and gynaecological surgeon who performed the first scientific autopsy of a mummy.

AB Granville was a pioneer obstetrician and gynaecologic surgeon who performed the world's first myomectomy and the first ovariotomy in England. He also performed the first scientific autopsy of an Egyptian mummy, discovering the oldest known ovarian tumour. He thought it was malignant and caused her death from 'ovarian dropsy'. This study reveals the tumour to be a benign cystadenoma. Further analysis indicates she died from terminal pneumonia from tuberculosis.

[Influence of anesthesia and antisepsis on the earliest gynecologic laparotomies: historical notes on the bicentennial of the introduction of ovariectomy]. / Influencias de la anestesia y antisepsia sobre las primeras laparotomías ginecológicas. Notas históricas a propósito del 2do centenario de la introducción de la ovariectomía.

On the occasion of the bicentennial of the first ovariectomy, we reviewed the beginnings of abdominal gynecologic surgery in Spain in order to shed light on aspects that are still unclear in medical historiography and that are often wrongly presented. We consulted a large number of sources that allowed us to follow events in the last quarter of the nineteenth century, discovering information we consider definitive and that confirmed our initial hypotheses. The work of Dr Federico Rubio, the first to perform an ovariectomy in Spain, is highlighted among the early experiences of our Spanish surgeons. Emphasis is placed on the high mortality rate associated with this operation at the beginning. We also analyze the problems of anesthesia and antisepsis and the influence of each on the surgical procedure. The events uncovered were the work of a group of forward-thinking surgeons who made considerable progress against opposing groups with more conservative views and whose contributions to Spanish surgery were far less brilliant.

Influencias de la anestesia y antisepsia sobre las primeras laparotomías ginecológicas. Notas históricas a propósito del 2º centenario de la introducción de la ovariectomía / Influence of anesthesia and antisepsis on the earliest gynecologic laparotomies: historical notes on the bicentennial of the introduction of ovariectomy

Con motivo del segundo centenario de la primeraovariectomía, hemos realizado este trabajo con el propósitode revisar los comienzos de la cirugía ginecológicaabdominal en España, a la vez que se pretende esclareceralgunos aspectos históricos que aparecen en nuestrahistoriografía médica no perfectamente claros y, muchasveces, tergiversados. Se analiza una importante bibliografíaque nos permitió hacer un seguimiento a lo largodel último cuarto del siglo XIX, proporcionándonosdatos que consideramos definitivos y que confirmaríannuestras suposiciones iniciales. Se hace hincapié en lalabor del Dr. Federico Rubio cómo iniciador en Españade la operación de la ovariectomía, así como de las experienciasprimeras de nuestros cirujanos; destacando lagran mortalidad de esta operación durante estos primerosensayos. También se analizó el problema de la anestesiay de la antisepsia, y la influencia que ambas tuvieronsobre esta cirugía, resaltando la labor de un grupode cirujanos de nueva mentalidad que con el auxilio deestos medios, lograron éxitos notables en contraposicióna otros, que anclados en el pasado, escribían una páginade mucho menos brillo en nuestra cirugía(AU)

On the occasion of the bicentennial of the firstovariectomy, we reviewed the beginnings of abdominalgynecologic surgery in Spain in order to shed light onaspects that are still unclear in medical historiographyand that are often wrongly presented. We consulted alarge number of sources that allowed us to follow eventsin the last quarter of the nineteenth century, discoveringinformation we consider definitive and that confirmedour initial hypotheses. The work of Dr Federico Rubio,the first to perform an ovariectomy in Spain, ishighlighted among the early experiences of our Spanishsurgeons. Emphasis is placed on the high mortality rateassociated with this operation at the beginning. We alsoanalyze the problems of anesthesia and antisepsis andthe influence of each on the surgical procedure. Theevents uncovered were the work of a group of forwardthinkingsurgeons who made considerable progressagainst opposing groups with more conservative viewsand whose contributions to Spanish surgery were farless brilliant(AU)

The first successful elective laparotomy.

The first time the abdomen was opened at an elective operation, the pathology excised and made a smooth recovery was not, as you might guess, performed in some famous university hospital in the British Isles or mainland Europe about a hundred years ago, but in a private house in the backwoods of Kentucky in 1807, and the story is a fascinating one.

William James West (1794-1848): abdominal surgeon and distraught father.

William West was an early-nineteenth-century successful small-town surgeon-apothecary who took a major role in the local movement for medical reform. He published the first series of ovariotomies in England in 1837. His son suffered from a type of infantile spasm which West described in the Lancet in 1841, and which is now known as West's syndrome.

[Eugene Koebèrlé (1828-1915), founder of modern surgery]. / Eugène Koeberlé (1828-1915), père de la chirurgie moderne.

Eugène Koeberlé, surgeon and anatomist gained international renown due to his outstanding ability in resection of ovary cysts and in hysterectomy. He was one of the first to perform these operations successfully. He was a pioneer in asepsis and pre- and postoperative care. He also invented many surgical instruments, among them an efficient hemostatic forceps.

Unravelling the biochemical basis of blood group ABO and Lewis antigenic specificity.

The ABO blood-group polymorphism is still the most clinically important system in blood transfusion practice. The groups were discovered in 1900 and the genes at the ABO locus were cloned nearly a century later in 1990. To enable this goal to be reached intensive studies were carried out in the intervening years on the serology, genetics, inheritance and biochemistry of the antigens belonging to this system. This article describes biochemical genetic investigations on ABO and the related Lewis antigens starting from the time in the 1940s when serological and classical genetical studies had established the immunological basis and mode of inheritance of the antigens but practically nothing was known about their chemical structure. Essential steps were the definition of H as the product of a genetic system Hh independent of ABO, and the establishment of the precursor-product relationship of H to A and B antigens. Indirect methods gave first indications that the specificity of antigens resided in carbohydrate and revealed the immunodominant sugars in the antigenic structures. Subsequently chemical fragmentation procedures enabled the complete determinant structures to be established. Degradation experiments with glycosidases revealed how loss of one specificity by the removal of a single sugar unit exposed a new specificity and suggested that biosynthesis proceeded by a reversal of this process whereby the oligosaccharide structures were built up by the sequential addition of sugar units. Hence, the primary blood-group gene products were predicted to be glycosyltransferase enzymes that added the last sugar to complete the determinant structures. Identification of these enzymes gave new genetic markers and eventually purification of the blood-group A-gene encoded N-acetylgalactosaminyltransferase gave a probe for cloning the ABO locus. Blood-group ABO genotyping by DNA methods has now become a practical possibility.

How old is endometriosis? Late 17th- and 18th-century European descriptions of the disease.

UNLABELLED: DESIGN OF THE PROJECT: This study is the result of a detailed examination of numerous historical documents as well as several contemporary works describing endometriosis. The historic texts are housed in the National Library of Medicine in Bethesda, Maryland, and had not been unearthed previously. Those primary sources date from 1690 to 1797 and repeatedly describe the organic damage and constitutional symptoms currently identified with endometriosis. The biologic research for this study was done during 1997 and 1998 in the Pathology Department of the Canton-Potsdam Hospital located in Potsdam, New York. CONCLUSION(S): Endometriosis was described in European history approximately 300 years ago.

The early historical roots of pediatric and adolescent gynecology.

BACKGROUND: The science of medicine is a constantly evolving process that builds on the experiences and observations of the past. We hypothesized that the issues of pediatric and adolescent gynecology were also of concern to physicians practicing in the 19th century. We sought to determine the extent to which our forebears of over 100 years ago considered, diagnosed, and treated these problems. METHODS: We conducted an exhaustive search through two English-language medical journals, The Obstetrical Journal of Great Britain and Ireland (vol. 1-7, 1873-1880) and The American Journal of Obstetrics (vol. 1-32, 1869-1895), for articles relating to pediatric and adolescent gynecology. RESULTS: The most frequently encountered subject was the surgical management of congenital absence or atresia of the vagina and associated anomalies of adjacent organs. By 1881, the opinion expressed by many investigators was that the method used by Thomas Addis Emmet to create an artificial vagina between the bladder and the rectum by a single-stage procedure of blunt dissection and the immediate placement of a glass vaginal dilator gave the best chance of a favorable outcome. The practice of making an artificial opening through the rectum was abandoned. In 1882, a review of published reports noted 43% postoperative mortality in children treated for benign and malignant ovarian tumors. A review article in 1891 reported a 10% mortality rate associated with treatment of the imperforate hymen. A research article in 1870 noted the mean age at menarche in England to be 14.96 years. Additional subjects in the literature included: "Acquired Venereal Disease in Children" warning of the need for "rigid ... scrutiny of the attendants and playmates of children" (1893), the enigmatic occurrence of "Vaginal Hemorrhage in an Infant Five-Days-Old" (1874), the brutal atrocities perpetrated against "The Child Wives of India" (1895), "Early Pregnancy" reviewing childbirth by young adolescents (1874), "Hermaphrodism" (1886), "The ... Hymen and Its Remains ..." (1871), a "Case of Fatal Hemorrhage from the Genital Organs" in which a 17-year-old exsanguinated from a vaginal laceration (1879), and "Primary Sarcoma of the Vagina ... in a Child Three-Years-Old" (1881). CONCLUSION: Modern pediatric and adolescent gynecology can trace its roots to well over a century ago.

[The Revista Médica de Chile: 100 years ago]. / La Revista Médica de Chile: 100 años atras.

The percutaneous drainage of a giant ovarian cyst using a thick needle is described. The author, Dr Juan N Casanova sustained a controversy with medical authorities of the so called Protomedicato.

The pathogenesis of ovarian neoplasia.

Currently in the United States intra-abdominal neoplasia involving or originating in the ovary is responsible for the death of 11,000 women per year, or one every 50 minutes. Historically, as well as can be documented, although benign ovarian cysts were common, malignant neoplasia was rare. Furthermore, similar lesions arising in or adjacent to the testes are essentially unknown. The uniqueness of the tumors is appreciated by the recognition of the common cell of origin, but there are many different histologic varieties of neoplasia that may arise therefrom. The differences in incidence between the sexes and the apparent significance of irritants to which the female pelvic cavity may be exposed suggest that such proliferating agents may ascend from the vagina through the patent fallopian tube and into the pelvic and/or the general abdominal cavities. Since little improvement has been made in the overall five-year survival rate during the past 25 years (in spite of the widespread use of chemotherapeutic and other treatment modalities), possibly our basic thrusts should be directed at defining carcinogenic processes and thus preventing the development of such lethal disease.