A depiction of poliomyelitis in a 17th -century Piedmontese fresco?

INTRODUCTION: A potential representation of poliomyelitis is investigated in an Italian artwork. MATERIALS AND METHODS: A 17th century Piedmontese fresco is analyzed by combining historico-medical, palaeopathological and clinical approaches. Alternative diagnoses are considered. RESULTS, DISCUSSION AND CONCLUSIONS: The man appearing in the fresco holding a crutch is characterized by an atrophic left leg reminiscent of poliomyelitic atrophic. Other congenital anomalies or cerebrovascular causes appear less likely. A reflection on the difficulty of retrospectively diagnosis poliomyelitis is offered.

Vincenzo Malacarne (1744-1816) and the First Description of the Human Cerebellum.

Vincenzo Malacarne, professor of medicine, surgery, and obstetrics in Turin, Pavia, and Padua, Italy, represented a perfect example of an eighteenth century "letterato", combining interests in humanities, sciences, and politics, embodying the ideal of an encyclopedic and universal culture. He made important contributions in anatomy and surgery, teratology, obstetrics, neurology, and history of medicine, adopting a interdisciplinary approach based on the correlation between anatomy, surgery, and clinics. He deserves a special place in the history of neurology because of the first complete description of the human cerebellum. He quantified the units of the cerebellar internal structures, the lamellae being numbered for a systematic description of the human cerebellum. He thought the mental faculties depended on their number, considering a relation between the number of cerebellar lamellae and the expression of intellectual faculties. In this way, he made first statistics on human faculties. He advanced the concept that the number of cerebellar folia was influenced by the environment, thus providing the first nature-nurture hypothesis made on the basis of observations, and the concept of neuroplasticity in the scientific literature. Finally, he also contributed to the emergence of a new science, namely electrophysiology, because he laid down experimental foundations of a project on the recording of brain electricity, comparing the structure of the human brain with Volta's galvanic pillar.

Giovanni Verga (1879-1923), author of a pioneering treatise on pituitary surgery: the foundations of this new field in Europe in the early 1900s.

The field of pituitary surgery was born in the first decade of the twentieth century in Europe, and it evolved rapidly with the development of numerous innovative surgical techniques by some of the founding fathers of neurosurgery. This study investigates the pioneering Italian treatise on pituitary surgery, La Patologia Chirurgica dell'Ipofisi (Surgical Pathology of the Hypophysis), published in 1911 by Giovanni Verga (1879-1923), a surgeon from Pavía and one of Golgi's disciples. This little-known monograph compiles the earliest experience on pituitary surgery through the analysis of the first 50 procedures performed between 1903 and 1911. We conducted a biographical survey of Giovanni Verga and the motivations for his work on pituitary surgery. In addition, a systematic analysis of all original reports and historical documents about these pituitary procedures referenced in Verga's treatise was carried out. Verga's treatise provides a summary of the techniques employed and surgical outcomes for the first 50 attempted procedures of pituitary tumor removal. This monograph is the only scientific source that includes a complete account of the series of 10 pituitary tumors operated on by Sir Victor Horsley in the 1900s. Three major types of surgery were employed: (i) palliative procedures of craniectomy (n = 6); (ii) transcranial approaches to the pituitary gland, either subfrontal or subtemporal (n = 13); and (iii) transphenoidal routes to expose the sella turcica, either using an upper transnasal-transethmoidal approach (n = 19) or a lower sublabial/endonasal-transeptal one (n = 12). An operative mortality rate of 36% (n = 17) was observed in these early series. The pathological nature of the tumors operated on was available in 42 cases. There were 28 adenomas and 15 craniopharyngiomas. Sir Victor Horsley (1857-1916) and the Viennese surgeons Anton von Eiselsberg (1860-1939) and Oskar Hirsch (1877-1965) were the leading European figures in the development of pituitary surgery. Giovanni Verga's treatise La Patologia Chirurgica dell'Ipofisi is a fundamental, pioneering book in the history of pituitary surgery, a work that compiles the foundations of this field in Europe and the only authoritative source providing a complete record of pituitary procedures performed by Sir Victor Horsley.

Pavia, September, 1961: a window on muscles and nerves.

In September 1961, the First International Congress of Electromyography (EMG) was held at the University of Pavia. This event proved to be a sort of foundation stone for the further development of EMG as an organized field. Many of the most distinguished clinical neurophysiologists attended this congress and took an active part in it, delivering important lectures and scientific communications on the various aspects of EMG, including electroneurography. They included: Henri Gastaut, Fritz Buchthal, Jean Edouard Desmedt, Eric Kugelberg, Roger W. Gilliatt, John A. Simpson, Albrecht Struppler, Irena Hausmanowa-Petrusewicz, and Howard Edward Lambert. The congress was organized by Paolo Pinelli, at the time a young and brilliant clinical neurophysiologist who had learned the EMG procedure in Copenhagen under the guidance of Fritz Buchthal. Various scientific and social aspects of this important congress are outlined in this paper.

Cesare Lombroso: an anthropologist between evolution and degeneration.

Cesare Lombroso (1835-1909) was a prominent Italian medical doctor and intellectual in the second half of the nineteenth century. He became world famous for his theory that criminality, madness and genius were all sides of the same psychobiological condition: an expression of degeneration, a sort of regression along the phylogenetic scale, and an arrest at an early stage of evolution. Degeneration affected criminals especially, in particular the "born delinquent" whose development had stopped at an early stage, making them the most "atavistic" types of human being. Lombroso also advocated the theory that genius was closely linked with madness. A man of genius was a degenerate, an example of retrograde evolution in whom madness was a form of "biological compensation" for excessive intellectual development. To confirm this theory, in August 1897, Lombroso, while attending the Twelfth International Medical Congress in Moscow, decided to meet the great Russian writer Lev Tolstoy in order to directly verify, in him, his theory of degeneration in the genius. Lombroso's anthropological ideas fuelled a heated debate on the biological determinism of human behaviour.

Gangliformis Intumescentia and Beyond: Antonio Scarpa and His Core Contribution to Neuroanatomy, Neurosurgery, and Otoneurosurgery.

Nearly 250 years ago, Antonio Scarpa became a professor of anatomy and surgery only 2 years after he graduated from the University of Padua. The young lecturer soon became one of the most renowned anatomists in Italy and a director of the Faculty of Medicine at the University of Pavia. He worked in the fields of general surgery and ophthalmology. Several anatomic structures have been named after him, mainly Scarpa fascia and Scarpa triangle. His interest in neuroanatomy was ardent, despite being occasionally neglected. Scarpa's contributions to the fields of neurosciences have been significant. He was the first to describe the round window and the secondary tympanic membrane, and he eventually focused on the auditory and olfactory organs. Notably, the vestibular ganglion is now known as Scarpa ganglion. Scarpa's magnum opus was the book Tabulae Neurologicae, in which he described the path of several cranial nerves including the vagus nerve and innervation of the heart. Since his death in 1832, Scarpa's head has been preserved at the University History Museum of the University of Pavia. In this historical vignette, we aim to describe Antonio Scarpa's troubled life and brilliant career, focusing on his core contributions to neuroanatomy, neurosurgery, and otoneurosurgery.

Discovery and rediscoveries of Golgi cells.

When Camillo Golgi invented the black reaction in 1873 and first described the fine anatomical structure of the nervous system, he described a 'big nerve cell' that later took his name, the Golgi cell of cerebellum ('Golgi'schen Zellen', Gustaf Retzius, 1892). The Golgi cell was then proposed as the prototype of type-II interneurons, which form complex connections and exert their actions exclusively within the local network. Santiago Ramón y Cajal (who received the Nobel Prize with Golgi in 1906) proceeded to a detailed description of Golgi cell morphological characteristics, but functional insight remained very limited for many years. The first rediscovery happened in the 1960s, when neurophysiological analysis in vivo revealed that Golgi cells are inhibitory interneurons. This finding promoted the development of two major cerebellar theories, the 'beam theory' of John Eccles and the 'motor learning theory' of David Marr, in which the Golgi cells regulate the spatial organisation and the gain of input signals to be processed and learned by the cerebellar circuit. However, the matter was not set and a series of pioneering observations using single unit recordings and electronmicroscopy raised new issues that could not be fully explored until the 1990s. Then, the advent of new electrophysiological and imaging techniques in vitro and in vivo demonstrated the cellular and network activities of these neurons. Now we know that Golgi cells, through complex systems of chemical and electrical synapses, effectively control the spatio-temporal organisation of cerebellar responses. The Golgi cells regulate the timing and number of spikes emitted by granule cells and coordinate their coherent activity. Moreover, the Golgi cells regulate the induction of long-term synaptic plasticity along the mossy fibre pathway. Eventually, the Golgi cells transform the granular layer of cerebellum into an adaptable spatio-temporal filter capable of performing several kinds of logical operation. After more than a century, Golgi's intuition that the Golgi cell had to generate under a new perspective complex ensemble effects at the network level has finally been demonstrated.

The Original Histological Slides of Camillo Golgi and His Discoveries on Neuronal Structure.

The metallic impregnation invented by Camillo Golgi in 1873 has allowed the visualization of individual neurons in their entirety, leading to a breakthrough in the knowledge on the structure of the nervous system. Professor of Histology and of General Pathology, Golgi worked for decades at the University of Pavia, leading a very active laboratory. Unfortunately, most of Golgi's histological preparations are lost. The present contribution provides an account of the original slides on the nervous system from Golgi's laboratory available nowadays at the Golgi Museum and Historical Museum of the University of Pavia. Knowledge on the organization of the nervous tissue at the time of Golgi's observations is recalled. Notes on the equipment of Golgi's laboratory and the methodology Golgi used for his preparations are presented. Images of neurons from his slides (mostly from hippocampus, neocortex and cerebellum) are here shown for the first time together with some of Golgi's drawings. The sections are stained with the Golgi impregnation and Cajal stain. Golgi-impregnated sections are very thick (some more than 150 µm) and require continuous focusing during the microscopic observation. Heterogeneity of neuronal size and shape, free endings of distal dendritic arborizations, axonal branching stand out at the microscopic observation of Golgi-impregnated sections and in Golgi's drawings, and were novel findings at his time. Golgi also pointed out that the axon only originates from cell bodies, representing a constant and distinctive feature of nerve cells which distinguishes them from glia, and subserving transmission at a distance. Dendritic spines can be seen in some cortical neurons, although Golgi, possibly worried about artifacts, did not identify them. The puzzling intricacy of fully impregnated nervous tissue components offered to the first microscopic observations still elicit nowadays the emotion Golgi must have felt looking at his slides.

From images to physiology: A strange paradox at the origin of modern neuroscience.

In 1873 Camillo Golgi published an article that contained the description of entire nerve cells stained in black with a new histological procedure, the black reaction. He subsequently organized all the observations made with this method in a book published in 1885. On the basis of these studies, Golgi developed a physiological model of the brain that was influenced by a holistic conception he had in mind. He named this theory diffuse nervous network, assuming that the axonal prolongations were fused (or intimately interlaced) in a diffuse web along which the nervous impulse propagated. One of the scientists who quickly understood the importance of Golgi's results was the Spanish anatomist Santiago Ramón y Cajal. However, when he studied the brain with the black reaction, he had in mind the idea of the nerve cells as independent "units" (named neurons by Waldeyer, 1891). Thus Ramón y Cajal quickly became the champion of the neuron theory that paradoxically developed thanks to the same black reaction used by Golgi for the formulation of the opposite diffuse nervous network theory. The controversy between Golgi and Ramón y Cajal represents a dramatic instance of a theory-driven perception of the same morphological evidence.

Net without nodes and vice versa, the paradoxical Golgi-Cajal story: a reconciliation?

In 1906, the first Nobel prize in the neurosciences was awarded jointly to Camillo Golgi and Santiago Ramón y Cajal in recognition of their work on the structure of the nervous system. The Nobel Prize in Physiology or Medicine linked together forever these two scientists. One century later, what remains of their opposite views on the brain?

Golgi and Ranvier: from the black reaction to a theory of referred pain.

In his brief report on the structure of the gray matter of the central nervous system (1873), in which he described the "black reaction", Golgi noted the ramifications of the axon. This discovery prompted the French histologist Louis Antoine Ranvier, one of the first to try the black reaction outside Italy, to propose an ingenious theory of referred pain in his Traité technique d'histologie. Ranvier suggested that the nerve fibers originating from the irritated area and those coming from the region to which the sensation is referred converge on the same axon and thus the same cell body, causing the spatial dislocation of sensation. This theory of referred pain is a powerful example of the extraordinary clinical-physiological impact of the first of Golgi's neurocytological discoveries.