Pediatric Patients as a Source of Bias in Joseph Lister's Study of Antisepsis

Joseph Lister's (1827-1912) use of carbolic acid to prevent wound infection in open fractures of the extremities (1865) provided a basic science rationale for the practice of surgery. His series of 11 patients included 4 children, aged 7 to 13. Children, today known to better survive a given injury when compared with adults, may have biased his results in favor of survival, and led him to conclude that his method of carbolic-soaked dressing changes prevented fatal wound sepsis. His success with antisepsis may have been less a testament to his application of germ theory to surgery than to the physiological resilience of his young patients.

Laparoscopic anatomical left hemihepatectomy guided by middle hepatic vein in the treatment of left hepatolithiasis with a history of upper abdominal surgery

BACKGROUND

This study aimed to investigate the safety and efficacy of laparoscopic anatomical left hemihepatectomy guided by the middle hepatic vein (MHV) for the treatment of patients with hepatolithiasis who had a history of upper abdominal surgery.

METHODS

Retrospective data analysis was performed on patients who underwent laparoscopic left hepatectomy for hepatolithiasis and with previous upper abdominal surgery at the Second Affiliated Hospital of Nanchang University from January 2018 to April 2022. According to the different surgical approaches, patients were divided into laparoscopic anatomical left hepatectomy guided by the MHV group (MHV-AH group) and laparoscopic traditional anatomical left hepatectomy not guided by the MHV group (non-MHV-AH group).

RESULTS

This study included 81 patients, with 37 and 44 patients in the MHV-AH and non-MHV-AH groups, respectively. There was no significant difference in the basic information between the two groups. Five cases were converted to laparotomy, and the remaining were successfully completed under laparoscopy. Compared to the non-MHV-AH group, the MHV-AH group had a slightly longer operation time (319.30 min vs 273.93 min, P = 0.032), lower bile leakage rate (5.4% vs 20.5%, P = 0.047), stone residual rate (2.7% vs 20.5%, P = 0.015), stone recurrence rate (5.4% vs 22.7%, P = 0.028), and cholangitis recurrence rate (2.7% vs 22.7%, P = 0.008).There were no significant differences in the results of other observation indices between the groups.

CONCLUSIONS

Laparoscopic anatomical left hepatectomy guided by the MHV is safe and effective in the treatment of left hepatolithiasis with a history of upper abdominal surgery. It does not increase intraoperative bleeding and reduces the risk of postoperative bile leakage, residual stones, stone recurrence, and cholangitis recurrence.

John Hunter and the Descent of the Testis

The descent of the testis and the development of an inguinal hernia were the earliest published scientific work by John Hunter, the Scottish surgeon and anatomist who is acknowledged as the father of scientific surgery. Hunter's anatomic descriptions are the ones we use today to describe the prenatal descent of the testis and to explain the pathogenesis of an undescended testis and inguinal hernia in infancy. His work appeared in print in 1762, not as a formal publication but as an addendum to a screed written by his older brother William publicly accusing Percival Pott of pirating John's observations on the pathogenesis of an inguinal hernia and publishing them as his own, an early example of scientific rivalry.

The Medical Historical Cultural Foundations of Western Nasal Surgery from Ancient Greece to the Middle Ages

The manuscript aims to clarify the origins of Western rhinosurgery through the ancient texts of the greatest physicians of the past, up to the Byzantine Era, focusing on the "exchange of knowledge" between peoples. This excursus is carried out by quoting the texts of the greatest doctors of the past, such as Hippocrates, Galen and Celsus and by analysing the works of Byzantine authors such as Oribasius, Aetius, Antillus, which, more than others, represent the moment of fusion and interpenetration of Ancient Medical knowledge, paving the way for the Medieval Scholae Medicae in the West. The aim, therefore, is to fill that sort of "great gap" (from the foundation of Constantinople in the 4th century AD to the early Arab culture in the 11th century AD) due to the fact that figures such as Branca, Vianeo and, finally, Tagliacozzi, are considered direct actors of a recovery of the "ancient knowledge" of classic authors. This literature tends to less evaluate, instead, that important and huge cultural exchange -literally osmotic- in medical and surgical knowledge between peoples and civilizations, that find a trait d'union in the application of medical knowledge and surgical practical techniques matured in the Byzantine, Arab and Early Medieval period. In final analysis, through the History of Rhinosurgery, this paper aims to highlight how Western medical knowledge is made up of the ensemble of cultures which are apparently distant and different from each other, which merge themselves in a truly universal and transcultural knowledge: the Medical knowledge. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Justin H. Kelly and his procedure for bladder exstrophy and epispadias

The operations involved in the repair of complete bladder exstrophy (CBE), familiarly known as the Kelly procedure, evolved over more than 100 years. Through repeated cycles of trial and error, some of the most prominent urologists in the world developed techniques that addressed each of the formidable surgical challenges presented by CBE and epispadias. A key figure is Justin H. Kelly of the Royal Children's Hospital, Melbourne, who made surgery for CBE his life's work. He took the lessons of his surgical predecessors, giants like: Friedrich Trendelenburg, Hugh Hampton Young, John Dees, and Guy Leadbetter, applied techniques for anorectal anomalies from his contemporary Alberto Peña, and saw his procedures improved by the next generation of leaders in paediatric urology that included Phillip Ransley, Peter Cuckow, Patrick Duffy, and John Gearhart. Over his long career, Mr Kelly modified and perfected his eponymous procedure patient-by-patient through a painstaking process of trial-and-error, bearing with his young patients and their families through every heart-breaking complication, and gradually creating the standard operation for children with CBE and epispadias.

Surgery in antiquity: the origin of the Trendelenburg position revisited

INTRODUCTION

The Raised Pelvic Position, also known as Trendelenburg position, consists of the elevation of the pelvis above the horizontal plane in the supine position with the head lowered. The position is named after Friedrich Trendelenburg, a German surgeon, who flourished in Berlin at the end of the nineteenth century. Although modern studies trace the position's principle back to the first century BC, we herein present even earlier descriptions, dating back to the fifth century BC.

MATERIAL AND METHODS

The whole ancient Greek literature was digitally searched. All relevant references were analyzed from the original sources.

RESULTS

We found at least nine references to the Raised Pelvic Position in the ancient Greek literature from the following physicians: Hippocrates (fifth century BC), Soranus of Ephesus (first century AD), Aetius of Amida (fifth century AD) and Paulus Aegineta (seventh century AD).

DISCUSSION AND CONCLUSION

All references presented, describe clearly the Raised Pelvic Position, as part of a strategy to repair uterine pathologies, mainly prolapsed uterus, but also instability, bleeding, tumors and infertility. We conclude that ancient Greek writers were aware of the usefulness of the head-down position, as reflected from the numerous existing descriptions dating back to the fifth century BC.

Transperineal total mesorectal excision for rectal cancer on the residual rectum after multiple abdominal surgeries in a patient with Crohn's disease: a case report

BACKGROUND

The improved prognosis of Crohn's disease may increase the opportunities of surgical treatment for patients with Crohn's disease and the risk of development of colorectal cancer. We herein describe a patient with Crohn's disease and a history of multiple surgeries who developed rectal stump carcinoma that was treated laparoscopically and transperineally.

CASE PRESENTATION

A 51-year-old man had been diagnosed with Crohn's disease 35 years earlier and had undergone several operations for treatment of Crohn's colitis. Colonoscopic examination was performed and revealed rectal cancer at the residual rectum. The patient was then referred to our department. The tumor was diagnosed as clinical T2N0M0, Stage I. We treated the tumor by combination of laparoscopic surgery and concomitant transperineal resection of the rectum. While the intra-abdominal adhesion was dissected laparoscopically, rectal dissection in the correct plane progressed by the transperineal approach. The rectal cancer was resected without involvement of the resection margin. The duration of the operation was 3 h 48 min, the blood loss volume was 50 mL, and no intraoperative complications occurred. The pathological diagnosis of the tumor was type 5 well- and moderately differentiated adenocarcinoma, pT2N0, Stage I. No recurrence was evident 3 months after the operation, and no adjuvant chemotherapy was performed.

CONCLUSION

The transperineal approach might be useful in patients with Crohn's disease who develop rectal cancer after multiple abdominal surgeries.

When did gastro-esophageal reflux become a disease? A historical perspective on GER(D) nomenclature

BACKGROUND

Within the span of a few decades, gastro-esophageal reflux (GER) evolved from a rare entity to the most commonly diagnosed upper gastro-intestinal disease, i.e. gastro-esophageal reflux disease (GERD). The boundaries of GERD remain matter of controversy and appear to be ever expanding in both children and adults. Our aim is to answer the questions: when did GER become a disease? And when did it become specifically a pediatric disease?

METHODS

We performed a comprehensive historical review of the original medical literature using Medline and Google, along with a compilation of original and secondary texts in English, French and German.

RESULTS

Our finding is that those actively involved in treating the reflux, first surgeons in the 1960s and then gastroenterologists in the 1970s, initiated naming it a disease. In pediatrics, the possible correlation between reflux events and sudden infant death syndrome accelerated the management of reflux associated with respiratory symptoms with surgery in the 1970s. Surgeons were also the first specialists to formulate the term pediatric GERD in 1982.

CONCLUSION

Understanding the genesis of GERD may shed light upon its expansion as a disease category and its persistent controversial nature in pediatrics.

Mark M. Ravitch MD: Surgeon, author, teacher, soldier

Mark M. Ravitch (1910-1989) was the most prolific surgeon-author of the 20th Century as well as an outstanding clinical surgeon, scholar, historian, and researcher. While today he would not be considered a "pure pediatric surgeon," he was a charter member of the American Pediatric Surgical Association and received the William E. Ladd medal from the Surgical Section of the American Academy of Pediatrics and the Denis Brown Medal from the British Association of Pediatric Surgeons. He contributed to the treatment of benign colon and rectal disease, intussusception, and chest wall deformities. His most enduring contribution was surgical stapling, a technology that he brought from Russia during the Cold War that opened the door to minimally invasive surgery.

The history of surgery for esophageal atresia

Until the successful repair of esophageal atresia (EA) and distal tracheoesophageal fistula (TEF) in 1941 by Cameron Haight of Ann Arbor, MI, every infant operated upon for this anomaly died within days and often hours of surgery. A key step was the posterior extrapleural approach to the mediastinum pioneered by Charles Mixter of Boston in 1929 that gave direct exposure of the anomaly without entering the pleural cavity and collapsing the lung. From 1936 to 1939 Thomas Lanman, also of Boston, made five unsuccessful attempts at primary repair of EA. His experience established the basic principles of early radiological diagnosis and prompt surgical intervention to minimize the risks of aspiration pneumonia, dehydration, and inanition. In 1939 N. Logan Leven of Minneapolis and William Ladd of Boston independently had the first long-term survivors of EA with a series of operations to construct skin-lined tubes on the anterior chest wall that connected an esophagostomy to a gastrostomy. Haight first tried primary repair in 1939, finally succeeding in his fourth case in March 1941. In their publications Lanman (1940), Haight (1943 and 1944), and Ladd (1944 and 1947) presented case-by-case chronologies. The evolution of surgical management thus can be traced from a fatal condition to one where survival became the expected outcome. History recognizes Haight for his work with EA, not only for its first successful primary repair, but also his lifelong dedication to its surgical management.

[About history of surgeons hidden behind our daily surgical instruments: Scissors]

Many surgical instruments are named after their inventors, acclaimed surgeons of the past, because of their discoveries and their contributions in the field of surgical techniques. However, these daily reminders of history of surgery are often forgotten by the modern practitioners. We propose to review, through a selection of instruments, short biographies of these precursors. This third original article will focus on the inventors of modern scissors: Mayo, Metzenbaum, Stevens and Lister.

The influence of Arabic medicine on surgery in the Low Countries1

The influence of Arab Medicine on Western science has recently been challenged. Using the example of two Flemish surgeons, Jan Yperman in the early 14th and Thomas Fijens in the late 16th century, this article argues that Arab physicians and surgeons have imposed a long lasting influence on the surgical practitioners in the Low Countries.

Baylor University Medical Center's leap to prominence: The 1972 conference "Great Ideas in Surgery"

In 1972, Baylor University Medical Center established the A. Webb Roberts Center for Continuing Education in the Health Sciences. The center included the Beulah Porter Beasley Memorial Auditorium and a 25,000-volume medical library. The author was fortunate enough to attend the 2-day meeting (November 3-4) as a fellow in cardiovascular surgery. The following account is based on his personal recollections but also on the papers published by the participants and bequeathed to him by the late chief of the Department of Surgery, Robert S. Sparkman, MD.

[The art of surgery in nuce : Introduction to Institutiones chirurgicae (1601) by Johannes Jessenius (1566-1621)]

BACKGROUND

In 1601, Johannes Jessenius published the surgical work Institutiones chirurgicae, which is of particular importance for the history of surgery in Germany. So far, research has predominantly concentrated on the anatomical works of Jessenius; his surgical work including aspects of urology has not been the subject of investigation.

OBJECTIVES

In the present article, we analyze the structure, reasoning, and linguistic means used by the author in this work.

RESULTS

According to the introduction, surgery comprises three basic components: agens, actor or the surgeon, actio, the activity, that is, the operation, and per quae et quibus actio perficitur, which means instruments and medications. The operations are arranged in contrasts, solutio continuorum-junctio separatorum, the dissolution of the connected-connection of the separate, extirpatio superfluorum-recuperatio deficientium, to eliminate the superfluous-to restore the missing. The description of the instruments is also based on opposite pairs.

DISCUSSION

The three elements of surgical work represent a reduction of what is stated in the Hippocratic text De officina. Thus, recognizable here is an ancient tradition, which was also known to the predecessors of Jessenius.

CONCLUSIONS

At the beginning of the work, aspects of an introduction to the surgical work of the 16th century are briefly recapitulated. Jessenius adheres to this historical tradition including aspects of urology of this work. In the introduction, he refers to various medical writers, without directly adopting the texts. The surgical artistry that Jessenius stands for is of fundamental importance to this day.

Abulcasis (936-1013): his work and contribution to orthopaedics

AIM OF THE STUDY

The purpose of this historic review is to summarize the life and work of Abulcasis (936-1013) and his contribution to surgery and orthopaedics.

METHOD

We conducted an extensive search in libraries as well as online in PubMed and Google Scholar.

RESULTS

Abulcasis in his work combines the knowledge of ancient Greek and Roman physicians and surgeons with the extensive knowledge of Arabic medicine and pharmacology. He also pioneered surgical technique with the invention of numerous surgical instruments and with several revolutionary surgical techniques.

CONCLUSION

Abulcasis made an impact with his medical writings in which he summarized the works of ancient Greek and Roman physicians like Hippocrates and Galen with the influence of medieval authors and the knowledge of the Arabic medicine and pharmacology. His descriptions and innovations in his work remained a work of reference in the West and East for many centuries to come.

Surgical treatment of polydactyly and syndactyly during the 4th century AD

INTRODUCTION

Polydactyly, or polydactylism, is a common congenital disorder of the limbs, consisting of any digit duplication beyond the normal five. The term syndactyly refers to fused digits. We herein present a thorough description of these diseases together with their surgical treatment, provided by Oribasius, a Byzantine physician of the 4th century. To our knowledge, this is the earliest description of supernumerary and fused fingers and their surgical management.

MATERIAL AND METHODS

We conducted a thorough study of Oribasius' work.

RESULTS

The 15th chapter of the 47th book of Oribasius' work is devoted to finger abnormalities (i.e. polydactyly and syndactyly) and their surgical treatment.

DISCUSSION

With regard to the extensive medical knowledge of the 4th century as survived in Oribasius' work, these descriptions comprise, to the best of our knowledge, the earliest written references to the surgical treatment of polydactyly and syndactyly.

Esophageal atresia, Europe, and the future: BAPS Journal of Pediatric Surgery Lecture

Europe has changed remarkably over the past decades and so have concepts and outcomes of esophageal atresia repair. In this article, both the efforts to create a united Europe and the achievements in dealing with esophageal atresia from the 1950s on are outlined. Furthermore, this paper deals with the future of pediatric surgery and is focused on two aspects: the "Fourth Industrial Revolution" which builds on the digital revolution, artificial intelligence and robotics, and its potential impact on pediatric surgery and the life of patients. I suggest that pediatric surgeons should participate and lead in the development of machine learning, data control, assuring appropriate use of machines, control misuse, and in particular ensure appropriate maintenance of ethical standards. Changes in health care structures within Europe, in particular the effect of centralization, will affect the concept of treatment for patients with rare diseases.

[About history of surgeons hidden behind our daily surgical instruments: Forceps]

Many surgical instruments are named after their inventors, acclaimed surgeons of the past, because of their discoveries and their contributions in the field of surgical techniques. However, these daily reminders of History of Surgery are often forgotten by the modern practitioners. We propose to review, through a selection of instruments, short biographies of these precursors. This first original article will focus on the inventors of modern forceps: Debakey, Adson, Kocher, Péan, Tuffier and Halsted.

Insights into the Past and Future of Atlantoaxial Stabilization Techniques

Over the past century, atlantoaxial stabilization techniques have improved considerably. To our knowledge there has been a scarcity of articles published that focus specifically on the history of atlantoaxial stabilization. Examining the history of instrumentation allows us to evaluate the impact of early influences on current modern stabilization techniques. It also provides inspiration to further develop the techniques and prevents repetition of mistakes. This paper reviews the evolution of C1-C2 instrumentation techniques over time and provides insights into the future of these practices.We did an extensive literature search in PubMed, Embase and Google Scholar, using the following search terms: 'medical history', 'atlantoaxial', 'C1/C2', 'stabilization', 'instrumentation', 'fusion', 'arthrodesis', 'grafting', 'neuroimaging', 'biomechanical testing', 'anatomical considerations' and 'future'.Many different entry zones have been tested, as well as different constructs, from initial attempts with use of silk threads to use of hooks and rod-wire techniques, and handling of bone grafts, which eventually led to the development of the advanced screw-rod constructs that are currently in use. Much of this evolution is attributable to advancements in neuroimaging, a wide range of new materials available and an improvement in biomechanical understanding in relation to anatomical structures.

Pioneering women in American pediatric surgery

Women were among the pioneers in American pediatric surgery in its early decades. Once in practice, Benjy Brooks (Houston) and Jessie Ternberg (St. Louis) became identified with the specialty in their adopted communities, and Rowena Spencer in her hometown of New Orleans. Louise Schnaufer in Philadelphia, Kathryn Anderson in Washington, D.C., and Patricia Donahoe in Boston were all prominent surgeons at leading children's specialty hospitals in the country. Schnaufer was the unsung stalwart in general and thoracic surgery at the Children's Hospital of Philadelphia. Anderson became Surgeon-in-Chief in Los Angeles, and later the first woman leader of both professional societies in pediatric surgery as well as first woman President of the American College of Surgeons. Donahoe developed a spectacular academic career and became one of the outstanding surgical scientists in the country. Each faced gender discrimination at several stages of their careers: medical school enrollments that limited spots for women; widespread bias against women training in surgery and pediatric surgery; and the absence of woman role models and mentors. It is instructive and inspiring to review their individual stories that play an important part of the history of the specialty.

Popliteal cyst before William Baker: first report in the Galenic Corpus

INTRODUCTION

A popliteal cyst, also known as Baker cyst, is a benign fluctuant swelling of the gastrocnemius-semimembranosus bursa in the popliteal fossa at the back of the knee. The cyst is named after William Morrant Baker, who is considered to have first described this fluid collection with new sac formation outside of the knee-joint in 1877. We herein present a short description contained in the Galenic Corpus that appears to match to what we now call the Baker cyst.

MATERIAL AND METHODS

Α thorough survey of Kühn's Galenic Corpus was performed.

RESULTS

The 14th book of Kühn's edition contains a brief review of all the anatomical structures and pathologies. In the 17th chapter of this treatise, devoted to skin lesions, the author states that steatomas appear in the popliteal fossa. However, it is no more believed to reflect the Galenic teaching and is ascribed to Pseudo-Galen.

DISCUSSION

With regard to the descriptions survived and the anatomy knowledge in the post-Galenic era time, the brief report of the ancient text of unknown origin, appears to match what we now describe as popliteal cyst.

Nominee and nominator, but never Nobel Laureate: Vincenz Czerny and the Nobel Prize

PURPOSE

The Heidelberg surgeon Vincenz Czerny (1842-1916) is remembered as pioneer of innovative operations as well as entrepreneur of interdisciplinary cancer therapy. The purpose of this paper is to describe his role during the early history of the Nobel Prize in physiology or medicine.

METHOD

Based on documents from the Nobel Archive, this paper investigates how Czerny contributed, both as nominee and nominator, in shaping the early years of Nobel Prize history.

RESULTS

Vincenz Czerny was nominated at least three times for the Nobel Prize, but he was never selected. Czerny's own nomination letters pinpoint important trends in medicine around the turn of the century. At least seven of the candidates he put forward, became Nobel Laureates.

CONCLUSION

Czerny-like many other internationally renowned surgeons during the first decades of the twentieth century-missed out on the Nobel Prize, partly because it is not a lifetime award and his work would have to have been more recent. However, with his nominations, Czerny helped to shape the Nobel Prize to become the most important scientific award worldwide.

A history of meniscal surgery: from ancient times to the twenty-first century

The science and surgery of the meniscus have evolved significantly over time. Surgeons and scientists always enjoy looking forward to novel therapies. However, as part of the ongoing effort at optimizing interventions and outcomes, it may also be useful to reflect on important milestones from the past. The aim of the present manuscript was to explore the history of meniscal surgery across the ages, from ancient times to the twenty-first century. Herein, some of the investigations of the pioneers in orthopaedics are described, to underline how their work has influenced the management of the injured meniscus in modern times. Level of evidence V.

A historical perspective on ankle ligaments reconstructive surgery

Ankle sprains are by far the most common injuries treated by sport medicine physicians. Treatment is mainly conservative, but in some cases surgical intervention is required. The aim of the present manuscript is to give an insight into the origins and developments of ankle ligaments reconstructive surgery, underlining the fundamental steps that marked the transition from a mere conservative approach to surgical treatment options. In this historical note, the most illustrious figures who contributed to this particular field of orthopaedic practice are also acknowledged. Level of evidence V.

History of shoulder instability surgery

PURPOSE

The surgical management of shoulder instability is an expanding and increasingly complex area of study within orthopaedics. This article describes the history and evolution of shoulder instability surgery, examining the development of its key principles, the currently accepted concepts and available surgical interventions.

METHODS

A comprehensive review of the available literature was performed using PubMed. The reference lists of reviewed articles were also scrutinised to ensure relevant information was included.

RESULTS

The various types of shoulder instability including anterior, posterior and multidirectional instability are discussed, focussing on the history of surgical management of these topics, the current concepts and the results of available surgical interventions.

CONCLUSIONS

The last century has seen important advancements in the understanding and treatment of shoulder instability. The transition from open to arthroscopic surgery has allowed the discovery of previously unrecognised pathologic entities and facilitated techniques to treat these. Nevertheless, open surgery still produces comparable results in the treatment of many instability-related conditions and is often required in complex or revision cases, particularly in the presence of bone loss. More high-quality research is required to better understand and characterise this spectrum of conditions so that successful evidence-based management algorithms can be developed.

LEVEL OF EVIDENCE

IV.

A historical perspective on ankle ligaments reconstructive surgery

Ankle sprains are by far the most common injuries treated by sport medicine physicians. Treatment is mainly conservative, but in some cases surgical intervention is required. The aim of the present manuscript is to give an insight into the origins and developments of ankle ligaments reconstructive surgery, underlining the fundamental steps that marked the transition from a mere conservative approach to surgical treatment options. In this historical note, the most illustrious figures who contributed to this particular field of orthopaedic practice are also acknowledged. Level of evidence V.

Knee multi-ligament reconstruction: a historical note on the fundamental landmarks

Several eminent surgeons made breakthroughs in knee surgery throughout the nineteenth and twentieth centuries. Before that, knee injuries were only treated conservatively and it was thanks to the progress made in the field of biomechanics and biology that new surgical treatments were proposed. The history of medicine recalls some illustrious surgeons such as Thomas Annandale and Mayo Robson who were the first to perform and describe their revolutionary experience regarding meniscal and anterior cruciate ligament surgery. Less famous are the forefathers of multi-ligament reconstructive surgery: the purpose of this paper was to shed some light on the pioneers of this particular field of orthopaedic practice, which is gaining increasing interest in current clinical practice. Level of evidence V.

[Louis Ombrédanne (1871-1956) pediatric and plastic surgeon]

One of the fathers of pediatric surgery in France, Louis Ombrédanne (1871-1956) was a great plastic surgeon. During his residency he was initiated to plastic surgery by Charles Nélaton (1851-1911). Both wrote two books: "La rhinoplastie" and "Les autoplasties", taking stock of these techniques in the early 20th century. In 1906, he was the first to describe the pectoral muscle flap for immediate breast reconstruction after mastectomy. He used this flap in conjunction with an axillo thoracic flap. From 1908 to 1941, Louis Ombrédanne practised pediatric surgery, most of which was devoted in reconstruction of congenital and acquire anomalies. From 1924 to 1941, he was Professor of pediatric surgery at the hospital Enfants-Malades in Paris. In 1907, Louis Ombrédanne created a prototype of an ether inhaler as a safe anesthetic device. The device was successfully used for fifty years in Europe.

The Bolognese surgeon Giuseppe Ruggi: how and why the aseptic surgery was introduced in Bologna in the middle half of the XIX century

BACKGROUND

The first reliable statistic data about perioperatory mortality were published in 1841 by the French Joseph-Francois Malgaigne (1806-1863): he referred to a mean mortality of 60% for amputations and this bad result was to be attributed mainly to hospital acquired diseases. The idea of "hospital acquired disease" although vague, included five infective nosologic entities, which at that time were diagnosed more frequently: erysipelas, tetan, pyemia, septicemia, and gangrene. Nonetheless, the suppuration with pus production was considered from most of the surgeons and doctors of that time as a necessary and unavoidable step in the process of wound healing. During the end of the eighteenth century, hospitals of the main European cities were transforming into aggregations of several wards, where the high concentration of patients created poor sanitary conditions and a consistent increase of perioperatory mortality. In 1865, Lister applied his first antiseptic dressing on the surface of an exposed fracture. These experimental attempts lead to an effective reduction of wound infections respect to the dressing with strings used previously.

DISCUSSION

Lister's innovations in the field of wound treatment were based on two brand new concepts: germs causing rot were ubiquitarious and the wound infection was not a normal step in the process of wound healing. The concept of antisepsis was hardly accepted in the European surgical world: "Of all countries, Italy is the most indifferent and uninterested in experimenting this method, which has been so favorably judged from the greatest surgical societies in Germany". This quotation from the young surgeon Giuseppe Ruggi (1844-1925) from Bologna comes from his article where he presented his first experiences on aseptic medications started the previous year in the Surgical Department of Maggiore Hospital in Bologna. In his report, Ruggi described the adopted technique and suggested that the medication should be extended to all the surgical patients of the hospital:"… this is needed to totally remove from the hospital all those elements of infection which grow in the wounds dressed with the old method". The experimentation of this new dressing for the few treated cases was rigorous and concerned both the sterilization of surgical tools with the fenic acid (5%) and the shaving of the skin. Ruggi also observed that there was no correlation between the seriousness of the wound and its extension or way of healing: when "simple" cases that "should heal without complication" showed fever he often realized that "it was often due to a medication performed without following the rules for an accurate disinfection and dressing". Ruggi thought that the fever was connected to "reabsorption of pyrogenic substances, which can be removed cleaning and disinfecting the wound" in cases of wounds not accurately dressed and rarely medicated. Frequent postoperative medications of the wound were able to eliminate the fever within 2 h. Ruggi's attitude toward the fine reasoning lead him to introduce the concept of immunodeficiency related to physical deterioration: "… patients treated for surgical disease may sometimes suffer from complications of medical conditions, which initially escape the most accurate investigations… The surgical operation could, in some cases, hold the balance of power".

CONCLUSIONS

The obtained results, published in 1879, appear extremely interesting. As he wrote in 1898, for the presentation of his case record of more than 1000 laparotomies, he had started "… operating as a young surgeon without any tutor, helped only by his mind and what he could deduce from publications existing at the moment …".

The Limit of a strong Lobby: Why did August Bier and Ferdinand Sauerbruch never receive the Nobel Prize?

August Bier (1861-1949) and Ferdinand Sauerbruch (1875-1951) have remained two of the most influential figures during the first half of the 20th century in German and even in international surgery. They were jointly awarded Adolf Hitler's German Science Prize in 1937, but never the Nobel Prize for Physiology or Medicine, although no other German surgeons were nominated as often as Bier and Sauerbruch for the prestigeful award from 1901 to 1950. This contribution gives an overview of the reasons why and by whom Bier and Sauerbruch were nominated, and discusses the reasons of the Nobel Prize Committee for not awarding them.

Ottoman surgical treatises and their influences on modern neurosurgery in Turkey

OBJECTIVE

To introduce the authors of 6 prominent Ottoman surgical treatises, to present the chapters that relate to present-day neurosurgery, and to discuss their influence on the establishment of modern Turkish neurosurgery.

METHODS

Neurosurgery-related chapters of 6 prominent Ottoman surgical treatises and their role i the establishment of modern neurosurgery in Turkey are discussed.

RESULTS

Neurosurgery-related chapters of "Hulasa-i Tıbb" by Surgeon Mesud (Summary of Medicine), "Cerrahhiyet-al Haniyye" by Şerefeddin Sabuncuoğlu (Imperial Surgery), "Cerrahname" by an unknown author (Surgical Treatise), "Ala'im-i Cerrahin" by Surgeon Ibrahim (Wonders of Surgeons) "Cerrahname" by Ali Munşi of Bursa (Surgical Treatise), and "The law of surgeons" by Şanizade Ataullah Mehmed Efendi (Kanun-al Cerrahin) were analyzed.

CONCLUSIONS

These treatises, including sections on neurosurgery-related topics, were important influences on the establishment of contemporary neurosurgery in modern Turkey.