Biomedical subjects
Publications and source records attributed to D Gourevitch.
The Hippocratic doctor does not believe any more in magico-religious "miasmata" that pollute whole populations; he accuses the environmental air, thus freeing his fellow-men from the fear of gods' wrath but impeding the rise of the concept of contagion and disconnecting his own experience from the vet's. Galen however observing a few cases of lepra in Minor Asia intuits human contagion.
From ionian Greek, used by Hippocrates, to scientific English, some key-moments.
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Galen, who was certainly not a great amateur of women, nevertheless was interested in some disfunctions of sexual activity in men. Although he develops a theory about the problem, he is matter of fact as far as daily life is concerned, and, even if he quotes him, quite different from what Epicurus used to be.
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The day before yesterday: the physician-philologist. The times of the first appearance of printed books and of the re-discovery of ancient texts are also the times of syphilis. The physician, more than a philosopher as Galen suggested, is also a philologist. A very interesting example is fournished by Antonio Benivieni (+1502) and by his book De causis abditis (1506). Yesterday: the philologist-physician. Charles Daremberg (1816-1872) is our example. In 1841, he wrote his medical thesis Exposition des connaissances de Galien sur l'anatomie, la physiologie et la pathologie du systeme nerveux (faculte de medecine de Paris, n 222). Today: a necessary couple, the physician and the philologist. Greek and Latin are no more subjects of teaching in school, and the philologists seem to be strange, dusty and dirty people. Is the physician-philologist still alive or not? To be useful to the daily practice of medicine, history of medicine will be also a philological matter, as philology is the complete study of ancient, modern and contemporary texts. It teaches to read well, to understand all that has been written and, as a consequence, all that the patients tell today to their physicians. The problem is not teaching something more (new facts, new notions...) but teaching to know well; in a word, teaching the famous continuous learning, which is still a difficult reality.
Why is the relationship between Galen and his female patients particularly difficult?
The author explains that several ancient diseases bear the name of satyriasis. One of them is a form of lepra. An ancient terra-cotta mask of a satyre helps understanding why it is so.
The hippocratic treatise Airs, waters and places is a book for travelling practitioners, explaining them all they have to check when they arrive in a new unknown place. According to the author of this manual, one of the most frequent causes of diseases is the bad quality of environmental air. Admitting this theory, the medical man could not imagine that diseases might be transmitted by contagion. Yet vets had always known about contagion among herds and flocks. Christian literature which used so frequently the metaphor of the good sheperd and the sick sheep might have drawn doctors' attention and parallelized the situation among animals and that among human beings. The authority of the so-called father of medicine was so powerful that this did not happen and that contagionists and anticontagionists would quarrel for ages.
Is the new-born babe beautiful, is it ugly? When it comes to life, it is, in a way, a monster. It will be the nurse's task to reshape its tender flesh gently, as a potter could do with clay, and to carry it to its real nature and beauty, which are socio-cultural.
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The authors describe a method of inserting an Atkinson tube using a flexible upper gastrointestinal endoscope which does not require the use of X-ray screening. A retrospective review of 50 patients intubated by this technique has been undertaken and the results presented. Of the lesions, 40% were squamous cell carcinoma and 40% adenocarcinoma, with 84% being situated in the lower third of the oesophagus; 94% of patients only required one intubation. The two major complications of the procedure are tube displacement and oesophageal leak; a tube displacement rate of 13% was recorded, comparable with other series. Eleven patients (20.8%) were found to have an oesophageal leak, but this resulted in death in only three patients (6%). The reasons for these figures are explained. An operative mortality rate of 12% is comparable with series using other methods. The authors conclude that this method of intubation is as safe as Atkinson's original method but has the advantage that X-ray screening is not required.
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