Anita Magowska

Wandering Spleen: A Medical Enigma, Its Natural History and Rationalization

IntroductionWandering spleen is a rare condition in which the spleen is not located in the left upper quadrant but is found lower in the abdomen or in the pelvic region because of the laxity of the peritoneal attachments. Many patients with wandering spleen are asymptomatic, hence the condition can be discovered only by abdominal examination or at a hospital emergency department if a patient is admitted to hospital because of severe abdominal pain, vomiting or obstipation. MethodsThis article aims to provide a historical overview of wandering spleen diagnostics and surgical treatment supplemented with an analyses of articles on wandering spleen included in the PubMed database. ResultsOne of the first clinical descriptions of a wandering spleen was written by Józef Dietl in 1854. The next years of vital importance are 1877 when A. Martin conducted the first splenectomy and in 1895 when Ludwik Rydygier carried out the first splenopexy to immobilize a wandering spleen. Since that time various techniques of splenectomy and splenopexy have been developed. ConclusionsIntroducing medical technologies was a watershed in the development and treatment of wandering spleen, which is confirmed by the PubMed database. Despite the increased number of publications medical literature shows that a wandering spleen still remains a misdiagnosed condition, especially among children.

The Unwanted Heroes: War Invalids in Poland after World War I

This article focuses on the unique and hitherto unknown history of disabled ex-servicemen and civilians in interwar Poland. In 1914, thousands of Poles were conscripted into the Austrian, Prussian, and Russian armies and forced to fight against each other. When the war ended and Poland regained independence after more than one hundred years of partition, the fledgling government was unable to provide support for the more than three hundred thousand disabled war victims, not to mention the many civilians left injured or orphaned by the war. The vast majority of these victims were ex-servicemen of foreign armies, and were deprived of any war compensation. Neither the Polish government nor the impoverished society could meet the disabled ex-servicemen’s medical and material needs; therefore, these men had to take responsibility for themselves and started cooperatives and war-invalids-owned enterprises. A social collaboration between Poland and America, rare in Europe at that time, was initiated by the Polish community in the United States to help blind ex-servicemen in Poland.

Surgery, fame, and misfortune: the life of Bronislaw Kader.

Bronisław Kader (1863–1937) introduced one of the traditional methods of gastrostomy. He was a Polish doctor who had been trained by such eminent surgeons as Ernst von Bergmann, Otto E. Küstner, Jan Mikulicz, and Eduard von Wahl. The Kader method implies blunt division of the left rectus muscle and opening of the stomach by a very small incision. A drainage tube is then inserted and fastened to the stomach wall by a stitch. Next, the stomach wall is sutured to the abdominal wall in a manner that places the tube in a tunnel surrounded by serosa. In comparison to others, Kader’s method of gastrostomy was considered simpler, cheaper (fewer stitches), speedy, and safe. Although recommendations to perform gastric fistula were limited at the time, the value of gastrostomy remains undisputable. This is a method of choice for securing alimentation in cases of intractable stenosis of the pharynx or esophagus, which are usually due to cancer, chemical burns, trauma, or congenital defects. Nowadays, it is performed endoscopically or laparoscopically. This article presents the life history of Bronisław Kader, the eponymous of this method and a gifted surgeon who lost his eyesight at the height of his fame.

A doctor facing turbulent times: Antoni Tomasz Jurasz, citizen of the world.

The eponymous of the Jurasz procedure is Antoni Tomasz Jurasz (1882–1961). The procedure is a standard approach to treating mature pancreatic pseudocysts that are in contact with the stomach, although recent advances in instrumentation have empowered surgeons to perform pseudocystogastrostomy laparoscopically for this problem. Dr. Jurasz was born in Germany but felt himself as Polish as his ancestors. He graduated from Heidelberg with a degree in medicine. Over the following years, he developed a German surgery school, especially helping with the achievements of Erich Lexer and Erwin Payr. During the period between World Wars I and II, Jurasz chaired and led the Surgery Clinic of Poznan University in Poland; and he gave lectures and performed public operations abroad. These activities, together with articles published in German-, French-, and English-language medical journals, made him a world-renowned figure in the field of abdominal and thyroid surgery. During World War II, he revealed exceptional traits, taking part in the September Campaign in Poland as a surgeon. He then organized the Polish School of Medicine and the Paderewski Hospital in Edinburgh. Despite his outstanding mind, generosity, and merits, A. T. Jurasz became persona non grata in Communist Poland, which ultimately persuaded him to emigrate to the United States.

Under the British Roof: The British Contribution to the Development of Hospice and Palliative Care in Poland

The article focuses on British contribution to the development of palliative and hospice care in Poland in the 1980s and beyond. It is based on archival research in the hospices in Cracow and Poznan and broad-scoped Polish journals’ review. The social background of the hospice movement in Poland is described. We explore the role of inspiration and help of Dame Cicely Saunders and other British leaders in the transfer of British hospice philosophy and practice of palliative care to the medical community in Poland. This study demonstrates the importance of institutions for the formal exchange of medical information.

Jean-Alexandre Barré (1880–1967)

War I (1914–1918). The war brought new challenges for the medical staff of the time: millions of soldiers suffered severe psychological and somatic injuries of new types and on a scale never experienced before. Barré began his military service as a member of a front-line ambulance unit, but was later directed, fortunately, to hospital work within a neurological unit of the Sixth Army in the northern region of France. This relocation not only radically improved his chances of surviving the war, but also gave rise to a successful collaboration with Georges Guillain (1876–1961), the chief physician at the Sixth Army’s neurology center at the time. In 1917, Barré was assigned to the military neurological center in Nantes and afterwards, in 1918, with the end of the war, he gained a position as Director of the Neuropsychiatric Military Center in the Eastern Region of France. Throughout the war years, Barré effectively combined his military duties and care of injured soldiers with his scientific interests: hundreds of wounded men were not only the subject of his medical attention, but also the inspiration for in-depth clinical analysis. In cases of suspected hysteria as a way of avoiding army service, Barré warned against hastily attributing the symptoms observed to psychological causes and recommended a careful neurological examination of each patient. In close collaboration with Guillain, he studied the clinical presentation and course of numerous cases of peripheral and central nervous system traumatic lesions. The two men’s research work on wounded soldiers resulted in improved neurological examination techniques and contributed new insights to localizing symptomatology, in particular of spinal cord injuries. Their observations supported the conception of the early surgical management of spinal cord trauma and accompanying vertebral fractures. However, a high mortality rate due to bacterial infections remained an impassable obstacle for Barré and his colleagues in that pre-antibiotic era [2]. Jean-Alexandre Barré (Fig. 1) was a French neurologist, now mostly known for an early description of acute immunemediated inflammatory polyneuropathy, a heterogeneous neurological condition classified and grouped under the eponym Guillain-Barré syndrome. A skillful and perceptive clinician, he was also the author of the Barré test, a diagnostic maneuver still sometimes used in everyday neurological practice. Barré was born on May 25, 1880, in Nantes in France. He studied medicine at the University of Nantes and, following his graduation, began his medical career at a hospital in his hometown as an intern, with the idea of becoming a surgeon. In 1901, he completed his compulsory military service and, 5 years later, moved to Paris, where he successfully applied for an internship. It was during that time that he met Joseph Babiński (1857–1932), a masterful clinician of Polish origin, who introduced Barré to the fascinating world of neurology. Meeting Babiński influenced Barré’s life: he abandoned his surgical plans and began his neurological career. He completed his medical training under the guidance of Dr Alexandre-Achille Souques (1860–1944) and Professor Pierre Marie (1853–1940). Barré’s interests at that time were focused on syphilis and the skeletal changes caused by the disease. In 1912, he obtained his doctorate degree for an original thesis entitled “Osteoarthropathies in spinal syphilis. A critical study and a new conception” [1]. In the following years, Barré continued his neurological work as assistant to Babiński until the outbreak of World

George Huntington (1850–1916)

To the memory of Magdalena P. and all my patients with Huntington’s disease that I was unable to help as I wished. The nineteenth century was a time when specializations evolved from general medicine. General physicians, out of necessity dealing with the majority of their patients’ health problems, sometimes made important observations relevant to particular emerging specializations. For instance, a single article might unintentionally become an unquestioned and significant contribution to the development of a specific field of medicine. A good example in this context is George Huntington, the American family doctor after whom Huntington’s disease (or Huntington’s chorea) is named. George Huntington (Fig. 1) was born on April 9, 1850, in East Hampton on Long Island, New York, to a family with a rich medical tradition. He represented the third generation of physicians: his father, George Lee Huntington (1811–1881), had continued the medical practice opened by his own father, Abel Huntington (1777–1858). George Junior graduated from the Clinton Academy in his native town and, in 1868, began his medical studies at the College of Physicians and Surgeons at Columbia University in New York. In 1871, he qualified in medicine, with an inaugural dissertation on opium, at the age of 21. Shortly afterwards, he moved to Pomeroy in Ohio, where he began work as a family doctor [1]. On February 15, 1872, young Huntington traveled to the neighboring town of Middleport, Ohio. As it would turn out, the destination of that trip of a few miles was much farther: to a permanent place in the history of medicine. In front of the local medical society at the Meigs and Mason Academy of Medicine, a 22-year-old family doctor from a small town in the East of the United States, only 1 year after completing his medical graduation, with little clinical experience, gave a speech “On chorea”. Huntington must have been surprised by the significant difference he had noticed when comparing Sydenham’s chorea during his studies with those cases of chorea seen at his father’s practice. This probably explains why he chose to speak on chorea as a kind of welcome introduction to his new medical colleagues [2]. In his lecture, Huntington presented the clinical characteristics of chorea but, paradoxically, he dedicated the majority of the speech to discussing the symptomatology of Sydenham’s disease. Only in the final paragraphs did he specify the clinical features of the type of chorea later named after him: its hereditary nature, the onset occurring at “adult or middle life”, the predisposition to developing psychiatric symptoms, and a tendency to suicide. He also pointed out the steady progression of the disease, without any remission. At that time, he considered this form of chorea to be exclusive to Long Island and restricted “fortunately [to] a few families”; this was probably the reason he finished his lecture claiming that he only presented a “medical curiosity” with little practical significance. Time has shown how wrong he was in this opinion. The applause that followed the lecture prompted him to send his manuscript to The Medical and Surgical Reporter in Philadelphia, where it was printed only 8 weeks later, on April 13, 1872 [3]. This scientific report was noticed and published in the same year in the form of an abstract in the German medical press by Adolf Kussmaul (1822–1902) and Carl Nothnagel (1841–1905) in Jahresbericht or the Yearbook of Important Medical Writing for the Year 1872. Thus, was George Huntington’s name introduced into European medical literature [4]. The increasing recognition of the disease and, hence, growing interest in it contributed to further medical case reports that presented its clinical symptomatology consistent with Huntington’s own perception. In fact, the accurate and comprehensive characterization of chorea presented by George Huntington has become one of the classical descriptions of neurological diseases, and the reason the disease, in a period of eponyms, was named after this modest American physician. Several years later, in 1887, the designation “Huntington’s chorea” was coined by Huber [5]. But no man is an island. George Huntington had no patients of his own * Michał K. Owecki michal.owecki@wp.pl

Kazimierz Orzechowski (1878 – 1942)

Kazimierz Orzechowski, a Polish neurologist, coined the term ‘opsoclonus’ to refer to unpredictable involuntary, horizontal and vertical oscillations of the eyes occurring in some neurological disorders [1]. While today the term is associated primarily with the opsoclonus–myoclonus syndrome, first described in 1962, it is still frequently used in its original meaning, as confirmed by 38,618 articles in the PubMed database (on 30 October 2017). Kazimierz Orzechowski was born into a noble family in the town of Przemyśl in the Austrian Partition (since the end of the eighteenth century to 11 November 1918 Poland was partitioned by Austria, Prussia and Russia) on 5 February 1878. After graduating from secondary school, he went to Lvov (also in the Austrian Partition), where he studied medicine. Having obtained a doctor’s diploma in 1902, he worked for several months as an intern in a local hospital, but soon went to Vienna to learn about the emerging subject of neurology. He was admitted as an intern to the Second Medical Clinic of the University of Vienna which was run by Edmund von Neusser (1852–1912). At the same time, he worked at the Clinic for Psychiatry and Nervous Diseases which was led by Richard von Krafft-Ebing (1840–1902) and, after his sudden death, by Julius Wagner-Jauregg (1857–1940), a pioneer in the study of the effects of thyroid diseases on the nervous system. A year later, in 1904, he moved to the Neurological Institute which was founded and run by Heinrich Obersteiner (1847–1922), a prominent neuroanatomist and neuropathologist, at the University of Vienna. There he carried out his first histological examination of neoplasms in the subarachnoid space and presented results at the meetings of the Psychiatric Society in Vienna. In 1907, he also worked at a clinic led by Lothar von Frankl-Hochwart (1862–1914), who conducted innovative research on pituitary disorders, the pathogenesis of tetany and brain tumours. In February 1909, rich in knowledge and skills, he returned to Lvov to head a much-neglected department of mental diseases at the city hospital. In a short time, he transformed it into a well-organised neurological department with an adjacent clinic. In 1910, he received a postdoctoral degree (called in German-speaking countries ‘habilitation’) in the anatomy of the nervous system and was appointed as an assistant professor of neuropathology without the right to remuneration. He also conducted all histological examinations at the department, trained other doctors in this field and took an active part in the meetings of the Lvov Medical Society. After the outbreak of World War I, he became a neuroscience consultant at the Red Cross Hospital in Lvov and headed the department of nervous system diseases for some time. After the end of this war, he was appointed as an associate professor of neurology at the University of Lvov (Fig. 1). At the beginning of the twentieth century, Lvov was the most important medical centre on the territory of Poland (still partitioned) since all local doctors were graduates or former employees of the University of Vienna. No wonder then that, after Poland regained its independence in November 1918, newly established or reactivated Polish universities sought candidates for chairs and clinics there. In the spring of 1920, being a full professor, Orzechowski was appointed as organiser and head of the Department and Clinic of Neuroscience at the University of Warsaw. The newcomer from Lvov faced open hostility from Warsaw neurologists, the followers of Edward Flatau (1868–1932), who were convinced that the prestigious clinic should be entrusted to one of them. After the death of Flatau in 1932, Orzechowski took over his legacy and became the head of the Department of Neurobiology at the Nencki Institute of Experimental Biology and the Neurosurgical Department at the Trauma Institute in Warsaw. For the rest of life, he remained as the most influential figure in Polish neurology. He founded the Warsaw Neurological Society, later transformed into the Polish Neurological Society, and became its president. He also established its * Anita Maria Magowska anitamagowska@yahoo.com

Henri Meige (1866–1940)

his Jewish patients an irrepressible need to wander continuously, “from city to city, from clinic to clinic” in a search for “an efficacious remedy”. However, at the same time, he also noted these patients’ tendency to withdraw swiftly from any proposed therapy with new medications which were allegedly much more effective. Diagnosing “an obsession with constant traveling” or a compulsive unsteadiness in his patients, Meige reached the conclusion that this was a kind of putatively congenital and race-specific disease touching the Jewish population, and that racial factors were responsible for their inability to settle in a certain place or become part of a certain nation. Words that, in the context of the future Holocaust, are abhorrent. Fortunately, Meige’s doctoral analysis is not what represents his considerable contribution to neurology [2]. In 1894, Meige left Salpêtrière and followed his new mentor, Édouard Brissaud, to continue his neurological work at the Saint-Antoine Hospital in Paris. Meige’s interest at that time was focused on acromegaly and the skeletal changes caused by the disease. In 1895, with Brissaud’s cooperation, Meige accurately concluded that gigantism in teenagers and acromegaly in adults shared the same pathogenesis and was actually the same disease entity, although with a different age of onset [3]. Later, in collaboration with Eugene Feindel, Meige took up a subject that Georges Gilles de la Tourette had dealt with a decade or so earlier. In 1885, Tourette precisely reported the case of the Marquise de Dampierre, who was touched by a disease presenting with a composition of vocal and motor tics. Her illness began in childhood and the tics increased in number and severity over time. Although Tourette was awarded the honour of having the syndrome named after him, he proposed an explanation of the disease pathogenesis that reflected the spirit of the time: tics were a consequence of inherited nervous system degeneration due Henri Meige was a French neurologist now known for the eponymous “Meige’s syndrome”, which is a neurological condition characterized by blepharospasm and orofacial dystonic movements. Born on February 11, 1866 in Moulins-sur-Allier in France, into a family with a rich medical tradition, Meige represented the fourth generation of doctors. He graduated from high school in his hometown, moved to Paris to study medicine and, following his graduation, qualified for a position at Salpêtrière Hospital. His medical training was conducted under the guidance of Jean-Martin Charcot, the Head and the Chair of the Clinic of Nervous System Diseases at Salpêtrière. Meige had the advantage of being one of Charcot’s last interns and, until the end of his life, Meige remained under the great influence of his master’s genius. A few years after Charcot’s death, Meige wrote a short monograph, glorifying not only Charcot’s artistic interests, but also the artistry of his clinical skills and unmistakable diagnostic accuracy; the book was re-edited in 1925 [1]. In 1893, the year of Charcot’s death, Meige obtained his doctorate with a thesis entitled “The Study of Certain Neuropathological Travelers: The Wandering Jew at the Salpêtrière”. Meige prepared his doctoral dissertation under Charcot’s tutelage, basing it on his and Charcot’s observations of Jews hospitalized at the Salpêtrière. However, he also incorporated some conclusions derived from non-academic papers on “wandering Jews”; part of which comprised hideously anti-Semitic trends. Meige noticed in

Discovering herbalism through art. plants in Polish symbolic painting (1890-1914).

Summary The article focuses on the historical link between herbalism and art at the turn of the twentieth century. The aim of this investigation is to recognize medicinal plants shown as symbols in Polish painting between 1890 and 1914 and find some cultural context of their presence in artworks. In this qualitative study online art galleries and museum collections were analyzed to select Polish symbolists’ artworks including plant images. Next, their botanical classification and medicinal context were examined. Twenty wild-growing plant species were recognized. Some of them had been used in traditional medicine (Alcea rosea, Angelica archangelica, Artemisia abrotanum, Betula pendula, Carduus marianus, Convallaria majalis, Crocus sativus, Lilium candidum, Matricaria chamomilla, Nuphar lutea, Paeonia officinalis, Papaver somniferum, Pelargonium hortorum, Populus nigra, Primula veris, Sorbus aucuparia, Taraxacum officinale, and Verbascum thapsus) and two species grown in the Carpathians (Digitalis purpurea, Lilium bulbiferum) at the time. Used to paint realistic objects, the symbolists made free-hand drawings in nature and in this way they recorded some wild-growing plants typical for surroundings of the town of Cracow and the Carpathian Mountains. Artistic images of plants were not intentionally aimed at taxonomic identification, however, sometimes classification was possible. Streszczenie Artykuł przedstawia historyczne powiązania między zielarstwem a sztuką na początku XX wieku. Celem badania jest rozpoznanie roślin leczniczych pokazanych jako symbole w malarstwie polskim w latach 1890-1914 oraz znalezienie kulturowego kontekstu ich obecności w dziełach sztuki. W niniejszym badaniu jakościowym przeanalizowano internetowe galerie sztuki i kolekcje muzealne w celu wybrania prac polskich symbolistów zawierających wizerunki roślin. Następnie opracowano ich klasyfikację botaniczną i kontekst medyczny. Rozpoznano 20 gatunków dziko rosnących roślin leczniczych, z których część znajdowała zastosowanie w medycynie tradycyjnej (Alcea rosea, Angelica archangelica, Artemisia abrotanum, Betula pendula, Carduus marianus, Convallaria majalis, Crocus sativus, Lilium candidum, Matricaria chamomilla, Nuphar lutea, Paeonia officinalis, Papaver somniferum, Pelargonium hortorum, Populus nigra, Primula veris, Sorbus aucuparia, Taraxacum officinale i Verbascum thapsus) i dwa gatunki występujące wtedy w Karpatach (Digitalis purpurea, Lilium bulbiferum). Przyzwyczajeni do malowania rzeczywistych obiektów, symboliści przygotowywali szkice w plenerze, utrwalając w ten sposób wizerunki roślin leczniczych typowych dla okolic Krakowa i Karpat. Artystycznych wizerunków roślin nie sporządzano w celu ich identyfikacji taksonomicznej, ale niekiedy jest ona możliwa.