Constantinos Trompoukis

Aspects of Informed Consent in Medical Practice in the Eastern Mediterranean Region During the 17th and 18th Centuries

Informed consent is a question of central importance in contemporary medical ethics, and clinical practice is inconceivable without considering the issues it raises. Although it is often vigorously argued that consent, informed or otherwise, is a recent phenomenon and that no sources testify to its existence before the 20th century, it is difficult to accept that a process for regulating the common and fundamental parameters in the relationship between doctor and patient and the planning of treatment had not concerned previous eras. A review of the Registers of the Islamic Court of Candia (Heraklion) in Crete, a series of records that touches on, among other things, matters of medical interest, reveals that the concept of informed consent was not only known during a period that stretched from the mid-17th to the early 19th century, but it was concerned with the same principles that prevail or have been a point of contention today. An extension of this study into other periods may thus provide contemporary researchers with material and information valuable in the discussion of today’s bioethical issues.

From the Roots of Parasitology: Hippocrates' First Scientific Observations in Helminthology

Although knowledge of intestinal parasites predates Hippocrates, the Hippocratic Corpus provides the first scientific observations about the clinical perception and treatment of helminthic diseases. These observations follow the scientific principles of Hippocrates, the father of modern medicine, who relied on knowledge and observation. This article is based on a systematic study of the Hippocratic texts, and presents observations on diseases caused by intestinal parasites with respect to regularity of appearance, patient age, symptoms, and treatment. Three types of helminths are described: “helmins strongyle” (roundworm), “helmins plateia” (flatworm), and “ascaris” (which corresponds to Enterobius vermicularis). Helminthic diseases primarily appear during childhood, well after teething. The described systemic symptoms include weakness, sickness, discomfort, tiredness, anorexia, and emotional instability; gastrointestinal symptoms include change in bowel movements, vomiting, and colic pain in the epigastrium. We identified several accounts of cases of helminthic diseases in the Hippocratic texts. Of particular interest are the descriptions of a helminth emerging from a fistula in the navel region and the surgical treatment of helminthic diseases, reinforced by being described on a dedicatory inscription at the Asclepion in Epidaurus. We finally encountered the use of powerful purgatives as antihelminthics, which have been widely used, even into the 21st century.

The breast: from Ancient Greek myths to Hippocrates and Galen

This is a historical article about Ancient Greek literature from mythological times until the first centuries AD with regard to the female breast. We endeavoured to collect several elegant narratives on the topic as well as to explore the knowledge of Ancient Greek doctors on the role, physiology and pathology of breast and the treatment of its diseases. We identified such descriptions in myths regarding Amazons, Hercules, Zeus, Hera and Amaltheia. Furthermore, descriptions on the topic were also found in the work of Hippocrates, Aristoteles, Soranos, Alexander of Aphrodisias, Celsus, Archigenis, Leonides, Galen and Oribasius. We may conclude that some of todays medical knowledge or practice regarding the breast was also known in the historical period.

Historical Note: Melampous: a psychiatrist before psychiatry

Although psychiatry was the last among the major branches of medicine to be recognized, taught and practised as a separate speciality, it is commonly accepted that even in antiquity there was a clear desire to study and understand mental illnesses, although they were not seen as distinct from physical diseases. Melampous is a figure balanced between historical reality and myth. Reading between the lines of the enchanting narrative preserved by Greek mythology, we can see the desire to comprehend mental illnesses and to propose systematic and credible treatments for them. In this article, an account is given of the myth of Melampous, with emphasis on the details that present him as a pioneer of contemporary psychiatric treatment and as having introduced pioneering approaches to psychiatric disorders.

Paul of Aegina's surgical instruments: a complete surgical instrumentarium in the seventh century AD.

Although current progress in surgical instruments is oriented towards stapler devices, minimally invasive instrumentation and advanced cautery tools, it definitely seems intriguing to determine what instruments were used in antiquity and to appraise their use. Most adequate information can be retrieved from manuscripts of early medical authors, of whom Paul of Aegina (AD 625–690), also being a most important surgeon, is the most recent. The aim of this study is to present surgical instruments used in his practice.

Conception, complicated pregnancy, and labour of gods and heroes in Greek mythology

Pregnancy and labour are holy moments in a womans life. Even in Greek mythology we can find descriptions of them. We searched in the Greek myths to find descriptions of labours of ancient heroes and gods. We identified descriptions of extracorporeal fertilization, superfecundation, ectopic pregnancy, preterm labour, prolonged pregnancy and Caesarean section. The use of imagination could help the reader to find similarities in present or future developments in the field of obstetrics. It could be concluded that various aspects of modern obstetrical practice are described in Greek mythology.

Landmarks in the history of adrenal surgery

The last 100 years have seen a revolution in the understanding of adrenal disease and its surgical treatment. The isolation of hormones, the detailed study of the adrenal medulla and cortex, as long as the enormous expansion of surgery served as catalysts to this revolution. The original surgical procedures described were modified as time went by and nowadays laparoscopic adrenalectomy serves as the first-line therapy choice for the management of most functional and non-functional adrenal tumors. With respect to the pioneers who, often at the risk of compromising their careers, surpassed significant milestones at their times, we review the historical evolution of adrenal surgery and report in a chronological fashion its major landmarks from antiquity to the current era.

First report of palmar fibromatosis and camptodactyly in the 2nd century AD

Byzantine physicians compiled, standardized and enriched the medical knowledge of their GrecoRoman predecessors. Their medical treatises had a significant impact on Western medicine, as they formed the basis of Arabic medical knowledge. Antyllus was an eminent surgeon, who probably flourished during the early Byzantine period. Little is known of his place and date of birth. He is mentioned by Oribasius, but is nowhere quoted by Galen. Therefore, he must have lived between the late third and the early fourth century. He is considered a voluminous writer, but only fragments of his works have been preserved by his successors, i.e. Oribasius and Aetius. His descriptions refer to a skillful surgeon. He was the first to provide a thorough description of tracheotomy and he is credited with the first description of aneurysms and their treatment. He distinguished between developmental, i.e. caused by dilatation, and traumatic aneurysms and advocated the application of ligatures, before cutting the vessel.[1] Unfortunately, as mentioned above, all Antyllus’ works are lost, but distinct sessions are reflected in his successors’ writings. These fragments were collected and separately published from Gebauer in 1799, under the title ‘Antylli, Veteris Chirurgi’. Oribasius was the writer, who preserved most of the Antyllus’ fragments in his medical encyclopedia. Oribasius, born in Pergamus in the beginning of the fourth century, began his studies at the school of Zeno the Cyprian at Sardes and then continued his studies in Egypt. He was favored with Julian’s acquaintance and friendship, and soon became known as ‘Julian’s physician’. He attended Julian in his last expedition against Persia, and was present at the time of his death in AD 363. On the emperor’s order, Oribasius compiled the most important medical knowledge of his times in an anthology, consisting of 70 books, titled ‘Collectiones Medicae’ or ‘Hebdomecontabiblos’. Even though only one-third of this work is still extant, Oribasius refers to Antyllus several times, especially when dealing with surgical diseases.[1] The best translation of Oribasius’ work was published in six volumes in Paris by Charles Viktor Daremberg and Ulco Cats Bussemaker between 1851 and 1876 (Figure 1). Daremberg was an eminent librarian and medical historian who also translated works by Galen and Hippocrates. Except

Trichiasis in ancient times

Trichiasis, recognized since the time of Hippocrates, is a cause of ocular irritation that may result in scarring of the cornea and threaten sight. We have reviewed the original Greek medical texts made from the 1st to the 7th century ce and present the existing medical knowledge relating to trichiasis, including its clinical picture, cause, diagnosis, and treatment. Recognition of trichiasis as a stage of trachoma and its distinction from pseudotrichiasis gave the impetus for physicians of the era to use a significant number of pharmaceutical and surgical treatments.