Lorenzo Lorusso

Functional Neuroimaging: A Historical Perspective

Stefano Zago1, Lorenzo Lorusso2, Roberta Ferrucci3 and Alberto Priori3 1Dipartimento di Neuroscienze ed Organi di Senso, Universita degli Studi di Milano, U.O.C. di Neurologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 2Unita Operativa di Neurologia, Azienda Ospedaliera ‘M. Mellini’ Chiari, Brescia, 3Centro Clinico per la Neurostimolazione, le Neurotecnologie e i Disordini del Movimento, Dipartimento di Neuroscienze ed organi di Senso, Universita degli Studi di Milano, Italy

Augusto Pellegrini (1877-1958): contributions to surgery and prosthetic orthopaedics.

Augusto Pellegrini worked as a general surgeon in Northern Italy. In 1905, in the field of orthopaedics, he described post-traumatic knee ossification associated particularly with sports activities, which took the name of Pellegrini disease. In collaboration with Giuliano Vanghetti, he contributed to the application of kinematic prostheses of the upper extremity (kineplasty), enabling the patient to use his muscles to power the prosthesis. His surgical innovations were particularly in the field of abdominal surgery at a time when antibiotics were not available and when radiological diagnostics were in their infancy. He advocated the surgical treatment of acute appendicitis ‘at presentation’, namely within 24–48 hours of diagnosis, thereby reducing the development of abdominal complications. In 1904 he introduced disinfection of the hands solely with alcohol before each surgical operation, encouraging the healing of wounds by first intention.

Water and the city of Milan at the end of the nineteenth century

Abstract Since the Middle Ages Milan obtained its water supply satisfactorily from shallow wells. Significant problems developed during the nineteenth century, however, prompting the Lombard Institute to announce the Cagnola Award for a three-year study project to analyse the water both chemically and physically and to remedy the problem of pollution. The award was made to Angelo Pavesi (1830–96), a chemist, and Ermenegildo Rotondi (1845–1915), a civil engineer. They concluded that cemetery wastewater should be prevented from entering the city and that the number of deep artesian wells should be increased. Some years later, another problem regarding hygiene and water supply arose and it seemed doubtful whether the principal hospital of the city could fulfil the new hygiene requirements. Pietro Canetta (1836–1903) studied the records of the main hospitals water supply and disposal from 1457, demonstrating that it could be regarded as a model for the supply of good-quality water and for wastewater disposal without polluting the city. Since 1906 all of Milans drinking water has been derived from groundwater; untreated wastewater continued to be discharged into rivers until 2004 but since then all water has been treated.

Historical Aspects of Transcranial Electric Stimulation

The first clinical experience with electric fish, and a long history of application of electrotherapeutic techniques, started from the eighteenth century leading to the modern use of transcranial direct current stimulation (tDCS). This history had various degrees of success and the treatment of mental disorders using electricity followed a cyclical course throughout the centuries. In the beginning, clinicians approached transcranial electric stimulation with enthusiasm, treating numerous disorders such as neurasthenia, melancholia, mania, and hysteria, but also hallucinations, migraine, and dementia. This phase saw a lot of excesses and exaggerations, typical of early stages of the application of a new therapeutic technique. Later, at the end of the nineteenth century transcranial electric stimulation was considerably less used, After failing to produce consistent results. In the twentieth century, experimental data clearly demonstrated that using motor evoked potentials tDCS resulted in changes in motor-cortical excitability supporting a series of new experimental clinical evidence. Today, tDCS is recognized as being an effective technique in applying a direct current to the scalp, further demonstrating its ability to treat clinical conditions such as affective disorders, chronic pain and post-lesional cognitive disorders.

Geology, conservation and dissolution of corpses by Paolo Gorini (1813–1881)

Abstract Paolo Gorini (1813–1881), an Italian mathematician, is considered one of the fathers of experimental geology, and his work contributed to the evolution of medicine and hygiene. In 1844, he studied food conservation and worked out a method for conserving corpses and anatomical specimens, approved by the Medical School of Pavia. His geological studies mainly concerned mineralisation. At that time several researchers, including Jean Nicolas Gannal (1791–1852), Girolamo Segato (1792–1836), Ludovico Brunetti (1813–1899) and Efisio Marini (1835–1900), experimented on the scientific conservation of corpses. Later (1851), Gorini studied the formation of mountains and suggested experiments and demonstrations to produce volcanoes artificially. These studies were fundamental to realizing the early methods of corpse cremation in order to solve the problem of hygiene in cities and cemeteries. Gorini also supervised the construction of the first crematorium (Woking, UK). Gorini conserved the corpse of the Italian politician Giuseppe Mazzini (1805–1872). Gorini’s theories were not scientifically confirmed, but his attempt to understand the Universe and the origin of life and evolution by means of a single law is interesting as an early model for the emerging positivism of that time.

Filippo Lussana (1820-1897): from medical practitioner to neuroscience

Filippo Lussana’s scientific activities are neglected in neurological field. His activity could be divided into two phases: as a medical practitioner and the academic period, as a clinical neurophysiologist. The focus of his various research studies was the central nervous system, including balance disorders (the role of the cerebellum and semicircular canals), taste innervation, pain and speech disorders (theories of brain localisation). Lussana’s clinical method and direct dealings with patients laid the groundwork for his subsequent academic activities as a neurophysiologist, in Parma and later in Padua. Influenced by phrenological theories, he also conducted interesting studies on synaesthesia for which he determined a brain site. He contributed to the neurophysiology of taste, emphasising the role of the facial nerve. With his study on muscle sense, he also joined the debate on the role of the cerebellum in balance, setting the foundation for later studies on this organ by Luigi Luciani.

Modernity in medicine and hygiene at the end of the 19th century: the example of cremation

Medicine in the second half of the nineteenth century takes on some characteristics of modernity. These characteristics are worthy of our attention because they help us to understand better some of the current problems of hygiene and public health. One of the topics that was most discussed in the scientific-academic milieu of the second half of the nineteenth century was cremation. There was a poetic precedent: the cremation of Percy Bysse Shelley (1792-1822). The earliest apparatus to completely destroy the corpse was made in Italy and Germany in the 1870s. As far as hygiene was concerned, the reasons for cremation were not to pollute the water-bearing strata and an attempt to streamline the cemetery structure. As in an apparent schizophrenia, scientists of the day worked to both destroy and preserve corpses. There is also the unusual paradox that when the first cremations took place, the corpses were first preserved then to be destroyed later. The catholic world (mainly in Italy) and forensic scientists opposed cremation. It was left to the hygienists to spread the practice of cremation. An analysis of scientific literature shows us that if we leave out the related forensic and ethical problems, recent years have seen attention paid to any harmful emissions from crematoria equipment which have poured into the environment. Another issue is the assessment of inadvertent damage which may be caused by the condition of the corpse. Some topics, however, such as the need for preventive autopsies (first proposed in 1884 in Milan) are still a subject of debate, and seem to pass virtually unchanged from one generation to the next.

The Pellegrini–Stieda Lesion Dissected Historically

Abstract The Pellegrini‐Stieda lesion is a common finding on conventional X‐rays. Whether it originates in the medial collateral ligament (MCL) of the knee or the medial head of the gastrocnemius muscle or another structure remains under debate. We discuss the difference in the articles by Pellegrini and Stieda and follow the vision on the origin of the lesion through time. A systematic research in PubMed/MEDLINE was conducted, identifying all articles on the Pellegrini‐Stieda lesion and analyzing them for proposed origin of the lesion. The articles with their conclusion based on either finding during surgery or magnetic resonance imaging (MRI)/computed tomography were analyzed in more detail. Our PubMed/Medline search identified 4,997 articles. After exclusion of articles that were not on the Pellegrini‐Stieda lesion and of doubles, 27 articles remained. By checking the references manually, 10 more articles were identified. Proposed origins were MCL, medial gastrocnemius, adductor magnus, vastus medialis, deep MCL, and superficial MCL. Although the MCL was most often coined as origin of the lesion (54% overall, 25% on MRI, and 57% during surgery), many cases remained undecided (50% on MRI) or no specific structure was found to be the origin (29% during surgery). There are diverse proposed origins of a calcification on the medial side of the knee. The eponymous term Pellegrini‐Stieda lesion seems fitting, as it comprises two different thoughts on the origin of the lesion. MRI seems to be a noninvasive and quite accurate method for future research.

Between Bouillaud and Broca: An unknown Italian debate on cerebral localization of language.

From 1825 onward, Bouillaud began gathering clinical evidence to support the hypothesis that speech is located in the cerebral frontal lobes. His aim was to provide empirical proof to Galls theory of a specific substratum of speech in the anterior region of the brain. A well-known discussion ensued inside the French school among supporters and detractors that went far beyond Brocas first report in 1861. Unknown is that Bouillauds investigations on localization of articulated language also gave rise to a discussion in Italy in the same period. In particular, speech localization formed a central topic in the mid-19th century in Northern Italy mainly thanks to four physicians, Michelangelo Asson, Mosè Rizzi, Gaetano Strambio and Filippo Lussana, who reported on language-impaired patients and approached these cases in the light of Bouillauds claims. Similarly to the French debate, the Italian medical community also included attacks and advocacies of the hypothesis of a precise localization of articulated language in the frontal lobes. However, they were mainly interested in investigating the anatomo-clinical relationships rather than in supporting Galls organology. This Italian debate appears to be the first to have developed in the mid-19th century outside that of the French community.

Vomiting Stones: Mental Illness and Forensic Medicine in 18th Century Italy

Abstract In 1746 the case of a young woman vomiting stones, nails, glasses and other foreign bodies came to the notice of the general scientific and religious communities. The Bishop of Cremona, Alessandro Maria Litta (1671–1754), deemed that a scientific–medical approach was necessary. Paolo Valcarenghi (d. 1780), one of the most famous of Cremona’s physicians, was charged with this task. Many physicians, both local and from the wider area of Northern Italy, became actively involved in the discussion: Martino Ghisi (1715–1794), who was the first to describe diphtheria on a scientific basis; Carlo Francesco Cogrossi (1682–1769, Professor of Practical Medicine at Padua University), who is noted for his parasitic theory of contagion; Carlo Gandini (1705–1788), who introduced some typical traditional Chinese Medicine practices into Italian medicine; and Francesco Roncalli Parolino (1692–1769), who recorded the case in his work entitled Europae medicina a sapientibus illustrata et a comite Francisco Roncalli Parolino observationibus adaucta (1747), a foundational work in the reconstruction of medical praxis in Europe. Their work is amongst the earliest texts from the Italian Peninsula to deny the natural formation of stones in the stomach, with the debate between the religious and scientific communities resulting in the acceptance of the medical explanation.