Pedro L. Mangabeira Albernaz

Festivals are quite characteristic of the human race and, therefore, have been in existence for many, many centuries. All of the religion scholars agree that the “new” religions evolved from older ones. And the “new” ones adapted the old festivals to their own concepts. This is the reason that all of the present religious festivals have prehistorical roots. The most important old festivals were those of the spring equinox, the winter solstice and the harvests. We recently enjoyed a “new” harvest festival, particularly important in the United States and not really linked to any special religion, in spite of the fact that we are basically thanking God for the blessings that He bestowed on us. Thanksgiving is a very meaningful festival that I particularly enjoy. We are now approaching the winter solstice. It seems that this festival originated in the Scandinavian countries, where the days become definitely shorter as the solstice approaches. And people would light fires and pray tha...

Bartolomeo Eustachi was one of most important anatomists of the sixteenth century. He is more commonly referred to by his Latin name, Eustachius. He was born in San Severino, in Italy, around 1510. He was a contemporary of Vesalius, with whom he shares the reputation of having created the science of human anatomy. His father, Mariano, was a physician, and he gave his son a classical education. He studied Greek, Hebrew, and Arabic. He studied Medicine in Rome and began his practice around 1540. He became a professor of anatomy at the Archiginnasio della Sapienza, in Rome and, because of his position, he was able to obtain human cadavers for dissection. Religious reverence for the body made the Roman Catholic Church prohibit the dissection of  human corpses for many centuries. Following the Black Death Plague, however, the Popes wanted to know the cause of the disease and permitted postmortem examinations of plague victims. But it was almost 200 years later that Pope Clement VII, in ...

Our ears are sensitive to loud noise. We may acquire a hearing loss from acoustic trauma, such as explosions, gun shots, and similar sudden loud noises, or we can get hearing loss from repeated sound stimulation, as working in a factory with machines that produce loud noises. In the past hearing losses were related to some old professions, like blacksmiths and makers of metal pans and pots. During the II World War acoustic trauma and noise induced hearing loss became a serious problem. Soldiers were affected by loud sounds from artillery (guns, cannons, granades), explosions of shells and bombs. Pilots were constantly exposed to the noise of their airplanes. The Department of Otolaryngology at Washington University in Saint Louis was commissioned by the United States Army Air Force to make an experimental study on acoustic trauma, hoping that understanding the involved mechanisms would help to establish adequate mechanisms of prevention. These studies led to interesting neurophys...

Today it is not about Medicine. It is about Literature. “The Lusiads” is an epic poem written by Luís Vaz de Camões, the most famous of  Portuguese poets. He is considered the best epic poet of all Portuguese literature and also the best lyric poet of his time. I remember reading a book by William Somerset Maugham in which he tells us of a man that he met somewhere in the South Seas who was writing a new translation of “The Lusiads.” “It is the best epic poem ever written,” said the man to Maugham. “It tells much more than all others. The Iliad is all about the Trojan War. The Odyssey is merely Ulysses’ return travel to Greece. The Aeneid is just Aeneas trip from the destroyed city of Troy to Italy. “But ‘The Lusiads’, although focused on Vasco da Gama’s discovery of the route to India, tell us all of the history of Portugal. Unfortunately it is written in a language that few people read and the existing translations are not good.” The poem was first published in 1572 an...

Although Malpighi began to use the microscope for anatomical studies in the 1600's, almost three centuries elapsed until it began to be used in the operating room. Microsurgical techniques are now employed in several areas of Medicine. But we, ear, nose and throat specialists, are proud to have been the ones who started using these techniques. A Swedish otolaryngologist, Carl-Olof Siggesson Nylén (1892-1978), was the father of microsurgery. In 1921, in the University of Stockholm, he built the first surgical microscope, a modified monocular Brinell-Leitz microscope. At first he used it for operations in animals. In November of the same ear he used it to operate on a patient with chronic otitis media who had a labyrinthine fistula. Nylén was particularly interested in Neurotology and is well known for describing a disease that he named vestibular neuritis, a sudden loss of function of one of the labyrinths. Nylen's microscope was soon replaced by a binocular microscope, develope...

Marcello Malpighi was the first anatomist to incorporate the microscope in his studies. Marcello Malpighi - Wikimedia Commons The microscope was invented by Hans Jansen, a Dutch spectacle-maker, in 1590 and was modified by Galileo in 1609. Its possibilities for biological studies, however, came approximately 50 years later, when Robert Hooke improved it. Then Malpighi, Hooke, Nehemiah Grew and Antoine van Leeuwenhoek  began their investigations using the new tool. Hooke studied mainly insects, and was the creator of the word cell for describing biological organisms. Grew was a vegetable anatomist. Leeuwenhoek manufactured many microscopes (of high quality for that time) and actually made important discoveries, such as bacteria   (large Selenomonads from the human mouth), the vacuoles of the cells, the banded pattern of muscular fibers and the spermatozoa (for this discovery he had serious disagreements with the Dutch theologists). Hooke's microscope, employed by Malpi...

In 1966 I wrote a thesis to become an Associate Professor in Otolaryngology at my Medical School and wrote a paper reporting the most important findings. This was published  in The Laryngoscope*. Soon after the publication, I received a letter from Dr. Wallace Rubin, congratulating me for the paper. I had heard of him and had read many of his papers, but we had never met. I was happy to receive a compliment, at the beginning of my career, from a well known physician with whom I had had no personal contact. In 1971 he was invited to a Congress in Brazil. We were together several times during the meeting, some of them with our wives. We became good friends. My wife and I used to stay in his home when we traveled to New Orleans and Elsie and Wally stayed in our home when they came to São Paulo. In 1976 he asked New Orleans Mayor to make me an Honorary Citizen of the city; this certificate is proudly hanging from one of the walls of my office. When we went to New York they would fl...

Renaissance was a cultural movement that began in 14th century in Florence, in the Late Middle Ages, and lasted three centuries, spreading to all Europe. It probably arised from the rediscovery of Greek, Roman and Arabic classical texts on natural sciences, philosophy and mathematics, leading to a sudden flowering of literature, science, art, religion, education and politics. Renaissance brought progress in many areas, even if it is better known by its artists. The Renaissance scholars employed the humanist method of study, and searched for realism and human emotion in art. Science and art were intermingled in the early Renaissance, with artists such as Leonardo da Vinci studying anatomy to improve the quality of his paintings and sculptures. Dissections of human cadavers were strictly prohibited by the Roman Catholic Church, but Da Vinci performed them. The illustration depicted here shows one of his anatomical drawings. It is quite possible that Michelangelo did the same. The “secr...

We know now that our inner ears contain a fluid called endolymph , a fluid totally different from all of our “extracellular” fluids, like blood, lymph and cerebral spinal fluid. All of these fluids have a large concentration of sodium and a small concentration of potassium. But endolymph is rich in potassium and has little sodium. Just like the fluids that we have inside our cells. Large amounts of energy are needed to fuel our sodium-potassium “pumps,” the enzymes that remove the sodium from these special, potassium rich, fluids. Of course, all scientists know this. But not all of them know who discovered the composition of endolymph. It was a scientist called Catherine Smith. She worked for many years at the Department of Otolaryngology of Washington University in Saint Louis. This important work was published in 1954*. Vascularization of the stria vascularis She started her brilliant career as a laboratory technician. Drs. Theo Walsh, Walter  Covell and Edward Dempsey, P...

For many years the measurement of hearing in small children had been a serious challenge. Hearing is the most important of our sense organs, the basis of language and communication. I used to tell my students in Medical School that we remember learning to read and write, but we do not remember learning to speak, which is much more complicated. Reading and writing is simply a representation of our speech with symbols. Learning to speak is a much more difficult task for our nervous system, a task that starts when we are born. The period of time from two months to 30 months of age is the most intense activity in acquiring language. In the old days most of the hearing tests in young children could only be done by conditioning . There are two types of conditioning, the classical , or pavlovian type, developed by Ivan Pavlov in 1927, and the instrumental type, developed by Edward Thorndike and extensively revised by B. F. Skinner. In Pavlov’s classical experiment the dogs were conditioned ...

Bill House is my guru, my otological model, my friend. Most probably his name will appear many times in this blog. His associate Jim Sheehy used to say that he is a “far out thinker.” His inventive capacity has no limits. He changed otology and neurotology. Making changes in Medicine is a complex thing. Many people resent it. Many people  make unfavorable comments. Many people try to block progress. The history of otology tells us that all new procedures were severely criticized before becoming standardized techniques. I am happy that Bill decided to write a memoir telling us how controversial most of his work was, something that young otologists do not realize. Very aptly, his book is called The Struggles of a Medical Innovator – Cochlear Implants and Other Ear Surgeries. The Table of Contents, in itself, is a list of his accomplishments in the areas of otosclerosis, the facial nerve recess, surgery for Menière’s Disease, the middle fossa and translabyrinthine approaches for ...

Nautilus is the name of several species of marine animals, cephalopod mollusks of the Nautilidae family. These animals originated 65 million years ago and all of its close relatives are now extinct. Fig. 1. The nautilus in its natural habitat (Wikimedia commons). Fig. 1 shows a nautilus in its natural habitat. Fig. 2 is a schematic drawing of its chambers, which can be filled with water when the nautilus wants to move to a greater depth. When it wants to go closer to the surface the water is expelled from the chambers. This is a complicated process that requires the elimination of the sodium from the water in the chambers, accomplished by special enzymes. The osmotic pressure change makes the fluid  flow against the ocean’s hydrostatic pressure. Fig. 2. A schematic drawing showing the chambers that the  nautilus uses to move into different depths. The shell is very hard. At a depth of 400 meters, the usual depth in which the nautilus hunts, the hydrostatic pressure is 10...

History of Medicine ... 8 In old times surgeons were not physicians, they were classified with the barbers. They were people with manual abilities, but usually uncultured and without adequate knowledge of the glorious medical profession. They were despised by the physicians. Ambroise Paré was the man who changed this, he was probably the first eminent surgeon. He was also a pioneer on forensic medicine. He was born around 1510 in Laval, France, and died in Paris in 1590. He first learned to be a barber and later learned wound-dressing at the Hôtel-Dieu, in Paris. Snubbed by the physicians at the Collège de St. Côme, he decided to join the army, where he achieved his fame. A Spanish surgeon, Juan de Vigo, published in 1514 a book called Practica Copiosa in Arte Chirurgica , in which he stated, quite dogmatically, that gunshot wounds were poisoned and had to be treated with boiling oil. This became the treatment of choice for these wounds. Paré followed this tradition for a certain perio...

A few days ago I received a copy of the second edition of Joe Kraft’s book, Diabetes Epidemic & You . It was autographed this way:   Dear Pedro: You are now a part of this book – forever. Thank you so much. Joe.   I was very touched. And he also included my comments about the 2009 edition in his Preface-2011. I met him in Bad Kissingen, many years ago, in a meeting of the Neurotological and Equilibriometric Society, presided by our common friend Claus Claussen. But I had been following his line of work before that. It was in 1972 that Joe Kraft began to titrate insulin in the oral glucose tolerance tests and published the results of the first 500 patients. When he retired in 1998, he had tested 14,384 patients! He established the concept of diabetes in situ, or occult diabetes, and established hyperinsulinemia as the most important sign of early diabetes. Otologists have known for a long time the relation between changes in carbohydrate metabolism and hearin...

Carlo Mondini was an anatomist of the University of Bologna. He was born at the city of Bologna in 1729 and died in 1803. In 1791 he made a detailed report on the dissection of the temporal bones of an 8-year-old boy whom he knew to be deaf and who had died of gangrene resulting from an infection of a foot. In fact, he had been run over by a carriage and in those days open fractures became easily infected and most severe infections were fatal. Mondini was not specialized in inner ear anatomy, so he performed his dissections very slowly, so that he would not make any mistakes. He also felt that in case he did make a mistake in the first bone, he would avoid it in the second. But he did not make any mistakes, and he himself drew pictures to show his findings. He stated that the congenital defect in this boy’s ears was the same: the superior coil of the cochlea was missing, the entire labyrinth was enlarged and the vestibular aqueducts were very large. For many ears the Mondini dyspl...

Many years ago I went to Paris, to a meeting organized by Prof. Jean-Marc Sterkers. William House and Ugo Fish were the special guests. The meeting was excellent but still the four of us found many hours to talk about many things, medical and non-medical. In one of the meeting’s sessions Ugo told us about one of his patients, a man who lived in one of the many mountains in Switzerland and had little contact with the big cities. One day this man realized that he had lost most of his hearing in one ear. He knew a  famous sorcerer near his home and went there hoping to find a cure for his ailment. The sorcerer stared at him for several minutes and then said: “You have a tumor in your ear. Take a train to Zürich, go to the Universitätspital and look for Professor Ugo Fish. He will cure you.” So the man took a train to Zürich, walked to the University Hospital and succeeded in making an appointment with Professor Ugo Fish. Ugo examined the patient, sent him for audiological tests and th...

One day Dr. Walter Page Covell, Professor of Anatomy and Otolaryngology (and a very good friend) told me that there was a large collection of sections of guinea pig cochleas that had been used in an investigation carried out for the American Air Forces during the Second Word War. All of the guinea pigs had been exposed to noise and the hair cells in the organ of Corti had been carefully evaluated, establishing a relation between the intensity of the noise exposure and the cell damage. Different frequencies had been used, as well as different intensities. This extensive study was carried out by Dr. Covell and Dr. Donald H. Eldredge, a neurophysiologist at the Central Institute for the Deaf (CID). “In many of these sections,” said Dr. Covell, “we can see parts of the vestibular labyrinth. I want you to check whether the intense sound can also damage the vestibular end-organs.” For the next few months I was busy checking the sections of each guinea pig in the study to find the ones in whi...

History of Medicine ... 7 Alchemy was an important discipline in the Middle Ages and it extended itself into  Renaissance. Most alchemists were highly educated persons and possessed knowledge in many areas. Philippus Aureolus Theophrastus Bombastus von Hohenheim was an alchemist who was also a physician, philosopher, botanist, astrologer and a specialist in occult sciences.He called himself “Paracelsus,” for he considered himself “equal or superior to Celsus,” referring to Roman encyclopedist Cornelius Celsus, who wrote six treatises about medicine in the 1st century. Incidentally, these were the first medical books to be printed in movable type after Gutenberg invented them. Paracelsus was born near Zürich in 1493 and died in the Old Swiss Confederacy in 1541. He started to study Medicine in Basel, moved to Vienna and finished his studies in  Ferrara. He journeyed extensively through Germany, France, Spain, Hungary, the Netherlands, Denmark, Sweden and Russia, all the time qu...