Oreja de Stahl y su manejo quirúrgico / Stahl ear and its surgical management

RESUMEN Introducción: La oreja de Stahl presenta una baja incidencia, aún en centros especializados de reconstrucción auricular. Se caracteriza por presentar un remanente cartilaginoso anormal que se extiende desde el antihélix hasta el borde del hélix, formando una tercer crura. Caso clínico: Varón de 17 años de edad, con deformidad auricular caracterizada por hipoplasia de la raíz del antihélix y presencia de una tercer crura, que comunica el antihélix al hélix. Se realiza resección de la tercer crura y reconstrucción cartilaginosa del pabellón auricular, logrando una adecuada reconstrucción, con buen resultado estético, sin alteración de tamaño en comparación con la oreja contralateral. Conclusiones: Esta es una rara deformidad auricular, muchas veces subdiagnosticada, incluso en centros especializados. Puede acarrear trastornos y estigmas sociales importantes al paciente. El tratamiento quirúrgico es manejo preferencial, y se centra principalmente en la corrección de la tercer crura.

ABSTRACT Introduction: Stahl's ear presents a low incidence, even in specialized ear reconstruction centers. It is characterized by an abno rmal cartilaginous remnant, extending from the antihelix to the edge of the helix, forming a third crura. Case report: A 17-year-old man presented an ear deformity characterized by hypoplasia of the root of the antihelix and the presence of a third crura, which communicates the antihelix to the helix. A resection of third crura and cartilaginous reconstruction of the auricular pavilion was performed, achieving an adequate reconstruction, with good aesthetic results, without size alteration in comparison to the contralateral ear. Conclusions: Stahl's deformity is a rare ear deformity that can lead to significant social disruption and stigma. Surgical treatment is the preferential option for handling this deformity, and focuses mainly on the correction of the third crura.

The Vitalism of Paul-Joseph Barthez (1734~1806) / 의사학

In The Logic of Life (1970), Francois Jacob (1920~ ), Nobel Prize laureate in Physiology or Medicine (1965), proclaimed the end of vitalism based on the concept of life. More than two decades before this capital sentence condemning vitalism was pronounced, Georges Canguilhem (1904~1995), a French philosopher of medicine, already acknowledged that eighteenth-century vitalism was scientifically retrograde and politically reactionary or counter-revolutionary insofar as it was rooted in the animism of Georg Ernst Stahl (1660~1734). The negative preconception of the term 'vitalism' came to be established as an orthodox view, since Claude Bernard (1813~1878) unfairly criticized contemporary vitalism in order to propagate his idea of experimental medicine. An eminent evolutionary biologist like Ernst Mayr (1904~2005) still defended similar views in This is Biology (1997), arguing that if vitalists were decisive and convincing in their rejection of the Cartesian model (negative heuristics), however they were equally indecisive and unconvincing in their own explanatory endeavors (positive heuristics). Historically speaking, vitalists came to the forefront for their outstanding criticism of Cartesian mechanism and physicochemical reductionism, while their innovative concepts and theories were underestimated and received much less attention. Is it true that vitalism was merely a pseudo-science, representing a kind of romanticism or mysticism in biomedical science? Did vitalists lack any positive heuristics in their biomedical research? Above all, what was actually the so.called 'vitalism'? This paper aims to reveal the positive heuristics of vitalism defined by Paul.Joseph Barthez (1734~1806) who was the founder of the vitalist school of Montpellier. To this end, his work and idea are introduced with regard to the vying doctrines in physiology and medicine. At the moment when he taught at the medical school of Montpellier, his colleagues advocated the mechanism of Rene Descartes (1596~1650), the iatromechanism of Herman Boerhaave (1668~1738), the iatrochemistry of Jan Baptist van Helmont (1579~1644), the animism of Stahl, and the organicism of Theophile de Bordeu (1722~1776). On the contrary, Barthez devoted himself to synthesize diverse doctrines and his vitalism consequently illustrated an eclectic character. Always taking a skeptical standpoint regarding the capacity of biomedical science, he defined his famous concept of 'vital principle (principe vital)' as the 'x (unknown variable)' of physiology. He argued that the hypothetical concept of vital principle referred to the 'experimental cause (cause experimentale)' verifiable by positive science. Thus, the vital principle was not presupposed as an a priori regulative principle. It was an a posteriori heuristic principle resulting from several experiments. The 'positivist hypothetism' of Barthez demonstrates not only pragmatism but also positivism in his scientific terminology. Furthermore, Barthez established a guideline for clinical practice according to his own methodological principles. It can be characterized as a 'humanist pragmatism' for the reason that all sort of treatments were permitted as far as they were beneficial to the patient. Theoretical incoherence or incommensurability among different treatments did not matter to Barthez. His practical strategy for clinical medicine consisted of three principles: namely, the natural, analytic, and empirical method. This formulation is indebted to the 'analytic method (methode analytique)' of the French empiricist philosopher Etienne Bonnot de Condillac (1714~1780). In conclusion, the eighteenth.century French vitalism conceived by Barthez pursued pragmatism in general, positivism in methodology, and humanism in clinics.

Vitalism and Mechanism: Their Meanings in the Millieu of the 17th and 18th Centuries / 의사학

The views on the life in the early modern period(the 17th and 18th centuries) with their socio-cultural backgrounds and their meanings at that time were discussed in this paper. Those views discussed here were the dualistic, mechanistic one of Rene Descartes(1596-1650), the animistic, vitalistic one of Georg Ernst Stahl(1660-1734), and the monistic, mechanistic one of Julien Offray de La Mettrie(1709-1751). Author stressed that the processes of their view formation were influenced by the wide range of the various political and religious factors as well as the scientific, medical facts and opinions at that time, and that not only the contents of the views but also their historical contexts should be pursed in the study on the medical thoughts.