Ambroise Paré: His Contribution to the Future Advancement of Neurosurgery and the Hardships of His Times Affecting His Life and Brilliant Career.

Ambroise Paré was celebrated surgeon of the 16th century whose practical accomplishments, books, and ideas transformed surgery and was a precursor for the later development of neurosurgery. He developed many surgical innovations related to wound management, arterial ligation for the prevention of hemorrhage during limb amputations, and the treatment of war-related head and spine injuries. He maintained that a surgeon should operate gently to reduce pain and improve outcome, and he dedicated his career to the wounded, sick, and poor. He also served 4 consecutive French monarchs-Henri II and his 3 sons François II, Charles IX, and Henri III. As a Huguenot (a Reformed Protestant) by faith, he lived in an environment dominated by Catholicism. Hence, his practice and life were sometimes hindered by political circumstances and religious prejudice. In this historical vignette, we will discuss the professional accomplishments of Ambroise Paré that influenced the future development of neurosurgery, including his descriptions of phantom-limb pain and peripheral nerve injury, his innovations in neurotraumatology, and the saws he invented for use in skull surgery. We will also highlight Paré's broad neurosurgical contributions to the field. Finally, we will discuss his personal life during the difficult and dangerous political circumstances of 16th century France.

Median Nerve Injury from the Eye of an Artist: Gladiators.

Artists use their work to help us understand the universe. With their creations, we can rest our souls, find some solutions to problems, and even explore new dimensions. A 19th-century artist, Gérôme, has depicted a gesture used to ask for mercy as a benediction sign in two of his works of art dealing with gladiatorial fighting. A warrior defeated in a gladiator combat is well known to ask for mercy with the extended index finger and fist. A benediction gesture by a gladiator after combat could be due to an acute nerve injury. At the sources that inspired the artist, the mercy gesture may have evolved into the benediction sign for an unknown reason. It is probable that a warrior cannot accurately form the mercy gesture following a peripheral nerve injury during combat. While his index finger was extended, the other fingers could not flex in the strict sense of making a fist due to traumatic median nerve injury.

Publications on Peripheral Nerve Injuries during World War I: A Dramatic Increase in Knowledge.

Publications from French (Jules Tinel and Chiriachitza Athanassio-Bénisty), English (James Purves-Stewart, Arthur Henry Evans and Hartley Sidney Carter), German (Otfrid Foerster and Hermann Oppenheim) and American (Charles Harrison Frazier and Byron Stookey) physicians from both sides of the front during World War I (WWI) contributed to a dramatic increase in knowledge about peripheral nerve injuries. Silas Weir Mitchell's original experience with respect to these injuries, and particularly causalgia, during the American Civil War was further expanded in Europe during WWI. Following the translation of one of his books, he was referred to mainly by French physicians. During WWI, several French books were in turn translated into English, which influenced American physicians, as was observed in the case of Byron Stookey. The establishment of neurological centres played an important role in the concentration of experience and knowledge. Several eponyms originated during this period (including the Hoffmann-Tinel sign and the Froment sign). Electrodiagnostic tools were increasingly used.

Sir Herbert Seddon (1903-1977) and his classification scheme for peripheral nerve injury.

Sir Herbert Seddon was a visionary neuroscientist and surgeon. Internationally, he is best known for his classification of the peripheral nerve injury, now known as Seddon's classification. The authors reviewed his life with a special emphasis on his legacy to neuroscience.

Brachial plexus injury management in military casualties: who, what, when, why, and how.

The Global War on Terrorism has achieved an unprecedented 90% casualty survival rate because of far forward surgical support, rapid transport, and body armor. Despite the remarkable protection body armor affords, peripheral nerve injuries continue to occur. The brachial plexus in particular is still susceptible to penetrating trauma through the axilla as well as blunt mechanisms. We report 1,818 individuals with reported cases of peripheral nerve injury, 97 of which had brachial plexus injury incident from Operation Iraqi Freedom and Operation Enduring Freedom. We suspect that true prevalence is higher as initial focus on vascular and orthopedic reconstruction in complex shoulder injuries may overlook brachial plexus lesions. Accordingly, emergency physicians, general and orthopedic trauma surgeons, and vascular surgeons should all consider the possibility of brachial plexus and other peripheral nerve injury for early and appropriate referral to surgeons (plastic, orthopedic, or neurosurgical) for further evaluation and reconstruction. The latter group should be familiar with appropriate modern diagnostic and initial as well as salvage therapeutic options.

Sir Ludwig Guttmann: his neurology research and his role in the treatment of peripheral nerve injuries, 1939-1944.

Ludwig Guttmann spent five crucial years in Oxford between 1939 and 1944, carrying out fundamental research in peripheral nerve regeneration and the rehabilitation of patients with peripheral nerve injuries. He worked with Peter Medawar, John Zachary Young, Graham Weddell, Ernst Gutmann and others. He dismissed this period of his life, but the experience he gained was critical for his subsequent career in rehabilitating spinal injury patients.