A depiction of poliomyelitis in a 17th -century Piedmontese fresco?

INTRODUCTION: A potential representation of poliomyelitis is investigated in an Italian artwork. MATERIALS AND METHODS: A 17th century Piedmontese fresco is analyzed by combining historico-medical, palaeopathological and clinical approaches. Alternative diagnoses are considered. RESULTS, DISCUSSION AND CONCLUSIONS: The man appearing in the fresco holding a crutch is characterized by an atrophic left leg reminiscent of poliomyelitic atrophic. Other congenital anomalies or cerebrovascular causes appear less likely. A reflection on the difficulty of retrospectively diagnosis poliomyelitis is offered.

Gangliformis Intumescentia and Beyond: Antonio Scarpa and His Core Contribution to Neuroanatomy, Neurosurgery, and Otoneurosurgery.

Nearly 250 years ago, Antonio Scarpa became a professor of anatomy and surgery only 2 years after he graduated from the University of Padua. The young lecturer soon became one of the most renowned anatomists in Italy and a director of the Faculty of Medicine at the University of Pavia. He worked in the fields of general surgery and ophthalmology. Several anatomic structures have been named after him, mainly Scarpa fascia and Scarpa triangle. His interest in neuroanatomy was ardent, despite being occasionally neglected. Scarpa's contributions to the fields of neurosciences have been significant. He was the first to describe the round window and the secondary tympanic membrane, and he eventually focused on the auditory and olfactory organs. Notably, the vestibular ganglion is now known as Scarpa ganglion. Scarpa's magnum opus was the book Tabulae Neurologicae, in which he described the path of several cranial nerves including the vagus nerve and innervation of the heart. Since his death in 1832, Scarpa's head has been preserved at the University History Museum of the University of Pavia. In this historical vignette, we aim to describe Antonio Scarpa's troubled life and brilliant career, focusing on his core contributions to neuroanatomy, neurosurgery, and otoneurosurgery.

The Original Histological Slides of Camillo Golgi and His Discoveries on Neuronal Structure.

The metallic impregnation invented by Camillo Golgi in 1873 has allowed the visualization of individual neurons in their entirety, leading to a breakthrough in the knowledge on the structure of the nervous system. Professor of Histology and of General Pathology, Golgi worked for decades at the University of Pavia, leading a very active laboratory. Unfortunately, most of Golgi's histological preparations are lost. The present contribution provides an account of the original slides on the nervous system from Golgi's laboratory available nowadays at the Golgi Museum and Historical Museum of the University of Pavia. Knowledge on the organization of the nervous tissue at the time of Golgi's observations is recalled. Notes on the equipment of Golgi's laboratory and the methodology Golgi used for his preparations are presented. Images of neurons from his slides (mostly from hippocampus, neocortex and cerebellum) are here shown for the first time together with some of Golgi's drawings. The sections are stained with the Golgi impregnation and Cajal stain. Golgi-impregnated sections are very thick (some more than 150 µm) and require continuous focusing during the microscopic observation. Heterogeneity of neuronal size and shape, free endings of distal dendritic arborizations, axonal branching stand out at the microscopic observation of Golgi-impregnated sections and in Golgi's drawings, and were novel findings at his time. Golgi also pointed out that the axon only originates from cell bodies, representing a constant and distinctive feature of nerve cells which distinguishes them from glia, and subserving transmission at a distance. Dendritic spines can be seen in some cortical neurons, although Golgi, possibly worried about artifacts, did not identify them. The puzzling intricacy of fully impregnated nervous tissue components offered to the first microscopic observations still elicit nowadays the emotion Golgi must have felt looking at his slides.

From images to physiology: A strange paradox at the origin of modern neuroscience.

In 1873 Camillo Golgi published an article that contained the description of entire nerve cells stained in black with a new histological procedure, the black reaction. He subsequently organized all the observations made with this method in a book published in 1885. On the basis of these studies, Golgi developed a physiological model of the brain that was influenced by a holistic conception he had in mind. He named this theory diffuse nervous network, assuming that the axonal prolongations were fused (or intimately interlaced) in a diffuse web along which the nervous impulse propagated. One of the scientists who quickly understood the importance of Golgi's results was the Spanish anatomist Santiago Ramón y Cajal. However, when he studied the brain with the black reaction, he had in mind the idea of the nerve cells as independent "units" (named neurons by Waldeyer, 1891). Thus Ramón y Cajal quickly became the champion of the neuron theory that paradoxically developed thanks to the same black reaction used by Golgi for the formulation of the opposite diffuse nervous network theory. The controversy between Golgi and Ramón y Cajal represents a dramatic instance of a theory-driven perception of the same morphological evidence.

Vincenzo Malacarne (1744-1816) and the First Description of the Human Cerebellum.

Vincenzo Malacarne, professor of medicine, surgery, and obstetrics in Turin, Pavia, and Padua, Italy, represented a perfect example of an eighteenth century "letterato", combining interests in humanities, sciences, and politics, embodying the ideal of an encyclopedic and universal culture. He made important contributions in anatomy and surgery, teratology, obstetrics, neurology, and history of medicine, adopting a interdisciplinary approach based on the correlation between anatomy, surgery, and clinics. He deserves a special place in the history of neurology because of the first complete description of the human cerebellum. He quantified the units of the cerebellar internal structures, the lamellae being numbered for a systematic description of the human cerebellum. He thought the mental faculties depended on their number, considering a relation between the number of cerebellar lamellae and the expression of intellectual faculties. In this way, he made first statistics on human faculties. He advanced the concept that the number of cerebellar folia was influenced by the environment, thus providing the first nature-nurture hypothesis made on the basis of observations, and the concept of neuroplasticity in the scientific literature. Finally, he also contributed to the emergence of a new science, namely electrophysiology, because he laid down experimental foundations of a project on the recording of brain electricity, comparing the structure of the human brain with Volta's galvanic pillar.

Giovanni Verga (1879-1923), author of a pioneering treatise on pituitary surgery: the foundations of this new field in Europe in the early 1900s.

The field of pituitary surgery was born in the first decade of the twentieth century in Europe, and it evolved rapidly with the development of numerous innovative surgical techniques by some of the founding fathers of neurosurgery. This study investigates the pioneering Italian treatise on pituitary surgery, La Patologia Chirurgica dell'Ipofisi (Surgical Pathology of the Hypophysis), published in 1911 by Giovanni Verga (1879-1923), a surgeon from Pavía and one of Golgi's disciples. This little-known monograph compiles the earliest experience on pituitary surgery through the analysis of the first 50 procedures performed between 1903 and 1911. We conducted a biographical survey of Giovanni Verga and the motivations for his work on pituitary surgery. In addition, a systematic analysis of all original reports and historical documents about these pituitary procedures referenced in Verga's treatise was carried out. Verga's treatise provides a summary of the techniques employed and surgical outcomes for the first 50 attempted procedures of pituitary tumor removal. This monograph is the only scientific source that includes a complete account of the series of 10 pituitary tumors operated on by Sir Victor Horsley in the 1900s. Three major types of surgery were employed: (i) palliative procedures of craniectomy (n = 6); (ii) transcranial approaches to the pituitary gland, either subfrontal or subtemporal (n = 13); and (iii) transphenoidal routes to expose the sella turcica, either using an upper transnasal-transethmoidal approach (n = 19) or a lower sublabial/endonasal-transeptal one (n = 12). An operative mortality rate of 36% (n = 17) was observed in these early series. The pathological nature of the tumors operated on was available in 42 cases. There were 28 adenomas and 15 craniopharyngiomas. Sir Victor Horsley (1857-1916) and the Viennese surgeons Anton von Eiselsberg (1860-1939) and Oskar Hirsch (1877-1965) were the leading European figures in the development of pituitary surgery. Giovanni Verga's treatise La Patologia Chirurgica dell'Ipofisi is a fundamental, pioneering book in the history of pituitary surgery, a work that compiles the foundations of this field in Europe and the only authoritative source providing a complete record of pituitary procedures performed by Sir Victor Horsley.

Golgi and Ranvier: from the black reaction to a theory of referred pain.

In his brief report on the structure of the gray matter of the central nervous system (1873), in which he described the "black reaction", Golgi noted the ramifications of the axon. This discovery prompted the French histologist Louis Antoine Ranvier, one of the first to try the black reaction outside Italy, to propose an ingenious theory of referred pain in his Traité technique d'histologie. Ranvier suggested that the nerve fibers originating from the irritated area and those coming from the region to which the sensation is referred converge on the same axon and thus the same cell body, causing the spatial dislocation of sensation. This theory of referred pain is a powerful example of the extraordinary clinical-physiological impact of the first of Golgi's neurocytological discoveries.

Sir Victor Horsley: pioneer craniopharyngioma surgeon.

Sir Victor Horsley (1857-1916) is considered to be the pioneer of pituitary surgery. He is known to have performed the first surgical operation on the pituitary gland in 1889, and in 1906 he stated that he had operated on 10 patients with pituitary tumors. He did not publish the details of these procedures nor did he provide evidence of the pathology of the pituitary lesions operated on. Four of the patients underwent surgery at the National Hospital for Neurology and Neurosurgery (Queen Square, London), and the records of those cases were recently retrieved and analyzed by members of the hospital staff. The remaining cases corresponded to private operations whose records were presumably kept in Horsley's personal notebooks, most of which have been lost. In this paper, the authors have investigated the only scientific monograph providing a complete account of the pituitary surgeries that Horsley performed in his private practice, La Patologia Chirurgica dell'Ipofisi (Surgical Pathology of the Hypophysis), written in 1911 by Giovanni Verga, Italian assistant professor of anatomy at the University of Pavia. They have traced the life and work of this little-known physician who contributed to the preservation of Horsley's legacy in pituitary surgery. Within Verga's pituitary treatise, a full transcription of Horsley's notes is provided for 10 pituitary cases, including the patients' clinical symptoms, surgical techniques employed, intraoperative findings, and the outcome of surgery. The descriptions of the topographical and macroscopic features of two of the lesions correspond unmistakably to the features of craniopharyngiomas, one of the squamous-papillary type and one of the adamantinomatous type. The former lesion was found on necropsy after the patient's sudden death following a temporal osteoplastic craniectomy. Surgical removal of the lesion in the latter case, with the assumed nature of an adamantinomatous craniopharyngioma, was successful. According to the evidence provided in Giovanni Verga's monograph, it can be claimed that Sir Victor Horsley was not only the pioneer of pituitary gland surgery but also the pioneer of craniopharyngioma surgery.

The art of human anatomy: Renaissance to 21st century.

This session examines the relationship between the art and science of anatomy from the time of Vesalius to the present with particular emphasis on the role of the medical artist and the changing nature of anatomical illustration over the last five centuries. Pivotal changes in the art of anatomy will be examined including the evolution of media and brain imaging from Golgi to Geschwind.

MRI observation of hippocampal degeneration in Alzheimer's disease: a forgotten case.

At the beginning of the 1990s, as part of work being done for a master's degree thesis in physics, an important observation of hippocampal degeneration in Alzheimer's disease was made in Pavia. However this result was never published in a full scientific paper. This case gives an idea of how an isolated observation can, in the right setting, develop into a real scientific achievement.