Lessico
Ippocrate
da Veterum illustrium philosophorum etc. imagines
(1685)
di Giovanni Pietro Bellori (Roma 1613-1696)
Fulvio Orsini
Medico greco (Kos o Coo 460 - Larissa ca. 370 aC). Lo si dice figlio del medico
Eracleide che operò a Coo, isola greca del Mar Egeo, nel gruppo delle Sporadi
Meridionali (arcipelago del Dodecaneso).. Compì molti viaggi in Tessaglia,
Tracia, Egitto e Libia, ma svolse la maggior parte
della sua attività a Coo, divenendo il più noto esponente della scuola
medica ivi esistente. Pare
che Ippocrate sia stato il primo a descrivere le dita a bacchetta di tamburo
caratteristiche dell'osteopatia ipertrofizzante pneumica di Pierre Marie
e della sindrome di Eisenmenger,
etichettate pertanto in semeiotica come dita ippocratiche. Esse si associano a
unghie a vetrino d'orologio.
Universalmente indicato come il fondatore della medicina scientifica, al suo nome vennero ascritte circa settanta opere, costituenti il cosiddetto Corpus hippocraticum. Sull'effettiva paternità delle opere del Corpus, che presentano notevoli differenze di impostazione metodologica, sono stati dati pareri discordi. La critica più recente tende a riconoscere la presenza di un pensiero sostanzialmente omogeneo in un gruppo di circa venti opere, tra le quali figurano: Antica medicina, acuto esame critico degli indirizzi medici anteriori a Ippocrate; Le arie, le acque e i luoghi, dove si istituisce una stretta correlazione fra le malattie e le condizioni climatiche e geografiche; Prognostico, dove è delineata una vera e propria patologia generale degli stati morbosi; Male sacro, in cui si afferma che l'epilessia è dovuta a cause naturali, come le altre malattie, e non all'intervento di divinità; Epidemie, sistematica raccolta di osservazioni circa le malattie che si diffusero nell'isola di Taso in relazione a determinate vicende atmosferiche; il Giuramento, vero e proprio manifesto morale della scuola.
da
Histoire de la médecine par Daniel Le Clerc
Amsterdam - 1702
Caratteristica generale dell'impostazione metodologica avviata da Ippocrate è la critica di ogni concezione aprioristica e quindi il ricorso all'esperienza. Egli, infatti, condusse una decisa polemica nei confronti della tradizione medica ancora operante alla sua epoca e inserita in un contesto mistico religioso. Problema centrale dei suoi studi fu perciò quello di dare alla medicina uno strumento teorico di spiegazione efficace e un metodo di indagine che giustificasse e potenziasse il legame fra teoria ed esperienza. Lo schema teorico generale elaborato dalla scuola ippocratica consiste essenzialmente nella dottrina dei quattro umori, un'originale derivazione dalle teorie degli elementi primordiali.
Secondo tale teoria gli umori, o elementi fondamentali costitutivi del corpo umano, sono: il sangue, elemento caldo proveniente dal cuore, la flemma, elemento freddo che proviene dal cervello; la bile gialla, asciutta, secreta dal fegato; e la bile nera, elemento umido, prodotta dalla milza. La salute di un organismo viene ricondotta a un rapporto proporzionato (crasi) fra i vari umori. Allorché questo rapporto viene alterato (discrasia) si origina la malattia che, secondo il particolare umore alterato, si distingue in sanguigna, flemmatica, biliare e atrobiliare. Subentra allora un periodo critico in cui l'organismo oppone resistenza agli agenti esterni responsabili della malattia.
Compito del medico è di aiutare l'organismo in questa lotta cercando di ripristinare le giuste condizioni per il suo funzionamento, soprattutto facendo in modo da rendere inoffensivi tutti i fattori esterni che hanno causato la malattia. Da questo punto di vista la malattia non è considerata come un fatto improvviso o accidentale: essa ha una storia che può essere ricostruita attraverso l'individuazione delle cause che l'hanno resa operante e una previsione della loro efficacia futura resa possibile dalla numerosa precettistica desunta fondamentalmente dall'esperienza. Secondo tale originale indirizzo, la terapia si riduce ad assecondare la forza medicatrice della natura; di qui l'importanza della dieta e delle norme igieniche che tendono a ripristinare, correggendo le anomalie, l'equilibrio precedente. La medicina ippocratica ha esercitato un'enorme influenza lungo tutta la storia del pensiero scientifico; ciò in massima parte è dovuto all'assetto metodico e non dogmatico conferito alla medicina da Ippocrate e dalla sua scuola che le consentì di sopravvivere a ogni conquista dottrinale e di essere riscoperta in epoche diverse nella sua funzione di guida e di orientamento teorico e deontologico.
Ippocrate
e Galeno
vigilano sul malato e sui medici che lo assistono
Giuramento di Ippocrate
Janus
Cornarius
aveva così tradotto dal greco in latino il giuramento di Ippocrate:
«Apollinem
medicum et Aesculapium Hygeamque ac Panaceam iuro deosque omnes itemque deas
testes facio me hoc iusiurandum et hanc contestationem conscriptam pro viribus
et iudicio meo integre servaturum esse: Praeceptorem sane qui me hanc edocuit
artem, parentum loco habiturum, vitam communicaturum, eaque quibus opus
habuerit impertiturum: eos item qui ex eo nati sunt pro fratribus masculis
iudicaturum artemque hanc, si discere voluerint, absque mercede et pacto
edocturum: praeceptionum, ac auditionum, reliquaeque totius disciplinae
participes facturum, tum meos, tum praeceptoris mei filios, imo et discipulos,
qui mihi scripto caverint, et medico iureiurando addicti fuerint, alii vero
praeter hos nulli. Ceterum quod ad aegros attinet sanandos, diaetam ipsis
constitutam pro facultate et iudicio meo commodam, omneque detrimentum et
iniuriam ab eis prohibebo. Neque vero ullius preces apud me adeo validae
fuerint, ut cuipiam venenum sim propinaturus, neque etiam ad hanc rem
consilium dabo. Similiter autem neque mulieri talum vulvae subditicium, ad
corrumpendum conceptum, vel foetum dabo. Porro praeterea et sancte vitam et
artem meam conservabo. Nec vero calculo laborantes secabo, sed viris
chirurgiae operariis eius rei faciendae locum dabo. In quascumque autem domos
ingrediar, ob utilitatem aegrotantium intrabo, ab omnique iniuria voluntaria
inferenda, et corruptione cum alia, tum praesertim operum venereorum abstinebo,
sive muliebria sive virilia, liberorumve hominum aut servorum corpora mihi
contigerint curanda. Quaecumque vero inter curandum videro aut audiero, imo
etiam ad medicandum non adhibitus in communi hominum vita cognovero, ea
siquidem efferre non contulerit, tacebo: et tanquam arcana apud me continebo.
Hoc igitur iusiurandum mihi integre servanti, et non confundenti, contingat et
vita et arte feliciter frui, et apud omnes homines in perpetuum gloriam meam
celebrari. Transgredienti autem et peieranti, his contraria eveniant.» - Hippocratis
Coi medicorum omnium longe principis, opera quae ad nos extant omnia (Froben,
Basilea, 1546)
Icones veterum aliquot ac recentium Medicorum
Philosophorumque
Ioannes Sambucus / János Zsámboky
Antverpiae 1574
Hippocrates of Cos or Hippokrates of Kos (ca. 460 BC – ca. 370 BC) - Greek: Ἱπποκράτης; Hippokrátës was an ancient Greek physician of the Age of Pericles, and was considered one of the most outstanding figures in the history of medicine. He is referred to as the "father of medicine" in recognition of his lasting contributions to the field as the founder of the Hippocratic School of medicine. This intellectual school revolutionized medicine in ancient Greece, establishing it as a discipline distinct from other fields that it had traditionally been associated with (notably theurgy and philosophy), thus making medicine a profession.
However, the achievements of the writers of the Corpus, the practitioners of Hippocratic medicine, and the actions of Hippocrates himself are often commingled; thus very little is known about what Hippocrates actually thought, wrote, and did. Nevertheless, Hippocrates is commonly portrayed as the paragon of the ancient physician. In particular, he is credited with greatly advancing the systematic study of clinical medicine, summing up the medical knowledge of previous schools, and prescribing practices for physicians through the Hippocratic Oath and other works.
Biography
Asklepieion on Kos
Historians accept that Hippocrates was born around the year 460 BC on the Greek island of Kos (Cos), and became a famous physician and teacher of medicine. Other biographical information, however, is likely to be untrue (see Legends). Soranus of Ephesus, a 2nd-century Greek gynecologist, was Hippocrates' first biographer and is the source of most information on Hippocrates' person. Information about Hippocrates can also be found in the writings of Aristotle, which date from the 4th century BC, in the Suda of the 10th century AD, and in the works of John Tzetzes, which date from the 12th century AD. Soranus wrote that Hippocrates' father was Heraclides, a physician; his mother was Praxitela, daughter of Tizane. The two sons of Hippocrates, Thessalus and Draco, and his son-in-law, Polybus, were his students. According to Galen, a later physician, Polybus was Hippocrates' true successor, while Thessalus and Draco each had a son named Hippocrates.
Soranus said that Hippocrates learned medicine from his father and grandfather, and studied other subjects with Democritus and Gorgias. Hippocrates was probably trained at the asklepieion of Kos, and took lessons from the Thracian physician Herodicus of Selymbria. The only contemporaneous mention of Hippocrates is in Plato's dialogue Protagoras, where Plato describes Hippocrates as "Hippocrates of Kos, the Asclepiad". Hippocrates taught and practiced medicine throughout his life, traveling at least as far as Thessaly, Thrace, and the Sea of Marmara. He probably died in Larissa at the age of 83 or 90, though some accounts say he lived to be well over 100; several different accounts of his death exist.
Hippocratic theory
Hippocrates is credited with being the first physician to reject superstitions, legends and beliefs that credited supernatural or divine forces with causing illness. Hippocrates was credited by the disciples of Pythagoras of allying philosophy and medicine. He separated the discipline of medicine from religion, believing and arguing that disease was not a punishment inflicted by the gods but rather the product of environmental factors, diet, and living habits. Indeed there is not a single mention of a mystical illness in the entirety of the Hippocratic Corpus. However, Hippocrates did work with many convictions that were based on what is now known to be incorrect anatomy and physiology, such as Humorism.
Ancient Greek schools of medicine were split (into the Knidian and Koan) on how to deal with disease. The Knidian school of medicine focused on diagnosis. Medicine at the time of Hippocrates knew almost nothing of human anatomy and physiology because of the Greek taboo forbidding the dissection of humans. The Knidian school consequently failed to distinguish when one disease caused many possible series of symptoms. The Hippocratic school or Koan school achieved greater success by applying general diagnoses and passive treatments. Its focus was on patient care and prognosis, not diagnosis. It could effectively treat diseases and allowed for a great development in clinical practice.
Hippocratic medicine and its philosophy are far removed from that of modern medicine. Now, the physician focuses on specific diagnosis and specialized treatment, both of which were espoused by the Knidian school. This shift in medical thought since Hippocrates' day has caused serious criticism over the past two millennia, with the passivity of Hippocratic treatment being the subject of particularly strong denunciations; for example, the French doctor M. S. Houdart called the Hippocratic treatment a "meditation upon death".
Humorism and crisis
The Hippocratic school held that all illness was the result of an imbalance in the body of the four humours, fluids which in health were naturally equal in proportion (pepsis). When the four humours, blood, black bile, yellow bile and phlegm, were not in balance (dyscrasia, meaning "bad mixture"), a person would become sick and remain that way until the balance was somehow restored. Hippocratic therapy was directed towards restoring this balance. For instance, using citrus was thought to be beneficial when phlegm was overabundant.
Another important concept in Hippocratic medicine was that of a crisis, a point in the progression of disease at which either the illness would begin to triumph and the patient would succumb to death, or the opposite would occur and natural processes would make the patient recover. After a crisis, a relapse might follow, and then another deciding crisis. According to this doctrine, crises tend to occur on critical days, which were supposed to be a fixed time after the contraction of a disease. If a crisis occurred on a day far from a critical day, a relapse might be expected. Galen believed that this idea originated with Hippocrates, though it is possible that it predated him.
Hippocratic medicine was humble and passive. The therapeutic approach was based on "the healing power of nature" ("vis medicatrix naturae" in Latin). According to this doctrine, the body contains within itself the power to re-balance the four humours and heal itself (physis). Hippocratic therapy focused on simply easing this natural process. To this end, Hippocrates believed "rest and immobilization [were] of capital importance". In general, the Hippocratic medicine was very kind to the patient; treatment was gentle, and emphasized keeping the patient clean and sterile. For example, only clean water or wine were ever used on wounds, though "dry" treatment was preferable. Soothing balms were sometimes employed.
Hippocrates was reluctant to administer drugs and engage in specialized treatment that might prove to be wrongly chosen; generalized therapy followed a generalized diagnosis. Potent drugs were, however, used on certain occasions. This passive approach was very successful in treating relatively simple ailments such as broken bones which required traction to stretch the skeletal system and relieve pressure on the injured area. The Hippocratic bench and other devices were used to this end.
One of the strengths of Hippocratic medicine was its emphasis on prognosis. At Hippocrates' time, medicinal therapy was quite immature, and often the best thing that physicians could do was to evaluate an illness and induce its likely progression based upon data collected in detailed case histories.
Professionalism
Hippocratic medicine was notable for its strict professionalism, discipline and rigorous practice. The Hippocratic work On the Physician recommends that physicians always be well-kempt, honest, calm, understanding, and serious. The Hippocratic physician paid careful attention to all aspects of his practice: he followed detailed specifications for, "lighting, personnel, instruments, positioning of the patient, and techniques of bandaging and splinting" in the ancient operating room. He even kept his fingernails to a precise length.
The Hippocratic School gave importance to the clinical doctrines of observation and documentation. These doctrines dictate that physicians record their findings and their medicinal methods in a very clear and objective manner, so that these records may be passed down and employed by other physicians. Hippocrates made careful, regular note of many symptoms including complexion, pulse, fever, pains, movement, and excretions. He is said to have measured a patient's pulse when taking a case history to know if the patient lied. Hippocrates extended clinical observations into family history and environment. "To him medicine owes the art of clinical inspection and observation". For this reason, he may more properly be termed as the "Father of Clinical Medicine".
Direct contributions to medicine
Clubbing
of fingers in a patient with Eisenmenger's syndrome.
Clubbing was first described by Hippocrates,
then clubbing is also known as "Hippocratic fingers".
Hippocrates and his followers were first to describe many diseases and medical conditions. He is given credit for the first description of clubbing of the fingers, an important diagnostic sign in chronic suppurative lung disease, lung cancer and cyanotic heart disease. For this reason, clubbed fingers are sometimes referred to as "Hippocratic fingers". Hippocrates was also the first physician to describe Hippocratic face in Prognosis. Shakespeare famously alludes to this description when writing of Falstaff's death in Act II, Scene iii. of Henry V.
Hippocrates began to categorize illnesses as acute, chronic, endemic and epidemic, and use terms such as, "exacerbation, relapse, resolution, crisis, paroxysm, peak, and convalescence." Another of Hippocrates' major contributions may be found in his descriptions of the symptomatology, physical findings, surgical treatment and prognosis of thoracic empyema, i.e. suppuration of the lining of the chest cavity. His teachings remain relevant to present-day students of pulmonary medicine and surgery. Hippocrates was the first documented chest surgeon and his findings are still valid.
The Hippocratic school of medicine described well the ailments of the human rectum and the treatment thereof, despite the school's poor theory of medicine. Hemorrhoids, for instance, though believed to be caused by an excess of bile and phlegm, were treated by Hippocratic physicians in relatively advanced ways. Cautery and excision are described in the Hippocratic Corpus, in addition to the preferred methods: ligating the hemorrhoids and drying them with a hot iron. Other treatments such as applying various salves are suggested as well. Today, "treatment [for hemorrhoids] still includes burning, strangling, and excising". Also, some of the fundamental concepts of proctoscopy outlined in the Corpus are still in use. For example, the uses of the rectal speculum, a common medical device, are discussed in the Hippocratic Corpus. This constitutes the earliest recorded reference to endoscopy.
Hippocratic Corpus
The Hippocratic Corpus (Latin: Corpus Hippocraticum) is a collection of around seventy early medical works from ancient Greece, written in Ionic Greek. The question of whether Hippocrates himself was the author of the corpus has not been conclusively answered, but the volumes were probably produced by his students and followers. Because of the variety of subjects, writing styles and apparent date of construction, scholars believe Hippocratic Corpus could not have been written by one person (Ermerins numbers the authors at nineteen). The corpus was attributed to Hippocrates in antiquity, and its teaching generally followed principles of him; thus it came to be known by his name. It might be the remains of a library of Kos, or a collection compiled in the 3rd century BC in Alexandria.
The Hippocratic Corpus contains textbooks, lectures, research, notes and philosophical essays on various subjects in medicine, in no particular order. These works were written for different audiences, both specialists and laymen, and were sometimes written from opposing view points; significant contradictions can be found between works in the Corpus. Notable among the treatises of the Corpus are The Hippocratic Oath; The Book of Prognostics; On Regimen in Acute Diseases; Aphorisms; On Airs, Waters and Places; Instruments of Reduction; On The Sacred Disease; etc.
Hippocratic Oath
The Hippocratic Oath, a seminal document on the ethics of medical practice, was attributed to Hippocrates in antiquity although new information shows it may have been written after his death. This is probably the most famous document of the Hippocratic Corpus. Recently the authenticity of the documents author has come under scrutiny. While the Oath is rarely used in its original form today, it serves as a foundation for other, similar oaths and laws that define good medical practice and morals. Such derivatives are regularly taken today by medical graduates about to enter medical practice.
Legacy
Hippocrates is widely considered to be the "Father of Medicine". His contributions revolutionized the practice of medicine; but after his death the advancement stalled. So revered was Hippocrates that his teachings were largely taken as too great to be improved upon and no significant advancements of his methods were made for a long time. The centuries after Hippocrates' death were marked as much by retrograde movement as by further advancement. For instance, "after the Hippocratic period, the practice of taking clinical case-histories died out...", according to Fielding Garrison. After Hippocrates, the next significant physician was Galen, a Greek who lived from 129 to 200 AD. Galen perpetuated Hippocratic medicine, moving both forward and backward. In the Middle Ages, Arabs adopted Hippocratic methods. After the European Renaissance, Hippocratic methods were revived in Europe and even further expanded in the 19th century. Notable among those who employed Hippocrates' rigorous clinical techniques were Sydenham, Heberden, Charcot and Osler. Henri Huchard, a French physician, said that these revivals make up "the whole history of internal medicine".
Image
According to Aristotle's testimony, Hippocrates was known as "the Great Hippocrates". Concerning his disposition, Hippocrates was first portrayed as a "kind, dignified, old country doctor'" and later as "stern and forbidding". He is certainly considered wise, of very great intellect and especially as very practical. Francis Adams describes him as "strictly the physician of experience and common sense". His image as the wise, old doctor is reinforced by busts of him, which wear large beards on a wrinkled face. Many physicians of the time wore their hair in the style of Jove and Asklepius. Accordingly, the busts of Hippocrates that we have could be only altered versions of portraits of these deities. Hippocrates and the beliefs that he embodied are considered medical ideals. Fielding Garrison, an authority on medical history, stated, "He is, above all, the exemplar of that flexible, critical, well-poised attitude of mind, ever on the lookout for sources of error, which is the very essence of the scientific spirit". "His figure... stands for all time as that of the ideal physician”, according to A Short History of Medicine, inspiring the medical profession since his death.
Legends
Most stories of Hippocrates' life are likely to be untrue because of their inconsistency with historical evidence, and because similar or identical stories are told of other figures such as Avicenna and Socrates, suggesting a legendary origin. Even during his life, Hippocrates' renown was great, and stories of miraculous cures arose. For example, Hippocrates was supposed to have aided in the healing of Athenians during the Plague of Athens by lighting great fires as "disinfectants" and engaging in other treatments. There is a story of Hippocrates curing Perdiccas, a Macedonian king, of "love sickness". Neither of these accounts is corroborated by any historians and they are thus unlikely to have ever occurred.
Another legend concerns how Hippocrates rejected a formal request to visit the court of Artaxerxes, the King of Persia. The validity of this is accepted by ancient sources but denied by some modern ones, and is thus under contention. Another tale states that Democritus was supposed to be mad because he laughed at everything, and so he was sent to Hippocrates to be cured. Hippocrates diagnosed him as having a merely happy disposition. Democritus has since been called "the laughing philosopher".
Not all stories of Hippocrates portrayed him in a positive manner. In one legend, Hippocrates is said to have fled after setting fire to a healing temple in Greece. Soranus of Ephesus, the source of this story, names the temple as the one of Knidos. However centuries later, the Byzantine Greek grammarian John Tzetzes, writes that Hippocrates burned down his own temple, the Temple of Cos, speculating that he did it to maintain a monopoly of medical knowledge. This account is very much in conflict with traditional estimations of Hippocrates' personality. Other legends tell of his resurrection of Augustus' nephew; this feat was supposedly created by the erection of a statue of Hippocrates and the establishment of a professorship in his honor in Rome.
Genealogy
Hippocrates' legendary genealogy traces his paternal heritage directly to Asklepius and his maternal ancestry to Heracles. According to Tzetzes' Chiliades, the ahnentafel of Hippocrates II is:
1.
Hippocrates II The Father of Medicine
2. Heraclides
4. Hippocrates I.
8. Gnosidicus
16. Nebrus
32. Sostratus III.
64. Theodorus II.
128. Sostratus, II.
256. Thedorus
512. Cleomyttades
1024. Crisamis
2048. Dardanus
4096. Sostatus
8192. Hippolochus
16384. Podalirius
32768. Asklepius
Namesakes
Some clinical symptoms and signs have been named after Hippocrates as he is believed to be the first person to describe those. Hippocratic face is the change produced in the countenance by death, or long sickness, excessive evacuations, excessive hunger, and the like. Clubbing, a deformity of the fingers and fingernails, is also known as Hippocratic fingers. Hippocratic succussion is the internal splashing noise of hydropneumothorax or pyopneumothorax. Hippocratic bench (a device which uses tension to aid in setting bones) and Hippocratic cap-shaped bandage are two devices named after Hippocrates. Hippocratic Corpus and Hippocratic Oath are also his namesakes. The drink hypocras is also believed to be invented by Hippocrates. Risus sardonicus, a sustained spasming of the face muscles may also be termed the Hippocratic Smile.
In the modern age, a lunar crater has been named Hippocrates. The Hippocratic Museum, a museum on the Greek island of Kos is dedicated to him. The Hippocrates Project is a program of the New York University Medical Center to enhance education through use of technology. Project Hippocrates (an acronym of "HIgh PerfOrmance Computing for Robot-AssisTEd Surgery") is an effort of the Carnegie Mellon School of Computer Science and Shadyside Medical Center, "to develop advanced planning, simulation, and execution technologies for the next generation of computer-assisted surgical robots." Both the Canadian Hippocratic Registry and American Hippocratic Registry are organizations of physicians who uphold the principles of the original Hippocratic Oath as inviolable through changing social times.
Dictionnaire historique
de la médecine ancienne et moderne
par Nicolas François Joseph Eloy
Mons – 1778
Osteopatia
ipertrofizzante pneumica
Malattia di Pierre-Marie
Dita
ippocratiche
Dita a bacchetta di tamburo con unghie a vetrino d'orologio
Ingrossamento delle ossa degli arti, e precisamente della parte superficiale di esse, o periostio. La manifestazione più evidente e caratteristica di questa affezione è rappresentata dalle cosiddette dita a bacchetta di tamburo, o dita ippocratiche, cioè ingrossate a clava nell'ultima falange, con incurvamento delle unghie a vetrino d'orologio. Di solito questa affezione si accompagna a malformazioni congenite di cuore, a vizi valvolari cardiaci, a malattie broncopolmonari croniche quali per esempio le bronchiectasie o l'ascesso polmonare. La terapia deve essere indirizzata a combattere la malattia polmonare o cardiaca in atto. Il meccanismo d'insorgenza di questo fenomeno patologico non è stato ancora oggi del tutto chiarito, ma probabilmente consiste in un aumentato afflusso di sangue nei vasi capillari delle dita, che spiegherebbe l'ipertrofia dei tessuti.
Pierre Marie
Medico francese (Parigi 1853 - Cannes 1940). Formatosi alla scuola del neuropsichiatra francese Jean Martin Charcot (Parigi 1825 - lago di Settons, Nièvre, 1893)., si è occupato essenzialmente di neurologia. Descrisse numerose malattie, fra le quali l'acromegalia (sindrome di Marie), l'atassia cerebellare ereditaria (malattia o atassia di Marie), l'osteopatia ipertrofizzante pneumica (sindrome di Marie-Bamberger, 1890), l'atrofia progressiva dei muscoli peronei (malattia di Charcot-Marie-Tooth), il diabete levulosurico. Portano il suo nome anche alcuni segni clinici, per es. la mano succulenta di Marie. Scrisse: Leçons sur les maladies de la moelle épinière (1892) e Leçons de clinique médicale (1896).
Hypertrophic
pulmonary osteoarthropathy
Marie-Bamberger disease
Clubbing
of fingers in a patient with Eisenmenger's syndrome.
Clubbing was
first described by Hippocrates,
then
clubbing is also known as "Hippocratic fingers".
Hypertrophic pulmonary osteoarthropathy (or Marie-Bamberger disease) is a medical condition combining clubbing and periostitis of the long bones of the upper and lower extremities. Distal expansion of the long bones as well as painful, swollen joints and synovial villous proliferation are often seen. The condition may be primary or secondary to diseases like lung cancer. It is also known as "osteoarthropathia hypertrophicans". It is named for Eugen von Bamberger and Pierre Marie.
Pierre Marie (born 9 September 1853, died 13 April 1940) was a French neurologist who was a native of Paris. After finishing medical school, he became an interne in 1878, where he was an assistant to the famous neurologist Jean Martin Charcot (1825-1893) at the Salpêtrière and Bicêtre Hospitals. In 1883 he received his medical doctorate with a graduate thesis on Basedow’s disease, and in 1888 was promoted to Médecin des hôpitaux in Paris. In 1907 he attained the chair of pathological anatomy at the Faculty of Medicine, and in 1917 was appointed to the chair of neurology, a position he held until 1925. In 1911 Marie became a member of the Académie de Médecine.
One of Marie's earlier contributions was a description of a disorder of the pituitary gland known as acromegaly. His analysis of the disease was an important contribution in the emerging field of endocrinology. Marie is also credited as the first to describe pulmonary hypertrophic osteoarthropathy, cleidocranial dysostosis and rhizomelic spondylosis. In his extensive research of aphasia, his views concerning language disorders sharply contrasted the generally accepted views of Paul Broca (1824-1880). In 1907, he was the first person to describe the speech production disorder of foreign accent syndrome.
Marie was the first general secretary of the Société Française de Neurologie and with Edouard Brissaud (1852-1909) he was co-founder of the journal Revue neurologique. His name is associated with the eponymous Charcot-Marie-Tooth disease; which is named along with Jean-Martin Charcot and Howard Henry Tooth (1856-1925). This disease is characterized by gradual progressive loss of muscle tissue in the legs, arms and feet. It is considered one of the more common hereditary neurological diseases. Associated eponyms:
Marie's
ataxia: an hereditary disease of the nervous system, with cerebellar ataxia.
Marie-Foix-Alajouanine syndrome: cerebellar ataxia of the cerebellum in the
elderly; usually due to alcohol abuse. Named along with neurologists Théophile
Alajouanine (1890-1980) and Charles Foix (1882-1927).
Marie's anarthria: inability to articulate words due to cerebral lesions.
Marie–Strümpel Disease: also known as Ankylosing spondylitis; a severe arthritic spinal deformity. Named along with German neurologist Adolph Strümpell (1853-1925). The disease is sometimes referred to as "Bekhterev Disease"; named after Russian neurophysiologist Vladimir Bekhterev (1857-1927).
Marie-Léri syndrome: hand deformity caused by osteolysis of the articular surfaces of the fingers. Named with neurologist André Léri (1875-1930).
Pierre Marie né le 9 novembre 1853 à Paris et mort le 14 avril 1940 à Cannes est un médecin neurologue français. Il est à l'origine de la découverte de plusieurs entités cliniques nouvelles comme l'atrophie musculaire progressive en 1886, l'acromégalie en 1886, l'ostéoartropathie hypertrophique « pneumique » en 1890, l'hérédoataxie cérébelleuse en 1893, la spondylarthrite ankylosante (sous le nom de « spondylose rhizomélique ») en 1898, ce qui lui vaut une réputation internationale. À la clinique neurologique de la Salpêtrière, il succède en 1917 à Dejerine à la Chaire inaugurée par Jean-Martin Charcot.
Après ses études de médecine, il est nommé interne des hôpitaux de Paris en 1878 et commence à étudier la neurologie sous la tutelle de Jean-Martin Charcot à la Salpêtrière et à Bicêtre. Pierre Marie est l'un des étudiants les plus remarquables de Charcot dont il devient l'assistant spécial et le chef de son laboratoire. Il obtînt son doctorat en médecine en 1883 avec une thèse sur une maladie thyroïdienne, la maladie de Basedow. Il obtient son agrégation à la Faculté de Médecine de Paris en 1889 où il a présenté une série de conférences célèbres sur les maladies de la moelle épinière.
Entre 1885 et 1910, période la plus productive de sa carrière, il a écrit des nombreux articles et livres et a développé une école internationale de neurologie. Marie a identifié avec succès et a décrit une série de désordres auxquels son nom est lié. En 1886, il décrit l'acromégalie, une maladie qui portera plus tard son nom (maladie de Pierre Marie). L'analyse qu'il fait à cette occasion des désordre de l'hypophyse contribue de façon déterminante au domaine naissant de l'endocrinologie.
En 1897 il a créé un service neurologique à Bicêtre qui a rapidement eu une réputation mondiale. Ses travaux sur l'aphasie l'ont opposé à Paul Broca (1824-1880) et Carl Wernicke (1848-1905) quant à la localisation du centre de la parole. En 1907 il a sollicité avec succès la chaire vacante d'anatomie pathologique à la Faculté de Médecine et, avec l'aide de Gustave Roussy, son successeur, Marie a complètement modernisé l'enseignement d'anatomie pathologique.
En collaboration avec Charles Foix, Henry Meige et d'autres, il publia différents travaux consacrés aux séquelles neurologiques de la guerre. En 1917, âgé 64, Marie a été nommé à la chaire de neurologie qui avait été créée pour Charcot et occupée depuis par Fulgence Raymond (1844-1919), Édouard Brissaud (1852-1909) et Joseph Jules Dejerine (1849-1917). Avec Édouard Brissaud, il a fondé la Revue de Neurologie en 1893, et la Société Française de Neurologie dont il fut le premier secrétaire général. Il a été nommé membre de l'Académie de médecine en 1911.
Dita
ippocratiche
Dita a bacchetta di tamburo con unghie a vetrino d'orologio
Condizione di ipertensione arteriosa polmonare conseguente a cardiopatia o vasculopatia congenita, in cui lo shunt sinistra-destra si inverte e compare cianosi, accompagnata da dispnea, dolore stenocardico, emottisi ed epistassi, sincope e cefalea. Può essere complicata da insufficienza cardiaca congestizia, aritmie, infarti miocardici e polmonari. Insorge dopo i 2 anni di età, in media verso i 14 anni, e conduce a morte entro i 30-35 anni. Tuttavia le persone affette conducono una vita pressoché normale fino alla morte, che è di solito improvvisa. Sono fattori di rischio per un aggravamento della sindrome emorragie, febbre, vomito e diarrea, gravidanza e puerperio. La terapia consiste nel porre particolare attenzione a questi fattori di rischio e, poiché è in genere controindicato l'intervento chirurgico, l'orientamento è quello di evitare che insorga la sindrome, operando tutti i bambini con comunicazione sistemico-polmonare. Nell'adulto si può intervenire solo col trapianto cuore-polmoni. Fu descritta nel 1897 dal Dr Victor Eisenmenger (Vienna 1864-1932).
Clubbing
of fingers in a patient with Eisenmenger's syndrome.
Clubbing was
first described by Hippocrates,
then
clubbing is also known as "Hippocratic fingers".
Eisenmenger's syndrome (or Eisenmenger's reaction) is defined as the process in which a left-to-right shunt caused by a ventricular septal defect in the heart causes increased flow through the pulmonary vasculature, causing pulmonary hypertension, which in turn, causes increased pressures in the right side of the heart and reversal of the shunt into a right-to-left shunt. It can cause serious complications in pregnancy, though successful delivery has been reported.
Conditions needed for a person to be diagnosed with Eisenmenger's Syndrome are:
- an underlying heart defect that allows blood to pass between the left and right sides of the heart.
- pulmonary hypertension, or elevated blood pressure in the lungs
- polycythemia, an increase in the number of red blood cells
- the reversal of the shunt.
Eisenmenger's syndrome was so named by Dr. Paul Hamilton Wood (London 1907-1962) after Dr. Victor Eisenmenger (Vienna 1864-1932), who first described the condition in 1897.
A number of congenital heart defects can cause Eisenmenger's syndrome, including atrial septal defects, ventricular septal defects, patent ductus arteriosus, and more complex types of acyanotic heart disease. The left side of the heart supplies blood to the whole body, and as a result has higher pressures than the right side, which supplies only deoxygenated blood to the lungs. If a large anatomic defect exists between the sides of the heart, blood will flow from the left side to the right side. This results in high blood flow and pressure travelling through the lungs. The increased pressure causes damage to delicate capillaries, which then are replaced with scar tissue. Scar tissue does not contribute to oxygen transfer, therefore decreasing the useful volume of the pulmonary vasculature. The scar tissue also provides less flexibility than normal lung tissue, causing further increases in blood pressure, and the heart must pump harder to continue supplying the lungs, leading to damage of more capillaries.
The reduction in oxygen transfer reduces oxygen saturation in the blood, leading to increased production of red blood cells in an attempt to bring the oxygen saturation up. The excess of red blood cells is called polycythemia. Desperate for enough circulating oxygen, the body begins to dump immature red cells into the blood stream. Immature red cells are not as efficient at carrying oxygen as mature red cells, and they are less flexible, less able to easily squeeze through tiny capillaries in the lungs, and so contribute to death of pulmonary capillary beds. The increase in red blood cells also causes hyperviscosity syndrome.
A person with Eisenmenger's Syndrome is paradoxically subject to the possibility of both uncontrolled bleeding due to damaged capillaries and high pressure, and random clots due to hyperviscosity and stasis of blood. The rough places in the heart lining at the site of the septal defects/shunts tend to gather platelets and keep them out of circulation, and may be the source of random clots. Eventually, due to increased resistance, pulmonary pressures may increase sufficiently to cause a reversal of blood flow, so blood begins to travel from the right side of the heart to the left side, and the body is supplied with deoxygenated blood, leading to cyanosis and resultant organ damage.
In early childhood, surgical intervention can repair the heart defect, preventing most of the pathogenesis of Eisenmenger's syndrome. If treatment has not taken place, heart-lung transplant is required to fully treat the syndrome. If this option is not available, treatment is mostly palliative, using pulmonary vasodilators such as bosentan, antibiotic prophylaxis to prevent endocarditis, phlebotomy to treat polycythemia, and maintaining proper fluid balance. These measures can prolong lifespan and improve quality of life. Anticoagulants should rarely if ever be administered to a patient with Eisenmenger's syndrome due to the fact that they generally have a prolonged aPTT, PT, decreased coagulation factors, decreased platelet counts and abnormal platelet function. If anticoagulants are administered, the INR should be kept on the low side of the therapeutic range.
