International Society of History of Otorhinolaryngology 11 working ...

International Society of History of Otorhinolaryngology 11-th working meeting, Varna, Bulgaria 28.09-01.10.2017

Under the auspicies of Medical University - Varna

To all the participants at the 11-th Working Meeting of the International Society of History of Otorhinolaryngology, Varna, Bulgaria Dear colleagues, It is an honor to welcome you in Bulgaria and at Medical University of Varna. For us it is a privilege to host the 11-th working meeting of the International Society of History of Otorhinolaryngology. Medical University - Varna is an academic institution, which respects traditions. Therefore, we support the efforts of every scientific community to turn over the history pages of medicine in order to build up a sustainable future. Congratulations to all the members of the International Society of History of Otorhinolaryngology and the participants of this event for doing this! We can state that 11-th working meeting is already a good tradition and a place to share competences and practical experience. The increased interest towards the forum is clear evidence, that there is a growing awareness among the medical community for the need to investigate the history of medicine, otorhinolaryngology being a particular example. I believe that the 11-th working meeting of the International Society of History of Otorhinolaryngology is a rewarding initiative. I wish you all beneficial working meeting and a pleasant stay in Varna!

28.09.2017 Varna

Prof. Krasimir Ivanov, MD, PhD, DSc Rector of Medical University “Prof. Dr. ParaskevStoyanov” - Varna 2

Dear Friends and Colleagues, The 11-th meeting of the International Society of History of Otorhinolaryngology is taking place from September 28 through October 1, 2017 in the Museum of Archaeology in the centre of Varna, Bulgaria. This annual meeting is organized under the auspices of the Medical University Varna. The University just turned 55 years. Even at this age it shows commitment to history - it hosts the only Museum of the History of Medicine on the Balkans. On the other hand the Varna Museum of Archaeology displays artefacts, which belong to the oldest in the world and will surprise you. The meeting will be an opportunity to share our passion for the history of otorhinolaryngology in an academic milieu with colleagues and students - our future colleagues. Welcome in Varna. With kind regards Assoc. Prof. N. Sapundzhiev Department of ORL, Medical University - Varna Prof. A. Tonchev Departmement of Anatomy and Cell Biology Medical University - Varna Prof. R. Sokiranski Radiological Center SinsheimEberbach-Erbach-Walldorf-Heidelberg Prof. W. Pirsig University at Ulm/Hamburg

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PROGRAMME Thursday, 28.09.2017 15:00 – 17:00 A visit in the museum (English guide) 17:00 - 17:30 Opening greetings, addresses Vassil Tenekedjiev (Varna, Bulgaria) 17:30 - 18:15 Varna in Praehistory and Ancient Times: an Outlook Roman Sokiranski (Heidelberg, Germany) 18:15 - 19:00 Development of medical imaging of the head from x-ray to holography 19:00 Evening reception Friday, 29.09.2017 Alexander Minchev (Varna, Bulgaria) 09:00 - 09:20 Ancient Medicine in Bulgaria: Archaeolgical and epigraphic evidence (4th c. BC - 6th c. AD) Robert J. Ruben (New York, USA) 09:20 – 09:40 The developing concept of tonotopic organization of the inner ear, or, Where did I hear that? Rinze A. Tange (Utrecht, The Netherlands) 09:40 – 10:00 Martha‘s Vineyard‘s role in deafness Herwig Swoboda (Vienna, Austria) 10:00 - 10:20 Karl Henning’s moulages of ear diseases – a discovery just in time for his Centenary Albert Mudry (Lausanne, Switzerland) 10:20 – 10:40 Hieronymus Bosch’s stamps: realistic, satirical, grotesque and otorhinolaryngological! John Riddington Young (North Devon, UK) 10:40 – 11:00 The strange and eventful history of Jacobsen‘s Organ 11:00 – 11:30 Coffee break

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Egbert Huizing (Utrecht, The Netherlands) Puccini‘s Throat Benedikt Folz (Bad Lippspringe, Germany) 11:50 – 12:10 Short history of head and neck oncology Neil F. Weir (Farnham, Surrey, UK) Manuel Patricio Rodriguez Garcia (1805-1906): The 12:10 – 12:30 “inventor of the laryngoscope” and world-renowned singing teacher 11:30 – 11:50

12:30 - 14:00 Lunch 14:00 – 14:20 14:20 – 14:30 14:30 – 14:40 14:40 – 14:50 14:50 – 15:00 15:20 – 15:40

Nikolay Sapundzhiev (Varna, BG) Prophylaxis and treatment of acute viral infections (Presentation sponsored by BerlinChemie) Alice Renjilian (Varna, BG) Preauricular sinus – a tale of forgetful rediscovery Boyko Matev (Varna, BG) Losing one’s voice to save one’s life – a brief history of laryngectomy Georgi Stoyanov (Varna, BG) The Vomeronasal organ – found in humans, denied in humans, or so Jacobsеn told us Magdalena Bliznakova (Varna, Bulgaria) Giving a voice to the voiceless - learning how to speak for the second time Iliyaz Hadzhiev (Varna, Bulgaria) The surgeon from Dionisiopolis - what was his ENT spectrum

15:40 – 16:00 Coffee break

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16:00 – 16:40

16:40 – 17:00 17:00 – 17:10 17:10 – 17:30 17:30 – 17:50 17:50 – 18:10

Nikolay Sapundzhiev (Varna, BG) Ear, nose and throat red flags for MPS II from a century perspective (30 min presentation and 10 min discussion), (Presentation sponsored by Shire) Wolfgang Pirsig (Ulm, Germany) The human trachea depicted in the visual arts from the Egyptian Old Kingdom to Leonardo da Vinci Ivan Valkadinov (Varna, Bulgaria) Remarks on tracheal anatomy and its depiction Kees Graamans (Nijmegen, The Netherlands) Urk, the place to be Afshin Teymoortash (Marburg, Germany) Cystadenolymphoma of the parotid gland: Historical aspects Herwig Swoboda (Vienna, Austria) Sacro Monte of the Great War – Vienna’s polychrome broken face sculptures

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Varna (Odessos) and vicinity in prehistory and ancient period: an overview

Vassil Tenekedjiev, Varna, Bulgaria Correspondence: [email protected]

The oldest archaeological finds in the vicinity of modern city of Varna are of Mesolithic Period and date back to about 10-th-8-th millennium BC. However, the most flourishing Prehistoric period was the Aeneolithic (Copper Age) when in the contemporary industrial zone of the city there were located several settlements situated on the shores of Varna Lake dated to mid-6th millennium BC. To one of them belonged once a little necropolis of ca 4600-4400 BC, where the first in the world gold worked by human hands wa discovered: a small necklace made of gold beads. Between 4400-4200 BC was dated the famous Varna “Gold” necropolis within the modern city), where in a number of graves over 6 kg of gold artifacts as well as various other objects have been found. After several centuries with no life in the region – during Bronze Age (about 3600-3200 BC) on the shores of Varna Lake there appeared again settlements but of another ethnic group. Later on – maybe about 1600-1200 BC a group of Thracians settled on a cape at Varna Bay and named their new residence Odessos. In early 6th c. BC, here arrived Greek immigrants from the Asia Minor city of Miletos and established their apoikia (daughter city) where they lived and worked for the pros7

perity of their new homeland together with the indigene people. Soon Odessos – as an independent city-state became one of the most important ports and trade center on the Western Black Sea coast. In early 1st c. AD the city was incorporated in the Roman Empire – within the Province of Moesia / later Moesia Inferior. During 1st-3rd c. AD Odessos developed as a flourishing trade- religious- and cultural city and important port of the province. In the Late Antique period (4-th – early 7-th c. AD), the city became a large Christian center and was Bishopric (later – Archbishopric) seat. The city was captured and burnt to ashes during in AD 614 during one of the last invasions of Avars- and Slavs on the Balkans. This marked the end of Odessos as well as the end the Ancient culture and life in general between the Balkan Range (Stara Planina Mountain) and Danube River because the Early Byzantine Empire withdrew from that region. Vassil Tenekedjiev PhD is archaeologist at the Varna Regional Museum of History with a dissertation on Early Christian architecture and liturgical arrangement of the church’s interior. His main scientific interests are focused on the archaeology of Late Antiquity and Early Christianity (4-th- 6-th C. AD) and also on Christian art. Currently he is an assistant professor at the Varna Regional Museum of History, department of Archaeology and works extensively as an archaeologist in Varna (the ancient Odessos) and its region. Since 2007 together with Alexander Minchev he has been excavating the Early Byzantine monastery in the Djanavara locality – one of the major archaeological sites near Varna.

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Development of medical imaging of the head from x-ray to holography

Roman Sokiranski, Heidelberg, Germany Correspondence: [email protected]

A short history of medical imaging by means of the computer tomography is presented. X-ray technology was an invention of the end of the 19-th century. A milestone for modern medical imaging was the development of the sectional image technique using x-ray. In 1971, Godfrey Hounsfield succeeded in constructing a device capable of producing images of the human body for diagnostic purposes. For this invention he received the Nobel Prize for Medicine in 1979. Decisive parameters were the required examination time and the resulting slice thickness (i.e. resolution) of the image. The first devices, exclusively developed for the head examination, took hours. The slice thickness was 13 mm. In the following 45 years, computer tomography has developed rapidly. Both the examination times and the resolution could be dramatically reduced. Thus it is now possible to examine the entire head with a scanning time of 0.15 sec and a slice thickness of 0.4 mm. At the same time, the required beam exposure was reduced to a minimum.
The price of this immense development was a steadily growing number of resulting images. For example, a maximum of 10 images was taken for the head in the initial phase. Currently, the number of images for the head is around 500. To be able to diagnose from this amount of images specific hardware and soft9

ware developments have been required. Soon simple cine and multiplanar reconstruction procedures were introduced into the three-dimensional and virtual reconstruction techniques. Newest techniques are able to calculate holographic reconstructions from these data sets. The role of these fascinating procedures for diagnostics and teaching in the future is still the subject of research. Significant progress has also been made in the field of functional radiological imaging. Due to the extremely short examination time, it is even possible to present a functional actions of the heart not only three-dimensionally but also four-dimensionally (changes of three-dimensionality in the time axis). Functional parameters from the laryngeal areas can also be presented. Roman Sokiranski MD, PhD, Visiting Professor at the Medical University of Varna and Head of one Radiology Center in Heidelberg (Germany). Born in Poland in 1955, he grew up in Israel and Germany. He studied physics and biology at the Technical University of Berlin and at the Free University (FU) of Berlin from 1974 until 1978. Then he studied medicine at the FU Berlin where he graduated in 1985. During the study period, he worked as tutor at the Institute of Anatomy for 3 years. His medical career began 1986 in the department of surgery of the Hospital Hubertus in Berlin. His radiological career began 1987 at the Medical University of the FU Berlin. He received his degree Dr. med. of the FU Berlin in 1990 His scientific work was continued at the University Clinic Tübingen and the University Clinic Ulm. 1998 he was appointed as University lecturer for Radiology. His research topic was „Significance of modern computer-tomographic diagnostic procedures with joint implants“. 1999 he was nominated chief physician of the department of radiology and nuclear medicine at the Traunstein Clinic. From 2006 to 2009 he worked as head of the breast diagnostics center in Unterhaching in Munich. 2006 he was appointed as visiting professor at the Tongji Medical College of Huazhong University of Science and Technology in Wuhan, China and 2016 as visiting professor at the Department of Anatomy, Histology and Embryology at Medical University of Varna. 10

Since 2009 he is the head of one national radiology center in Heidelberg. Roman Sokiranski has 107 national and international publications on various medical topics inclusive history of medicine. His focus is on multi-dimensional medical imaging. 2015, he organized together with Wolfgang Pirsig, the 9-th Working Meeting of the International Society of History of Otorhinolaryngology in Heidelberg.

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Ancient medicine and pharmacy in Bulgaria (4 – 6-th c. BC): archaeological and epigraphic data -th

Alexander Minchev, Varna, Bulgaria Correspondence: [email protected]

The oldest data about ancient medicine in Bulgaria goes back to 4 c. BC. It is a small pottery container of the famous imported cure called lykion. However, the abundant information about medical care and pharmacy in the country is of Roman period (1st - 3rd c. AD). The data confirms medical practices in civilian life - in larger and smaller towns as well as in military camps and religious centers: temples and sanctuaries. The later ones were dedicated to: Asclepius and Hygeia; Apollo Ietros; the Thracian Horseman and the Three nymphs, which are typical Thracian deities. Inscriptions of mainly 2nd-3rd c. AD discovered in the roman provinces of Moesia Inferior and Thrace revealed the names of 9 civilian physicians; 4 military ones and 2 veterinarians. Usually, they practiced both medical care and pharmacy. There is also data about existing collegiae – professional organizations of physicians in some cities located along the Black Sea coast. Some of their members held also some important positions in the administrative- and religious life there. The only sure hospital discovered in the country was based in the military camp/ town of Novae (near modern Svishtov) on the Danube River frontier. -th

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During late Antiquity / Early Byzantine period the tradition of medical practice continued though to a lesser level. The largest set of medical- and surgical instruments and accessories connected to medicine (over 30 pieces) was found in a house (or hospital?) destroyed by fire in mid-5-th c. AD at Marcianopolis (Devnya) but it contained a lot of earlier in date – Roman instruments too. The last finds connected to medicine are single instruments of late 6 - early 7-th c. AD too, used mainly in the pharmacy and possibly for preparing some home-made cures. This is the time when the Ancient life and culture cease to exist in the lands between the Danube River and Balkan Range due to one of the last invasions of Avars- and Slavs in AD 614. -th

Alexander Minchev PhD is Emeritus Head of the Ancient Art Department at Varna Arcaheological Museum (1972-1991; 2002-2016) and Director of Varna Regional Museum of History (1991-2002). He is a leading specialist in Ancient and Early Byzantine Archaeology, author or co-author of over 200 articles (3 on Ancient medicine} and 7 books published in 21 countries: in Europe, Canada and Japan. Main scientific interests: Ancient glass and pottery; Thracian and Scythian art; Early Christian art and culture. His main contributions are on Ancient glass on the Western Black Sea Coast; Late Antique Mosaics in Northeastren Bulgaria; Late Antique and Mediaeval ports on the Western Black Sea Coast; Early Christian reliquaries in Bulgaria, etc.

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The developing concept of tonotopic organization of the inner ear, or, Where did I hear that?

Robert J. Ruben, New York, USA Correspondence: [email protected]

Objective: To document historical conceptualization of the inner ear as the anatomical location for the appreciation of sound at a continuum of frequencies, and examine the evolution of current understanding of tonotopic organization. Method: Primary sources from the 6-th century BCE through the -th 20 century CE which had been noted in the various histories of otology, audiology, and acoustics were read, in the original language and/or in translation, to determine the view of the organization of the inner ear in that work/reference. Additionally, PubMed, Scopus, Google scholar and Index Med were searched for the terms tonotopic, cochlear mechanics and place theory of hearing. Each work/reference was categorized as to the methodology used to determine the role of the inner ear. The classifications were: theoretical; observation of anatomical structure which could account for localization of sound perception; physical models utilizing simulation; physical models utilizing biological material; physiological; animal behavioral studies; and human behavioral studies. Results: Current understanding of the properties of the inner ear is a consequence of the acquisition over a long, complex history of the development of accurate information concerning acoustics, and the anato14

my, physiology, and psychophysics of hearing. It was not until the 16-th century that the physical and mathematical basis of resonance was described by Galileo. Concurrently, advances were made in the knowledge anatomy of the inner ear. This new knowledge led, in the 17-th century, to the first theory of tonotopic organization in the 17-th century, which stated that that high-frequency hearing was at the apex of the cochlea and low-frequency at the base of the cochlea. It was not until the 19-th century that more accurate anatomical information became available which led to an opposite conclusion, and the formulation of the view we hold today: the localization of high tones at the base of the cochlea and low tones of the apex of the cochlea. During the end of the 19-thcentury and beginning 20-th century behavioral studies were carried out which in some instances were congruent of this concept. The discovery of physiological properties of the ear in 1930 allowed for physiological studies which were consistent with the concept of high low tone sensitivity continuum from base to apex. During the middle third of the 20-th century both animal and human behavioral studies further supported this concept. Physical biological studies of the mid-20-th century, however, while confirmig the findings of greater sensitivity of high tones at the base and low tones at the apex, further demonstrated that for high-intensity sound there was a spread of effect through the entire cochlea, more so for low frequency tones than for high tones. This was consistent with animal and human behavioral studies. Conclusion: Current understanding of tonotopic organization of the inner ear with regard to pure tones is the result of the acquisition over time of knowledge of acoustics, the anatomy, physical properties and physiology of the inner ear, and ultimately behavioral studies. Examination of this complex evolution leads to understanding of the way each approach through time builds upon those before it, culminating, through behavior studies, in a profound appreciation of empirical verification. Robert J. Ruben MD is the Distinguished University Professor and Chairman Emeritus of the Departments of Otorhinolaryngology - Head and Neck Surgery and Pediatrics at the Albert Einstein Col15

lege of Medicine and the Montefiore Medical Center, Bronx, NY, USA. He has graduated medicine at Princeton University. While a 4-th year medical student, he pioneered the first recording of the human VIII cranial nerve action potential. Following his residency at Johns Hopkins School of Medicine he became a research associate at the NIH where he carried out pioneering studies of the terminal mitosis of the mammalian inner ear. Following NIH he transferred to New York where he coauthored the first techniques for organ culture of the mammalian inner ear. In 1987, he organized a conference, the report from which became the basis for establishing a new institute at NIH, the National Institute on Deafness and Other Communication Disorders (NIDCD), in 1989. Since then, Dr. Ruben has been a leading Congressional advocate for the institute, providing testimony to pertinent committees and working with Members of Congress. He is founder of the International Journal of Pediatric Otorhinolaryngology, of which he serves as Editor-in-Chief. Dr Ruben has been awarded numerous awards, including the Edmund Prince Fowler award of the American Laryngological, Rhinological, and Otological Society; Gold Medal Ninth World Congress on Otolaryngology for the film Extracorporal Growth of the Inner Ear; Schrelber Gold Medal of the National Association of the Deaf; Society Scholars of Johns Hopkins University; Member Collegium Oto-Rhino-Laryngologicum Amicitae Sacrum (CORLAS); George Shambaugh Award of CORLAS; Award of Merit of the American Otological Society; Honorary Professor to the Beijing Institute of Otolaryngology; Honorary Member of the Polish Otolaryngology Society; guest of honor at various ORL societies worldwide; President of the American Society of Pediatric Otolaryngology; President of the Association for Research in Otolaryngology; President of the Society for Ear, Nose and Throat Advances in Children; and Director of the American Board of Otolaryngology; Honorary Member European Society of Pediatric Otolaryngology.

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Martha’s Vineyard’s role in Deafness

Rinze A.Tange, Utrecht, The Netherlands Correspondence: [email protected]

A recessive trait of a congenital disease can be spread in an isolated population. In this paper we focus on the history of the spread of recessive deafness. In an area in Kent known as Weald (UK) existed a large deaf population in the 17-th century. The high number of deaf people was caused by a genetic mutation in that time which resulted in a recessive gene for deafness being passed for generations. Due to religious disagreement Reverend John Lothrop had to leave England and he moved with his Puritans congregation from Weald to the new world. They landed in Massachusetts and moved to the island Martha’s Vinyards. For many years the population on the island was extremely isolated. In the 19-th century the deaf born population on Martha’s Vineyard was very high compared with the mainland. The deaf people were well integrated into the society due to the use of sign language. Three major towns on Martha’s Vineyard had the most the deaf persons. In the small isolated town Chilmark the deaf-to-hearing ratio was one in 25 in the mid-19-th century. In the neighbourhood village Squibnocket this ration was even higher (1 to 4). Graham Bell (inventor of the telephone) was asked to study the deafness on the island. He did an extensive pedigree research and presented his results in 1883. He concluded and believed that deaf 17

people should not marry . He proposed repressive and preventive measures. Bell was an eugenician and his work supported the eugenic practice of sterilization of deaf people in America which continued into the 20-th century. The deafness on Martha’s Vineyard began to end because of the gene pools expanded and the increase number of immigrants. At the turn of the 19-th century only 15 deaf were alive and in 1925 only 4. Rinze Anthony Tange MD, PhD, Associate Professor Emeritus was a medical specialist in otolaryngology & otology in the Amsterdam Medical Center and Utrecht University in The Netherlands. Rinze Tange was born in Utrecht, in 1950. He studied medicine at the Utrecht University where he graduated in 1976. Thereafter he started his medical education in the specific specialty of otolaryngology by completing a 4-year residency at the Erasmus University in Rotterdam. In 1977 Tange went to the Kresge Hearing Research Institute in Ann Arbor, Michigan USA to study the inner ear anatomy research methods. In 1983 he finished his thesis entitled “Degenerative ototoxic changes in the cochlea as seen in microdissections and surface preparations”. Tange worked as otologist for 28 years in the University of Amsterdam (AMC) and 8 years in The University of Utrecht (UMC) thereafter. Tange became interested in the treatment of hearing loss due to otosclerosis and since then he has performed over 1500 stapedectomies during his career with recovery of hearing in more than 90%. Tange has published over 180 papers. He has been the co-founder of the Dutch Journal of Otolaryngology / Head and Neck surgery established on 28 June 1994. Since 1986 Tange studied the history of otolaryngology. The main topics were the historical facts in rhinology and otology. Over 30 historical publications appeared in national and international journals. Tange published 2 historical books: “Het neusspeculum door de eeuwen heen”(with Wolfgang Pirsig) and recently “The History of Otosclerosis Treatment”. Tange is an enthusiast member and Co-Editor of Historia Otorhinolaryngologiae Society. He was the co-organizer of the 10th working Meeting 29-9 to 1-10 2016 in Utrecht, The Netherlands.

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Karl Henning’s moulages of ear diseases – a discovery just in time for his Centenary

Herwig Swoboda1, Eduard Winter2 General Hospital Hietzing with Neurological Center Rosenhügel, and Wilhelminenspital, Vienna 2 Pathologic-Anatomical Museum, Natural History Museum, Vienna 1

Correspondence: [email protected] A box at the Institute of Anatomy of the Medical University of Vienna contained ca. 400 moulages of diseases of the external ear, and some post-therapeutic results. They were made by the artist and surgeon Karl Henning (1860-1917) for the University Department of Otology, chaired by Adam Politzer (1835-1920) and, since 1907, by Viktor von Urbantschitsch (1847-1921). Many are in a good state of preservation, but some need restauration. Henning’s advanced well hardening wax formula allowed for a good rendering of fine details, an essential advantage for the three-dimensional peculiarities of normal and diseased auriculae. Diseases prevalent in the Vienna Fin-de-siècle, and good therapeutic, essentially surgical results, found an excellent documentation. Ear ceroplasty began with a high grade of perfection with Giovanni Mazzolini’s 1749 reevaluation of Valsalva’s “De aure humana tractatus” (1704, 1707, 1717). Rendering of skin disease throughout the 19th century escaped engraving and photographic techniques, needing coloured 19

artistic representation, as evidenced in Hebra’s Atlas of Dermatology (physician-artists Anton Elfinger, also moulageur, and Karl Heitzmann). Furthermore, the spatial orientation of ear anatomy needs different angles of view to be fully perceived, conferring the moulage techniques a particularly high didactic value in rendition of ear disease. This value already was emphasized by Mazzolini’s comments on Valsalva. The large number of specimens reflects the intense and sought-after otologic teaching in Vienna. Stanislaus von Stein from Moscow, Giuseppe Gradenigo from Turin, Marcel Lermoyez and Achille Gougenheim, both from Paris, and Max Goldstein from St. Louis, Missouri, attended such courses, to name only a few. The recently found masterpieces of the highly inventive moulage and facial epithesis artist Karl Henning were a constitutive element of the high level of education at the Vienna University Department of Otology around 1900. Herwig Swoboda, M.D., is head of the ORL Departments of the Wilhelminenspital and the General Hospital Hietzing, the latter being Vienna’s first Department of the united subspecialties Otology and Rhino-laryngology, founded 1908 by Otto Mayer (1876-1951), the 1928 Dalby-Memorial-Laureate. Eduard Winter, physicist, is acting manager of the Narrenturm and its pathologic-anatomical museum, leading its current renovation. His experimental investigations of Karl Henning’s wax formulas recently confirmed their high end product staunchness, especially suited for modeling of fine structures like auricles.

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Hieronymus Bosch’s stamps: realistic, satirical, grotesque and otorhinolaryngological!

Albert Mudry, Lausanne, Switzerland Correspondence: [email protected]

In 2016 was celebrated the 500-th year anniversary of the death of the early Dutch painter Hieronymus Bosch (c.1450/6-1516), a largely discussed and somewhat original, innovative, visionary, fantastic, satirical, moral, grotesque and unique artist. This jubilee notably generated the production of various stamps and books to remember him, his workshop and followers considered together, and to open new interpretations, speculations, and discussions around them. The aim of this research is to study in detail all these paintings and to try to find out what is visually related to otorhinolaryngology in using as a primary support documents of the different published stamps related to Bosch. A meticulous observation of all the faces found in his paintings was conducted and correlated to the produced stamps found on the market. All of Bosch’s essential paintings were effectively reproduced on stamps in different countries and at different times. Nearly all possible forms of nose were found, from normal, to deformed, pathological, satirical and finally to grotesque ones. Alongside the famous symbolic double ears with a knife, the ears are usually nicely depicted, with some rare exceptions showing deformations. Except one example of examination of the mouth, no specific anomalies of the neck were observed, but only 21

some voluntary traumatic lesions. Bosch also illustrated the three otorhinolaryngological senses, hearing, olfaction, and taste. The main outcome was that Bosch seems to have been an excellent observer, close to the reality, with a certain knowledge of anatomy demonstrated by meticulous reproduction of some medical anomalies. Albert Mudry MD, PhD, born in Switzerland, gained his MD at the University of Lausanne in 1990 and later specialised in OHNS in Lausanne, Lucerne and Würzburg. He was granted a PhD in Arts in 2007 by the History faculty of the University of Lausanne. He currently combines a busy private practice in otology in Lausanne with research projects in the history of OHNS as Faculty Member (Adjunct Professor) of the Department of OHNS at Stanford University School of Medicine, California. He published more than 130 papers and 5 books.

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The strange and eventful history of Jacobsen‘s Organ

John Riddington Young, North Devon, UK Correspondence: [email protected]

The vomeronasal organ was not in fact first described by Ludwig Jacobsen in 1809, but by Frederik Ruysch in 1703. Neither of these meticulous surgeons fully understood its function. Other anatomists (von Sömmering, Gratiolet, Dursy, Kölliker) described its morphology and in 1897, Robert Broom ascribed it with the function of an accessory olfactory organ. Little more was written in the twentieth century until MontiBloch developed the electrovomerogram showing its functionality (1994) and Trotier (1998) postulated on genetic grounds that the organ was non functional. Jacobsen’s Organ remains an interesting anatomical vestige. John Riddington Young MD is a retired Consultant Surgeon. In 2015, he gave the Watson Williams Lecture on “Sexual Aspects of the Nose.” His research thesis entitledMedical Ideas in English Poetry to the End of the Seventeenth Century (Brussels 2000) was published as a book (Poetry, Physick, Pestilence and Pox). He has published seven other books , including a book on the history of otolaryngology Offbeat Otolaryngology, a book on Devon Church History and a short book on Military History. His most successful two books however were controversial 23

criticisms of deteriorating management in the British Health Service (The Hospital Revolution and There‘s a Nasty Cancer in the Health Service). He spent many years in the Army, and was the Commanding Officer of a Field Hospital. He has written an opera and lists his hobbies as long distance walking, fishing, shooting, making stained-glass windows and mosaics, cabinet-making, woodcarving, Punch and Judy, growing prize-winning sweetpeas, British bulldogs and calligraphy (English and Arabic).

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Puccini‘s Throat

Egbert Huizing, Utrecht, Netherlands Correspondence: [email protected]

In this presentation the smoking addiction and the resulting laryxcarcinoma and death of the famous Italian opera composer Giacomo Puccini is explored. The history of the diagnosis and treatment by means of radium needles in a clinic at Brussels of his final disease will be discussed. Egbert H. Huizing MD is emeritus professor of Otorhinolaryngology. He served at Leiden University as an Associate Professor (19651976), as Professor and Chairman at the Erasmus University Rotterdam (1976-1980) and the University Medical Centrum Utrecht (1980-1998). He trained some 50 ORL-specialists and supervised 30 PhD theses. His research, scientific publications and books were devoted to the pathophysiology of the ear and functional corrective nasal surgery. For his work he was awarded the Gold Medal of the World Association of ORL and a honorary membership of 14 national and international scientific societies. He is a amateur cellist and served three years as the solocellist of the Netherlands National Student Orchestre. His recent book “Mozart’s Ear, Haydn’s Nose and Puccini’s Throat” is the outcome of studies on Music and Ear-Nose-Throat Diseases. 25

Short history of head and neck oncology

Benedikt Folz, Bad Lippspringe, Germany Correspondence: [email protected]

This presentation reviews the history of head and neck oncology. The oldest artefacts which tell us about cancer in the head and neck are bony specimen of individuals, who died in an age, when the concept of scripture, most likely, had not yet been developed. These paleopathologic specimens as well as the knowledge, which has been outlined in medical history articles were the sources of this review. Literature was systematically analyzed with the search engines “Google Scholar” and “PubMed” and the retrieved publications were cross-referenced. In addition, books and, when possible, original sources were consulted. The cradle of oncology was located in ancient Egypt and Greece. The search showed that traces of tumors could be found in Egyptian mummys (e.g. nasopharyngeal carcinoma), where the tumors eroded bone. First tumor treatments in the head and neck were either for cutaneous malignancies or cancers on the mucosal surfaces of the oral cavity. The origin, diagnosis and treatment of more deeply situated tumors of the larynx and hypopharynx remained obscure for many centuries. The medieval age brought little progress to medicine in general, and in head and neck oncology in particular, due to religious concerns. Renaissance 26

medicine was characterized by advances in medicine and oncology made by systematic dissection studies of normal and pathologic anatomy. The 19-th and 20-th century reflect the development of head and neck oncology in the era of science based medicine. Almost all of our current understanding of head and neck oncology, our diagnostic methods and treatment strategies have been developed in these two centuries. Benedikt Folz MD, PhD studied medicine in Hamburg, Germany. Thereafter he started his medical education in Otorhinolaryngology at the University of Kiel, Germany. Later he continued his medical and scientific work at the Philipp University of Marburg, Germany. There he was from 2004-2006 Vice Chairman at the Department of Otorhinolaryngology, Head and Neck Surgery. Since 2006 he is Chairman at the Dept. of ORL, Karl Hansen Medical Center, Bad Lippspringe. His research is focused on hereditary hemorrhagic telangiectasia, quality of life assessment for chronic diseases in the head and neck region, mucosal melanomas of the head and neck, medical history of otolaryngology and head and neck surgery. Prof. Folz was the organizer of multiple, predominantly international Meetings and Courses. He is editor and reviewer in multiple journals, including European Archives of Oto-Rhino-Laryngology, European Journal of Dermatology, The Laryngoscope, Journal of Thrombosis and Hemostasis, Melanoma Research, Laryngo-Rhino-Otologie, Annals of Otolaryngology and Rhinology, The Open Otorhinolaryngological Journal, The World Journal of Gastrointestinal Surgery.

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Manuel Patricio Rodriguez Garcia (1805-1906): The “inventor of the laryngoscope” and world renowned singing teacher Neil F. Weir, Farnham, Surrey, UK Correspondence: [email protected]

Manuel Garcia was born into a family of singers: he sang in the opera house and the concert hall and at about the age of 25 decided to concentrate on teaching singing. In 1835 he was appointed professor of singing at the Paris conservatory, among his pupils was Jenny Lind, and wrote Memoire sur la Voix Humain (1840). He fled Paris during the revolution of 1848 and was appointed to the staff of the Royal Academy of Music in London where he remained for the rest of his long life. In 1854 he made his famous discovery. Neil Weir MD MA FRCS qualified from King’s College and Westminster Medical School in 1965 and was Consultant ORL surgeon to the Royal Surrey County Hospital, Guildford from 1978-2002. From 19871997 he was Honorary Consultant Otologist to St George’s Hospital Neuroscience Centre. He wrote Otolaryngology – An Illustrated History in 1990 (2-nd edition with Albert Mudry, 2013) for which he received the University of London George Davey Howell Memorial Prize. He became president of the British Society for the History of ENT in 2007.

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Preauricular sinus – a tale of forgetful rediscovery

Alice Renjilian, Boyko Matev, Magdalena Bliznakova, Dimitrichka Bliznakova, Georgi Stoyanov Faculty of Medicine, Medical University - Varna, Bulgaria Correspondence: [email protected] The Preauricular sinus (PAuS) is a supposedly inheritable congenital malformation, characterized by a dent, dimple or a foramen, usually located on the crus of the auricular helix, although, rarely, it can be found on the pinna, tragus, or even in the postauricular area contradictory to the established name in modern times. The structure was first described in 1864 by C. F. Heusinger when describing the findings in a patient characteristic of the brachio-oto-renal syndrome. Later Rudolph Virchow also described the structure, although simply stating in his article “I also know a patient like that.” Virchow, however, was the first to postulate that the PauS is a result of a defect in the embryological fusion of the pharyngeal arches, a statement what was widely contradicted at the time. The structure was later called “natural ear ring holes” and “fistula auris congenita” with a number of authors publishing on the subject. Despite that initial interest, however no articles were published after a sudden stop in the late 1940s, until a resurgence in the 1970s and 80s where the structure reappears under a new name - PAuS. Since then research on the structure has seldom been carried out and the mechanisms of its transgenerational inheritance remain widely forgotten in the literature of the 1940s and prior. Furthermore, the PAuS is often a component of a number of inherited syndromes such as Melnik-Frazier, also known as the already mentioned brachio-oto-renal syndrome, Beckwith-Wiedemann and Lachiewicz–Sibley. 29

Losing one’s voice to save one’s life – a brief history of laryngectomy

Boyko Matev1, Alice Renjilian1, Magdalena Bliznakova1, Asen Asenov2, Georgi Stoyanov1, Lora Nikiforova1 1) 2)

Faculty of Medicine, Medical University - Varna, Bulgaria Department of Otolaryngology, MBAL Plovdiv Hospital - Plovdiv, Bulgaria

Correspondence: [email protected]

Laryngectomy is a surgical procedure which involves the surgical removal of the laryngeal complex, thereby separating the upper from the lower respiratory tracts, resulting in a tracheostoma, through which respiration is achieved and a neopharynx, serving only as a digestive passage between the mouth and esophagus. Until the introduction of the procedure patients with laryngeal cancer were considered terminally ill. The procedure is currently indicated only for such patients, although in the past other indications were considered for it. The first recorded laryngectomy was performed in 1873 by one of the fathers of modern surgical sciences - Theodor Billroth. A myriad of complications and a local recurrence, led to patient’s death 7 months later. Until the 1880s the mortality rate of laryngectomies was around 50%. This led to the development of a two-step laryngectomy by Themistocles Gluck in 1881 aiming to increase patient survival. The protocol for the two-step laryngectomy introduced a preliminary tracheal separation and stoma formation and a second stage laryngectomy. The procedure was further developed by his student Sorenson in the 1890s, who due to the development of surgical sciences was again able to introduce a modified single stage laryngectomy, akin to modern methods, with the same post-operative 30

survival as the two-step procedure developed by his mentors. The procedure was well received by medical specialist and was swiftly introduced around the world, allowing for cure and significantly increased lifespan, despite the loss of important physiological functions.

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The Vomeronasal organ – found in humans, denied in humans, or so Jacobsen told us

Georgi Stoyanov1, Klementina Moneva1, Nikolay Sapundzhiev2, Anton Tonchev3 Faculty of Medicine, Medical University Varna, Bulgaria 2) Department of Otorhinolaryngology, Medical University, Varna, Bulgaria 3) Department of Anatomy, Histology and Embryology, Medical University, Varna, Bulgaria 1)

Correspondence: [email protected] The Vomeronasal organ (VNO) is a structure located in the antero-inferior portion of the nasal septum and is part of the accessory olfactory system. The VNO, together with its associated structures, has been shown to play a role in the formation of social and sexual behavior in animals, thanks to its pheromone receptor cells and the stimulating effect on the secretion of gonadotropin releasing hormone. The VNO was first described as a structure by the Dutch botanist and anatomist Frederik Ruysch in 1703, while dissecting a young male cadaver of a human. This finding, however, is widely contradicted due to no sketches of the finding or elaborate descriptions being made by the Ruysch. The discovery of the VNO is more widely attributed to the Danish surgeon Ludwig Jacobsen, with whom the VNO has been synonymized. In 1803 he described the structure in a variety of mammals. Whilst Jacobson extensively studied prior reports of the VNO, he publicly denied its existence in humans. The first widely accepted description of the structure in humans was 32

made by Kölliker in 1877, as he provided both gross morphological and histological evidence of the structure. Following these discoveries and contradictory statements in 1891 Potiquet whilst discussing and supporting the findings of a VNO in humans introduced the term Jacobson’s organ, paradoxically synonymizing Jacobson’s name and statements with the organ itself. To this day, despite the first report of the organs existence being made in a human and many articles stating its presence, the presence of a VNO in humans is still widely debated upon.

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Giving a voice to the voiceless - learning how to speak for the second time

Magdalena Bliznakova1, Boyko Matev1, Alice Renjilian1, Georgi Stoyanov1, Asen Asenov2, Blagovesta Spasova1 1) 2)

Faculty of Medicine, Medical University - Varna, Bulgaria Department of Otolaryngology, MBAL Plovdiv Hospital - Plovdiv, Bulgaria

Correspondence: [email protected]

Total excision of the human laryngeal complex is the most effective modality for treatment of advanced laryngeal carcinoma, resulting in a number of disturbances the most severe of which is aphonia. Ways of correcting this inevitable disorder have been in development since the first such procedures were carried out. In 1873, Theodor Billroth, proposed an artificial larynx – an apparatus consisting of 3 cannulas, characterized by its limited functionality. In the years following the standardization of the procedure for total laryngectomy, multiple different types of non-surgical, surgical and combined prosthesis apparatus were developed, operating based on vibration, whistling or both. In 1908 Gutzmann pioneered a rehabilitation technique, later dubbed as esophageal speech, based around producing speech by the forceful insufflation and exsufflation of air in the esophagus, still widely used to this day. In 1942 Gilbert Wright proposed the first true electrolarynx, phonation with which was based on vibration. One of the oldest developed and currently widely used methods of rehabilitation are tracheo-oephageal shunts with a prosthesis. The procedure was incidentally developed not from medical doctors, but from a patient when he forcefully punctured the posterior wall of his trachea, connecting it to the esophagus. This 34

allowed airflow to the esophagus, when the tracheostoma was occluded, therefore allowing for near physiological mechanism of phonation. Despite a century and a half of development of new techniques and procedures, producing reasonable acoustic results, aphonia post laryngectomy is still a process of history in the making.

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The surgeon from Dionisiopolis - what was his ENT spectrum

Iliyaz Hadzhiev1, Aleksandar Yordanov1, Dimo Dimov2, Nikolai Sapundzhiev3 Faculty of Medicine, Medical University - Varna, Bulgaria First clinic of surgery and Department of General and operative surgery, Varna, Bulgaria 3) Department of ORL, Medical University – Varna, Bulgaria 1) 2)

Correspondence: [email protected] In the beginning of the XX century excavations in Balchik (Dionisopolis) revealed the tomb of a doctor and a priest. The findings date back to II century BC. The most notable discovery in the tomb was a hefty kit of surgical instruments and other medical equipment. The findings were described and published in 1912 by Karel and Herman Škorpil with the additions of Dr. Paraskev Stoyanov – patron of the Vara medical university. The surgical instruments discovered belong to 3 groups: A) Cutting tools: 1. Scalpellus - a simple two-pointed knife-scalpel. 2. Forceps - surgical scissors resembling the current garden shears. They were used for rough and inaccurate incisions during surgery. B) Tools for gripping and restoring tissues: 1. Vulsella - dilapidated tweezers, used to remove hair, foreign bodies from wounds, and also observable polyps in the nasal cavity. 2. Hamulus retusus - a dull hook, used for dissections. During operation, they served to extricate soft tissues from surrounding blood vessels and to expand the surgical access. C) Auxiliary tools: 1. Strigulus - a small spatula-shaped instrument, used to apply medicine into the external auditory meatus and probably to pre-warm it. 2. Spathomela - a bobbin probe, used for draining 36

wounds, putting pressure on the tongue root, and insertion of tampons into the nasal cavity. 3. Wing spoon with a long curved handle, used for taking ointments and applying them to the eyes of the patient. Some of the surgical instruments from the ancient Dionisopolis may have had otorhinolaryngological use. Iliyaz Hadzhiev and Aleksandar Yordanov are students at the Medical University, Varna Bulgaria. Dr. Dimov is assistant professor at the Department of General and operative surgery of the Medical University in Varna, Bulgaria. He has interest in history of surgery.

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Ear, nose and throat red flags for MPS II from a century perspective

Nikolay Sapundzhiev, Varna, Bulgaria Correspondence: [email protected]

In 1917 Dr Charles Hunter described a symptom complex, that later was eponymously named after him. A century later the disease is known as Mucopolysaccharidosis type II – an X-linked recessive disorder. Nowadays there is clear evidence that ENT symptoms represent quite early red flags for the diagnosis, that if made timely may very much influence the intent to treat and the overall prognosis. Dr. Hunter’s original description of the ENT and other physical features of this disease was nearly complete. Nikolay Sapundzhiev MD, graduated medicine at the Varna University in Bulgaria. Thereafter there he started his medical education in Otorhinolaryngology, that was later continued at the Philipps University of Marburg, Germany. In the period 2004‑2006 he was member of the Department of Otorhinolaryngology, MBAL Tsaritsa Yoanna, Sofia, Bulgaria. Since 2007 he teaches Otorhinolaryngology at the University in Varna and form 2011 on he is head of the Educational centre for ORL. Clinical focuses of Dr. Sapundzhiev include head and neck oncology, plastic reconstructive surgery, rhinology and pediatric airways. 38

The human trachea depicted in the visual arts from the Egyptian Old Kingdom to Leonardo da Vinci

Wolfgang Pirsig, Ulm, Germany Correspondence: [email protected]

On our meeting in Heidelberg 2015, the rather close to nature depiction of a human trachea, punched in gold, found in Assur and dated to ca. 1300 BC was presented. I wanted to find out whether this work of art was influenced by the contemporary ancient Egyptian art. In their semi-relieves and stelae, the ancient Egyptians depicted the trachea in a diagrammatic view as a long tube made up of many superposed rings ending between the lungs at the bottom. Early depictions of trachea and lungs were delivered from the 4th dynasty at the side walls of the thrones of the kings Chephren I (2572-2546 BC) and Mykineros (2539-2511 BC). These semi-relieves of trachea-lungs symbols were also sculpted on the side walls of the thrones of King Niuserre (5th dynasty), King Seostris I (12th dynasty) and King Ramesses II (19th dynasty). The ancient Egyptians also had hieroglyphs for the trachea. Hieroglyphs of the trachea-lungs or trachea-heart were painted or inscribed on stelae and wall paintings in tombs from the Old, Middle and New Kingdoms. I could not conclude an influence of the Egyptian mode to depict tracheas on the Assyrian punched gold trachea. In the Hellenistic period and in the Etruscan ex-votos trachea and lungs were sculpted rather close to nature. The examples of the tracheas depicted in the 13-th to 15-th century AD 39

in the medical literature are far from anatomical similarity. We had to wait till Leonardo da Vinci about 1510 surprised us with his true to nature drawings of the human trachea. Wolfgang Pirsig, Prof. Dr.med., was born 1937 in Neustrelitz, Germany. He studied medicine and philosophy at the Universities of Göttingen and Hamburg. From 1963-1965 he studied the auditory pathways of the guinea pig in the electrophysiological laboratory of the ORL clinic at Hamburg University, where he became Privatdozent for ORL in 1971 and extraordinary Professor in 1976. Since 1980 he helped to establish the ORL clinic at the University of Ulm, where he was nominated head of the Section for Rhinology and Rhonchopathies until his retirement in 2002. He has published 70 papers and two books related to the history of medicine and mummies.

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Remarks on tracheal anatomy and its depiction

Ivan Valkadinov1, Desislava Cherneva1, Georgi Valchev2, Nikolay Sapundzhiev3, Anton Tonchev4 Faculty of Medicine, Medical University - Varna, Bulgaria Department of imaging diagnostics and radiotherapy, Medical University, Varna, Bulgaria 3) Department of Otorhinolaryngology, Medical University, Varna, Bulgaria 4) Department of Anatomy, Histology and Embryology, Medical University, Varna, Bulgaria 1) 2)

Correspondence: [email protected] Anatomy of tracheal cartilages was studied in 18 cadaver tracheas (10 male, 8 female, mean age 69±8.9 y) and 14 computer tomography reconstructions (10 male and 4 female, mean age 63 y., 46-77 y). In 12/32 (37,5%) cases cartilages with a shape, different from the simple horseshoe one, were observed in the cervical region and in 21/32 (65,6%) – in the thoracic area. Further the depiction of trachea in medical books was evaluated (including ENT, Anatomy, Surgery textbooks, atlases and articles). Only 29% of the specialized ENT textbooks contain illustrations with anatomically correct tracheas with irregular cartilages. Twenty percent of the anatomy textbooks and 71% of the ENT textbooks have illustrations with strictly parallel tracheal rings. The illustrations of the trachea in the medical textbooks are deceivingly stylized, not corresponding to the real anatomical structure. In certain surgical situations such a wrong and schematic concept may mislead the inexperienced surgeon. 41

Urk, the place to be

Kees Graamans, Nijmegen, The Netherlands Correspondence: [email protected]

Urk is a village in the Netherlands with a population of around 20,000. Formerly a small island in the Zuiderzee, it was connected to the mainland in 1942 after parts of that sea had been turned into dry land (polders) during the 1930s. For centuries, the inhabitants have formed a close community: they are all family, they share only a few surnames, and many are afflicted with hereditary disorders. Their only source of income is fishery. The village is one of the country’s most religious places. Many of its inhabitants wear traditional costumes and speak a dialect unique to Urk. A historical medical library was established there in 2008, taking advantage of the ample availability of storehouses that had formerly served the fishing industry. Digitalization and the process of merging hospitals in the Netherlands had created redundancy in medical libraries, and this was an important impetus for the initiative. Gifts and bequests followed rapidly. Nowadays the collection comprises around 3 million medical books and journals published from the year 1850 onward. In addition, an exhibition of historical instruments was recently installed on the premises. The Urk institution has become a meeting place for all who are interested in the history of medicine. 42

Kees Graamans (1944), professor emeritus study medicine in Groningen and Rotterdam, MD in 1971. Military service 1971-1973, first lieutenant Medical Service. Residency (1974-1978) and chef de clinique (1978-1980), ORL Dept. Free University Amsterdam. PhD-thesis entitled “Nose and Airways” 1980. University Hospital Utrecht/Wilhemina Childrens Hospital Utrecht 1980-2000, focus on skull base surgery and neurotology. Several national board functions e.g. president of the Netherlands ORL Society 1996-1999. Professor and chairman Radboud University Hospital Nijmegen 2000-2010.

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Cystadenolymphoma of the parotid gland: Historical aspects

Afshin Teymoortash, Marburg, Germany Correspondence: [email protected]

The exact etiopathogenesis of the Warthin‘s tumor of the parotid gland is still unclear. After initial description of this lesion by Hildebrand in 1895 and 15 years later by Albrecht and Arzt and presentation of their theories about the development of this lesion many different hypotheses were introduced in the literature. Hildebrand considered this disease a variant of lateral cyst of the neck whereas Albrecht and Arzt stated that this lesion arises from salivary gland tissue entrapped within regional lymph nodes during embryogenesis. They called this lesion papillary cystadenoma in typical lymph node tissue. Heterotopic salivary gland tissue can be usually found in parotid and periparotid lymph nodes. Glandular inclusions in lymph nodes can be seen repeatedly in tissue specimens of the parotid gland and upper neck after parotidectomy and neck dissection. Neisse was one of the first who studied the glandular inclusions in lymph nodes. He consistently found glandular inclusions in lymph nodes in and around the parotid of 14 newborn infants in 1898. While some authors confirmed the opinion of Hildebrand, Albrecht and Arzt others explained the histogenesis of this lesion in many different ways. However, the review of published data specially about polyclonality and evidence of lymphatic sinus in tissue specimens of this 44

lesion revealed that recent literature is in conformity with the supposed hypothesis about pathogenesis of cystadenolymphoma of the parotid gland of those authors about the origin of this lesion from lymph nodes almost a century ago. Afshin Teymoortash MD, PhD studied medicine at the ChristianAlbrecht University in Kiel, Germany. Thereafter he started his medical education in Otorhinolaryngology at the Philipp University of Marburg, Germany. He was from 2008-2013 the Vice-Chairman and from 20132017 Head of the Department of Otorhinolaryngology, Head and Neck Surgery at the Philipps University Marburg. He has the certification as Facial Plastic Surgeon, Special E.N.T. and Head and Neck Surgery, Palliative Care, and Pharmacological Cancer Treatment. Clinical focuses of Prof. Teymoortash are head and neck oncology, plastic reconstructive surgery including microvascular surgery, rhinology including rhinoplasty, and salivary gland diseases. In April 2017 he founded Center for Otolaryngology in Middle Hessen in Germany.

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Sacro Monte of the Great War – Vienna’s polychrome broken face sculptures

Herwig Swoboda1, Johannes Kirchner2, Reinhard Mundschütz3 General Hospital Hietzing with Neurological Center Rosenhügel, and Wilhelminenspital, Vienna 2 Museum of Dentistry, Medical University of Vienna 3 University Library, Medical University of Vienna 1

Correspondence: [email protected] With outbreak of World War One, severity and frequency of facial wounds caused by high speed projectiles were anticipated and soon recognized. Two centers of facial reconstruction were established in the Austro-Hungarian Empire, both near its North-Eastern front: one back area hospital in Brno (“Reservespital II”), and one field hospital near Lublin (“Kriegszahnklinik der 4. Armee”). The Lublin War Dental Clinic was dedicated to comprehensive, functional, early and continuous care of maxillo-facial battlefield injuries. It was established and directed by the Lviv born Viennese dentist Juljan Zilz (1871-1930). It was operational from 1915 to 1918 before ultimately being removed to Vienna. For scientific and teaching purposes, plaster models were created, first using simple wax-paraffine casts, but ultimately turning towards the elaborate moulage techniques of Karl Henning (1860-1917). These sculptures rank among the most vivid documents of one of the Great War’s specific tragedies, the craniofacial mutilations, this type of injury which, be46

sides Shell Shock (war neurosis) dominates the medical records of the 1914 catastrophe. Stylistically, these sculptures remind the terracotta sculptures of the only extant station of the Viennese “Via Crucis” to the Hernals Calvary Church (1639-1674), adjacent to the Trinitarian Church, at the corner Alserstraße and Schlösselgasse, vis-à-vis the main entrance to the Vienna General Hospital in Vienna. Herwig Swoboda, M.D., is head of the ORL Departments of the Wilhelminenspital and the General Hospital Hietzing, the latter being Vienna’s first Department of the united subspecialties Otology and Rhino-laryngology, founded 1908 by Otto Mayer (1876-1951), the 1928 Dalby-Memorial-Laureate. Johannes Kirchner, dentist and university lecturer, has been curating the Museum of Dentistry of the Medical University of Vienna. This collection was intitiated by austro-hungarian pioneer of dentistry Georg Carabelli (1787-1842). The Museum harbours the polychrome plaster casts of facial wounds from the Austro-Hungarian battle-fields. Reinhard Mundschütz is a devoted historian at the University Library of the Medical University of Vienna. His research, among other topics, focusses around World War One, and on the art of moulage at the time of the Henning factory.

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2017 Working meeting of the International Society of History of Otorhinolaryngology is kindly supported by