Article
Hydrocephalus in the ancient medicine
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Authors
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Peter Grunert
- Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes, Homburg/Saar
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Joachim Oertel
- Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes, Homburg/Saar
| Published: | June 2, 2015 |
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Outline
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Objective: The term hydrocephalus was introduced by the ancient Greek physicians. The main ancient literature on this topic goes back to the imperial Roman time. The concept of hydrocephalus in the ancient time differed substantially from our present understanding. Hydrocephalus was defined as any visible and palpable fluid collection at the head of infants. It was never associated with the dilatation of the ventricular system.
Method: The work is based on the translation of the most important original sources to hydrocephalus by the author from the work "The physician" of Galen and "The medical collection" by the late encyclopedists Oreibasios from the 4th and Aetios from Amida from the 5th century AD.
Results: Galen distinguished depending on the fluid collection four types of hydrocephalus: Type I in the subgaleal,Type II in the subperiostal, Type III in the epidural and a lethal type IV in the subdural space. The clinical symptoms and surgical therapy is described in detail in the works of Oreibasios and Aetios. Their description allows a good correspondence to present diseases Type I to subgaleal hematoma of the new born, Type II to the cephal hematoma, Type III with increased head circumference to hydrocephalus in our present understanding and Type IV probably with bulging fontanel and neurological symptoms due to lethal increase of intracranial pressure. Oreibasios and Aetios described in detail the surgical therapy of fluid evacuation by incisions. From our present point of view it is credible that these operations were successful: they were not treating hydrocephalus in our sense but extracranial hematomas.
Conclusions: The term hydrocephalus is in historical context misleading because the ancient and the present concept of hydrocephalus are very different. The present concept of hydrocephalus goes back to the anatomist Vesallius (1553) who disected a child with gigantic increase of head circumference and the only pathology he could find were enormously dilated ventricles and thinned brain tissue.
