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Hemostatic herbs
CORRESPONDENCE
Hemostatic Herbs To the Editor: I read the interesting letter by Dr Hollaus [1] about military medicine in ancient Greece. He wrote: “Bleeding was stopped with herbs that also are described to have analgesic effects. Unfortunately, the used plants are not described and still remain unknown.” I believe that I have the answer. The plant with these properties is dittany plants (Origanum dictamnus). It is mentioned in the Aeneid by Vergil, who lived between 70 and 19 bc. The poem describes the feats of Aeneas, a Trojan hero, who fled west after the fall of Troy and fought in Latium, where he became an ancestor of the Romans. In the 12th book, the hero, son of Anchises and Aphrodite, is wounded by an arrow. Seeing that the physician Iapis is unable to remove the arrow, Aphrodite (Venus in Roman mythology) uses dittany to cure her son: A branch of healing dittany she brought Which in the Cretan fields with care she sought: Rough is the stern, which woolly leafs surround; The leafs with flow’rs, the flow’rs with purple crown’d, Well known to wounded goats; a sure relief To draw the pointed steel, and ease the grief. (Apparently, wounded goats in Crete, where the plant grew, used to eat dittany to decrease bleeding.) After the herbal concoction is applied, the tip of the arrow is easily and bloodlessly removed: The leech, unknowing of superior art which aids the cure, with this foments the part; And in a moment ceas’d the raging smart. Stanch’d is the blood, and in the bottom stands: The steel, but scarcely touch’d with tender hands, Moves up, and follows of its own accord, And health and vigor are at once restor’d. The scene—Aeneas wounded, his son weeping, Iapis exploring the wound, and Aphrodite carrying dittany—is depicted in a Pompeian fresco on display at the National Archeological Museum in Naples. In a sense, we could consider dittany a predecessor of aprotinin. Alejandro Aris, MD, PhD Cardiac Surgery Service Hospital de la Santa Creu i Sant Pau Av San Antonio M. Claret 167 08025 Barcelona, Spain e-mail: [email protected]
Reference 1. Hollaus PH. Military medicine in ancient Greece. Ann Thorac Surg 2001;72:1793.
Reply To the Editor: I appreciate the interest and the comments of Dr Aris concerning my letter dealing with military medicine in ancient Greece. The Pompeian fresco showing Iapis exploring Aeneas’ wounded thigh is one of the most famous pictures displaying ancient medical action. Iapis represents the beginning of the history of Roman military doctors. © 2002 by The Society of Thoracic Surgeons Published by Elsevier Science Inc
Homer’s Iliad remains the oldest Western poetry identified to date and is thought to have been written in the eighth century bc. It is assumed that the battle of Troy took place about 1240 bc, 400 years earlier. Therefore, Homer wrote about a historic event that he did not see. The same applies to the culture and the persons described, although some of them, like Agamemnon, have been proven to have existed. We must assume that Homer, whose work should be regarded as poetry and not as a historic work, described the world he lived in and not the ancient Mycenaean world in which the siege of Troy took place. The Aeneid, describing the feats of Aeneas, who escaped after the destruction of Troy to the area now known as Italy and became the ancestor of the Romans, was written by Vergil, who lived between 70 and 19 bc which is about 700 years after Homer and more than 1,000 years after the siege of Troy. Again we must assume that Vergil was not a historian but a poet, and the same things I mentioned about Homer apply also to Vergil. In addition, we must not forget that since the times of Homer, the Greeks had performed postmorten examination on humans in Alexandria. For example, they had identified the brain as the center of thinking (!). Alexandrian surgeons developed the technique of arterial ligature and experimented, though not successfully, with anesthesia using extracts of mandragora. Thus the medical knowledge had changed dramatically and the techniques described by Vergil stem from a medical science that had been enriched over a period of 700 years. I do not know when the use of dittany was first described in the ancient literature, but we will not find any clues in Homer’s works. I am afraid that the herbs used in the Iliad still remain unknown. Peter H. Hollaus, MD Department of Thoracic Surgery Otto Wagner Hospital Sanatoriumstrasse 2 A-1145 Vienna, Austria e-mail: [email protected]
Esophagectomy in Elderly Patients Over 70 Years of Age To the Editor: Although the article by Fang and associates [1] demonstrated that those patients over 70 years of age with esophagectomy gained “satisfactory” long-term results, three issues should be considered by the authors. The first issue regards the incidence of esophagogastric leakage. The authors showed that the leak rate of esophagogastric anastomosis is from 26% to 35%. Such a high leak rate, which is usually caused by poor surgical anastomosis technique, would undoubtedly influence statistical studies for short-term and long-term results. Acceptably, the incidence of transthoracic esophagogastric anastomosis leakage should be less than 5%, although a few surgeons may control it within 2%. The second issue relates to postoperative esophagogastric reflux. Fang and associates had not shown whether postoperative esophagogastric reflux could influence the long-term results. In our animal experiments [2–3], 17% of animals with esophagectomy died of esophagogastric reflux; in some medical centers, about 30% of patients with esophagectomy died of postoperative esophagogastric reflux and not by the recurrence of tumor. The third issue relates to the significance of cervical lymphadenectomy. In the so-called radical cervical lymphadenectomy, it is hard to reach the link area between neck and thoracic space. Ann Thorac Surg 2002;74:1291– 4
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0003-4975/02/$22.00
Hemostatic Herbs To the Editor: I read the interesting letter by Dr Hollaus [1] about military medicine in ancient Greece. He wrote: “Bleeding was stopped with herbs that also are described to have analgesic effects. Unfortunately, the used plants are not described and still remain unknown.” I believe that I have the answer. The plant with these properties is dittany plants (Origanum dictamnus). It is mentioned in the Aeneid by Vergil, who lived between 70 and 19 bc. The poem describes the feats of Aeneas, a Trojan hero, who fled west after the fall of Troy and fought in Latium, where he became an ancestor of the Romans. In the 12th book, the hero, son of Anchises and Aphrodite, is wounded by an arrow. Seeing that the physician Iapis is unable to remove the arrow, Aphrodite (Venus in Roman mythology) uses dittany to cure her son: A branch of healing dittany she brought Which in the Cretan fields with care she sought: Rough is the stern, which woolly leafs surround; The leafs with flow’rs, the flow’rs with purple crown’d, Well known to wounded goats; a sure relief To draw the pointed steel, and ease the grief. (Apparently, wounded goats in Crete, where the plant grew, used to eat dittany to decrease bleeding.) After the herbal concoction is applied, the tip of the arrow is easily and bloodlessly removed: The leech, unknowing of superior art which aids the cure, with this foments the part; And in a moment ceas’d the raging smart. Stanch’d is the blood, and in the bottom stands: The steel, but scarcely touch’d with tender hands, Moves up, and follows of its own accord, And health and vigor are at once restor’d. The scene—Aeneas wounded, his son weeping, Iapis exploring the wound, and Aphrodite carrying dittany—is depicted in a Pompeian fresco on display at the National Archeological Museum in Naples. In a sense, we could consider dittany a predecessor of aprotinin. Alejandro Aris, MD, PhD Cardiac Surgery Service Hospital de la Santa Creu i Sant Pau Av San Antonio M. Claret 167 08025 Barcelona, Spain e-mail: [email protected]
Reference 1. Hollaus PH. Military medicine in ancient Greece. Ann Thorac Surg 2001;72:1793.
Reply To the Editor: I appreciate the interest and the comments of Dr Aris concerning my letter dealing with military medicine in ancient Greece. The Pompeian fresco showing Iapis exploring Aeneas’ wounded thigh is one of the most famous pictures displaying ancient medical action. Iapis represents the beginning of the history of Roman military doctors. © 2002 by The Society of Thoracic Surgeons Published by Elsevier Science Inc
Homer’s Iliad remains the oldest Western poetry identified to date and is thought to have been written in the eighth century bc. It is assumed that the battle of Troy took place about 1240 bc, 400 years earlier. Therefore, Homer wrote about a historic event that he did not see. The same applies to the culture and the persons described, although some of them, like Agamemnon, have been proven to have existed. We must assume that Homer, whose work should be regarded as poetry and not as a historic work, described the world he lived in and not the ancient Mycenaean world in which the siege of Troy took place. The Aeneid, describing the feats of Aeneas, who escaped after the destruction of Troy to the area now known as Italy and became the ancestor of the Romans, was written by Vergil, who lived between 70 and 19 bc which is about 700 years after Homer and more than 1,000 years after the siege of Troy. Again we must assume that Vergil was not a historian but a poet, and the same things I mentioned about Homer apply also to Vergil. In addition, we must not forget that since the times of Homer, the Greeks had performed postmorten examination on humans in Alexandria. For example, they had identified the brain as the center of thinking (!). Alexandrian surgeons developed the technique of arterial ligature and experimented, though not successfully, with anesthesia using extracts of mandragora. Thus the medical knowledge had changed dramatically and the techniques described by Vergil stem from a medical science that had been enriched over a period of 700 years. I do not know when the use of dittany was first described in the ancient literature, but we will not find any clues in Homer’s works. I am afraid that the herbs used in the Iliad still remain unknown. Peter H. Hollaus, MD Department of Thoracic Surgery Otto Wagner Hospital Sanatoriumstrasse 2 A-1145 Vienna, Austria e-mail: [email protected]
Esophagectomy in Elderly Patients Over 70 Years of Age To the Editor: Although the article by Fang and associates [1] demonstrated that those patients over 70 years of age with esophagectomy gained “satisfactory” long-term results, three issues should be considered by the authors. The first issue regards the incidence of esophagogastric leakage. The authors showed that the leak rate of esophagogastric anastomosis is from 26% to 35%. Such a high leak rate, which is usually caused by poor surgical anastomosis technique, would undoubtedly influence statistical studies for short-term and long-term results. Acceptably, the incidence of transthoracic esophagogastric anastomosis leakage should be less than 5%, although a few surgeons may control it within 2%. The second issue relates to postoperative esophagogastric reflux. Fang and associates had not shown whether postoperative esophagogastric reflux could influence the long-term results. In our animal experiments [2–3], 17% of animals with esophagectomy died of esophagogastric reflux; in some medical centers, about 30% of patients with esophagectomy died of postoperative esophagogastric reflux and not by the recurrence of tumor. The third issue relates to the significance of cervical lymphadenectomy. In the so-called radical cervical lymphadenectomy, it is hard to reach the link area between neck and thoracic space. Ann Thorac Surg 2002;74:1291– 4
•
0003-4975/02/$22.00