- Email: [email protected]
The Practicable and the Laser
ARTICLE IN PRESS
Medical Laser Application 21 (2006) 91–93 www.elsevier.de/mla
The ‘Practicable’ and the Laser Fritz Heppner University Hospital of Neurosurgery, Graz, Austria
Note from the editors This paper was presented by o. University Professor Dr. F. Heppner at the 2nd Meeting of the DGLM e.V. in Graz March 1984. He chaired this meeting and was Vice-president of the DGLM e.V. from 1984 to 1988 and President of the ISLSM. Together with the Senior Assistant of the University Hospital of Neurosurgery Graz, Prof. Dr. Peter Ascher, he developed the basis for the application of lasers in neurosurgery. Thus, he built up the Neurosurgery in Graz to an internationally recognised neurological laser center. Due to the solid experience in all neurosurgical interventions the application of the CO2 and the Nd:YAG laser are related to strong indications according to their specific biophysical interactions. This article was first published in March 1985 in the Verhandlungsberichte der DGLM e.V. zur 2. Tagung.
The medical laser owes its discovery and handling to the development of modern technology which can be led back to the rethinking of people that started at the period of the Renaissance. At that time human beings were no longer willing to believe; they sought to gain knowledge. However, to be exact the impulse to question nature in order to find out more about its laws is much older. Albertus Magnus already started to conduct experiments and it was he who described the element arsenic. It has to be pointed out that the rationalistic exploration of the nature of the Western world started in the 6th century B.C. The philosophers of the Ionian school, located at the Asia Minor coast in the town Milet, tried to prove that divine power is in fact superstition. Thales, the founder of that school, labelled the science of nature as physiology. His pupil Anaximander can be seen as the father of the evolutionary theory. This theory caused a dispute which has not been over yet. He established the term Pneuma as a Corresponding editor. Frank Frank, Tel.: +49 8092 850092; fax: +49 8092 850092. E-mail address: [email protected].
1615-1615/$ - see front matter doi:10.1016/j.mla.2006.03.008
philosophy of life. This term was popular until the 18th century A.D. Additionally, Demokrit developed an atomic theory whose basic elements anticipate the modern nuclear physics. Aristoteles’ natural doctrines furthermore influenced the philosophy of life of the PreSocratics. However, that process of demythologising divine powers was interrupted by the Christianisation for almost 2500 years. The idea to demythologise deities was revived during the era of the enlightenment. At that time people tried to substitute myth by ratio with an increasing success. Therefore, the secularisation of the world is already 2500 years old and was stopped only by the influence of Christianity. The exploration of the laws of nature, called physics, and their application, called technology, made many things comfortable for mankind. However, the human was regrettably removed from all historically grown relations and minimised old and established values. The strive for profit as well as the general tendency of single persons becoming a close part of the collective led to difficulties that touched the human values of the last millennium in a very significant and negative way. These difficulties resulted from the fact that the machines were
ARTICLE IN PRESS 92
F. Heppner / Medical Laser Application 21 (2006) 91–93
no longer helping hands of the human beings who developed and constructed them. Moreover, the machines changed from sorcerer’s apprentices to tyrants. Instead of being useful to people’s needs they determine needs as well as the speed of the human professional and private everyday life. Furthermore, the machines did not keep their original destiny that their founders thought of, on contrast, they took advantage of it, exploited and sullied it. It is no surprise that critical voices as well as accusations were raised against the persons who invented the machines, that is, against researchers and technicians and moreover, against science itself. Scientific curiosity and inventiveness are made responsible for all cruelties that have befallen mankind with novelties like unfair business practices and new destructive weapons. In these times of the so-called ‘‘era of discomfort’’ – the stereotypical expression that the media uses in order to characterise the social and political weakness of our time – the field of technology is simply included when negative developments are discussed. Unfortunately, it is ignored that the intellect that wants to enter new dimensions and creates new cultural values is basically without any aim, in fact, it has no sense of purpose. For example, the wheel, the lever and the cotter were certainly not developed on purpose. They were made playfully just like as the rock and cave paintings of ancient cultures. In order to justify the beginning of science, one has to stress that there exist two types of research. The motive of an academic laboratory being engaged in molecular acoustics differs from the attitude of a washing detergent company that tests the tensions on the surface area of detergents. The first case indicates the impulse to achieve knowledge. The second one mirrors the necessity to make profit. Laymen often ignore this important difference and sensu strictiori accuse all scientists wrongfully. Sometimes it is assumed that Louis Pasteur is responsible for the alleged overpopulation of our planet, Niels Bohr is considered responsible for the nuclear power plant in Zwentendorf and Allesandro Volta is blamed to be the founder of the power station in Haiburg. That all sounds bizarre, however, it is worth to mention because the critical utterances concerning technical developments are based on simplifications. It is assumed that Galileo once said that all measurable should be measured and all things impossible to measure should be made measurable. This idea is legitimate concerning the human being who admires knowledge more than paradisiac harmony. Although forbidden, the human tried of the tree of knowledge and paid that with mortality. The genesis says literally, ‘‘but the tree of the knowledge of good and evil, thou shalt not eat of it: for on the day that thou eatest thereof thou shalt surely die’’. This important addition is often
forgotten, ignored or unknown. In coherence to this, research becomes a sin if it ignores the difference of good and evil. That is a very important aspect with a strong commitment, especially in these times of the threat of nuclear bombs, missiles, space travel, communication engineering, micro electronics, robots, forest decline and genetic manipulations. Looking back on the developments of recent periods it becomes obvious, that research transcends the ideas of Galileo and aspires the goal to realise all that is practicable and to design all that is not doable as feasible. Once again, the genesis comes to one’s mind when it is stated in the Lutheran Bible: ‘‘And out of the ground made the Lord God to grow the tree of life also in the midst of the garden, and the tree of knowledge of good and evil’’. The ending is well-known: ‘‘So he drove out the man; and he placed at the east of the garden Eden Cherubim’s, and a flaming sword which turned every way to keep the way of the tree of life.’’ Strong images are included in this description like in other old myths too. It can be questioned if the human beings are already on the road to that tree of life, the absolute forbidden and unreachable, when they start to make everything feasible. Who knows, it may be the sword of Cherub’s that flamed over Hiroshima. While the playful character of former inventions was stressed in previous parts of this text, it is now necessary to focus on the collective and almost identical significance of the researchers and artists. For the highly vaulted building of culture it is of no importance to define who acted on it earlier, the homo ludens or the homo faber. The culture was based on the occidental Christian ethos, consisting of the three terms: individuality, freedom and legal order. The tasks of these are to oppose the loss of humanity that is threatened by the strive for profit and consumption claims. This development is called ‘‘decay’’ by Konrad Lorenz. Therefore, these tasks must interfere a situation where pollution is not only restricted to environment but can also be referred to the defilement of the inner self of mankind. It is like a special kind of depravity that extends like a shadow of a cloud over the countries of this planet without making any difference in nation, race, climate or ideologies. It can be seen as an aberrance caused by technocracy that furthermore undermines democracy including its blessings and freedoms. Plus, it also seems not only to destroy old-dated taboos. The depravity does even attack proven and long tested values that were grown and established over a period of thousands of years. The bewilderment of the values in the mental area is not less alarming as Damocles’ sword floating over the heads of the nations like a war led with nuclear weapons. The visionary exclamation of Georges Clemenc¸eau: ‘‘The apes stole Jove’s flash.’’ can be aimed to this. Even the decline of values like work as ethos, acquittal, discipline, faithfulness is a threatening
ARTICLE IN PRESS F. Heppner / Medical Laser Application 21 (2006) 91–93
phenomena. This decay is incommensurate with the law of nature that insists on power and order as a principle of survival and it is even inconsistent with the moral demands of considerateness, awe and salvage, in which all living has to be included. It is of a demoniac fascination to notice how machines got a life of their own, a process which probably originally started at the basis of a social idea, dissociated from it and frenetically makes its nuisance now. Once again, one remembers the sorcerer’s apprentice. This way of putting the broom to the corner is the same action as the scientists and artists are called to do; the researcher appears in awareness of his responsibility to the harmony of the creation; the artist while making harmony visible. The only way to salvage the questioned humanities is to control excessive needs and to reduce material wishes to human eligibility. This speaks for a re-establishment of a hierarchy that puts convenience, accommodation and the getting of delight aback. When it is necessary to substitute the out – dated by something superior while maintaining the constant as valid, every single person is asked to bravely make contributions to that idea. Rays of light, that are bundled monochromatically, coherently and parallel are, as far as I know no spontaneous natural phenomena. Therefore, the laser can be considered as an object that was made feasible. According to that, in my opinion, it is exaggerated to declare the laser as a devil’s false front. Neither the laser nor the satellites are of evil thoughts. Their usage concerning a good or bad orientation is ambivalent as well. As surgeons, we have the advantage to use the new technologies in service to life and health. This mark is especially aimed to the medical laser who becomes established on a broad basis, regardless of high expensives and opposing opinions that all new inventions have to face. Since our last meeting in Munich 1982, there were countless regional laser meetings and even the global show in Detroit 1983 proved that the palette of offers amplified from year to year. There hardly exists any illness in ophthalmology, except of infections, that cannot be cured by the help of an argon, CO2 and Nd:YAG laser. The light guides, by the way, approach the bulbus from the outside. The endoscopical laser is an essential instrument of modern urologists, gastroenterologists, gynaecologists and neurosurgeons who are able to deflate and stop the bleeding of brain masses only by the help of the laser. Fibre optics and laser microsurgery brought important progress to the fertilisation of men and women, vessel reconstruction and to the area of the larynx. Totally new therapeutic aspects were brought by the Photo Dynamic Therapy with a preceding sensitisation made of a hematoporphyrin derivation in dermatology as well as in the surgery with malignancy. The consequences are not imaginable.
93
A real surgeon working with laser can be seen as a beneficiary of a philosophical-technical development that started with Thales of Milet. The artist, however, who is a part of every true surgeon and aware of a technical, perfect handling, is conscious of the fact that every ill person can only be cured by the help of transcendental powers. In the imagination of the Ionian Philosophers of Nature these transcendental powers are of demonic nature; in the imagination of the modern scientists, however, these powers are of a divine nature.
Redaktionelle Anmerkung Das Machbare und der Laser Dieser Vortrag wurde von Herrn o. Universita¨tsProfessor F. Heppner auf der 2 Tagung der DGLM e.V. in Graz im Ma¨rz 1984 gehalten. Er war der Tagungspra¨sident und von 1984 bis 1988 Vizepra¨sident der DGLM e.V. und Pra¨sident der ISLMS. Er hat zusammen mit dem Oberarzt der Neurochirurgischen Universita¨tsklinik Graz, Prof. Dr. Peter Ascher, die wesentlichen Grundbausteine zur Anwendung von Lasern in der Neurochirurgie gelegt und baute damit die Grazer Neurochirurgie zu einem international anerkannten neurochirurgischem Laserzentrum aus. Die großen Erfahrungen bei neurochirurgischen Eingriffen bildete die Basis fu¨r die Applikation von CO2- and Nd:YAG-Lasern entsprechend ihrer spezifischen biophysikalischen Wechselwirkung strengen Indikationsbereichen zu zuordnen. Dieser Artikel wurde in den Verhandlungsberichten der DGLM e.V. zur 2. Tagung im Ma¨rz 1985 erstmalig vero¨ffentlicht.
Nota de los editores El la´ser y lo factible Este articulo fue presentado por el Prof. Dr. F. Heppner en la 21 Reunio´n de DGLM e.V en Graz, en Marzo de 1984. Heppner, quien modero´ la reunio´n, fue el Vicepresidente de la DGLM e.V. desde 1984 a 1988, y presidente de la ISLSM. Junto al Prof. Dr. Peter Ascher del Hospital Universitario de Neurocirugı´ a de Graz, desarrollo´ la base para la aplicacio´n de los la´seres en neurocirugı´ a, convirtiendo este hospital en un centro de renombre internacional en neurologı´ a la´ser. Dada la vasta experiencia en intervenciones neuroquiru´rgicas, el uso de los la´seres de CO2 y el Nd:YAG se relaciona en forma estricta segu´n sus interacciones bı´ ofı´ sicas especı´ ficas. Este articulo fue publicado por primera vez en Marzo de 1985 en el Verhandlungsberichte der DGLM e.V. zur 2. Tagung.
Medical Laser Application 21 (2006) 91–93 www.elsevier.de/mla
The ‘Practicable’ and the Laser Fritz Heppner University Hospital of Neurosurgery, Graz, Austria
Note from the editors This paper was presented by o. University Professor Dr. F. Heppner at the 2nd Meeting of the DGLM e.V. in Graz March 1984. He chaired this meeting and was Vice-president of the DGLM e.V. from 1984 to 1988 and President of the ISLSM. Together with the Senior Assistant of the University Hospital of Neurosurgery Graz, Prof. Dr. Peter Ascher, he developed the basis for the application of lasers in neurosurgery. Thus, he built up the Neurosurgery in Graz to an internationally recognised neurological laser center. Due to the solid experience in all neurosurgical interventions the application of the CO2 and the Nd:YAG laser are related to strong indications according to their specific biophysical interactions. This article was first published in March 1985 in the Verhandlungsberichte der DGLM e.V. zur 2. Tagung.
The medical laser owes its discovery and handling to the development of modern technology which can be led back to the rethinking of people that started at the period of the Renaissance. At that time human beings were no longer willing to believe; they sought to gain knowledge. However, to be exact the impulse to question nature in order to find out more about its laws is much older. Albertus Magnus already started to conduct experiments and it was he who described the element arsenic. It has to be pointed out that the rationalistic exploration of the nature of the Western world started in the 6th century B.C. The philosophers of the Ionian school, located at the Asia Minor coast in the town Milet, tried to prove that divine power is in fact superstition. Thales, the founder of that school, labelled the science of nature as physiology. His pupil Anaximander can be seen as the father of the evolutionary theory. This theory caused a dispute which has not been over yet. He established the term Pneuma as a Corresponding editor. Frank Frank, Tel.: +49 8092 850092; fax: +49 8092 850092. E-mail address: [email protected].
1615-1615/$ - see front matter doi:10.1016/j.mla.2006.03.008
philosophy of life. This term was popular until the 18th century A.D. Additionally, Demokrit developed an atomic theory whose basic elements anticipate the modern nuclear physics. Aristoteles’ natural doctrines furthermore influenced the philosophy of life of the PreSocratics. However, that process of demythologising divine powers was interrupted by the Christianisation for almost 2500 years. The idea to demythologise deities was revived during the era of the enlightenment. At that time people tried to substitute myth by ratio with an increasing success. Therefore, the secularisation of the world is already 2500 years old and was stopped only by the influence of Christianity. The exploration of the laws of nature, called physics, and their application, called technology, made many things comfortable for mankind. However, the human was regrettably removed from all historically grown relations and minimised old and established values. The strive for profit as well as the general tendency of single persons becoming a close part of the collective led to difficulties that touched the human values of the last millennium in a very significant and negative way. These difficulties resulted from the fact that the machines were
ARTICLE IN PRESS 92
F. Heppner / Medical Laser Application 21 (2006) 91–93
no longer helping hands of the human beings who developed and constructed them. Moreover, the machines changed from sorcerer’s apprentices to tyrants. Instead of being useful to people’s needs they determine needs as well as the speed of the human professional and private everyday life. Furthermore, the machines did not keep their original destiny that their founders thought of, on contrast, they took advantage of it, exploited and sullied it. It is no surprise that critical voices as well as accusations were raised against the persons who invented the machines, that is, against researchers and technicians and moreover, against science itself. Scientific curiosity and inventiveness are made responsible for all cruelties that have befallen mankind with novelties like unfair business practices and new destructive weapons. In these times of the so-called ‘‘era of discomfort’’ – the stereotypical expression that the media uses in order to characterise the social and political weakness of our time – the field of technology is simply included when negative developments are discussed. Unfortunately, it is ignored that the intellect that wants to enter new dimensions and creates new cultural values is basically without any aim, in fact, it has no sense of purpose. For example, the wheel, the lever and the cotter were certainly not developed on purpose. They were made playfully just like as the rock and cave paintings of ancient cultures. In order to justify the beginning of science, one has to stress that there exist two types of research. The motive of an academic laboratory being engaged in molecular acoustics differs from the attitude of a washing detergent company that tests the tensions on the surface area of detergents. The first case indicates the impulse to achieve knowledge. The second one mirrors the necessity to make profit. Laymen often ignore this important difference and sensu strictiori accuse all scientists wrongfully. Sometimes it is assumed that Louis Pasteur is responsible for the alleged overpopulation of our planet, Niels Bohr is considered responsible for the nuclear power plant in Zwentendorf and Allesandro Volta is blamed to be the founder of the power station in Haiburg. That all sounds bizarre, however, it is worth to mention because the critical utterances concerning technical developments are based on simplifications. It is assumed that Galileo once said that all measurable should be measured and all things impossible to measure should be made measurable. This idea is legitimate concerning the human being who admires knowledge more than paradisiac harmony. Although forbidden, the human tried of the tree of knowledge and paid that with mortality. The genesis says literally, ‘‘but the tree of the knowledge of good and evil, thou shalt not eat of it: for on the day that thou eatest thereof thou shalt surely die’’. This important addition is often
forgotten, ignored or unknown. In coherence to this, research becomes a sin if it ignores the difference of good and evil. That is a very important aspect with a strong commitment, especially in these times of the threat of nuclear bombs, missiles, space travel, communication engineering, micro electronics, robots, forest decline and genetic manipulations. Looking back on the developments of recent periods it becomes obvious, that research transcends the ideas of Galileo and aspires the goal to realise all that is practicable and to design all that is not doable as feasible. Once again, the genesis comes to one’s mind when it is stated in the Lutheran Bible: ‘‘And out of the ground made the Lord God to grow the tree of life also in the midst of the garden, and the tree of knowledge of good and evil’’. The ending is well-known: ‘‘So he drove out the man; and he placed at the east of the garden Eden Cherubim’s, and a flaming sword which turned every way to keep the way of the tree of life.’’ Strong images are included in this description like in other old myths too. It can be questioned if the human beings are already on the road to that tree of life, the absolute forbidden and unreachable, when they start to make everything feasible. Who knows, it may be the sword of Cherub’s that flamed over Hiroshima. While the playful character of former inventions was stressed in previous parts of this text, it is now necessary to focus on the collective and almost identical significance of the researchers and artists. For the highly vaulted building of culture it is of no importance to define who acted on it earlier, the homo ludens or the homo faber. The culture was based on the occidental Christian ethos, consisting of the three terms: individuality, freedom and legal order. The tasks of these are to oppose the loss of humanity that is threatened by the strive for profit and consumption claims. This development is called ‘‘decay’’ by Konrad Lorenz. Therefore, these tasks must interfere a situation where pollution is not only restricted to environment but can also be referred to the defilement of the inner self of mankind. It is like a special kind of depravity that extends like a shadow of a cloud over the countries of this planet without making any difference in nation, race, climate or ideologies. It can be seen as an aberrance caused by technocracy that furthermore undermines democracy including its blessings and freedoms. Plus, it also seems not only to destroy old-dated taboos. The depravity does even attack proven and long tested values that were grown and established over a period of thousands of years. The bewilderment of the values in the mental area is not less alarming as Damocles’ sword floating over the heads of the nations like a war led with nuclear weapons. The visionary exclamation of Georges Clemenc¸eau: ‘‘The apes stole Jove’s flash.’’ can be aimed to this. Even the decline of values like work as ethos, acquittal, discipline, faithfulness is a threatening
ARTICLE IN PRESS F. Heppner / Medical Laser Application 21 (2006) 91–93
phenomena. This decay is incommensurate with the law of nature that insists on power and order as a principle of survival and it is even inconsistent with the moral demands of considerateness, awe and salvage, in which all living has to be included. It is of a demoniac fascination to notice how machines got a life of their own, a process which probably originally started at the basis of a social idea, dissociated from it and frenetically makes its nuisance now. Once again, one remembers the sorcerer’s apprentice. This way of putting the broom to the corner is the same action as the scientists and artists are called to do; the researcher appears in awareness of his responsibility to the harmony of the creation; the artist while making harmony visible. The only way to salvage the questioned humanities is to control excessive needs and to reduce material wishes to human eligibility. This speaks for a re-establishment of a hierarchy that puts convenience, accommodation and the getting of delight aback. When it is necessary to substitute the out – dated by something superior while maintaining the constant as valid, every single person is asked to bravely make contributions to that idea. Rays of light, that are bundled monochromatically, coherently and parallel are, as far as I know no spontaneous natural phenomena. Therefore, the laser can be considered as an object that was made feasible. According to that, in my opinion, it is exaggerated to declare the laser as a devil’s false front. Neither the laser nor the satellites are of evil thoughts. Their usage concerning a good or bad orientation is ambivalent as well. As surgeons, we have the advantage to use the new technologies in service to life and health. This mark is especially aimed to the medical laser who becomes established on a broad basis, regardless of high expensives and opposing opinions that all new inventions have to face. Since our last meeting in Munich 1982, there were countless regional laser meetings and even the global show in Detroit 1983 proved that the palette of offers amplified from year to year. There hardly exists any illness in ophthalmology, except of infections, that cannot be cured by the help of an argon, CO2 and Nd:YAG laser. The light guides, by the way, approach the bulbus from the outside. The endoscopical laser is an essential instrument of modern urologists, gastroenterologists, gynaecologists and neurosurgeons who are able to deflate and stop the bleeding of brain masses only by the help of the laser. Fibre optics and laser microsurgery brought important progress to the fertilisation of men and women, vessel reconstruction and to the area of the larynx. Totally new therapeutic aspects were brought by the Photo Dynamic Therapy with a preceding sensitisation made of a hematoporphyrin derivation in dermatology as well as in the surgery with malignancy. The consequences are not imaginable.
93
A real surgeon working with laser can be seen as a beneficiary of a philosophical-technical development that started with Thales of Milet. The artist, however, who is a part of every true surgeon and aware of a technical, perfect handling, is conscious of the fact that every ill person can only be cured by the help of transcendental powers. In the imagination of the Ionian Philosophers of Nature these transcendental powers are of demonic nature; in the imagination of the modern scientists, however, these powers are of a divine nature.
Redaktionelle Anmerkung Das Machbare und der Laser Dieser Vortrag wurde von Herrn o. Universita¨tsProfessor F. Heppner auf der 2 Tagung der DGLM e.V. in Graz im Ma¨rz 1984 gehalten. Er war der Tagungspra¨sident und von 1984 bis 1988 Vizepra¨sident der DGLM e.V. und Pra¨sident der ISLMS. Er hat zusammen mit dem Oberarzt der Neurochirurgischen Universita¨tsklinik Graz, Prof. Dr. Peter Ascher, die wesentlichen Grundbausteine zur Anwendung von Lasern in der Neurochirurgie gelegt und baute damit die Grazer Neurochirurgie zu einem international anerkannten neurochirurgischem Laserzentrum aus. Die großen Erfahrungen bei neurochirurgischen Eingriffen bildete die Basis fu¨r die Applikation von CO2- and Nd:YAG-Lasern entsprechend ihrer spezifischen biophysikalischen Wechselwirkung strengen Indikationsbereichen zu zuordnen. Dieser Artikel wurde in den Verhandlungsberichten der DGLM e.V. zur 2. Tagung im Ma¨rz 1985 erstmalig vero¨ffentlicht.
Nota de los editores El la´ser y lo factible Este articulo fue presentado por el Prof. Dr. F. Heppner en la 21 Reunio´n de DGLM e.V en Graz, en Marzo de 1984. Heppner, quien modero´ la reunio´n, fue el Vicepresidente de la DGLM e.V. desde 1984 a 1988, y presidente de la ISLSM. Junto al Prof. Dr. Peter Ascher del Hospital Universitario de Neurocirugı´ a de Graz, desarrollo´ la base para la aplicacio´n de los la´seres en neurocirugı´ a, convirtiendo este hospital en un centro de renombre internacional en neurologı´ a la´ser. Dada la vasta experiencia en intervenciones neuroquiru´rgicas, el uso de los la´seres de CO2 y el Nd:YAG se relaciona en forma estricta segu´n sus interacciones bı´ ofı´ sicas especı´ ficas. Este articulo fue publicado por primera vez en Marzo de 1985 en el Verhandlungsberichte der DGLM e.V. zur 2. Tagung.