Diskussion:Soranos von Ephesos

APGAR-Score und Soranus von Ephesos

Da ich keine Erfahrung mit der Arbeit in wikipedia-Artikeln habe, möchte ich hier auf folgende Vermutung hinweisen: Soranus habe bereits einen Bewertungs-Score für Neugeborene entwickelt, der – bis auf die Herzfrequenz – dem APGAR-Score von Virginia Apgar entspricht. LG Robert Schleusener

Quelle: Emmanouil Galanakis, Apgar score and Soranus of Ephesus; The Lancet 1998, Vol. 352, Nr. 9145, S. 2012--2013

Ich kopiere den Text hier mal einfach rein:

Apgar score and Soranus of Ephesus Emmanouil Galanakis

Virginia Apgar was born in the USA in 1909. She attended Mount Holyoke College, Massachusetts, and enrolled at Columbia University College of Physicians and Surgeons. After her graduation and a surgical residency, she elected to do anaesthesiology and became the first woman in the USA to hold a full professorship at this college; subsequently she was the first person to become a clinical professor in teratology in the USA.1 At the Twenty-Seventh Annual Congress of Anesthetists, Virginia Beach (Sept 22–25, 1952), Apgar presented a scoring system for the evaluation of the newborn infant at 1 min of life. A year later, her suggestions were published.2 This scoring method was based on an ingenious application to the newborn baby of what might be called the cardinal signs of the anaesthesiologist: heart rate, respiration, reflex irritability, tone, and colour (panel).1 This method, subsequently named “the Apgar score”, soon became popular and was quickly included in medical textbooks and in medical curricula. No physician practising contemporary medicine can ingore the term Apgar. Even an acronym—APGAR—was developed to make it easy to memorise the categories of the score: A for appearance, P for pulse, G for grimace, A for activity, and R for respiration.3 A few modifications followed; currently the 1-min score is used to indicate the infant who requires more attention, and the 5-min score provides an index of the effectiveness of resuscitation efforts.4 The ease of scoring has led to its wide use and even to misuse, as in an erroneous definition of asphyxia in the International Classification of Diseases, revision 9.4 At the time of her death, in 1974, Apgar was already a legend.1 Some thousands of citations of her name can readily be found in medical published work. From the little that is known of his life, Soranus was born at Ephesus, a flourishing Ionian colony on the coast of Asia Minor, in the second half of the first century. He studied in the leading medical school of Alexandria, and he successfully practised in Rome at the time of the emperors Trajan and Hadrian (AD 98–138). He died at about the time of Galen’s birth (c 129 AD).5–7 Soranus wrote copiously in Greek. Over 20 books have been attributed to him: these include On Fractures; On Bandages; On Acute and Chronic Diseases; On Embryology; and even a Life of Hippocrates and On the Soul. In these books, Soranus touched on philosophy, philology, and every specialty in medicine.5–7 Much of his written work has been lost; the surviving part in Greek (Gynaecia) was edited by Ilberg in the Corpus Medicorum Graecorum in 1927 and translated into English (Gynecology) by Temkin in 1956.7 A more recent edition, with a French translation and notes, by Gourevitch and colleagues, was published in the Budé series between 1988 and 1994 in three volumes.8 Gynaecia represents the most complete surviving account of gynaecology, midwifery, and paediatrics of the Greco-Roman world.5–7,9,10 In Book II.10, following the meticulous instructions on the care of the woman after labour, there is a series of brief chapters under the general title “On the care of the newborn”. The first chapter is strikingly called “How to recognise the newborn that is worth rearing”. The topic precedes even the chapters on “How to sever the navel cord”, and “How to cleanse”. In this chapter Soranus gives, in just 200 words, the criteria that will help the midwife to distinguish the healthy newborn baby, which is worth rearing, from the handicapped infant (panel). Soranus was regarded as being among the most critical and lucid authors of antiquity, and his influence on the forthcoming generations of physicians was enormous. Gynaecia was translated into Latin and Arabic and quoted by many writers of the eastern Roman Empire, including Oribasius, Aetius of Amida, and Paul of Aegina. Paraphrases were very popular during the Middle Ages and were used by Eucharius Rösslin 14 centuries later.7 Thereafter Soranus was gradually forgotten. Though very occasionally thought of as a pioneer of obstetrics and gynaecology, paediatrics, medical ethics, and dermatological surgery,5–7,9–14 Soranus is now virtually unknown in medicine. His name is not included in the medical dictionaries, and only a handful of citations can be traced in medical published work during the past 30 years—equal to one generation of physicians. Separated by 18 centuries, Virginia Apgar and Soranus of Ephesus had concerned themselves with the development of a method for distinguishing the healthy from the handicapped newborn baby. Both assessments were thought to be of primary importance. Apgar suggested a first minute assessment and Soranus an evaluation that should precede everything else in the care of the newborn baby. Both suggested very simple tests, based on observation. The Apgar score also required heart rate, but Apgar herself insisted on knowing how to recognise visible or palpable beats without a stethoscope.2 Four of the five criteria included in the Apgar score can be found more or less identically in Soranus’ instructions (panel). Only heart function was not mentioned; circulation had not been studied in the second century AD. On the other hand, Soranus insisted more on documentation of malformations. It is noteworthy that Apgar had a particular interest in birth defects.1 Two of Soranus’ criteria—the pregnant woman’s health and the newborn baby’s maturity—seem to be absent from the Apgar score. However, Apgar had noted in her publication that prematurity and complicated pregnancy may alter scoring.2 With respect to major differences, the Apgar score was a quantitative assessment—the sum of the rating (0, 1, or 2) assigned to each sign. By contrast, Soranus relied on the qualitative estimation and experience of the midwife. The most striking difference, however, is in the purpose of the two methods: the Apgar score was intended to highlight the need for more care of the weaker newborn infant, whereas such an infant, as identified by Soranus’ assessment, was simply considered not worth rearing. There is no information in Gynaecia about the fate of these newborn babies. However, other classical sources are more informative; exposure of handicapped newborn infants was a common practice throughout the Greco- Roman world. In mythology, Hera, the first in rank among the goddesses, threw away her crippled infant Hephaestus. The divine child survived but this was not the outcome for mortal infants so exposed. In Plato’s Theaetetus (151–161), Socrates (a midwife’s son) graphically depicts the scene of the midwife in which she suggests exposure of a handicapped newborn baby to the resisting primiparous mother. It seems that Greeks and Romans, as perhaps with many past societies, accepted only “healthy” children. It would probably be easy for today’s ethics to condemn such writings and practices; however, Soranus’ humanity is evident everywhere in his writings.5–7,10 The Christian writer and teacher Tertullian revered him highly and St Augustine called him “medicinae auctor nobilissimus”.7 The future of the names of Virginia Apgar and Soranus is unpredictable. However, if we are to name syndromes, symptoms, and scores in recognition of great physicians, and if we are to respect our ancestors in medical art when teaching our future physicians about newborn resuscitation, we should probably not only mention the honoured name of Virginia Apgar but also that of Soranus of Ephesus.