Nikolaos K. Louros (1898-1986): the Greek Gynecologist and Medical Philosopher

Abstract

Nikolaos K. Louros (1898-1986) was a prominent Greek gynecologist and obstetrician. He was the son of Konstantinos Louros (1864-1957), a professor of obstetrics and gynecology at the University of Athens and a member of parliament. Louros, beginning in Athens, pursued his medical education in Switzerland and completed his specialization in Germany under the guidance of renowned professors, where he conducted remarkable medical research. Upon returning to Greece, Louros played a pivotal role in revitalizing obstetrics and gynecology and held key academic positions. During the German occupation of Greece, he actively contributed to the country’s resistance efforts, frequently clashing with the occupiers and their supporters. His scientific contributions earned him international acclaim, positioning him among the world’s leading gynecologists. In addition to his medical achievements, Louros also engaged in literary and philosophical pursuits. He additionally addressed the most significant social issues of his time through public discourse.

KeyWords: Obstetrics, Gynecology, 20th century, History of Medicine

Introduction

Greece upholds a longstanding tradition dating back to antiquity, characterized by the cultivation of exceptional physicians who not only demonstrate medical proficiency but also exhibit profound spiritual insight and humanitarian culture. One of the most distinct recent continuators of this tradition is Nikolaos K. Louros (1898-1986) (Figure 1). Louros’ name is connected with prominent professors of medicine of Europe, especially of Germany and Switzerland, as well as with the renewal of obstetrics and gynecology in Greece. His medical expertise was combined with a sense of duty which allowed him to not only produce breakthrough scientific work, but to also maintain an irreproachable position during the German occupation of Greece (1941-1944), during which his actions constitute an example of bravery and freedom. The same sense of duty and humanism characterized his actions both as a political figure as well as an author and thinker. The present study mainly originates from his extensive autobiography, written by the pen of a belletrist physician, “Yesterday” (1980) [1].

Early years and medical studies

Nikolaos Louros was born on March 6th, 1898, in Athens, as the only son of Konstantinos Louros (1864-1957), a professor of obstetrics and gynecology at the University of Athens and a politician. Growing up in Athens, he was exposed to the world of theatre and art from an early age, fostering a lifelong passion for them. In fact, he initially aspired to pursue a career as an actor. Interestingly, his father envisioned a future for him as a journalist, recognizing the importance of the profession. However, Louros’ innate inclination towards medicine prevailed, leading him to enroll at the Medical School of the University of Athens. After completing two years of medical studies, Louros’ father encouraged him to further his education in Switzerland. It was during his time abroad that he formed a close friendship with Petros Kokkalis (1896-1962), a fellow Greek medical student who would later become a prominent physician and professor in Greece. Their friendship endured until Kokkalis’ active involvement with the Communist Party in Greece. During his studies abroad, Louros balanced academic pursuits alongside exposure to world-class physicians and a vibrant nightlife, while also nurturing his enduring interest in the arts.

One of the first surgeons whose figure deeply influenced and whose abilities captured the admiration of young Louros was Emil Theodor Kocher (1841-1917), an important personality in medicine’s  evolvement, recipient of the Nobel Prize in 1909, student and assistant of the infamous surgeon Theodor Billroth (1829-1894) [2]. He dedicated a special place for his life and work in his autobiography. Upon completing his medical studies, Louros pursued further education in Vienna, where he studied under the tutelage of the esteemed gynecologist Ernst Wertheim (1864-1920). Wertheim, a colleague of Louros’ father in Vienna, unfortunately passed away in 1920, before Louros could commence his specialization under his guidance. Nevertheless, Louros’ interest in Wertheim’s medical pursuits led him to Ernst Bumm (1858-1924), whom Louros acknowledges as his true mentor. After brief stints in Munich and Leipzig, where he encountered renowned physicians, Louros made the decision to continue his career in Berlin. It was there that he encountered the esteemed professor Bumm, a world-renowned gynecologist who was widely regarded as one of the best in Germany. Fortunately, professor Bumm accepted Louros as his assistant. Louros held immense admiration and respect for Bumm, both for his exceptional medical skills and for his seminal work “Obstetrics”, which Louros described as “immortal” and the “Gospel” of gynecology, complete with captivating drawings.

Bumm assessed Louros’ research on vaginal microorganisms as suitable for a thesis for the position of assistant professor at the Medical School of Berlin. However, Bumm passed away a few months later, prompting Louros to seek another professor to endorse his candidacy, which ultimately proved successful. Following his mentor’s demise, Louros followed his close friend and Bumm’s assistant Kurt Warnekros (1882-1949) to Dresden, where assumed the roles of attending physician and head of scientific projects. In 1928, after years of hard work and prolific scientific output, Louros became adjunct professor at the Medical School of Berlin’s University. Despite his success in Germany, Louros harbored a desire to return to Greece. An opportunity arose, when the renowned Prime Minister of Greece Eleftherios Venizelos (1864-1936) was hospitalized at the “Evangelismos” hospital in Athens and became acquainted about the talented young physician Louros. The director of the gynecological clinic at “Evangelismos” was due to retire, prompting Venizelos to propose Louros as his successor. Louros swiftly prepared the necessary paperwork for his return to Greece. However, negotiations with the hospital’s council faltered as Louros found some of their terms unacceptable. Eventually, Konstantinos Logothetopoulos (1878-1961), a distinguished Greek gynecologist who would later serve as Minister and Prime Minister during the German occupation of Greece, assumed the position [3]. Disappointed by this turn of events, Louros returned to Dresden.

Return to Greece and German occupation

The following summer, Louros returned to Greece, prepared to work in the clinic his father had envisioned for him. With the financial assistance of Elena Venizelou (1873-1959), the “Marika Iliadi” clinic was heralded as the most advanced in Greece at the time. Louros made a notable innovation by introducing colored walls, departing from the traditional white color scheme previously employed. Thanks to a bill proposed by the Minister, future Prime Minister, Georgios Papandreou (1888-1968), who Louros had come to know, the University of Athens was able to appoint adjunct professors. Consequently, Louros was appointed as an adjunct professor of obstetrics and gynecology at the University in 1933. By 1938, he had ascended to the position of professor and director of the 2nd University Clinic of Obstetrics and Gynecology at the “Areteio” University Hospital, a role he held until his resignation in 1942.

In 1939, Professor Warnekros, Louros’ close friend, arrived in Athens to attend to Princess Frederica’s pregnancy. Initially, Konstantinos Louros, Nikolaos’ father, served as the royal physician. However, due to his advanced age, Warnekros was called upon and collaborated with Nikolaos Louros for the birth of Princess Sofia (1938-), who later became Queen of Spain. When Princess Frederica was pregnant with the heir and future King, Konstantinos II of Greece (1940-2023), Warnekros entrusted Louros with the entire birthing procedure. As a result of his exceptional service, Louros was honored with some of the highest awards bestowed by the Greek State, awarded by King George II of Greece (1890-1947).

When the German occupation began, General Georgios Tsolakoglou (1886-1948), the first Prime Minister of occupied Greece, offered Louros the position of Prime Minister of Education and Hygiene. Louros promptly declined the offer. A few days later, he discovered that his colleague, professor Konstantinos Logothetopoulos, who he would later clash with on numerous occasions, had accepted the position. During the first days of the martyrial German occupation of Greece, Louros connected with the philosopher and Greece’s future Prime Minister Panagiotis Kanellopoulos (1902-1986), who was the organizer of multiple revolutionary acts at the time. Kanellopoulos wrote respectively: “During this time of struggle I was brotherly connected with the professor at the Medical School Nikolaos Louros who was willing to take on any dangerous mission” [4]. Kanellopoulos also mentions the “beautifully written” book of Louros “Retrospections” in his monumental “History of the European Spirit”, when talking about famous xylographies [5].

In 1942, Louros declined Minister Logothetopoulos’ proposal to assist in the establishment of a new Medical School in Thessaloniki, citing that the timing was not appropriate as many other pressing issues needed resolution first. Tensions between them heightened when Logothetopoulos demanded Kokkalis to take actions against his conscience. Despite his opposition to Kokkalis’ Communist activities, Louros encouraged him to maintain his stance, and when Logothetopoulos discharged Kokkalis, Louros and Konstantinos Choremis (1898-1966), a prominent figure in the rejuvenation of pediatrics in Greece, fulfilled their promise and resigned alongside Kokkalis. This incident illustrates Louros’ ethos of standing by his unjustly treated colleague, even when they did not see eye to eye politically.

During the tumultuous days of the occupation, when Greece endured harsh conditions alongside its people, Louros, unable to teach or practice medicine, embarked on an endeavor to establish a scientific corpus. He recalls that this effort constituted: “precious solace during the endless days of the occupation”. He finally presented his two books “Obstetrics” and “Gynecology”, in the vernacular, that later merged into one massive volume. In a night in July 1944, Louros was abducted and taken to the camp in Haidari, where he and Choremis, among many others, were imprisoned. There, he endured humiliation and violence at the hands of German soldiers. The appalling conditions and inhumane treatment are detailed in his autobiography. Despite the hardships, Louros endeavored to apply his medical knowledge to assist the severely wounded. After enduring a month of atrocities, he was finally released. Louros later learned from friends that Logothetopoulos was the one who had betrayed him, but he chose not to testify during Logothetopoulos’ multiple trials, so as not to further burden the ex-Prime Minister, who had already been sentenced to life imprisonment. On the other hand, Logothetopoulos claimed that it was through his own intervention that Louros and Choremis were ultimately freed by the German authorities [6].

Later years

After the liberation of Greece, Louros resumed his position as director at the 2nd University Clinic of Obstetrics and Gynecology, where he served until 1951. During this time, he also assumed the role of dean of the Medical School. Subsequently, he transitioned to the 1st University Clinic, that was finally housed at the “Alexandra” University Maternity Hospital, where he continued his dedicated service until his retirement from professorial duties in 1968 (Figure 2). “Alexandra’s” foundation stone was laid by Logothetopoulos during his tenure as Rector of the University in 1933 and flourished under the stewardship of Nikolaos Louros. From 1945 onwards, Louros held the reins of the obstetrics and gynecology specialty [7]. His students recall that: “He was the ultimate authority of the time regarding the specialty. With a single word, he could either pave the path to progress or relegate one to obscurity.” [8].

In 1966 he became member of the Academy of Athens [9]. He also served as President and Vice-President of the International College of Surgeons. By the time the dictatorship of the colonels (1967-1974) in Greece was over, Louros was appointed as the first Minister of Education, under which title he served for four months. In his speech to the youth on the national anniversary of the 28th of October, he stated: “Our back is fraught by the centuries of the constant struggle of a tortured race that lived and will live with the sense of freedom rooted inside us. Without it, there is no breath” (Figure 3).

Scientific and literature work

Louros’ scientific work is massive and breakthrough. During his years as a young researcher he was interested in infections. He therefore occupied himself with Streptococci and their attributes as well as with the importance of the reticuloendothelial system in infections. Septicemia in pregnant women was also a topic of his multiple works, as he contributed with the immunization of the pregnant women via the anti-streptococcic serum. In the realm of clinical practice, Louros made notable strides in advancing techniques for facilitating shorter and less painful childbirth experiences. Furthermore, he played a pivotal role in developing surgical approaches to the treatment of cervical cancer. Louros also invented a “conservative surgical” therapy method for managing fibromyomas in young women. His contributions extended to refining techniques such as ligamentopexy of the uterus and the creation of an artificial vagina. Through these innovations, Louros left an enduring surgical legacy in the field of gynecological operations.

A significant aspect of Louros’ contributions to medicine lies in his pivotal role in training multiple generations of gynecologists, imparting upon them the scientific approach he acquired from European professors and refined through his diligent work. Louros’ influence on the progress of obstetrics and gynecology in Greece is profound and undeniable. Whether in his capacity as a professor or Minister, he advocated for the rejuvenation and establishment of hospitals and universities, many of which stemmed from his commitment to social service. His scientific excellence transcended the borders of Greece, resonating across Europe, America, and beyond. Through his lectures delivered in numerous countries worldwide, Louros not only showcased his medical prowess but also seized the opportunity to honor Greece, perpetuating its legacy on the global stage.

In addition to his invaluable scientific contributions, Louros demonstrated a deep interest in literature, philosophy, and theoretical thought. His body of work encompasses a diverse range of texts, including articles on social issues, novels, and philosophical inquiries. Louros tackled a wide array of topics, from discussions on the cultivated individual to addressing demographic concerns, social insurance, and various socio-medical subjects. Louros’ multidisciplinary approach reflects his broad intellectual curiosity and commitment to exploring diverse facets of human knowledge and experience. He wrote regarding surgery: “Surgery is not a science, but art that services science. Therefore, it is not an aim rather than a means” [10]. He also stated about the modern physician: “The physician, especially the Greek, with his heavy spiritual heritage, in order to shape his personality, it is not accepted, as the old professor and medical philosopher [Theodoros] Afentoulis (1824-1893) claimed, to be unphilosophical. Despite the evolvement of science and the therapeutic outcomes of the medical specialties, we are nostalgic, from the perspective of his personality, the humanitarian family physician, often also medical philosopher, who … benefited his patients to a greater extent than the thermometer and the poor medical tools of his era permitted” [10].

Louros’ main philosophical interest rotated around the concept of “need”. He suggests regarding it that: “1. The need is an outcome of the deprivation or the insufficiency and 2. That the subjective prevalence depends on the weakness of ignorance. When the need responds and fulfills the pursuits of the weakness, then something useful for human emerges (Christ, Buddha, Muhammad). When, however, the subjective prevalence depends on the subjective exploitation of human weakness, the outcome becomes harmful [11]. “The Power of Weakness” (1974) is a captivating novel by Louros, in which he explores the timeless themes of the pursuit of knowledge, dreams, the influence of conscience and fortune on personal lives, and their impact on the course of humanity. Through multiple historical scenes, Louros delves into these profound aspects of the human experience, offering insightful reflections on the interconnectedness of individual destinies and the broader trajectory of human history. This novel represents just one of his many contributions to thought, showcasing his talent for weaving together intricate narratives that resonate with readers and provoke contemplation on the complexities of existence [12].

Conclusions

Nikolaos K. Louros died on April 7th, 1986. He stands as a significant figure in modern Greek medicine. His work ethic, expansive knowledge, philosophical outlook on life, and, notably, his acts of bravery during challenging times make him an exemplary figure for physicians and humanity at large. Louros’ life underscores the notion that excellence in medicine requires more than just scientific prowess; it necessitates the ability to apply medical knowledge with a steadfast commitment to alleviating human suffering.

For the modern physician, the study of literature and philosophy holds paramount importance. It serves as a reminder not to be overwhelmed by medicine’s rapid advancements but to always remember the human aspect—the individuals seeking help and the pain accompanying their illnesses. A good physician becomes a great one only when they recognize that patients require not only medical expertise but also someone to provide support during their times of struggle. Louros’ legacy serves as a guiding light, inspiring physicians to embody compassion, empathy, and resilience in their practice.

Conflicts of interest

All authors of this study have not any personal conflicts of interest or any financial conflicts of interest.

References

1. Louros N.K. Yesterday. Greek Education; 1980. [In Greek]
2. Christian Albert Theodor Billroth (1829-1894): a giant of surgery. Perdikakis M, Papadimitrakis D, Filippou D. REIBS. 2023 Sep-Dec;1(4): 17-21. https://reibs.org.gr/christian-albert-theodor-billroth-1829-1894-a-giant-of-surgery/
3. Konstantinos Logothetopoulos (1878-1961), pioneer gynecologist with controversial political action. Accessed April 27, 2024. https://iasis.med.uoa.gr/konstantinos-logothetopoylos/ [In Greek]
4. Kanellopoulos P. The Years of the Great War. Personal Edition; 1964. [In Greek]
5. Kanellopoulos P. History of the European Spirit. Volume III. Giallelis; 1976. [In Greek]
6. Logothetopoulos K. Here is the truth. Personal Edition; 1948. [In Greek]
7. Biography of Nikolaos Louros. Accessed April 27, 2024. https://www.louros-foundation.gr/portal/n-k-louros [In Greek]
8. Nikolaos Louros, a Personal Experience. Georgakopoulos P. Issues of Obstetrics and Gynecology. 2004 Oct-Dec;18(4). https://www.iatrikionline.gr/8emata_4-2004/9.htm [In Greek]
9. Emergent Meeting, December 10, 1966. Proceedings of the Academy of Athens. Accessed April 27, 2024. https://digitallibrary.academyofathens.gr/archive/item/17428?lang=el [In Greek]
10. Louros N.K. Reverberations of Experience. The Editions of the Friends; 1978. [In Greek]
11. Louros N.K. Worries. Personal Edition; 1981. [In Greek]
12. Louros N.K. The Power of the Weakness. The Editions of the Friends; 1974. [In Greek]