A historical and palaeopathological perspective on cancer.

Cancer is often wrongly considered to be a modern disease in many popular medical venues. Cancers have been known to humanity since ancient times. In fact, its antiquity can be identified through the application of palaeopathological methodologies. The present perspective demonstrates by means of a historical and palaeopathological analysis how oncological manifestations were present long before the emergence of anatomically modern humans and addresses the epidemiological transition from ancient times to the contemporary world. The final section of the article examines breast cancer and its identification in ancient human remains.

Unravelling social status in the first medieval military order of the Iberian Peninsula using isotope analysis.

Medieval Iberia witnessed the complex negotiation of religious, social, and economic identities, including the formation of religious orders that played a major role in border disputes and conflicts. While archival records provide insights into the compositions of these orders, there have been few direct dietary or osteoarchaeological studies to date. Here, we analysed 25 individuals discovered at the Zorita de los Canes Castle church cemetery, Guadalajara, Spain, where members of one of the first religious orders, the Order of Calatrava knights, were buried between the 12th to 15th centuries CE. Stable carbon (δ13C) and nitrogen (δ15N) isotope analyses of bone collagen reveal dietary patterns typical of the Medieval social elite, with the Bayesian R model, 'Simmr' suggesting a diet rich in poultry and marine fish in this inland population. Social comparisons and statistical analyses further support the idea that the order predominantly comprised the lower nobility and urban elite in agreement with historical sources. Our study suggests that while the cemetery primarily served the order's elite, the presence of individuals with diverse dietary patterns may indicate complexities of temporal use or wider social interaction of the medieval military order.

The Reformation.

The most important text at the end of the Middle Ages was the Bible. It had been published in manuscript on parchment bound between wooden covers. The production of such a book was time consuming and expensive. Martin Luther's proclamation of 95 theses directed against the practice and authority of the Roman Catholic church led to a speedy opposition from the church. However, the modern availability of paper and printing together with the printing of images, resulted in a rapid distribution of the bible in German. The church authorities had banned the spreading of literacy outside the clergy, but the publishing of Luther's bible involved the use of techniques which could be applied to other disciplines, improving the quality of the information on which their activities was based. This included the practice of surgery.

Two surgical instruments.

The only instruments for opening the cranium considered in this chapter are drills, and in some cases facilitated with a special chisel called a lenticular. There were two kinds of trepan. The modiolus was the Latin name for a crown trepan which had a circular base with teeth which sawed a hole. Then there were the non-penetrating trepans which had a bit shaped to prevent unwanted penetration. They made small openings which could be joined by chisels to remove altogether larger areas of bone than were accessible to modioli. They were the favored instrument from the ancient world up to the Renaissance. At the beginning of the Renaissance, there was a move toward greater use of crown trepans and various methods were applied to stop them sinking too far inward. These included wings in the outer wall and changing the shape of the bit from cylindrical to conic. In time preferences returned to the cylindrical shape and larger diameters. There was also two instruments called lenticulars, the illustrations of which have been confused in the literature. It is now clear that the Roman instrument was shaped to cut the cranium and minimize the need for trepanation. The Renaissance instrument had a different shape and was used to smooth rough bone edges and excise spicules penetrating the meninges. They were simply two different instruments to which the same name was applied.

The meninges.

The dura was first described in ancient Egypt. Hippocrates insisted that it should be protected and not penetrated. Celsus proposed an association between clinical findings and meningeal damage. Galen proposed that the dura was attached only at the sutures, and he was the first to describe the pia in humans. In the Middle Ages, new interest in the management of meningeal injuries arose, with renewed interest in relating clinical changes to intracranial injuries. These associations were neither consistent nor accurate. The Renaissance brought little change. It was in the 18th century that it became clear that the indication for opening the cranium following trauma was to relieve pressure from hematomas. Moreover, the important clinical findings on which to base an indication for intervention were changes in the level of consciousness.

The pericranium.

The purpose of this chapter is to present how past surgeons have viewed the pericranium and how they have reacted to its appearances. In ancient times, the membrane was considered formed by the dura through the sutures and it retained a relationship with the dura via vessels in the sutures. It was considered advisable to strip it totally from any area to be examined for fissure fractures and also for any area to be trepanned, as pericranial injury was thought to lead to fever and inflammation. In the 18th century, a new idea arose that posttraumatic spontaneous separation of the pericranium from the bone was a reliable indicator of the development of intracranial suppuration. This idea was subsequently refuted. For over two millennia, the pericranium was considered to be an important membrane requiring the close attention of the surgeon. It is no longer required to receive more than minimal attention.

Evolution of understanding.

From the time of Hippocrates to the early 19th century, knowledge advanced but that was an uneven process. Anatomy was basically defined by Galen and remained cast in stone until the early 16th century. Neuroanatomy was described by Galen but had little practical value, as brain surgery was not possible. The anatomy of the cranium was known and was largely correct. Care was taken to avoid the frontal air sinuses and the venous sinuses and the temporal region. The role of the brain in consciousness was not understood. It was considered the seat of the soul but there was a lack of understanding that damage to it could induce clinical symptoms such as stupor or paralysis. These were variously attributed to injuries to the meninges or the bone. This error was finally corrected in the 18th century when the brain was identified as responsible for much of the clinical disturbance following cranial trauma. All awareness that post traumatic neurological deficit was contralateral was ignored until the late 18th century, although several authors noted it. Likewise, the presence of CSF had to wait until the 18th century until it was recognized. Fissures were treated with trepanation, because of a perceived risk of infection developing between the bone and the dura. Depressed fracture fragments were elevated, replaced, or removed according to the details of the injury. Finally, for centuries surgeons blocked patients ears to reduce the sound of drilling, despite the fact that such a blocking would amplify the noise.

Age- and sex-related changes in vertebral trabecular bone architecture in Neolithic and Mediaeval populations from Poland.

This paper investigates trabecular bone ontogenetic changes in two different Polish populations, one prehistoric and the other historical. The studied populations are from the Brzesc Kujawski region in Kujawy (north-central Poland), one from the Neolithic Period (4500-4000 BC) and one from the Middle Ages (twelfth-sixteenth centuries AD), in total 62 vertebral specimens (32 males, 30 females). Eight morphometric parameters acquired from microCT scan images were analysed. Two-way ANOVA after Box-Cox transformation and multifactorial regression model were calculated. A significant decrease in percentage bone volume fraction (BV/TV; [%]) with age at death was observed in the studied sample; Tb.N (trabecular number) was also significantly decreased with age; trabecular separation (Tb.Sp) increased with advancing age; connectivity density (Conn.D) was negatively correlated with biological age and higher in the Neolithic population. These data are found to be compatible with data from the current biomedical literature, while no loss of horizontal trabeculae was recorded as would be expected based on modern osteoporosis.

Inferring diet, disease and antibiotic resistance from ancient human oral microbiomes.

The interaction between a host and its microbiome is an area of intense study. For the human host, it is known that the various body-site-associated microbiomes impact heavily on health and disease states. For instance, the oral microbiome is a source of various pathogens and potential antibiotic resistance gene pools. The effect of historical changes to the human host and environment to the associated microbiome, however, has been less well explored. In this review, we characterize several historical and prehistoric events which are considered to have impacted the oral environment and therefore the bacterial communities residing within it. The link between evolutionary changes to the oral microbiota and the significant societal and behavioural changes occurring during the pre-Neolithic, Agricultural Revolution, Industrial Revolution and Antibiotic Era is outlined. While previous studies suggest the functional profile of these communities may have shifted over the centuries, there is currently a gap in knowledge that needs to be filled. Biomolecular archaeological evidence of innate antimicrobial resistance within the oral microbiome shows an increase in the abundance of antimicrobial resistance genes since the advent and widespread use of antibiotics in the modern era. Nevertheless, a lack of research into the prevalence and evolution of antimicrobial resistance within the oral microbiome throughout history hinders our ability to combat antimicrobial resistance in the modern era.

Network of large pedigrees reveals social practices of Avar communities.

From AD 567-568, at the onset of the Avar period, populations from the Eurasian Steppe settled in the Carpathian Basin for approximately 250 years1. Extensive sampling for archaeogenomics (424 individuals) and isotopes, combined with archaeological, anthropological and historical contextualization of four Avar-period cemeteries, allowed for a detailed description of the genomic structure of these communities and their kinship and social practices. We present a set of large pedigrees, reconstructed using ancient DNA, spanning nine generations and comprising around 300 individuals. We uncover a strict patrilineal kinship system, in which patrilocality and female exogamy were the norm and multiple reproductive partnering and levirate unions were common. The absence of consanguinity indicates that this society maintained a detailed memory of ancestry over generations. These kinship practices correspond with previous evidence from historical sources and anthropological research on Eurasian Steppe societies2. Network analyses of identity-by-descent DNA connections suggest that social cohesion between communities was maintained via female exogamy. Finally, despite the absence of major ancestry shifts, the level of resolution of our analyses allowed us to detect genetic discontinuity caused by the replacement of a community at one of the sites. This was paralleled with changes in the archaeological record and was probably a result of local political realignment.

Fragments of Alchemy from a Cairene Synagogue: Context, Codicology, and Contents of the Alchemical Corpus of the Cairo Genizah.

This article presents the results of a survey and a first assessment of the corpus of alchemical manuscripts retrieved from the Cairo Genizah, a storage room mainly intended for sacred writings that is attached to the Ben Ezra synagogue of Old Cairo. The alchemical manuscripts are described in their codicological and palaeographic features; their content is analysed in the context of the medieval production of alchemical texts in the surrounding Islamic world. The alchemical corpus of the Genizah represents a unique and widely unstudied source for our understanding of the relationship between Jews and alchemy in the medieval Mediterranean World.

Ancient mitogenomes suggest complex maternal history of one of the oldest settlements of western India.

The ancient township of Vadnagar tells a story of a long chain of cultural diversity and exchange. Vadnagar has been continuously habituated and shows a presence of rich cultural amalgamation and continuous momentary sequences between the 2th century BCE and present-day. Seven cultural periods developed a complex and enriched settlement at Vadnagar in spatio-temporality. Although archaeological studies done on this oldest settlement suggested a rich cultural heritage, the genetic studies to pinpoint the genetic ancestry was lacking till date. In our current study we have for the first time reconstructed the complete mitogenomes of medieval individuals of the Vadnagar archaeological site in Gujarat. The study aimed to investigate the cosmopolitan nature of the present population as well as the migratory pattern and the inflow of different groups through trade, cultural and religious practices. Our analysis suggests heterogeneous nature of the medieval population of Vadnagar with presence of deeply rooted local ancestral components as well as central Asian genetic ancestry. This Central Asian component associated with mitochondrial haplotype U2e was not shared with any individual from India, but rather with individuals from the Bronze Age of Tajikistan and with an earlier age of coalescence. In summary, we propose that the medieval site of Vadnagar in western India was rich in cultural and genetic aspects, with both local and western Eurasian components.

Neither saintly nor psychotic: a narrative systematic review of the evolving Western perception of voice hearing.

We present a social-historical perspective on the evolution of the voice-hearing phenomenon in Western society. Based upon a systematic search from a selection of nine databases, we trace the way hearing voices has been understood throughout the ages. Originally, hearing voices was considered a gifted talent for accessing the divine, but the progressive influence of monotheistic religion gradually condemned the practice to social marginalization. Later, the medical and psychiatric professions of secular society were instrumental in attaching stigma to both voice hearers and the phenomenon itself, thereby reinforcing social exclusion. More recently, the re-integration of voice hearers into the community by health authorities in various countries appears to have provided a new, socially acceptable setting for the phenomenon.

Elevated genetic risk for multiple sclerosis emerged in steppe pastoralist populations.

Multiple sclerosis (MS) is a neuro-inflammatory and neurodegenerative disease that is most prevalent in Northern Europe. Although it is known that inherited risk for MS is located within or in close proximity to immune-related genes, it is unknown when, where and how this genetic risk originated1. Here, by using a large ancient genome dataset from the Mesolithic period to the Bronze Age2, along with new Medieval and post-Medieval genomes, we show that the genetic risk for MS rose among pastoralists from the Pontic steppe and was brought into Europe by the Yamnaya-related migration approximately 5,000 years ago. We further show that these MS-associated immunogenetic variants underwent positive selection both within the steppe population and later in Europe, probably driven by pathogenic challenges coinciding with changes in diet, lifestyle and population density. This study highlights the critical importance of the Neolithic period and Bronze Age as determinants of modern immune responses and their subsequent effect on the risk of developing MS in a changing environment.

A Late Antiquity case of a chronic osteomyelitis from the population of Cortijo Coracho, Córdoba, Spain (IV-VIII centuries AD).

The Cortijo Coracho archaeological site dates from the Late Antiquity period, from the 5th to the 8th century AD. During this period, a number of populations settled in the area (Germanic peoples until Visigothic rule, Byzantine until the arrival of the Arabs, etc.), each of them concentrating the historical characteristics in the Sub-Baetic that are currently known. The Cortijo Coracho archaeological site is currently located in the city of Lucena (Cordoba, Spain), found after the works on the A-45 motorway. The necropolis consists of 294 inhumations and the remains of a basilica, although after a series of surveys it is estimated that there are around 700 additional burials, which would make it the largest necropolis with ad sancti burials surrounding a martyrial basilica dating back to the 4th century AD. Among the burials, 397 subjects were recovered, which implies a large presence of shared and/or reused burials. These subjects were transferred to the city's museum, where they were examined, reorganised and classified. At this point, subjects of scientific interest were found, as is the case of subject 204, the topic of this article. This individual, described as an adult male, is an example of the living conditions of this period, since despite his injury on the left lower extremity, a double fracture aggravated by a chronic osteomyelitis infection, he continued to use that limb. This paper will give the details of that distinctive lesion and the possible hypotheses underlying it.

An overview of headache treatments during the tenth century.

Although the history of treating headaches spans thousands of years, scientists during the tenth century made unique and significant contributions to understanding, treating, and preventing the development of headaches. In fact, the tenth century saw the ability to differentiate between types of headache and treatments for the first time. This article looks at the contributions of Persian, Anglo-Saxon, and Chinese medicine to the diagnosis and treatment of different types of headaches in the tenth century. It does so with reference to a range of herbal, surgical, and pharmacological methods of treating this ailment. The article also uncovers how tenth-century herbal remedies were effective at explaining the properties of their ingredients in modern terms and concepts including analgesia, anti-inflammation, and antinociception, and explores the way tenth-century treatments relieved painful headaches and prevented their recurrence.

A Glimpse into Gynecologic Practice During the Islamic Golden Age.

The Islamic Golden Age was the time in history from eighth to fourteenth century. This era was marked by expansion of Islamic world to all the Middle East, North Africa, South and East Europe, and Central Asia. The Islamic world was the wealthiest region in the world at that time and that wealth was utilized to promote great flourishing in the arts, philosophy, science, and medicine. The practice of healing was considered the most noble of human undertakings by Islamic scholars. In this era, many great physician-scientists emerged in the Islamic world, albeit several were not Muslims, who examined prior writings, corrected many, and proceeded to produce their own observations and innovations. This article highlights some of the most important contributions to gynecology of some prominent scholars during this shining phase of medical history.

Genetic history of Cambridgeshire before and after the Black Death.

The extent of the devastation of the Black Death pandemic (1346-1353) on European populations is known from documentary sources and its bacterial source illuminated by studies of ancient pathogen DNA. What has remained less understood is the effect of the pandemic on human mobility and genetic diversity at the local scale. Here, we report 275 ancient genomes, including 109 with coverage >0.1×, from later medieval and postmedieval Cambridgeshire of individuals buried before and after the Black Death. Consistent with the function of the institutions, we found a lack of close relatives among the friars and the inmates of the hospital in contrast to their abundance in general urban and rural parish communities. While we detect long-term shifts in local genetic ancestry in Cambridgeshire, we find no evidence of major changes in genetic ancestry nor higher differentiation of immune loci between cohorts living before and after the Black Death.

Origins of Cannabis sativa in Ireland and the Concept of Celtic Hemp: An Interdisciplinary Review.

Introduction: Ireland's agriculture has been shaped by Celts, Romano-British Christians, Norse-Vikings, Anglo-Normans, and subsequent migrants. Who introduced hemp (Cannabis sativa) to Hibernia? We addressed this question using historical linguistics, fossil pollen studies (FPSs), archaeological data, and written records. Methods: Data gathering utilized digital resources coupled with citation tracking. Linguistic methods separated cognates (words with shared etymological origins) from loanwords (borrowed from other languages). Cannabis pollen in FPSs was identified using the "ecological proxy" method. Archaeological reports were ranked on a "robustness" scale. Results: Words for "hemp" in Celtic languages are loanwords, not cognates. The Irish word cnáib is first attested in texts written 1060 and 1127-1134 CE. Old Breton coarcholion, corrected to coarch, is attested in a text from the 9th century. Pollen consistent with cultivated Cannabis appears in the Middle Ages, ca. 700 CE, at sites in the vicinity of monasteries. Archaeological finds (hemp seeds and fiber) date to later Norse-Viking and Anglo-Norman sites. Discussion: People of the Hallstatt Culture in Central Europe have long been considered speakers of the "Proto-Celtic" language. The lack of "hemp" cognates means a Proto-Celtic word cannot be reconstructed, which implies that Hallstatt people (with robust archaeological evidence of hemp) did not speak Proto-Celtic. Cnáib is absent in Old Irish glossaries, epics, and mythologies (600-900 CE). FPS data suggest that the onset of hemp cultivation correlated-chronologically and spatially-with the founding of Romano-British monasteries. Irish cnáib was likely borrowed from Clerical Latin canapis or canabus.