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.

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.

Renaissance-Europe-17th Century.

The authors of the texts described in this chapter will have had access to the anatomy of Vesalius; a marked step forward. However, there was no equivalent advance in physiology. Harvey's book on the circulation of the blood was published in 1628 but it took many years for its contents to be accepted as standard teaching. The century saw the development of instruments some of which look more like instruments a modern surgeon would recognize. The two major technical advances were the acceptance of a single-handed trephine and the design of crown trepans with a conical shape and blades extending up the sides. Moreover, the crown trepan had once again become the favored instrument for gaining access to the interior of the cranium. In terms of technique there was a worrying trend that surgeons could feel when they had penetrated the inner table of the skull without the need to probe. All the way back to Hippocrates, it had been customary to use probes to assess depth while trepanning. Thus, the abandonment of this safety measure if it was real, is cause for concern. However, it is not impossible that probing was continued and simply not mentioned as it was so obviously necessary as not to require comment. The lenticular illustrated remains of the triangular shape first illustrated by Vidius. It is important to note that it was not used to incise the skull but to smooth of rough edges and spicules.

Renaissance-Europe-16th century.

Realistic images became available for the first time. The first major figure was Berengario da Carpi (1460-1530). He made contributions to knowledge. He stated the dura was attached all over the interior of the cranium not just at the sutures. He also noted that deterioration following traumatic hematomas was speedier the deeper within the brain the bleed had occurred and he noticed that post-traumatic neurological deficits were contralateral. Moreover, he introduced new instruments of a practical design. Specifically, he launched trepanation using a brace and bit handle. This instrument required two hands and rotated the trepan in the same direction all the time. In addition, he illustrated a crown trepan in which the bits could be interchanged. He also developed an improved elevator. He also provided the first drawing of a lenticular. The next illustrations came from Vidus Vidius (1509-1569). The illustrations in his text were elegant and realistic but some of them were impractical or unusable. Ambroise Paré (1510-1590) was a major surgeon. He designed an improved brace and bit trepan with a collar to control penetration. He also introduced instruments for expanding a cranial opening by biting up the bone and for depressing the dura to enable material to escape more easily.

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.

Renaissance-Europe-16th Century continued.

This chapter is limited to the text of Della Cruce, which contains the most comprehensive account of the instruments used in cranial surgery at the time. Of particular importance is Della Cruce's attitude to what he called non-perforating straight trepans, which in general he disliked. It may be noted that his text was the last to describe this sort of instrument. In the succeeding centuries, changes to penetrating instruments were all variations on the shape of different kinds of crown trepan. Like Berengario, Della Cruce described brace and bit trepans with interchangeable bits. Various methods were employed to prevent them penetrating too deeply.

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.

François Rabelais and his dystonic giants.

Spasmodic torticollis was an early designation used for cervical dystonia. The origin of this name is attributed to French physician and writer François Rabelais in the mid-sixteenth century. This early description of torticollis in the book Pantagruel was an inspiration for the understanding of cervical dystonia. The art expressed in Rabelais' literature ‒ which was immortalized by the drawings of Gustave Doré ‒ influenced poetry, art, and photography, and led to the adoption of the term torticollis in the neurological sciences.

Uma designação inicial usada para distonia cervical era torcicolo espasmódico. A origem desse termo é atribuída ao médico e escritor francês François Rabelais em meados do século XVI. Essa descrição inicial do torcicolo no livro Pantagruel foi uma inspiração para a compreensão da distonia cervical. A arte exibida na literatura de Rabelais ‒ imortalizada pelos desenhos de Gustave Doré ‒ influenciou a poesia, a arte e a fotografia, e levou à adoção do termo torcicolo nas ciências neurológicas.

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.

Travel medicine in Basel - 450 years before CISTM18.

Concern for travellers' wellbeing and safety is as old as humankind. Historic documents offer insights into how a safe journey was prepared or travel ailments treated based on the prevailing knowledge of body and (dys)function. In 1561, Guilhelmo Gratarolo published a comprehensive book on what we call today 'travel medicine'. Many then problems are still today's travel malaises. How they were dealt with 450 years ago is uncovered in his fascinating publication.

Translating Forbidden Authors: New Evidence on the Alchemical Library of Don Antonio de' Medici.

Research into the history of alchemy and Paracelsianism in Italy has highlighted the role of Italian courts in the sixteenth and seventeenth centuries as centres of elaboration and diffusion of alchemical knowledge. Among these, one of the best known is the Medici court which already dedicated spaces in the ducal foundry to the alchemical arts in the time of Cosimo I. This interest would remain alive with Francesco I and his son, Don Antonio de' Medici, one of the greatest supporters of Paracelsian medicine in Italy. This contribution presents previously unpublished sources, now preserved in the Archivio di Stato di Firenze and in the collection of the Biblioteca degli Intronati in Siena, that can help us reconstruct in greater detail some significant aspects of Medici alchemical engagement and can, above all, help further determine Paracelsus's influence in seventeenth century Florence.

La labor del Protomedicato en la salud pública en el virreinato del Perú / O trabalho do Protomedicato na saúde pública no vice-reinado do Peru / The work of the Protomedicato in public health in the viceroyalty of Peru

El objetivo de la presente investigación es conocer el papelque cumplió el Protomedicato en la salud publica en elvirreinato del Perú. La metodología utilizada fue la narraciónhistórica siguiendo el método heurístico y hermenéutico,utilizando fuentes primarias documentales de archivoshistóricos peruanos y españoles. El resultado obtenido fueconfirmar que el Protomedicato veló por la salud de losvecinos y que tenía carácter administrativo judicial y susfunciones principales fueron regularizar la labor de los queejercieran cualquier tipo de atención sanitaria, otorgandolicencias, fijando aranceles y vigilando el trabajo realizadoen las boticas y la calidad de los medicamentos, a través devisitas periódicas. La conclusión determina que hubo mejorassanitarias como consecuencia de la gestión del Protomedicatoen el virreinato del Perú, proponiendo medidas salubrese, incluso, disponía la movilización de personal médico através del virreinato y participaba ante cualquier consultade otras entidades coloniales, como el cabildo, referentes asalud pública, como eliminación de acequias, declaraciónde pestes, y otros.(AU)

The objective of this research is to know the role that theProtomedicato played in public health in the viceroyaltyof Peru. The methodology used was historical narrationfollowing the heuristic and hermeneutic method, usingprimary documentary sources from Peruvian and Spanishhistorical archives. The result obtained was to confirm thatthe Protomedicato looked after the health of the neighborsand that it had a judicial administrative nature and its main functions were to regularize the work of those whocarried out any type of health care, granting licenses, settingtariffs and monitoring the work carried out in pharmaciesand the quality of medicines, through periodic visits. Theconclusion determines that there were health improvementsas a consequence of the management of the Protomedicato inthe viceroyalty of Peru, proposing health measures and evenordered the mobilization of medical personnel throughoutthe viceroyalty and participated in any consultation fromother colonial entities, such as the council, referring to publichealth, such as elimination of ditches, declaration of pests,and others.(AU)

O objetivo desta pesquisa é conhecer o papel que o Protomedicatodesempenhou na saúde pública no vice-reinado do Peru. Ametodologia utilizada foi a narração histórica seguindo o métodoheurístico e hermenêutico, utilizando fontes documentaisprimárias de arquivos históricos peruanos e espanhóis. Oresultado obtido foi confirmar que o Protomedicato zelava pelasaúde dos vizinhos e que tinha caráter administrativo judiciale suas principais funções eram regularizar o trabalho de quemrealizava qualquer tipo de assistência à saúde, concedendolicenças, fixando tarifas e acompanhamento do trabalhorealizado nas farmácias e da qualidade dos medicamentos,através de visitas periódicas. A conclusão determina quehouve melhorias na saúde como consequência da gestão doProtomedicato no vice-reinado do Peru, propondo medidassanitárias e ainda ordenou a mobilização de pessoal médicoem todo o vice-reinado e participou de qualquer consultade outras entidades coloniais, como o conselho. , referentesà saúde pública, como eliminação de valas, declaração depragas, entre outros.(AU)

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.

Francisco Sánchez, filósofo y médico gallego, precursor de la Medicina Basada en la Evidencia / Francisco Sánchez, Galician philosopher and medical doctor, precursor of Evidence Based Medicine

November 16 marked the 400th anniversary of the death, in Toulouse, of Francisco Sánchez de Sousa, known as "the Skeptic" or "the Tudense" who was, without a doubt, the most prestigious doctor and philosopher in the history of Galicia. With a versatile, multifaceted and cosmopolitan spirit, he represents the living incarnation of the Renaissance prototype of universal man. From a medical point of view, it could be said that our protagonist was a precursor of Evidence-Based Medicine, since he advocated a direct examination of things and submitting the data from the experience to analysis and critical judgment. The medical work of Francisco Sánchez is collected in a very heterogeneous conglomerate, published posthumously under the generic title of Opera Medica. It consists of a compilation of philosophical texts and a collection of various medical writings that includes notes, monographs, conferences, speeches and even notes for teaching. (AU)

El 16 de noviembre se cumplieron 400 años de la muerte, en Toulouse, de Francisco Sánchez de Sousa, conocido por “el Escéptico” o “el Tudense” que fue, sin duda alguna, el médico y filósofo más prestigioso de la historia de Galicia. De espíritu versátil, polifacético y cosmopolita, representa la encarnación viva del prototipo renacentista de hombre universal. Desde el punto de vista médico se podría decir que nuestro protagonista fue un precursor de la Medicina Basada en la Evidencia ya que propugnaba un examen directo de las cosas y someter los datos de la experiencia al análisis y al juicio crítico. La obra médica de Francisco Sánchez está recogida en un conglomerado muy heterogéneo, publicado de forma póstuma con el título genérico de Opera Medica. Consiste en una recopilación de textos filosóficos y una colección de diversos escritos médicos que incluye apuntes, monografías, conferencias, discursos e incluso notas para impartir la docencia. (AU)

Genetic continuity and change among the Indigenous peoples of California.

Before the colonial period, California harboured more language variation than all of Europe, and linguistic and archaeological analyses have led to many hypotheses to explain this diversity1. We report genome-wide data from 79 ancient individuals from California and 40 ancient individuals from Northern Mexico dating to 7,400-200 years before present (BP). Our analyses document long-term genetic continuity between people living on the Northern Channel Islands of California and the adjacent Santa Barbara mainland coast from 7,400 years BP to modern Chumash groups represented by individuals who lived around 200 years BP. The distinctive genetic lineages that characterize present-day and ancient people from Northwest Mexico increased in frequency in Southern and Central California by 5,200 years BP, providing evidence for northward migrations that are candidates for spreading Uto-Aztecan languages before the dispersal of maize agriculture from Mexico2-4. Individuals from Baja California share more alleles with the earliest individual from Central California in the dataset than with later individuals from Central California, potentially reflecting an earlier linguistic substrate, whose impact on local ancestry was diluted by later migrations from inland regions1,5. After 1,600 years BP, ancient individuals from the Channel Islands lived in communities with effective sizes similar to those in pre-agricultural Caribbean and Patagonia, and smaller than those on the California mainland and in sampled regions of Mexico.

Paracelso y la medicina del Renacimiento en el cine / Paracelsus and the Medicine of the Renaissance in the Cinema

La breve, azarosa y fructífera vida de Paracelso, médico del siglo XVI, motivó en 1943, aproximadamente 400 años después de su muerte, a un film homenaje alemán que rescató un fragmento de su existencia. El rodaje y estreno se realizó en plena segunda guerra mundial y fue controlado rigurosamente por el nazismo. Esto produjo determinadas polémicas, aún vigentes, relacionadas con su director. Este trabajo intenta dar cuenta de ambos hechos. (AU)

The brief, eventful and fruitful life of Paracelsus, a 16th century doctor, motivated a German tribute film in 1943, approximately 400 years after his death that rescued a fragment of his existence. The filming and premiere took place during the Second World War and was rigorously controlled by the Nazis. This produced certain controversies, still in force, related to its director. This paper intends to portrait both facts. (AU)