The arsenic eaters of Styria, the toxicophagi.

INTRODUCTION: From at least the fifteenth to late nineteenth centuries, peasants in the Austrian province of Styria ate up to several hundred milligrams of arsenic trioxide or sulfide daily or weekly for periods up to a number of years. Taking these doses of arsenic was believed to increase muscular power and enhance the beauty and sexual attractiveness of peasant girls. There do not appear to be contemporaneous records of the known consequences of chronic arsenic exposure. The historical records of arsenic eating there are reviewed and appear to be valid. The benefits are subjective judgements by arsenic eaters. The lack of objective reports of the anticipated external and internal clinical and pathological effects of arsenic poisoning depends on a smaller number of clinical accounts and autopsy reports and the general medical literature of those times, so it is weaker, but it is consistent. CAN THE CLAIMED BENEFITS OF ARSENIC EATING AND THE APPARENT ABSENCE OF HARMFUL TOXIC EFFECTS BE TRUE?: Why the arsenic eaters did not show the well-known consequences of prolonged exposure to high doses of arsenic is not known. Possible explanations include increases in detoxifying metabolism in the consumers due to induced genomic changes and selection in people and in the gut microbiome, as shown in other populations. Whether these effects would suffice to protect people against their high doses of arsenic has not been explored. CONCLUSION: Although the nature and mechanisms of arsenic toxicity have been extensively described, much still remains to be discovered.

History of biological, mechanistic, and clinical understanding of concussion.

The history behind the biological, mechanistic, and clinical insights into concussion provides awareness of the current understanding and future areas for study. Although the initial description of concussion appeared in the 10th century, the potential long-term structural consequences were first defined by Harrison Martland, M.D., who performed a postmortem study of former boxers in 1928. He found evidence of perivascular microhemorrhage that he believed eventually evolved into a "replacement gliosis" underlying a clinical syndrome that he named "punch drunk," which was characterized by acute confusion with chronic cognitive and physical symptoms developing in those with prolonged exposure. Further research into the potential long-term consequences of repetitive concussions, particularly in athletics and the military, led to an understanding of chronic traumatic encephalopathy. To ameliorate possible long-term risks, research has been focused on preventative and therapeutic measures for concussion. In this review article, the authors present the history of concussion and the long-term sequelae of repeated head injury. Specifically, they consider how the understanding of concussion has evolved from antiquity into the modern era, and how this change in understanding of head injury has led to an appreciation of the fact that its long-term implications sometimes manifest as the clinical and histopathological entity of chronic traumatic encephalopathy.

The History of Orthopedics in the Long Term: From General Medicine to Medical Specialties.

A thorough literature search was done in PubMed and Google Scholar as well as in physical books in libraries to summarize the literature on the history and evolution of medicine and orthopedics. The philosophical ideas that emerged in ancient Greece served as a foundation for the development of medicine. In the 5th century BC, the schools of Knidos and Kos emerged as influential centers for the development of medical thinking. The field of orthopedics can be traced back to early human civilizations. Ancient Egyptians perpetuated the tradition of employing splinting techniques. Hippocrates provided insights for the diagnosis, correction and treatment of many musculoskeletal entities. The field of medicine experienced a period of limited advancement during the Middle Ages. The Renaissance provided for the foundation of modern orthopedics and important contributions to the understanding and implementation of antisepsis. The discovery of x-ray and advancements in infection control and anesthesia have shown substantial progress in the domain of orthopedics and have contributed to the development of orthopedic subspecialization. Orthopedic surgery holds a historical lineage deeply entrenched in ancient practices and early human civilizations. Physicians specializing in orthopedics should be aware of the historical origins of their discipline and continue to evolve through further subspecialization and enhanced research.

Dental disease in a 15th-17th centuries skeletal sample of enslaved Africans (Lagos, Portugal).

OBJECTIVE: Dental disease is frequently used as a proxy for diet and overall health of individuals of past populations. The aim of this study is to investigate dental disease in a sample of enslaved African individuals recovered from an urban dump (15th-17th centuries) in Lagos, Portugal. DESIGN: In all, 81 African individuals (>12 years old) were analysed (19 males, 49 females, and 13 of unknown sex), in a total of 2283 alveoli, 2061 teeth, and 2213 interdental septa. Analysed oral pathologies include dental caries, periodontal disease, and ante-mortem tooth loss. Dental wear was also recorded. RESULTS: Dental caries affected 52.0 % of the teeth, although only 31.9 % were cavitated lesions. In all, 96.3 % of the individuals presented at least one cariogenic lesion. Gingivitis and periodontitis were recorded in 56.7 % and 19.0 % of the septa, respectively. Only one male individual had all septal areas healthy. Ante-mortem tooth loss was recorded in 38.3 % of the individuals, in a total of 96 teeth lost (4.2 %). Regarding occlusal wear, 70.8 % of the surfaces were recorded with grades 1-3. CONCLUSIONS: The frequencies of the oral pathological conditions observed may not only reflect a cariogenic diet (rich in starches and with a high frequency of meals) but also the conditions during the maritime voyage of the first victims of the North Atlantic slave trade (xerostomia due to lack of water, sea sickness and vomiting, vitamin C deficiency, poor hygiene), and also the impact intentional dental modifications had on the dentitions.

Proto-Endocrinological Theories of Masculinity/Femininity (1490-1904).

From the mid-seventeenth century, resorption of a testicular "ferment" and resorption of some part of the semen constituted reputable accounts of secondary sexual characteristics. Only in the early twentieth century was the latter, "recrementitious secretion" theory, explicitly considered superseded by one of internal secretion, an advance ushering in the hormone era. A reconstruction of these proto-endocrinological concepts is offered onward from the first, 1490 print edition of Galen's On Semen. Early modern physicians picking up from Galen deliberated widely on the medium and pathway of male and female testicular influences on "the entire body," including the mind, causing "femininity" and "masculinity" in physical, mental-temperamental, and behavioral terms. A switch is discernible from "heat and strength" (Galen) to blood-borne "virility" or testicular vapor (such as proposed in 1564 by Tomás Rodrigues da Veiga), to iatrochemical postulations of a "seminal ferment" (suggested in the late 1650s, perhaps independently, by Thomas Willis at Oxford and Lambert van Velthuysen in Utrecht), finally to a "seminal recrement" or "reabsorbed semen" concept soon after (emergent in the posthumous work of Giovanni Alfonso Borelli, among others). During the late eighteenth century, mounting controversy surrounded both the very idea of that concept and the involved anatomical pathways, informed by multiple experiments.

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.

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.

Death of the suicide law: A changing standard of liability for clinicians.

High rates of suicide continue to plague the modern world, with clinicians, researchers, and policymakers working urgently to ameliorate what has been recognized as a worldwide public health crisis. Under American Law, individuals- including health care providers, could generally not be held liable for causing the suicide of another person. This article presents a review of suicide law in the United States in the context of a recent civil case in which a physician with expertise in mental health was sued for the death of an ex-partner who committed suicide in his home. Historical events and landmark legal cases spanning the 15th century to now are examined and presented as a narrative review to inform society and mental health clinicians a-like towards interpreting the changing medical-legal landscape. As modern advances in science continue to discern the critical biopsychosocial factors that contribute to the act of suicide, there is an inevitably growing concern that suicide may no longer be an incomprehensible nor irrational event as has been assumed for centuries. Thus, it may be considered that individual with expertise and qualification to treat a group of individuals at higher risk of suicide (severe mental illness) may be subject to a different standard than the average individual. This article seeks to present a complex matter where no simple or broad-sweeping conclusions can yet be drawn, however remains a critically important matter for mental health clinicians.

Past anthropogenic impacts revealed by trace elements in cave guano.

Natural and human-induced toxic elements can accumulate in the environment, posing significant risks to human health and ecosystems. This study explores cave bat guano, an unconventional and relatively under-researched environmental repository, to reveal historical pollution trends and sources. Through trace elements analysis of a 1.5-m-thick guano deposit from Zidita Cave (Romania), we track changes in mining and metallurgy from 1000 CE-2012. We identified substantial pollution primarily from porphyry copper and Au-Ag-Te mines, but also impacts from usage of leaded gasoline and agricultural practices. Our record shows disruptions caused by the Bubonic plague around 1250 CE and a major surge âˆ¼ 1500 CE. After the decline triggered by the European silver market collapse in 1525 CE, our study reveals a brief mining revival. This resurgence was followed by a continuous decline lasting until the early 1800s, driven by socio-economic upheavals and recurrent outbreaks of the bubonic plagues. The Industrial Revolution sparked prolonged growth that lasted until 1989 CE, only briefly interrupted by the Great Depression and World War II. Consequently, cave bat guano proves to be a critical resource for understanding spatial pollution patterns, both locally and regionally, and for identifying specific pollution sources.

History of Czech anatomical terminology.

Latin anatomical terminology has been codified since 1895. However, the situation is different for national anatomical terminologies. There are countries that have standardized anatomical terminology in their language, e.g., Poland, Slovenia, Japan, Spain, Hungary, others, such as the Czech Republic or Slovakia, are still lacking their own standardized and official terminology. In the Bohemian Lands, the first terms describing parts of the human body appeared as early as the ninth century in works written in Cyrillic script. The first comprehensive references to Czech anatomical terminology appeared in the fourteenth century. From the Baroque period, anatomical terms were preserved in the educational works of the Teacher of Nations Jan Amos Comenius' Janua linguarum reserata and Orbis sensualium pictus. Many of these terms have remained almost unchanged to this day, but some of them have acquired a pejorative meaning over time. We present here an overview of the history and examples of these terms describing parts of the human body.

Nomina anatomica-unde venient et quo vaditis?

As the title indicates, this article deals with the origins of anatomic terminology and its development up to the present day. The first attempt to name anatomical structures in animals and humans date back to Alkmaion, i.e. to the fifth century BC. Further work has been done at the same time by the Hippocratics and about 100 years later by Aristotle. As the Alexandrians Erasistratos and Herophilos first in history dissected human bodies, they expanded the anatomical terms. Until Celsus (around Christ's birth) and even later on, anatomical terminology was almost exclusively based on the Greek language. Thus, Celsus and not-as frequently done-Galenos has to be called the father of Latin-based anatomical terminology. Due to several translations including Arabic, first periods of proverbial Bable resulted. Return to systematic order was achieved finally by Andreas Vesal (1514/15-1564) and Caspar Bauhin (1560-1624). But again due to translations into several national languages, the uniformity of the anatomical nomenclature was undermined. Thus, by the end of the nineteenth century, in 1895 the newly founded Anatomische Gesellschaft created a uniform terminology, the Basle Nomina Anatomica (BNA). Although it has been revised several times, it is still the very basic of human anatomical terminology. Recently, an attempt was made to replace it by English translations of the original Latin (and also still Greek) terms to mainly get machine-readable denominations. As this will result again in non-uniformity of terminology, the Anatomische Gesellschaft proposes a version of the latest, generally accepted terminology, based on the Latin terms but incorporating recent developments.

La alimentación de los enfermos en los hospitales de la edad moderna, el caso de Vitoria (Álava, España) / A alimentação dos doentes nos hospitais na era moderna, o caso de Vitoria (Álava, Espanha) / Feeding the sick in hospitals in the modern age, the case of Vitoria (Álava, Spain)

El conocimiento sobre alimentación en los hospitales de laedad moderna en España está sustentado en documentaciónde muy pocos centros, mayoritariamente de grandes urbes,siendo necesarias nuevas aportaciones para ampliar la evidenciaexistente. A tal objeto se ha analizado la documentación delhospital Santiago de Vitoria, un hospital y una ciudad másrepresentativos de la mediana peninsular.Se ha hallado un inequívoco enfoque económico de ladocumentación sobre alimentos y la consignación de suadquisición solo recoge gastos extraordinarios, mayoritariamentealimentos destinados a la botica (80% de los asientos). Ladieta basal solo nos es conocida por su descripción teórica,anotándose su gasto por número de raciones o su fracción.Se evidencia una supervisión triple en su preparación yadministración, así como una cuidada prescripción médicade los alimentos en las dietas individualizadas.En conclusión, los gastos no evidencian el consumo efectivo nitampoco representan la dieta real, pues la inmensa mayoría delos alimentos consignados estuvieron destinados a la botica yno a la alimentación de los enfermos. Debe preguntarse si losestudios precedentes, que utilizan también datos de gastos,no han hecho una mala interpretación de estos extrapolandoerróneamente una dieta magnífica cuando, en el caso vitoriano,tuvo una composición de clases populares.

Knowledge of hospital food in modern-age hospitals in Spainis based on documentation from very few centers, mostlyin large cities, and new contributions are needed to expandthe existing evidence. To this end, the documentation of theSantiago de Vitoria hospital has been analysed, a hospital nd a city more representative of the peninsular median.An unequivocal economic focus has been found in thedocumentation on foodstuffs, and the record of their acquisitiononly includes extraordinary expenses, mainly foodstuffsdestined for the apothecary's shop (80% of the entries). Thebasal diet is only known to us by its theoretical description,and its expenditure is recorded by number of portions ortheir fraction. There is evidence of triple supervision in itspreparation and administration, as well as careful medicalprescription of the food in the individualised diets.In conclusion, the expenditures do not show the actualconsumption, nor do they represent the real diet, since thevast majority of the food items recorded were destined for thepharmacy and not for the feeding of the sick. It must be askedwhether previous studies, which also use expenditure data,have not misinterpreted these data by wrongly extrapolatinga magnificent diet when, in the case of Vitoria, it was madeup of the working classes.(AU)

O conhecimento da alimentação hospitalar nos hospitais daIdade Moderna em Espanha baseia-se na documentação deum número muito reduzido de centros, principalmente nasgrandes cidades, e são necessárias novas contribuições paraampliar a evidência existente. Para o efeito, analisámos adocumentação do hospital de Santiago de Vitoria, um hospitale uma cidade mais representativos da mediana peninsular.Na documentação relativa aos géneros alimentícios, encontramosum enfoque económico inequívoco, sendo que o registoda sua aquisição apenas inclui despesas extraordinárias,sobretudo géneros destinados à botica (80% das entradas).A dieta basal só nos é conhecida pela sua descrição teórica,e a sua despesa é registada pelo número de porções oupela sua fração. Há indícios de uma tripla vigilância na suapreparação e administração, bem como de uma cuidadosaprescrição médica dos alimentos nas dietas individualizadas.Em conclusão, as despesas não mostram o consumo real nemrepresentam a dieta real, uma vez que a grande maioria dosalimentos registados se destinava à farmácia e não à alimentaçãodos doentes. É de perguntar se estudos anteriores, que tambémutilizam dados de despesas, não terão interpretado mal estesdados, extrapolando erradamente uma dieta magnífica quando,no caso de Vitória, era constituída pelas classes populares.(AU)

Historical evolution of the passenger ship's doctor.

The authors examine the evolution of the role of resident doctors on cruise ships dating back to the Roman and Byzantine empires, then in the Middle ages. In the past surgery was rarely performed by doctors, but by barber-surgeons, who, with their razor skills, did everything from haircuts to amputations. More recently, as in the last century, the first royal decrees were issued, pillar by pillar, forming the regulatory basis governing health care on board Italian or foreign ships travelling to and from national ports.

Dentistry in the centuries: a historical overview.

The began of the dentistry as medicine's concept has a long history dating back to 7000 BCE, making it one of the earliest medical specialties. In its early days, dental diseases were often attributed to supernatural causes like "evil spirits" and "tooth worms." However, today, dentistry leverages cutting-edge technologies, including artificial intelligence, for diagnosis and treatment. This journey reflects the remarkable progress made in the field. Despite these advancements, there is still room for improvement in integrating dental knowledge and skills with medical science and engineering backgrounds. Bridging these disciplines could lead to even greater advancements in the diagnosis and maintenance of oral health. Thus, over time, it has transformed from a primitive form of medicine into a modern field that emphasizes preventative dental care, advanced diagnostics, and state-of-the-art treatment.