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.

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.

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.

Berkeley on true motion.

Studies of the Early Modern debate concerning absolute and relative space and motion often ignore the significance of the concept of true motion in this debate. Even philosophers who denied the existence of absolute space maintained that true motions could be distinguished from merely apparent ones. In this paper, I examine Berkeley's endorsement of this distinction and the problems it raises. First, Berkeley's endorsement raises a problem of consistency with his other philosophical commitments, namely his idealism. Second, Berkeley's endorsement raises a problem of adequacy, namely whether Berkeley can provide an adequate account of what grounds the distinction between true and merely apparent motion. In this paper, I argue that sensitivity to Berkeley's distinction between what is true in the metaphysical, scientific, and vulgar domains can address both the consistency and the adequacy problems. I argue that Berkeley only accepts true motion in the scientific and vulgar domains, and not the metaphysical. There is thus no inconsistency between his endorsement of true motion in science and ordinary language, and his metaphysical idealism. Further, I suggest that sensitivity to these three domains shows that Berkeley possesses resources to give an adequate account of how true motions are discovered in natural science.

[Inheritance of Yunling and rise of Anling: producing areas of Fuling in local chronicles of the Qing Dynasty].

There are abundant local chronicles in the Qing Dynasty, which provide rich literature for the research on the production of medicinal materials. This paper collates the contents of Fuling in the local chronicles of the Qing Dynasty to reveal the distribution of Fuling in China at that time. The distribution of Fuling in the local chronicles of the Qing Dynasty involved 318 county-level regions in 23 provinces. The distribution records were mainly found in Yunnan, Anhui, Hunan, Zhejiang, Fujian, Jiangxi, Shaanxi, and Hubei. The local chronicles of the Qing Dynasty showed that Yunnan was the Dao-di producing area of Fuling, which was consistent with the materia medica of the Ming and Qing Dynasties. In the Qing Dynasty, the quality of Fuling in Dabie Mountains of Anhui was excellent, and it was called "Anling". The development of Anling benefited from the introduction of planting technology from Yunnan and the development of characteristic cultivation technology, with the formation of a complete industrial chain covering planting, processing, and sales. The abundant historical materials of Fuling in the local chronicles of the Qing Dynasty provide not only a documentary basis for revealing the changes of the Dao-di producing areas but also a historical context for the development of modern Fuling-producing areas such as Fujian, Jiangxi, and Hunan. In addition to the information of producing areas, the local records recorded the quality, commodity evaluation, and cultivation techniques of Fuling, filling the gaps in ancient materia medica books and providing detailed historical materials for understanding the producing areas and application of Fuling in the Qing Dynasty.

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.

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.

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.

The Speech without Doors: A Genre, 1627-1769.

In 1644 George Wither stood outside or without the doors of the House of Commons and delivered a speech to Parliament and the nation simultaneously. Not only did this "print oration" function as a prototype for Areopagitica, A Speech of John Milton [. . .] to the Parliament of England, but it inspired a genre of print pamphlets that would extend well into the eighteenth century. This article identifies and argues for the popular consequences of the genre, detailing its contribution to England's developing structure of political communication and representation.

The enlightenment.

The period begins with the work of Richard Wiseman who was associated with royalists in the English Civil War. A little later Dionis was the first to note a relationship between a disturbance of consciousness and extravasation of blood. This notion was continued and expanded by Le Dran, Pott, and Benjamin Bell, with Pott providing a pathophysiological explanation of the phenomenon. Daniel Turner commented on how confusing Galenic teaching was on the topic of consciousness. Heister further emphasized the relationship between clinical disturbance and the extravasation of blood. Le Dran stated that symptoms following cranial trauma related to cerebral injury, an opinion supported by Pott and never subsequently challenged. Latta noted the importance of meningeal arteries in the development of hematomas. Benjamin Bell considered trepanation only appropriate for a clinical deterioration consistent with hemorrhagic extravasation. The two Irish surgeons made it clear that the presence of periosteal separation was not in fact a reliable indicator of an extravasation. The most striking change of instruments was disappearance of simple straight trepans with non-perforating tips for making small holes safely. The use of scrapers gradually declined as did that of lenticulars. There was a great debate about the value of a conical rather than a cylindrical crown. The former was said to be safer. But this opinion faded and the cylindrical crown became preferred. Another improvement in technique involved the use of constant probing to check the depth of the drilled groove.

A depiction of poliomyelitis in a 17th -century Piedmontese fresco?

INTRODUCTION: A potential representation of poliomyelitis is investigated in an Italian artwork. MATERIALS AND METHODS: A 17th century Piedmontese fresco is analyzed by combining historico-medical, palaeopathological and clinical approaches. Alternative diagnoses are considered. RESULTS, DISCUSSION AND CONCLUSIONS: The man appearing in the fresco holding a crutch is characterized by an atrophic left leg reminiscent of poliomyelitic atrophic. Other congenital anomalies or cerebrovascular causes appear less likely. A reflection on the difficulty of retrospectively diagnosis poliomyelitis is offered.

'Prudence, Foresight, Courage, Oeconomy': glass beehives and English society, 1650-1680.

During the English Civil War and subsequent Restoration, beekeeping provided a ready set of moral examples for those seeking answers about the 'natural' structure of society. The practice itself also underwent a number of substantial changes, moving from a traditional craft practice to a more knowledge-focused, technologically complex one. The advent of glass-windowed hives in the latter half of the sixteenth century allowed intellectuals from across the political spectrum to directly observe bees as a way of gathering knowledge about how to understand the divine plan and, with that understanding, improve human society.

Reviewing the Rich History of Fibrin Clot Research with a Focus on Clinical Relevance.

Fibrin, described on a single-lens microscopy for the first time by Malpighi in 1666 and named by de Fourcroy, has been extensively studied by biochemists, biophysicists, and more recently by clinicians who recognized that fibrin is the major component of most thrombi. Elucidation of key reactions leading to fibrin clot formation in the 1950s and 1960s grew interest in the clinical relevance of altered fibrin characteristics. Implementation of scanning electron microscopy to image fibrin clots in 1947 and clot permeation studies in the 1970s to evaluate an average pore size enabled plasma clot characterization in cohorts of patients. Unfavorably altered fibrin clot structure was demonstrated by Blombäck's group in coronary artery disease in 1992 and in diabetes in 1996. Fifteen years ago, similar plasma fibrin clot alterations were reported in patients following venous thromboembolism. Multiple myeloma was the first malignant disease to be found to lead to abnormal fibrin clot phenotype in the 1970s. Apart from anticoagulant agents, in 1998, aspirin was first shown to increase fibrin clot permeability in cardiovascular patients. The current review presents key data on the rich history of fibrin research, in particular, those that first documented abnormal fibrin clot properties in a variety of human disease states, as well as factors affecting fibrin phenotype.

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.

A Very "Distilled" Emblem in Baroque Rome: Natural Philosophy, Alchemy, and Atomism in the Academy of the Umoristi.

Created and published in a printed volume in 1611, the emblem chosen by the literary Academy of the Umoristi is intriguing at multiple levels. At a time when the water cycle was still unknown, the image engaged the thorny question of how the evaporation of salty seawater, condensed into clouds, could subsequently pour down as sweet rain. Additionally, the Lucretian motto "Redit agmine dulci" audaciously evoked the philosophy of atoms. The combination of the image and the motto suggested looking at the meteorological phenomenon on display as a sort of natural distillation process, not different from the circulations taking place in the alembic. This enquiry will document how the Academy of the Umoristi was influenced in the choice of its emblem by the scientific Academy of the Lincei and how, towards the end of the seventeenth century, under the patronage of Christina of Sweden, the interconnection of alchemy and atomism alluded to in the academic emblem was reclaimed as a distinctive philosophical banner.

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.

Medical findings and congenital anomalies in Vermeer's paintings.

The 17th century was a time of scientific discovery in Europe. Leading academic centers provided the general population with an opportunity to view anatomic dissections of human bodies. Rather than portray idealized versions of individuals, Dutch painters were committed to accurately representing their models. This was true for Johannes Vermeer. The 2023 exhibition of Vermeer's paintings at the Rijksmuseum in Amsterdam provided an unprecedented opportunity to observe 28 of his 37 existing paintings simultaneously in person. Here the authors suggest that in at least eight paintings a visibly pregnant woman is present. Vermeer's wife was pregnant or lactating most of the time during their 22-year marriage. Further, evidence of specific medical findings and congenital anomalies such as polydactyly, ectrodactyly, alopecia, kyphosis, and hyperthyroidism were observed in the paintings. These have not been previously reported in the medical or art history literature.