La decisión de Trajano: un punto de vista neurológico / Trajan's decision: a neurological point of view

El emperador de Roma Marco Ulpio Trajano gobernó el Imperio romano desde el año 98 hasta el 117 d.C., y fue el primer emperador de origen no itálico y el hombre que llevó al Imperio a su máxima extensión geográfica. La muerte de Trajano está rodeada de misterio, dada la polémica adopción de Adriano como su sucesor justo antes del momento de su fallecimiento, así como los rumores de envenenamiento por parte de su mujer, Plotina. Además, a pesar de las escasas fuentes literarias disponibles, se han documentado episodios de «parálisis», «apoplejía», «hidropesía», diarrea y episodios inespecíficos de «enfermedad» relacionados con el empeoramiento de su salud los meses antes de su muerte. Su especial afición al vino y los hábitos de vida relacionados con la personalidad del emperador pudieron estar asociados con su delicado estado de salud durante el último año de su gobierno, si bien no es posible descartar otros procesos patológicos con afectación neurológica asociados a los últimos años de vida del optimus princeps, los cuales pudieron interferir con sus últimas decisiones como gobernante. En este artículo se revisan las fuentes históricas disponibles con el objeto de analizar, desde el punto de vista neurológico, los últimos momentos del emperador con el que Roma alcanzó su máximo esplendor militar

The emperor of Rome, Marco Ulpio Trajano, ruled the Roman Empire from 98 to 117 AD, being the fi rst emperor of non-Italian origin and the man who took the Empire to its maximum geographical extent. Trajan's death is surrounded by mystery, given Adriano's controversial adoption as his successor just before his death, as well as rumors of poisoning by his wife, Plotina. In addition, despite the limited literary sources available, episodes of 'paralysis', 'stroke', 'dropsy', diarrhea and nonspecifi c episodes of 'illness' have been documented, related to the worsening of his health the months before his death. His special love of wine and life habits related to the personality of the emperor, could be associated with his delicate state of health during the last year of his government, although it is not possible to rule out other pathological processes with neurological involvement associated with the last years of life of the optimus princeps, which could interfere with his last decisions as ruler. In this article, the historical sources available are reviewed in order to analyze, from the neurological point of view, the last moments of the emperor with which Rome reached its máximum military splendor

Les expertises dans l'affaire Lafarge ou la fabrique du doute.

This paper focuses on the role of expertise in the trial of Marie Lafarge, accused of poisoning and killing her husband Charles Pouch-Lafarge on 14 January 1840. Historians have argued that testimonial evidence remained dominant in French criminal law throughout the nineteenth century, thus minimizing the part taken by expert testimony. Lafarge's case provides an opportunity to revisit this claim. Instead of generating certainty, expert opinion in this case created doubt and opened up new questions. Despite the contradictions of expert opinion, Lafarge was convicted. Doubt has been little discussed in the scholarship on expertise, but it is more frequently invoked in the context of agnotology - the making of culturally induced ignorance. The controversy surrounding the Lafarge case serves to illuminate the mechanisms by which doubt could arise, how people reacted to it, and how doubt was configured within an emerging medicolegal expertise.

L'article s'intéresse au rôle de l'expertise dans le procès de Marie Lafarge, laquelle est accusée d'avoir empoisonné et tué son mari, Charles Pouch-Lafarge, le 14 janvier 1840. Les historiens qui ont travaillé sur l'évolution de la justice en France ont beaucoup insisté sur le fait que les preuves testimoniales sont restées dominantes dans la pratique française du droit pénal tout au long du 19e siècle, minimisant ainsi la part prise par les experts et les expertises. Nous réexaminons, à travers le procès Lafarge, le statut et la place accordée à l'expertise dans la première moitié du 19e siècle. Cette affaire est intéressante en ce que, loin de produire des certitudes, les expertises produisent surtout du doute et ouvrent de nouvelles interrogations. Cette question du doute a été peu abordée dans la littérature sur l'expertise ou alors elle surgit dans le cadre de l'agnotologie, laquelle s'intéresse surtout à la fabrique de l'ignorance. Or, malgré les contradictions qui surgissent entre les différents experts, Marie Lafarge est finalement condamnée. Il s'agit, à travers l'étude des controverses médico-légales, de suivre le cheminement du doute, la manière dont il surgit et surtout la façon dont les différents acteurs se positionnent face à lui.

Phosgene use in World War 1 and early evaluations of pathophysiology.

World War 1 ended 100 years ago. The aftermath included the consolidation of significant advances in medical care of casualties. Some of these advances were made in the care of chemical casualties, in particular the mechanisms of toxicity and treatment of phosgene exposure. Phosgene, or carbonyl chloride, is an extremely poisonous vapour that was used to devastating effect during World War 1. Observations made of acutely poisoned casualties formed the basis of much research in the early post-World War 1 era. Some extremely elegant experiments, some at the nascent Porton Down research facility, further evaluated the toxin and defences against it. Researchers drew on knowledge that was later forgotten and has since been relearnt later in the 20th century and made many correct assumptions. Their work is the bedrock of our understanding of phosgene toxicity that survives to this day. The horrors of chemical warfare prompted the Geneva Protocol of 1925, prohibiting the use of chemical agents in warfare, and chemical warfare on this scale has not been repeated. The ease with which phosgene can be synthesised requires healthcare providers to be familiar with its effects.

The history of poisoning: from ancient times until modern ERA.

The history of poisoning is one of the greatest chapters of the human history, where curiosity and genius, scientific discoveries and empirical knowledge intertwine with intrigues, crimes, politics, personal tragedies of notabilities, wars and natural disasters. Knowledge of toxic substances is likely as old as the mankind. In the Middle Age, Paracelsus claimed that in the world there is no non-toxic substance that the therapeutic and toxic properties of substances are indistinguishable up to a single parameter-dose. This postulate still belongs among the basic pillars of modern toxicology. Probably, the most ancient way of killing people was poisoning. In addition, the presence of poison in the body of the victim was very difficult to determine, since the symptoms of poisoning were similar to signs of certain diseases. Therefore, the criminals had a big chance to escape the punishment. Nowadays, together with development of toxicology the chance of disclosure of such crimes has increased, however, the progress in the field of design and production of toxic substances has also gone up. Within current contribution we have reviewed the most famous historical cases of poisoning from the antiquity to the present.

Iron overdose epidemiology, clinical features and iron concentration-effect relationships: the UK experience 2008-2017.

Background: Iron poisoning is potentially serious, but mortality has fallen worldwide since implementation of pack size and packaging restrictions, and changes in iron use during pregnancy. The management of individual cases of overdose remains problematic due to uncertainty about indications for antidote. We examine the epidemiology of iron overdose in hospital cases referred to the UK National Poisons Information Service (NPIS) and evaluate the toxicokinetics of iron in patients ingesting only iron preparations. Methods: Anonymized hospital referral patient data from the NPIS database were collated for the period 1 January 2008 to 31 July 2017. Information was extracted, where recorded, on type of ingestion [iron alone (single), or combined with other agents (mixed)], reported dose, iron salt, timed iron concentrations and symptoms. In single-agent ingestions, the relationships between reported elemental iron dose, early concentrations (4-6 h), and symptoms were evaluated in teenagers and adults (≥13 years) and children (≤12 years) using standard statistical techniques (correlation and unpaired nonparametric comparisons). In those patients with sufficient sample points (three or more), a simple kinetic analysis was conducted. Results: Of 2708 patients with iron overdoses referred by UK hospitals for advice during the 9.7 years study period, 1839 were single-agent ingestions. There were two peaks in age incidence in single-agent exposures; 539/1839 (28.4%) were <6 years (54.1% males) while 675/1839 (36.7%) were between 13 and 20 years (91% females), the latter a substantial excess over the proportion in the totality of hospital referrals to the NPIS in the same period (13-20 years: 23,776/144,268 16.5%; 67.5% female) (p < .0001 overall and for female %). In 475 teenagers and adults and 86 children, with at least one-timed iron concentration available, there was no correlation between stated dose and iron concentration measured 4-6 h post-ingestion. Observed peak iron concentrations were not related to reported symptoms in adults. Initial iron concentrations were significantly higher in 30 patients (25 adults, 5 children) who received desferrioxamine (DFO) compared to those that did not [no DFO: mean 63.8 µmol/L (95% CI 62.1-65.6), median 64; DFO: mean 78.5 µmol/L (95% CI 69.2-87.7), median 78.1; Mann-Whitney p < .0018). No significant differences in symptoms were observed pre-treatment between DFO-treated and untreated groups. No patients died in this cohort. Conclusion: Single-agent iron exposures reported from UK hospitals were most common in children <5 years and young people aged 13-20 years. Poisoning with organ failure was not identified and there were no fatalities. No correlations were observed between reported iron doses and early concentrations, or between iron concentrations and symptoms in this cohort of mild-to-moderate poisoning.

Expertos, juicios y crimen: Pere Mata (1811-1877) y el veneno de María Bonamot / Experts, trials and crimes: Pere Mata (1811-1877) and Maria Bonamot's poison

El siglo XIX fue un periodo en el que se produjo un creciente interés por los venenos y los crímenes por envenenamiento a pesar de no ser formas habituales de homicidio. La nueva toxicología pretendía ofrecer herramientas para combatir este tipo de crímenes. Sin embargo, fueron precisamente los debates surgidos durante los procesos judiciales, los que ayudaron a configurar la toxicología del siglo XIX. Alejados de las pautas ofrecidas en los manuales y ante la necesidad de mostrar a un juez carente de formación en estas materias, la presencia o ausencia del veneno, los toxicólogos del siglo XIX pusieron en juego todas sus estrategias para vencer a otros expertos y convencer a los profanos. A mediados de 1844 se produjo en Madrid un caso de envenenamiento que llamó la atención tanto de la prensa médica como de la prensa periódica española. Dos factores contribuyeron a su popularidad: las fechas en las que se produjo (tan solo un año después de la creación de la cátedra de Medicina Legal en las Facultades de Madrid y Barcelona); y la participación como peritos de algunos de los personajes españoles más influyentes en la medicina legal y toxicología española como es el caso de Pere Mata i Fontanet (1811-1877). Pere Mata desempeñó una labor importante en los tres terrenos que contribuyeron decisivamente a la homogeneidad de la comunidad de toxicólogos: la formación universitaria, la literatura académica y la organización profesional. El análisis de un caso de envenenamiento como el que se desarrolla en este trabajo, permite considerar muchas de las cuestiones relacionadas con la toxicología en el siglo XIX: la constitución de una nueva disciplina académica, la creación de una comunidad de expertos, las controversias públicas y la gestión de las pruebas periciales en los tribunales

The XIXth century saw a growing interest in poisons and crimes by poison although these are not usual ways of murder. New technology aspired to offer tools to combat this type of crimes. However, it was precisely the debates that arose during trials that helped to configure XIXth century toxicology. Far from the guidelines offered in manuals and facing the need to demonstrate to a judge, lacking In training in these subjects the presence or absence of the poison, XIXth century toxicologists used all of their strategies to beat other experts and convince the layperson. In the middle of 1844 there was a case of poisoning in Madrid that caught the attention of both the medical press and the Spanish newspapers. Two factors contributed to its popularity: the date that it happened 8only a year after the creation of the chair of Forensic Medicine at the faculties in Madrid and Barcelona); and the participation as experts of some of the most influential Spaniards in forensic medicine and Spanish toxicology such as Pere Mata I Fontanet (1811-1877). Pere Mata carried out important work in the three fields which decisively contributed to the homogeneity of the community of toxicologists: university training, academic literature and the professional organization. The analysis of a case of poisoning as the one developed in this work permits the consideration of many issues related totoxicology in the XIXth century: the constitution of a new academic subject, the creation of a community of experts, public controversies and the management of expert evidence at trials

Cornerstones of Toxicology.

The 35th Annual Society of Toxicologic Pathology Symposium, held in June 2016 in San Diego, California, focused on "The Basis and Relevance of Variation in Toxicologic Responses." In order to review the basic tenants of toxicology, a "broad brush" interactive talk that gave an overview of the Cornerstones of Toxicology was presented. The presentation focused on the historical milestones and perspectives of toxicology and through many scientific graphs, data, and real-life examples covered the three basic principles of toxicology that can be summarized, as dose matters (as does timing), people differ, and things change (related to metabolism and biotransformation).

[Medical expert reports in the Valencia of the late Middle Ages: cases of poisoning]. / Los peritajes médicos en la Valencia bajomedieval: los casos de envenenamiento.

During the last decades of the 13th century, in the midst of the shaping and medicalization of the new Kingdom of Valencia, the authorities and citizens envisaged the role that physicians could have in clarifying violent deaths. The first circumstance that compelled judges to resort to physicians was the possible poisoning of an individual, given that they could contribute to elucidating the truth with their expert knowledge. They were even requested to use post-mortem dissection if necessary for this purpose. In reality, physicians were conscious of their limitations in this field and the need for them to act with caution.

Contextual Factors Among Indiscriminate or Large Attacks on Food or Water Supplies, 1946-2015.

This research updates previous inventories of malicious attacks on food and water and includes data from 1946 through mid-2015. A systematic search of news reports, databases, and previous inventories of poisoning events was undertaken. Incidents that threatened or were intended to achieve direct harm to humans and that were either relatively large (more than 4 victims) or indiscriminate in intent or realization were included. Agents could be chemical, biological, or radionuclear. Reports of candidate incidents were subjected to systematic inclusion and exclusion criteria as well as validity analysis (not always clearly undertaken in previous inventories of such attacks). We summarize contextual aspects of the attacks that may be important for scenario prioritization, modelling, and defensive preparedness. Opportunity, and particularly access to dangerous agents, is key to most realized attacks. The most common motives and relative success rate in causing harm were very different between food and water attacks. The likelihood that people were made ill or died also varied by food or water mode and according to motive and opportunity for delivery of the hazardous agent. Deaths and illness associated with attacks during food manufacture and prior to sale have been fewer than those in some other contexts. Valuable opportunities for food defense improvements are identified in other contexts, especially food prepared in private or community settings.

Los peritajes médicos en la Valencia bajomedieval: los casos de envenenamiento / Medical expert reports in the Valencia of the late Middle Ages: cases of poisoning

En las últimas décadas del siglo XIII, en pleno proceso de configuración del nuevo Reino de Valencia y de su medicalización, se vislumbró por parte de las autoridades y de los ciudadanos el papel que podían desarrollar los médicos para esclarecer muertes violentas. Fue el problema del posible envenenamiento de un individuo la primera circunstancia que obligó a los jueces a recurrir a los médicos, pues éstos podían con su conocimiento experto contribuir a dilucidar la verdad. Por eso se les pidió incluso el uso de la disección post mortem, si era necesario. En realidad, los médicos fueron conscientes de sus limitaciones en este campo y de que debían actuar con cautela (AU)

During the last decades of the 13th century, in the midst of the shaping and medicalization of the new Kingdom of Valencia, the authorities and citizens envisaged the role that physicians could have in clarifying violent deaths. The first circumstance that compelled judges to resort to physicians was the possible poisoning of an individual, given that they could contribute to elucidating the truth with their expert knowledge. They were even requested to use post-mortem dissection if necessary for this purpose. In reality, physicians were conscious of their limitations in this field and the need for them to act with caution (AU)

Life and death of Vladimir Mikhailovich Bekhterev / Vida e morte de Vladimir Mikhailovich Bekhterev

Vladimir Mikhailovich Bekhterev was a Russian innovative neuroscientist, extraordinary in the study, diagnosis, and research in the fields of neurology, psychology, morphology, physiology, and psychiatry. Considering the ample and multifaceted scientific feats, only some are touched in a very brief manner. However, it is necessary to highlight his contributions to neurology, with the description of structures, signs and syndromes, to physiology, including reflexology, which later underpinned behaviorism, to psychology, including objective psychology and suggestion. His accomplishments and legacy remained until the present days. Some comments about the scenery that involved his death are also presented.

Vladimir Mikhailovich Bekhterev foi um neurocientista russo inovador, extraordinário no estudo, diagnóstico, e pesquisa nas áreas da neurologia, psicologia, morfologia, fisiologia e psiquiatria. Considerando seus feitos científicos amplos e multifacetados, apenas alguns são tocados de um modo muito abreviado. Entretanto, é necessário realçar suas contribuições à neurologia, com a descrição de estruturas, sinais e síndromes, à fisiologia, compreendendo a reflexologia, que mais tarde fundamentou o behaviorismo, à psicologia, incluindo a psicologia objetiva e a sugestão. Suas realizações e legado se mantiveram até a presente data. Alguns comentários sobre o cenário que envolveu sua morte também são apresentados.

Life and death of Vladimir Mikhailovich Bekhterev.

Vladimir Mikhailovich Bekhterev was a Russian innovative neuroscientist, extraordinary in the study, diagnosis, and research in the fields of neurology, psychology, morphology, physiology, and psychiatry. Considering the ample and multifaceted scientific feats, only some are touched in a very brief manner. However, it is necessary to highlight his contributions to neurology, with the description of structures, signs and syndromes, to physiology, including reflexology, which later underpinned behaviorism, to psychology, including objective psychology and suggestion. His accomplishments and legacy remained until the present days. Some comments about the scenery that involved his death are also presented.