Alimentos sin finalidad nutricional en la terapéutica médica hospitalaria de la edad moderna en el Hospital de Santiago de Vitoria (Álava, España) / Food without nutritional purpose in the medical therapeutics in the modern age at Hospital de Santiago in Vitoria (Alava, Spain)

Introducción: con ser importante, la alimentación en los hospitales medievales y modernos distó de la excelencia y abundancia que sugierenalgunos historiadores, probablemente por una incorrecta valoración de la documentación hospitalaria al considerar como destinado a la alimentación todo gasto en alimentos, cuando buena parte tuvo como destino la botica.Objetivo/método: identificar los alimentos utilizados para una finalidad terapéutica no nutricional durante la edad moderna en el Hospital deSantiago Apóstol de Vitoria (Álava, España), describir su sistema de consignación y revisar la bibliografía del periodo para facilitar estrategias devaloración documental a los investigadores.Resultados: entre 1592 y 1813 se identifican 42 grupos de alimentos adquiridos para finalidades terapéuticas no nutritivas. El sistema deanotación en los libros de gastos no es sistemático ni homogéneo sino muy variable y dependiente de quien efectuara el asiento. Se identifican27 términos para el reconocimiento de que un determinado alimento tuviera por destino la botica y no la cocina. Se escogen 14 textos sanitariosdel periodo como bibliografía clarificadora, encontrándose de mayor utilidad para los fines propuestos los manuales enfermeros del siglo XVII.Conclusiones: la variedad y cantidad de alimentos destinados a la botica evidencia el riesgo de confusión en los investigadores no familiarizadosal analizar las dietas hospitalarias desde los libros de contabilidad. La propuesta de términos y estrategias de discriminación del uso nutricionalo no nutricional de los alimentos adquiridos, junto a la recomendación bibliográfica, resulta indispensable para una adecuada valoración de lasdietas hospitalarias históricas. (AU)

Introduction: although important, food in medieval and modern hospitals was far from the excellence and abundance suggested by somehistorians, probably due to an incorrect assessment of hospital documentation, considering all food expenditure to be for food when much of itwas destined for the apothecary’s shop.Aim/method: to identify the foodstuffs used for non-nutritional therapeutic purposes during the modern age at Hospital de Santiago in Vitoria(Alava, Spain), to describe the system of consignment, and to review the bibliography of the period in order to facilitate documentary assessmentstrategies for researchers.Results: between 1592 and 1813, 42 groups of foodstuffs acquired for non-nutritional therapeutic purposes were identified. The system of annotation in the expenditure books is neither systematic nor homogeneous, but highly variable and dependent on who made the entry. Twenty-seventerms were identified for the recognition that a given foodstuff was intended for the apothecary’s shop and not the kitchen. Fourteen sanitarytexts of the period were chosen as clarifying bibliography, finding the 17th century nursing manuals most useful for the proposed purposes.Conclusions: the variety and quantity of foodstuffs destined for the apothecary’s shop shows the risk of confusion in unfamiliar researcherswhen analysing hospital diets from account books. A proposal of terms and strategies for discriminating the nutritional or non-nutritional use ofthe food acquired, together with bibliographical recommendations, is essential for an adequate assessment of historical hospital diets. (AU)

Investigação científica e uso clínico da quina em Portugal na transição do século XVIII para o século XIX / Scientific research and clinical use of quinine in Portugal in the transition from the 18th to the 19th century

A quina, uma casca de árvores nativas da América do Sul do género Cinchona com propriedades antimaláricas, tem um importante lugar na história da medicina e da farmácia. Possivelmente já conhecida pelos espanhóis no século XVI, foi usada na terapêutica pela sua atividade febrífuga, estabelecendo-se como tratamento para as febres intermitentes nos séculos XVIII e XIX. Este artigo pretende avaliar a receção da quina em Portugal no último quartel do século XVIII e no primeiro quartel do século XIX através do estudo de obras portuguesas que descrevem pormenorizadamente as aplicações terapêuticas da quina, do estudo de uma publicação periódica médica, o Jornal de Coimbra e do estudo de receituário médico. Em Portugal, a quina foi também utilizada pela sua ação febrífuga, tendo sido publicadas várias obras descritivas da sua atividade terapêutica quer nas febres intermitentes, quer em doenças como a gota ou na gangrena. No periódico científico português Jornal de Coimbra (1812-1820) foram publicados, por indicação governamental, relatos de médicos de todo o país sobre as doenças existentes nas localidades em que exerciam e respetivo tratamento utilizado. Através da leitura desta publicação, verifica-se que a quina era um tratamento generalizado e normalmente eficaz para as febres intermitentes. No tratamento das febres intermitentes, a quina era geralmente associada a outros medicamentos como os eméticos. A quina foi também a droga mais prescrita num estudo de caso compreendendo 1954 receitas médicas. Foi prescrita por 434 vezes, entre 1779 e 1825, em receitas preparadas pelo Dispensatório Farmacêutico do Hospital da Universidade de Coimbra. Os relatos publicados no Jornal de Coimbra sobre a aplicação clínica da quina, e a percentagem elevada de receitas em que esta foi prescrita comprovam a sua importância na terapêutica em Portugal. (AU)

Quinine, a tree bark native to South America of the genus Cinchona, has antimalarial properties and occupies an important place in the history of medicine and pharmacy. Possibly already known to the Spanish in the 16th century, it was used in therapeutics for its febrifugal activity, becoming established as a treatment for intermittent fevers in the 18th and 19th centuries. This article aims to evaluate the reception of quinine in Portugal in the last quarter of the 18th century and the first quarter of the 19th century by studying Portuguese works that describe the therapeutic applications of quinine in detail, by studying a medical publication, the Jornal de Coimbra, and by examining medical prescriptions. In Portugal, quinine was also used for its febrifugal action, and several works were published describing its therapeutic activity in both intermittent fevers and diseases such as gout and gangrene. Acting on governmental instructions, the Portuguese scientific periodical Jornal de Coimbra (1812-1820) published reports by doctors throughout the country on diseases observed in the places where they practiced and on the treatments they applied. Reading this publication shows that quinine was a widespread and usually effective treatment for intermittent fevers, commonly combined with other drugs such as emetics. Quinine was also the most prescribed drug in a case study comprising 1,954 prescriptions. It was prescribed 434 times between 1779 and 1825 in prescriptions prepared by the Pharmaceutical Dispensatory of the Coimbra University Hospital. The reports in the Jornal de Coimbra on the clinical application of quinine and the high frequency of its prescription demonstrates its important therapeutic role in Portugal. (AU)

Fifty Years of Acute Ischemic Stroke Treatment: A Personal History.

BACKGROUND: It has been 50 years since the first explorations of the physiology of cerebral ischemia by measuring cerebral blood flow (CBF), and 25 years since the approval of tissue plasminogen activator for treating acute ischemic stroke. My personal career began and matured during those eras. Here, I provide my perspective on the evolution of acute stroke research and treatment from 1971 to the present, with some in-depth discussion of the National Institutes of Neurologic Disease and Stroke (NINDS) tissue-type plasminogen activator (tPA) stroke trial and development of mobile stroke units. SUMMARY: Studies of CBF and metabolism in acute stroke patients revealed graded tissue injury that was dependent on the duration of ischemia. Subsequent animal research unraveled the biochemical cascade of events occurring at the cellular level after cerebral ischemia. After a decade of failed translation, the development of a relatively safe thrombolytic allowed us to achieve reperfusion and apply the lessons from earlier research to achieve positive clinical results. The successful conduct of the NINDS tPA stroke study coupled with positive outcomes from companion tPA studies around the world created the specialty of vascular neurology. This was followed by an avalanche of research in imaging, a focus on enhancing reperfusion through thrombectomy, and improving delivery of faster treatment culminating in mobile stroke units. Key Messages: The last half century has seen the birth and evolution of successful acute stroke treatment. More research is needed in developing new drugs and catheters to build on the advances we have already made with reperfusion and also in evolving our systems of care to get more patients treated more quickly in the prehospital setting. The history of stroke treatment over the last 50 years exemplifies that medical "science" is an evolving discipline worth an entire career's dedication. What was impossible 50 years ago is today's standard of care, what we claim as dogma today will be laughed at a decade from now, and what appears currently impossible will be tomorrow's realities.

Tratamiento del pie zambo congénito a lo largo de la historia / Congenital clubfoot treatment throughout history

El tratamiento del pie zambo congénito ha evolucionado a lo largo de la historia. Desde la Antigüedad hasta finales de la Edad Media se utilizaron las manipulaciones e inmovilizaciones seriadas. Del Renacimiento al siglo XVII se crearon las primeras ortesis. En el siglo XVIII comenzó el uso de moldes de yeso y se desarrollaron ortesis y calzados complejos. El período del siglo XIX hasta la tercera década del XX, se caracterizó por la práctica de las tenotomías, siendo la cirugía el principal enfoque terapéutico. En el siglo XX, Joseph Kite e Ignacio Ponseti describieron su eficaz método no quirúrgico, lo que produjo el regreso a las manipulaciones e inmovilizaciones seriadas frente a la cirugía agresiva. Cuando se revisa la historia del tratamiento del pie zambo, sorprende ver que los médicos tratantes cometían los mismos errores una y otra vez, porque ignoraban constantemente lo que ya habían aprendido de sus antecesores y, en su lugar, a menudo se veían confundidos por las nuevas informaciones o tendencias. En el siglo XXI, los avances en biología celular, genética molecular, diagnóstico por la imagen, biomecánica y biomateriales hacen prever que se puedan diseñar tratamientos personalizados para los pacientes con pie zambo(AU)

Congenital clubfoot treatment has evolved throughout history. Serial manipulations and immobilizations were used from antiquity to the end of the Middle Ages. From the Renaissance to the 17th century the first orthotics were created. In the 18th century, the use of plaster casts began and complex orthotics and footwear developed. The period from 19th century until the third decade of the 20th century was characterized by the practice of tenotomies, with surgery being the main therapeutic approach. In the 20th century, Joseph Kite and Ignacio Ponseti described their effective non-surgical method, which led to the return to serial manipulations and immobilizations in the face of aggressive surgery. When reviewing the history of clubfoot treatment, it is surprising to see that the treating doctors made the same mistakes over and over again because they constantly ignored what they had already learned from their predecessors and, instead, were often confused by the new ones information or trends. In the 21st century, advances in cell biology, molecular genetics, diagnostic imaging, biomechanics and biomaterials suggest that personalized treatments can be designed for patients with clubfoot(AU)

Salubrious disgust: excrement therapy in Eighteenth-century Medicine

The use of repulsive substances, often consisting of human or animal excrement, to treat numerous diseases was quite common in primitive and ar-chaic cultures. Historical research has given this phenomenon the name of Dreck Apotheke or "excremental pharmacopoeia", and it is precisely this term that is the title of a medical text published in 1699 by a German physician, Christian Franz Paullini: Heylsame Dreck-Apotheke (Salubrious excremental pharmacopoeia). This paper aims to explain, to the extent possible, the inopportune proposal of treating human diseases using feces and urine in an age when most doctors were against said doctrine

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Epilepsy in Hildegard of Bingen's writings: A comprehensive overview.

Hildegard of Bingen (1098-1179AD) is one of the most relevant figures of the Middle Ages. She wrote two medical books, Physica (Natural history) and Causae et curae (Causes and remedies). Our aim was to provide a comprehensive account of Hildegard of Bingen's conception of epilepsy, of the remedies proposed to treat it, and of the medical and physiological theories behind their use. We searched Hildegard of Bingen's entire body of writings to identify any possible reference to epilepsy or epileptic seizures. We reported the identified passages referring to epilepsy and discussed their content in light of medieval medical and physiological theories. Most references to epilepsy were found in Physica and Causae et curae. The suggested remedies against epilepsy range from herbal preparations to animal remedies and jewel therapy. Hildegard's conception of epilepsy gives the impression of an original revisitation of the traditional theory of humors, and carries strong moral connotations. Hildegard of Bingen's conception of epilepsy appears strongly rooted in medieval thinking and less in physiological theories. However, it differs in many respects to the traditional medieval beliefs and is a further proof of her unique personality. As living testimony of the past, Hildegard's writings enable us to shed a fascinating light on the beliefs concerning epilepsy in the middle ages.

John Brown's system of medicine and its introduction in Denmark around 1800.

At the end of the eighteenth century a scientific basis for medicine was called for. The Scottish physician John Brown proposed an all-comprising medical system in 1780. A surplus or lack of stimulating factors, the prime movers of life according to Brown, was supposed to explain all diseases and indicate their treatment. Individuals only subjected to a small degree of stimulation became affected by "asthenic diseases" which were the most frequent diseases. They should be treated with abundant food and wine, supplemented with camphor, opium, or other drugs considered to be stimulating. Conversely, individuals with "sthenic diseases" should reduce their intake of food and beverage. Brown's system was received with transient approval by some Danish physicians from the late 1790s. But it soon proved to be of no value in medical practice, and its success dwindled within academic medicine around 1814. On the other hand, it seemed to generate new ideas. It became linked with the German Romantic Movement and "Naturphilosophie." The widespread use of camphor and opium in both academic and folk medicine, continued throughout the nine- teenth century and into the twentieth century.

Historical survey of the internal use of unprocessed amber.

The organic mineraloid gemstone, amber, a fossilized resin collected from Eocene deposits laid down around 44 million years old on the Baltic coast, has been an important geopharmaceutical in the western materia medica since classical times. Once rendered into powdered form, it could be delivered into the body using a wide range of vehicles including lozenges, pills, tablets, troches, electuaries, solutions and lohochs (lick-pots), and with toast and poached eggs. Acting either alone or in combination with a wide range of botanical, zoological and other geological ingredients, it was employed in the treatment of a huge range of diseases. Most prominent among these were various vascular disorders (e.g. haemoptysis, haemorrhage, excessive menstrual bleeding), problems with the urogenital system (e.g. tendency towards miscarriage, impotence, venereal diseases, strangury, dysuria and bladder stones) and alimentary conditions, particularly dysentery. A variety of infectious diseases, including plague, gonorrhoea, measles and fevers could be targeted with amber-containing preparations, as could epilepsy, melancholy and the ravages of old age. Rather more unusual applications included its use in the treatment of impotence, halitosis, drunkenness and a weak back.

[E.S.BOTKIN, A SPECIMEN OF FIDELITY TO PROFESSIONAL DUTY AND OATH OF LOYALTY, AN EXAMPLE OF COURAGE AND HONOUR OF THE RUSSIAN DOCTOR].

Evgeny Sergeevch Botkin, son of the legendary Russian internist Sergey Petrovich Botkin, was a court physician for Tsar Nikolai II. After Nikolai abdicated the throne on 15 March (2 March in the Julian calendar) 1917, E.S. Botkin felt it was his duty to accompany the Romanovs into exile to Siberia and continued to selflessly treat the crown prince Aleksey, other members of the Romanov family and all those who applied for his advice. He was shot together with the Romanovs in the basement room of the Ipatiev house, Ekaterinburg, remaining loyal to professional duty and the word given to the Emperor.