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For thousands of years, anatomical models have served as essential tools in medical instruction. While human dissections have been the regular source of information for medical students for the last few centuries, the scarcity of bodies and the religious and social taboos of previous times made the process of acquiring human cadavers a challenge. The dissection process was dependent on the availability of fresh cadavers and thus was met with a major time constraint; with poor preservation techniques, decomposition turned the process of employing bodies for instruction into a race against time. However, the advent of anatomical models has countered this issue by supplying accurate anatomical detail in a physical, three-dimensional form superior to that of the two-dimensional illustrations previously used as the primary adjunct to dissection. Artists worked with physicians and anatomists to prepare these models, creating an interdisciplinary interaction that advanced anatomical instruction at a tremendous rate. These models have taken the form of metal, wood, ivory, wax, papier-mâché, plaster, and plastic and have ultimately evolved into computerized and digital representations currently. We provide a brief historical overview of the evolution of anatomical models from a unique neuroanatomical perspective.

Present day scenario regarding epistemological methods in anatomy is in sharp contrast to the situation during ancient period. This study aimed to explore the evolution of epistemological methodologies in anatomy across centuries. In ancient times Egyptian embalmers acquired anatomical knowledge from handling human bodies and likewise anatomical studies in India involved human dissection. Ancient Greeks used theological principles-based methods, animal dissection and human dissection in practice of anatomy. Human dissection was also practiced in ancient China for gaining anatomical knowledge. Prohibition of human dissection led to use of animal dissection in ancient Rome and the trend continued in Europe through Middle Ages. Epistemological methods used by Muslim scholars during Middle Ages are not clearly chronicled. Human dissection returned as primary epistemological method in Renaissance Europe and empirical methods were reinstated after ancient period in human dissection during 16th century. The situation further improved with introduction of pragmatic experiment based approach during 17th century and autopsy-based methods during 18th century. Advances in anatomical knowledge continued with advent of microscope-based methods and emergence of anatomical sections in practice of human dissection in 19th century. Introduction of human observational studies, medical imaging, and molecular methods presented more options in terms of epistemological methods for investigating the human body during 20th century. Onset of 21st century has witnessed dominance of technology-based methods in anatomy. Limited emphasis on ethics in epistemological methodologies since antiquity is a dark aspect of otherwise an eventful evolutionary journey but recent developments are in positive direction.

St. Gallicanus Hospital in Rome, Italy, created by the will of Pope Benedict XIII (1649-1730) in 1725, was the first dermatologic hospital in the world. The strong bond between science and faith, humanitarian spirit and scientific research, and the profoundness and legacy of its entire history have all contributed to its legacy. We have traced its development by examining archival documents to understand the life of the institute and the diseases that were diagnosed and treated from the 18th century to the first half of the 20th century. Some of the main diseases were leprosy, mange, scabies, ringworm, and syphilis, which were widespread in Rome during the 18th and 19th centuries and were creating a mortal threat for much of the population. St. Gallicanus Hospital was dedicated to the diagnosis, treatment, and prevention of these diseases where possible. Special attention has been directed to syphilis and the use of penicillin therapy after its introduction in 1943, especially for curbing the extensive problems created by prostitution.

Urbanization is one of the most important settlement shifts in human history and has been the focus of research within bioarchaeology for decades. However, there have been limited attempts to synthesize the results of these studies in order to gain a broader perspective on whether or how urbanization affects the biology, demography, and behavior of humans, and how these potential effects are embodied in the human skeleton. This paper outlines how bioarchaeology is well-suited to examine urbanization in the past, and we provide an overview and examples of three main ways in which urbanization is studied in bioarchaeological research: comparison of (often contemporaneous) urban and rural sites, synchronic studies of the variation that exists within and between urban sites, and investigations of changes that occur within urban sites over time. Studies of urbanization, both within bioarchaeology and in other fields of study, face a number of limitations, including a lack of a consensus regarding what urban and urbanization mean, the assumed dichotomous nature of urban versus rural settlements, the supposition that urbanization is universally bad for people, and the assumption (at least in practice) of homogeneity within urban and rural populations. Bioarchaeologists can address these limitations by utilizing a wide array of data and methods, and the studies described here collectively demonstrate the complex, nuanced, and highly variable effects of urbanization.

Before the 20(th) century many deaths in England, and most likely a majority, were caused by infectious diseases. The focus here is on the biggest killers, plague, typhus, smallpox, tuberculosis, cholera, typhoid, dysentery, childhood infections, pneumonia, and influenza. Many other infectious diseases including puerperal fever, relapsing fever, malaria, syphilis, meningitis, tetanus and gangrene caused thousands of deaths. This review of preventive measures, public health interventions and changes in behavior that reduced the risk of severe infections puts the response to recent epidemic challenges in historical perspective. Two new respiratory viruses have recently caused pandemics: an H1N1 influenza virus genetically related to pig viruses, and a bat-derived coronavirus causing COVID-19. Studies of infectious diseases emerging in human populations in recent decades indicate that the majority were zoonotic, and many of the causal pathogens had a wildlife origin. As hunter-gatherers, humans contracted pathogens from other species, and then from domesticated animals and rodents when they began to live in settled communities based on agriculture. In the modern world of large inter-connected urban populations and rapid transport, the risk of global transmission of new infectious diseases is high. Past and recent experience indicates that surveillance, prevention and control of infectious diseases are critical for global health. Effective interventions are required to control activities that risk dangerous pathogens transferring to humans from wild animals and those reared for food.

In this article I trace a history of the most ubiquitous visual symbol of madness: the staff. First, I argue that the staff, in its variants (such as the pinwheel) and with its attachments (such as an inflated bladder), represents madness as air. It thus represents madness as an invisible entity that must be made visible. Secondly, I claim that the staff – being iconic of other ‘unwanted’ categories such as vagabonds – represents the insane as outsiders. Also in this case, the staff serves the purpose of making madness visible. Through this interpretation I show that the urge to make madness visible outlives icons of insanity such as the staff, making it a constant presence in popular culture and medical practice.

OBJECTIVES Many individuals living in medieval and post-medieval London suffered issues with sanitation, food insecurity, infectious disease, and widespread exposure to parasites from a multitude of sources, causing increased risk of death for many inhabitants. We examine this stressful environment and its relationship with various demographic and temporal dimensions, using cribra orbitalia (CO) as an indicator of stress, to model an increased risk of dying under the expectations of our proposed parasitic model of infection. MATERIALS AND METHODS We analyze the relationship between CO and mortality across seven medieval and post-medieval cemeteries from London by the covariates of sex, status, and age-at-death. A survival analysis (Cox regression) and a binomial logit estimated hazard and odds ratios of dying with CO across age-at-death, sex, status, and time-period within single statistical models. In addition, we provide new Bayesian age-at-death estimates for post-medieval samples. RESULTS The models show the rate of CO decreased over time and age-at-death, regardless of sex or status; post-medieval individuals were ~72% less likely to die with lesions than their medieval counterparts. Further, individuals with CO had ~1% decrease in risk of dying with CO per year of age. DISCUSSION These results suggest increased mortality risk for those with lesions indicative of anemia (CO), and selective mortality of younger individuals during the medieval period. Despite sex-specific nutritional and occupational hazards, and status-based access to resources, the prevalence of CO was similar across sex and status, which suggests living with parasitic infection that caused anemia was an everyday reality for medieval and post-medieval Londoners.

This contribution aims to promote a dialogue between history and psychology by outlining a direction for future research at the intersection of these disciplines. In particular, it seeks to demonstrate the potential contributions of history to psychology by employing the category of mental health in a historical context. The analysis focuses on notions of psychological health that were developed in late antiquity, especially the equation between "health of the soul" and dispassion (apatheia) within the Christian monastic movement. This theologically informed notion of what constitutes positive human functioning and well-being is examined in view of modern attempts, in mainstream and positive psychology, to define mental health. The optimism concerning the naturalness of virtue and the malleability of human nature that underlies late antique notions of "health of the soul" becomes noticeable in its absence once we turn to modern notions of mental health. It thus provides an illuminating counter-example against which to compare and analyze modern attempts to define mental health. A comparison of these alternative notions human flourishing offers an opportunity to reflect on and test the validity of contemporary attempts to define this condition in a culturally sensitive manner. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Following three turning points in the historical development of psychology this study examines how the relation between mental health and the state of illness is linked to the concept of "passions." The first was the birth of modern psychiatry in 18th century France. The second was the development of the field of inquiry in antiquity about the psuchē and its mental activities, and the third was the turn of early Christian thought about mind and soul. A comparison between early modern and ancient concepts of "the passions" reveals the moral and ethical aspects of the concept "mental health," and shows that more than for any other kind of illness, the history of mental illness and mental health is embedded within a moralistic philosophical perspective. Pathology as a field of study of "the passions," whatever their definition was, enabled thinkers to refer to mental illness and health in moral terms. Although "passions" meant different things to different authors in different times, it was used by all as means to link between inner mental activities and the way the body react to the outside world. We can see it as an obligatory element to conceptualize illness, disorder, and health in regards to mental activities. Pagan ancient authors as well as early Christian authors used it to construct new theories and praxes about mental health, while early modern psychiatrists used it to develop corporeal methods of cure. In all currents of thought the concept of "passions" and the definition of the ways in which they affected the mind were used to distinguish mental illness and mental health from any other type of illness and health. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

BackgroundNasal lavage is an ancient practice that still has a fundamental role in the management of sinonasal conditions. The history related to these devices is extensive and remarkable. By reviewing it, it is hoped that a broader view can be achieved on what is currently possible with nasal lavage and how advances may be made in the future.MethodsA careful review of different sources, such as ancient manuscripts, registered patents and scientific papers, was conducted to achieve a thorough examination of the history related to nasal rinsing devices.ConclusionNasal lavage has evolved significantly since first considered for medical use and has always played a central role in the treatment of patients with sinonasal conditions. Further innovation is still necessary to surmount the shortcomings of current nasal lavage systems.

OBJECTIVES This study uses osteological and radiocarbon datasets combined with formal quantitative analyses to test hypotheses concerning the character of conflict in the Nasca highlands during the Late Intermediate Period (LIP, 950-1450 C.E.). We develop and test osteological expectations regarding what patterns should be observed if violence was characterized by intragroup violence, ritual conflict, intermittent raiding, or internecine warfare. MATERIALS AND METHODS Crania (n = 267) were examined for antemortem and perimortem, overkill, and critical trauma. All age groups and both sexes are represented in the sample. One hundred twenty-four crania were AMS dated, allowing a detailed analysis of diachronic patterns in violence among various demographic groups. RESULTS Thirty-eight percent (102/267) of crania exhibit some form of cranial trauma, a significant increase from the preceding Middle Horizon era. There are distinct trauma frequencies within the three subphases of the LIP, but Phase III (1300-1450 C.E.) exhibits the highest frequencies of all trauma types. Males exhibit significantly more antemortem trauma than females, but both exhibit similar perimortem trauma rates. DISCUSSION There was chronic, internecine warfare throughout the Late Intermediate Period with important variations in violence throughout the three temporal phases. Evidence for heterogeneity in violent mortality shows a pattern consistent with social substitutability, whereby any and all members of the Nasca highland population were appropriate targets for lethal and sublethal violence. We argue that by testing hypotheses regarding the targets and types of conflict we are better able to explain the causes and consequences of human conflict.

Ginseng started to emerge as an international medicinal material during the Joseon Dynasty. This paper examines ginseng as a tribute presented to the Ming royal family by Joseon Dynasty. Joseon Dynasty presented peeled and dried ginseng (white ginseng) to the emperor. The Ming Dynasty demanded chosam (natural ginseng) with no peeling in 1602. By the request of Joseon Dynasty during the period of Lord Gwanghae, the presented ginseng was again changed to pasam (boiled and dried ginseng). Although Nurhachi of the Jurchen (女眞) is known to have invented this method of processing pasam, Joseon was exporting pasam to the Ming Dynasty earlier than that. As such, the Nurhachi theory of the invention of the pasam should be reexamined. Joseon Dynasty presented ginseng to each emperor and heir to the throne through its envoys. The total amount of ginseng sent to the royal family of the Ming Dynasty during the Joseon Dynasty is estimated to be approximately 664 to 880 geuns (斤) per year in the fifteenth century, 300 to 500 geuns in the sixteenth century, and about 160 to 360 geuns in the 17th century. When the Japanese Invasion of Korea occurred in 1592, the Joseon government informed the Ming Dynasty of the miserable situation of the Joseon people and chose to reduce the tribute. However, even after the war, the amount of tribute ginseng in Joseon continued to be small. This is because the medical industry in the Ming Dynasty grew significantly, and medical books prescribing Joseon ginseng increased, and the rich people of the Ming Dynasty loved ginseng so much that they imported Joseon ginseng at high prices. Local residents of Guangdong, China, a major customer base of Joseon ginseng, also used ginseng as a preventive medicine for JangGi. From the fifteenth to the seventeenth centuries, the amount of ginseng that Joseon tributed to the Ming Dynasty continued to decrease, and the ginseng processing method also moved in the direction of reducing the burden of processing. This was caused by changes in the environment surrounding the use of ginseng, including changes in the international situation at the time, growth of the medical industry, increasing interest in ginseng by the people of the Ming, and economic considerations of the Joseon government. The two countries sought changes in the ginseng tribute through an agreement.

In a time when social isolation heavily relies on the use of digital representation, photography, and e-books, it is easy to take for granted the impact imagery has on our society and the pedagogical purposes of illustration, particularly in the teaching of surgery. Illustrations after all are the basis of all anatomical atlases and are quintessential tools that allow for an expedient and thorough understanding of concepts underlying the fabric of the human body. Yet, surgery has not always been taught with an atlas. Illustrations, much like surgery, have seen an incredible transformative process spanning across the ages to achieve their status in modern medicine. Through this brief review, we will not only glean an understanding of the evolution of anatomical illustrations but also the social context in which surgery has also evolved throughout history.

In the time of the Renaissance, a major aspect of vision science was understanding how spatial information projected to the viewpoint of the observer, that is, visual perspective, which is one of the primary cues to depth perception. Perspective representation was thus an early form of virtual reality. Although accurate perspective representation was developed earlier in the 15th century, the first analytic perspective scheme was developed by Piero della Francesca, whose chef d’oeuvre is in the Church of San Francesco, Arezzo, in which the present lecture took place. The focus of the lecture was to evaluate some of the contributions of Piero della Francesca and his 15th-century contemporaries to the visual science, art and symbolism of his era, and its significance for the perception of depth structure from two-dimensional images.

This historical surgical retrospection focuses on the temporal de-escalation axillary surgery, focusing on the unceasing efforts of researchers toward new challenges, as documented by extensive studies and trials. Axillary surgery has evolved, aiming to offer the best oncologic treatment and improve the quality of life of women. Axillary lymph-node dissection (ALND) has been replaced by sentinel lymph-node biopsy (SLNB) in women with early clinically node-negative breast cancer, providing adequate axillary nodal staging information with minimal morbidity, and becoming the standard of care in the management of breast cancer. However, this is only the beginning. Strategies in defining systemic and radiotherapeutic treatments have gradually been optimized, offering increasingly refined and targeted breast cancer treatment tools. In recent years, the paradigm of completion ALND after a positive SLNB has been questioned, and several studies have led to revolutionary changes in clinical practice. Moreover, the increasingly pivotal role played by neoadjuvant chemotherapy (NAC) has had a profound effect on the extent of axillary surgery, paving the way to a more finite "targeted" procedure in women with node-positive breast cancer who convert to negative nodes clinically after NAC. The utility of SLNB itself and its subsequent omission in women with negative nodes clinically and breast conservative surgery is also under scientific evaluation. The changes over time in the surgical approach to breast cancer have been numerous and significant. The novel emerging perspective characterized by recent advances in biology and genetics, in dedicated axillary ultrasound imaging and chemotherapy regimens, is the present reality that points to the future of axillary node treatment in breast cancer.

Purpose The Primavera is considered amongst the greatest and controversial artistic masterpieces worldwide painted by renaissance artist Sandro Botticelli. The aim was to identify any underlying medical foundations for the painting. Methods Observational study. Results The painting reveals, a ‘butterfly’ malar rash, bilateral ptosis and a clear neck swelling consistent with a goitre in the figure of Flora. This could be explained by concomitant Graves’ disease and systemic lupus erythematosus, or other presentations of multiple autoimmune syndrome. Conclusion These findings highlight the likely presentation of the earliest pictorial depictions of thyroid disease with systemic lupus erythematosus and emphasize the exactitude of depiction demonstrated by Botticelli in renaissance era.

It is often suggested that the Greek tragedians present clinically credible pictures of mental disturbance. For instance, some modern interpreters have compared the process by which Cadmus brings Agave back to sanity in Euripides’ Bacchae with modern psychotherapy. But a reading of medical writers’ views on the psychological dimension of medicine offers little evidence for believing that these scenes reflect the practices of late fifth-century Athenian doctors, for whom verbal cures are associated with older traditions of non-rational thought, and thus are scorned in favor of more “scientific cures” based on diet or medication. This paper will argue that Athenian tragedians, working from older traditions that advocated verbal cures for some mental ailments, do understand the potential psychological effects that their work can have on audiences, since tragedy requires psychological interaction with its audience in order to be effective. From a close reading of select scenes in Euripidean tragedy, this paper suggests that the experiences of the characters who experience suffering in Euripides’ Heracles and Bacchae are analogues of the experiences undergone by the spectators of tragedy at large. Parallels are made between the way that Agave and Heracles are both talked back to sanity by looking upon what has happened, and the way that tragedians make their audiences observe lamentations and meditations that follow the central tragic act, to help them return from the intense emotion provoked, perhaps, by the violence they have seen.

Aim Sejong the Great (May 7, 1397-March 30, 1450), a king during Korea's Choson Dynasty, is the most respected historical figure in South Korean society, and consequently, many studies have been conducted on his achievements and the disease he suffered. The dominant trend of scholarship claims that Sejong suffered from diabetic retinopathy. However, this interpretation has not been medically verified. The present analysis aimed to demonstrate that Sejong's is the oldest documented case of ankylosing spondylitis. Methods The Annals of the Choson Dynasty (hereafter, The Annals) are daily records of the king. The Annals were recorded for 472 years (1392-1865) and contain 49 646 667 Chinese characters. Records in The Annals on Sejong span 1418-1450; the present study author reviewed these records. Results Sejong's medical records are mentioned 40 times in the source text. The king first experienced musculoskeletal pain in his knee at the age of 22 years. Sejong's knee pain is mentioned 3 times, and his back pain, which he described as "stiff and immobile", is mentioned 6 times. He complained most frequently of ocular symptoms described as "prickly or tingling," which are mentioned 12 times. Conclusions Based on the analysis of official documentation, the author argues that there is a high probability that Sejong suffered from ankylosing spondylitis, making this the oldest officially documented case of the disease.

Now a routine lifesaving treatment, blood transfusion between humans became a safe procedure only after many early therapeutic disasters. Performed between different species, heterologous transfusions actually succeeded homologous transfusions, those performed between members of the same species. In the early history of transfusion, both homologous and heterologous transfusions were performed in many clinical settings. Early clinicians were unable to distinguish between deaths caused by baseline illness and those resulting from transfusions. This report examines both early experiments with homologous transfusion between animals and later efforts investigating and finally abandoning heterologous transfusion. Topics explored include: 1) contributions and lessons learned from key individuals, 2) how these researchers suggested, performed, advocated, or challenged the practice of heterologous transfusion, and 3) why heterologous transfusions were even considered as a mode of therapy.

To determine the respective weights of certain facial signs on the assessment of perceived age, tired-look and healthy glow on Chinese men of different ages.Photographs were taken of the faces of 420 Chinese men of different ages, under standardized conditions. These photographs allowed to focus and define 15 facial signs, which were then graded by 15 experts and dermatologists, using standardized scales provided by a reference Skin Aging Atlas. The facial signs were dispatched into 5 clusters, namely wrinkles/texture, ptosis/sagging, pigmentation disorders, vascular disorders and cheek skin pores. A naïve panel, composed of 80 Chinese women, of similar age range were asked, when viewing full-face photographs, to: (i) attribute on a 0-10 scale their perception of both the tired-look and healthy glow aspects and (ii) estimate the age of the subject.With the exception of vascular disorders, the severity of all 4 clusters increased with age, although at different rates. The ptosis/sagging or pigmentation disorders showed a rather regular progression. Although perceived ages and real ages were found to be closely correlated, the vast majority of subjects were judged older by 2-10 years. The changes in facial signs (and their related clusters) were significantly correlated with perceived age, with the exceptions of skin spot density and cheek skin pores. Although the aspects of tired-look and healthy glow were logically found to be anti-correlated, tired-look was more statistically associated with perceived age for the five clusters. Signs of eye contour appear to be closely correlated with the perception of a tired-look.Within facial clinical clusters, wrinkles/texture and ptosis/sagging are major factors in the assessment of perceived age in Chinese men. Tired-look appears to be strongly associated with perceived age.De déterminer, pour des hommes chinois d’âges différents, les poids respectifs de certains signes faciaux entrant dans l’estimation de la perception des visages pour l’âge, l’air fatigué ou l’éclat. MATÉRIEL ET MÉTHODES: Les visages de 420 hommes chinois d’âges différents ont été photographiés dans des conditions standardisées. Ces clichés ont permis à 15 experts et dermatologistes d’évaluer 15 signes cliniques selon des échelles éditées dans les références Atlas Cliniques du Vieillissement. Ces signes faciaux sont regroupés dans 5 groupes (rides/texture, ptose/relâchement, désordres pigmentaires, désordres vasculaires, pores de la joue). Un panel de 80 consommatrices chinoises, d’un âge comparable, a été recruté pour donner leurs perceptions sur chaque visage complet photographié: d’abord en attribuant sur une échelle de 0 à 10 un score pour leurs perceptions de l’air fatigué et de l’aspect éclatant de santé, puis en estimant l’âge apparent du volontaire. RÉSULTATS: A l’exception des Désordres vasculaires, la sévérité des 4 groupes cliniques s’accroit avec l’âge selon des cinétiques différentes, parmi lesquelles la ptose/relâchement ou les désordres pigmentaires montrent la progression la plus constante et linéaire. Malgré une très importante et significative corrélation entre âge apparent et âge réel, une majorité des volontaires ont été jugés plus vieux que leurs âges réels, entre 2 et 10 ans. Les variations des signes faciaux (ou des groupes cliniques associés) ont été montrés significativement corrélées à l’âge apparent, à l’exception de la densité des taches pigmentaires et des pores de la joue. Bien que l’air fatigué et l’éclat sont logiquement observés comme anti-corrélés, c’est l’air fatigué qui se trouve le plus relié à l’âge apparent sur les 5 groupes cliniques. Les signes du contour des yeux apparaissent comme les plus corrélés à la perception de l’air fatigué.Parmi les groupes cliniques, les rides/texture et la ptose/relâchement sont les facteurs majeurs dans l’attribution d’un âge perçu pour les hommes chinois. L’air fatigué apparaît comme très fortement relié à l’âge apparent.

The betaretrovirus Mouse Mammary Tumor Virus (MMTV) is the well characterized etiological agent of mammary tumors in mice. In contrast, the etiology of sporadic human breast cancer (BC) is unknown, but accumulating data indicate a possible viral origin also for these malignancies. The presence of MMTVenv-like sequences (MMTVels) in the human salivary glands and saliva supports the latter as possible route of inter-human dissemination. In the absence of the demonstration of a mouse-man transmission of MMTV, we considered the possibility that a cross-species transmission could have occurred in ancient times. Therefore, we investigated MMTVels in the ancient dental calculus, which originates from saliva and is an excellent material for paleovirology. The calculus was collected from 36 ancient human skulls, excluding any possible mouse contamination. MMTV-like sequences were identified in the calculus of 6 individuals dated from the Copper Age to the 17th century. The MMTV-like sequences were compared with known human endogenous betaretroviruses and with animal exogenous betaretroviruses, confirming their exogenous origin and relation to MMTV. These data reveal that a human exogenous betaretrovirus similar to MMTV has existed at least since 4,500 years ago and indirectly support the hypothesis that it could play a role in human breast cancer.

Tuberculosis (TB), which is caused by bacteria of the Mycobacterium tuberculosis complex, is one of the oldest diseases known to affect humans and a major cause of death worldwide. Tuberculosis continues to be a huge peril disease against the human population and according to WHO, tuberculosis is a major killer of the human population after HIV/AIDS. Tuberculosis is highly prevalent among the low socioeconomic section of the population and marginalized sections of the community. In India, National strategic plan (2017-2025) has a national goal of elimination of tuberculosis by 2025. It requires increased awareness and understanding of Tuberculosis. In this review article history, taxonomy, epidemiology, histology, immunology, pathogenesis and clinical features of both pulmonary tuberculosis (PTB) and extra-pulmonary tuberculosis (EPTB) has been discussed. A great length of detailed information regarding diagnostic modalities has been explained along with diagnostic algorithm for PTB and EPTB. Treatment regimen for sensitive, drug resistant and extensive drug resistant tuberculosis has been summarized along with newer drugs recommended for multi drug resistant tuberculosis. This review article has been written after extensive literature study in view of better understanding and to increase awareness regarding tuberculosis, as a sincere effort that will help eliminate tuberculosis off the face of the earth in near future.

Purpose of review Leonardo Da Vinci possessed one of humanity's greatest minds, known for exploring the boundaries of art and science. The discipline of facial plastic surgery also relies on art and science for its advancement. This review focuses on key elements of Leonardo Da Vinci's work, and how they relate to concepts within facial plastic surgery. Recent findings Leonardo Da Vinci was a self-taught creative genius. Common themes that permeated his art were those of proportion, perspective, light and shadow, anatomy, and science. These principles are reflected in key aspects of facial plastic surgery, such as facial analysis, human gaze, facial subunits, surgery of the craniofacial skeleton, and evidence-based medicine. Summary Leonardo Da Vinci's approach to scientific inquiry and artistic beauty strikes a balance from which facial plastic surgeons have much to learn. In depth study of how Leonardo Da Vinci viewed the world furthers the analytical and creative sides of a facial plastic surgeon as well as informs their personal development.

Effective population size reflects the history of population growth, contraction, and structuring. When the effect of structuring is negligible, the inferred trajectory of the effective population size can be informative about the key events in the history of a population. We used the IBDNe and DoRIS approaches, which exploit the data on IBD sharing between genomes, to reconstruct the recent effective population size in two population datasets of Russians from Eastern European plain: (1) ethnic Russians sampled from the westernmost part of Russia; (2) ethnic Russians, Bashkirs, and Tatars sampled from the Volga-Ural region. In this way, we examined changes in effective population size among ethnic Russians that reside in their historical area at the West of the plain, and that expanded eastward to come into contact with the indigenous peoples at the East of the plain. We compared the inferred demographic trajectories of each ethnic group to written historical data related to demographic events such as migration, war, colonization, famine, establishment, and collapse of empires. According to IBDNe estimations, 200 generations (~6000 years) ago, the effective size of the ancestral populations of Russians, Bashkirs, and Tatars hovered around 3,000, 30,000, and 8,000 respectively. Then, the ethnic Russians exponentially grew with increasing rates for the last 115 generations and become the largest ethnic group of the plain. Russians do not show any drop in effective population size after the key historical conflicts, including the Mongol invasion. The only exception is a moderate drop in the 17th century, which is well known in Russian history as The Smuta. Our analyses suggest a more eventful recent population history for the two small ethnic groups that came into contact with ethnic Russians in the Volga-Ural region. We found that the effective population size of Bashkirs and Tatars started to decrease during the time of the Mongol invasion. Interestingly, there is an even stronger drop in the effective population size that coincides with the expansion of Russians to the East. Thus, 15–20 generations ago, i.e. in the 16–18th centuries in the trajectories of Bashkirs and Tatars, we observe the bottlenecks of four and twenty thousand, respectively. Our results on the recent effective population size correlate with the key events in the history of populations of the Eastern European plain and have importance for designing biomedical studies in the region.

Gender medicine as a subject began with Bernadine Healy’s 1991 article ‘The Yentl Syndrome’ which showed that women had worse outcomes following heart attacks since their symptoms are different from men. Since then gender-specific clinical research protocols have been progressively included so that evidence for guidelines can be better informed such that women are then less disadvantaged and care become more personalised. This paper traces back the historical roots of gender bias in medicine in Western culture, which is reflected in the pictorial arts and writings of each historical period, beginning with Hippocrates. It describes the changes that have led to attempts at improving the place of women, and the treatments of disease, on an equal footing with men, precipitated by Healy’s paper.

Health workers offer their skills and care to COVID-19 pandemic patients, just as St Roch offered healing to those stricken by bubonic plague during the Renaissance. This article interprets 3 works of art in light of Roch's story of illness and recovery and applies key insights of ethical, artistic, and clinical relevance to the COVID-19 pandemic.

This article reviews the collaboration between clinician and illustrator throughout the ages while highlighting the era of cardiac surgery. Historical notes are based on Professor Sanjib Kumar Ghosh’s extensive review, literature searches, and the archives of the Johns Hopkins University Department of Art as related to Medicine in Baltimore. Personal communications were explored with medical illustrators and medical practitioners, many of whom are colleagues and trainees, to further chronicle the history of medical illustration and education in the era of cardiac surgery. Medical illustrators use their talents and expressive ideas to demonstrate procedures and give them life. These methods are (1) hovering technique; (2) hidden anatomy, ghosted views, or transparency; (3) centrally focused perspective; (4) action techniques to give life to the procedure; (5) use of insets to highlight one part of the drawing; (6) human proportionality using hands or known objects to show size; and (7) step-by-step educational process to depict the stages of a procedure. Vivid examples showing these techniques are demonstrated. The result of this observational analysis underscores the importance of the collaboration between clinician and illustrator to accurately describe intricate pathoanatomy, three-dimensional interrelated anatomic detail, and complex operations. While there are few data to measure the impact of the atlas on medical education, it is an undeniable assertion that anatomical and surgical illustrations have helped to educate and train the modern-day surgeon, cardiologist, and related health-care professionals.

My essay focuses on Charles Rosenberg's provocative and enduring ideal type of epidemic drama in three acts, which he assembled from a vast knowledge of disease history that stretched from the end of the seventeenth century to his then-present pandemic, HIV/AIDS of the 1980s. Reaching back to the Plague of Athens, my essay elaborates on Rosenberg's dramaturgy by questioning whether blame, division, and collective violence were so universal or even the dominant "acts" of epidemics not only before the nineteenth century but to the present. Instead, with certain pandemics such as yellow fever in the Deep South or the Great Influenza of 1918–20, unity, mass volunteerism, and self-abnegation played leading roles. Finally, not all epidemics ended "with a whimper" as attested by the long early modern history of plague. These often concluded literally with a bang: lavish planning of festivals of thanksgiving, choreographed with processions, innumerable banners, commissions of paintings, ex-voto churches, trumpets, tambourines, artillery fire, and fireworks.

Cannabis has been used for millennia in religious ceremonies, for recreation and for its medicinal qualities. There are multiple accounts detailing the specific ailments cannabis has been used to treat, many of which have included epilepsy. Racial discrimination and political stigmatization led to prohibition, which limited both patients' and researchers' access to the drug through the 20th century. Recently, academic interest has been renewed in cannabis, especially regarding the modulation of cortical excitability via the human endocannabinoid system. Modern research has produced several promising studies regarding the treatment of epileptic encephalopathies. Legalization of marijuana in Canada has potentially allowed for further trials, but it is by no means an end to the controversy surrounding the treatment of epilepsy with cannabinoids.

We have known the accommodation phenomenon since 400 BC. Hypotheses about its mechanisms varied widely for two millennia. Early in the 17th century, when people became more aware of ophthalmic optics, Scheiner and Descartes were close to solving that accommodation worked by changes in the lens. Others rejected their idea, and people even denied the existence of accommodation because there was no clear proof. In the early 19th century, evidence accumulated for accommodation mechanisms studying bird, fish, insect, mammal and human eyes. On the discovery of muscle fibres in the ciliary body, attention shifted to its role in accommodation. Around 1850, came the proof that accommodation occurs by a change in the anterior lens curvature. Still for another 50 years, controversies remained about the exact changes in the lens and the precise accommodation mechanism. On looking back, this is not surprising because only late in the 20th century did it become clear that one cannot extrapolate from the multitude of accommodation mechanisms in the animal kingdom to human eyes.

An archaeoparasitological analysis of the soil samples from Nadym Gorodok site of Western Siberia has been carried out in this study. The archaeological site was dated as the 13 to 18th century, being characterized as permafrost region ensuring good preservation of ancient parasite eggs. Parasite eggs as Opisthorchis felineus, Alaria alata, and Diphyllobothrium sp. were found in the archaeological soil samples, which made clear about the detailed aspects of Nadym Gorodok people’s life. We found the Diphyllobothrium sp. eggs throughout the 14 to 18th century specimens, allowing us to presume that raw or undercooked fish might have been commonly used for the foods of Nadym Gorodok inhabitants and their dogs for at least the past 400 years. Our study on Nadym Gorodok specimens also demonstrate that there might have been migratory interactions and strong economic ties between the people and society in Western Siberia, based on archaeoparasitological results of Opisthorchis felineus in Western Siberia.

The contentious debate on evidence-based Global Mental Health care is challenged by the primary mental health program of Jamaica. Political independence in 1962 ushered in the postcolonial Jamaican Government and the deinstitutionalization of the country’s only mental hospital along with a plethora of mental health public policy innovations. The training locally of mental health professionals catalyzed institutional change. The mental health challenge for descendants of African people enslaved in Jamaica is to reverse the psychological impact of 500 years of European racism and colonial oppression and create a blueprint for the decolonization of GMH. The core innovations were the gradual downsizing and dismantling of the colonial mental hospital and the establishment of a novel community mental health initiative. The successful management of acute psychosis in open medical wards of general hospitals and a Diversion at the Point of Arrest Programme (DAPA) resulted in the reduction of stigma and the assimilation of mental health care into medicine in Jamaica. Successful decentralization has led to unmasking underlying social psychopathology and the subsequent development of primary prevention therapeutic programs based on psychohistoriographic cultural therapy and the Dream-A-World Cultural Therapy interventions. The Jamaican experience suggests that diversity in GMH must be approached not simply as a demographic fact but with postcolonial strategies that counter the historical legacy of structural violence.

The middle ages in the Arab world etched medical advancements that laid the foundations of modern medical practice. Among the several renowned physicians of historical importance, Abu Alkasem al-Zahrawi (Albucasis) left his mark in the fields of medicine and surgery. He is notably famous for his 30-volume compendium Kitab-al Tasreef, which served as his magnum opus. The last volume of this work was reserved for surgery. During his lifetime, Albucasis made contributions of unparalleled luminosity to the field of surgery. He described surgical techniques for a range of procedures encompassing several subspecialties that comprise modern plastic surgery. Beyond just a physician and surgeon, Albucasis was a remarkable teacher who taught medical students with fervor and emphasized the importance of affording treatment to patients of all social classes and the value of physician-patient relationships. The focus of this review is to explore the contributions of Albucasis to the field of plastic surgery.

International audience; On April 7, 1498, Charles VIII, King of France, attended a game of palm in the ditches of the Château d'Amboise. The 27-year-old King suddenly collapsed and became comatose. He laid down, almost on his own, on a straw mat that was hastily arranged, and he died 9 hours later. His contemporaries perceived his death as a perfect reminder of fatality: a king could die alone in a miserable gallery. All who looked into this curious death had dwelled on the frontal blow to head that the king had sustained right before his demise and had not considered alternative scenarios. The present study, still with limited available evidence, aimed to reexamine the historical account of his death in light of modern medical knowledge. It is virtually impossible that a minor bump with low kinetic energy could kill a 27-year-old man. Many historical accounts of Charles VIII’s life and death, including Italian ambassadors' letters, led us to reconsider the commonly held version and to propose an alternative hypothesis. We have concluded that Charles VIII had experienced an acute consciousness disorder with language impairment that could have been related to an epileptic condition secondary to neurosyphilis. We have discussed whether a more accurate diagnosis for the cause of death could be obtained by a pathological analysis of the King’s remains.

The medieval cell doctrine was a series of related psychological models based on ancient Greco-Roman ideas in which cognitive faculties were assigned to "cells," typically corresponding to the cerebral ventricles. During Late Antiquity and continuing during the Early Middle Ages, Christian philosophers attempted to reinterpret Aristotle's De Anima, along with later modifications by Herophilos and Galen, in a manner consistent with religious doctrine. The resulting medieval cell doctrine was formulated by the fathers of the early Christian Church in the fourth and fifth centuries. Printed images of the doctrine that appeared in medical, philosophical, and religious works, beginning with "graphic incunabula" at the end of the fifteenth century, extended and evolved a manuscript tradition that had been in place since at least the eleventh century. Some of these early psychological models just pigeonholed the various cognitive faculties in different non-overlapping bins within the brain (albeit without any clinicopathologic evidence supporting such localizations), while others specifically promoted or implied a linear sequence of events, resembling the process of digestion. By the sixteenth century, printed images of the doctrine were usually linear three-cell versions with few exceptions having four or five cells. Despite direct challenges by Massa and Vesalius in the sixteenth century, and Willis in the seventeenth century, the doctrine saw its most elaborate formulations in the late-sixteenth and early-seventeenth centuries with illustrations by the Paracelsan physicians Bacci and Fludd. Overthrow of the doctrine had to await abandonment of Galenic cardiovascular physiology from the late-seventeenth to early-eighteenth centuries.

This work is based on the study of 150 majolica vases dated back to the mid XVII century that once preserved medicinal remedies prepared in the ancient Pharmacy annexed to the Ospedale Maggiore Ca’ Granda in Milan (Lombardy, Italy). The Hortus simplicium was created in 1641 as a source of plant-based ingredients for those remedies. The main objective of the present work is to lay the knowledge base for the restoration of the ancient Garden for educational and informative purposes. Therefore, the following complementary phases were carried out: (i) the analysis of the inscriptions on the jars, along with the survey on historical medical texts, allowing for the positive identification of the plant ingredients of the remedies and their ancient use as medicines, (ii) the bibliographic research in modern pharmacological literature in order to validate or refute the historical uses, (iii) the realization of the checklist of plants potentially present in cultivation at the ancient Garden, concurrently with the comparison with the results of a previous in situ archaeobotanical study concerning pollen grains. For the species selection, considerations were made also regarding drug amounts in the remedies and pedoclimatic conditions of the study area. Out of the 150 vases, 108 contained plant-based remedies, corresponding to 148 taxa. The remedies mainly treated gastrointestinal and respiratory disorders. At least one of the medicinal uses was validated in scientific literature for 112 out of the 148 examined species. Finally, a checklist of 40 taxa, presumably hosted in the Hortus simplicium, was assembled.

Importance The recognition of the pulmonary circulation is a complex evolution in medical history and draws on theories across eras and cultures. Observations This narrative review summarizes evidence suggesting that the recognition of pulmonary circulation is older than the time of Ibn Nafis. The theory of pulmonary circulation originated in ancient Persia (ad224-637), was overshadowed by Greek theory from the 11th century, and reestablished by Ibn Nafis in the 13th century. Conclusions and Relevance The findings of this review may help contextualize the story of the discovery of pulmonary circulation in ancient Persian and Greek theories before Ibn Nafis.

Leonardo da Vinci, the Renaissance polymath, is still recognized today—above all for his oil paintings and mechanical inventions. His anatomical studies have attracted less attention, even though he devoted over 30 years of his life to them. This paper outlines Leonardo's career and research methods and focuses on the importance of his medical images for anatomical research and teaching. Following a short presentation of the state of (dental) medicine in the early Renaissance period, it offers a description of five of his cranial drawings that show the anatomy of the teeth, the nervous and vascular system on inner and outer tables of the skull and the paranasal sinuses in great detail. Leonardo da Vinci had obviously discovered and depicted the maxillary sinus 150 years before the anatomist Nathaniel Highmore, who is usually credited with this discovery. Other anatomical drawings by Leonardo address the correct human dental formula and describe the morphology of the four types of teeth. His handwritten notes show that he recognized the connection between tooth form and function. Finally, this paper evaluates the influence of these discoveries and innovations on the development of dentistry and its establishment as a scientific discipline. There is no doubt that Leonardo da Vinci's preoccupation with the anatomy of the maxillofacial region influenced the development of anatomy and dentistry, even though he never published his anatomical research., Leonardo da Vinci, the Renaissance polymath, conducted detailed anatomical studies. His anatomical drawings and notes address the human dental formula, describe the morphology of the different types of teeth, and highlight the relationship between tooth shape and function. Leonardo described the maxillary sinus 150 years earlier than the anatomist Nathaniel Highmore. Finally, the paper discusses his influence on the development of dentistry.

Finding order in disorder is a hallmark of science and art. In the time of Leonardo da Vinci, the schism between science and art had yet to arise. In fact, Leonardo freely used scientific methods for his art and vice versa; for example, when he used his observations of turbulent, whirling water to guide his artistic imagination. Half a millennium later, a cornerstone of modern biology is the continuing search for order in dynamic processes. In neuroscience, the search has focussed on understanding complex spacetime brain dynamics. Recently, turbulence has been shown to be a guiding principle underlying the necessary information processing, supporting Leonardo's search for order in disorder. Here, we argue that Leonardo's seminal insights have ongoing relevance for modern neuroscience.

This review traces the growing burden of cancer in India from antiquity. We searched PubMed, Internet Archive, the British Library, and several other sources for information on cancer in Indian history. Paleopathology studies from Indus Valley Civilization sites do not reveal any malignancy. Cancer-like diseases and remedies are mentioned in the ancient Ayurveda and Siddha manuscripts from India. Cancer was rarely mentioned in the medieval literature from India. Cancer case reports from India began in the 17th century. Between 1860 and 1910, several audits and cancer case series were published by Indian Medical Service doctors across India. The landmark study by Nath and Grewal used autopsy, pathology, and clinical data between 1917 and 1932 from various medical college hospitals across India to confirm that cancer was a common cause of death in middle-aged and elderly Indians. India’s cancer burden was apparently low as a result of the short life expectancy of the natives in those times. In 1946, a national committee on health reforms recommended the creation of sufficient facilities to diagnose and manage the increasing cancer burden in all Indian states. Trends from the Mumbai population-based cancer registry revealed a four-fold increase in patients with cancer from 1964 to 2012. Depending on the epidemiologic transition level, wide interstate variation in cancer burden is found in India. We conclude that cancer has been recognized in India since antiquity. India’s current burden of a million incident cancers is the result of an epidemiologic transition, improved cancer diagnostics, and improved cancer data capture. The increase in cancer in India with wide interstate variations offers useful insights and important lessons for developing countries in managing their increasing cancer burdens.

Until well in the 19th century, the Aristotelian concept of the scala naturae (ladder of nature) was the most common biological theory among Western scientists. It dictated that only humans possessed a rational soul that provided the ability to reason and reflect. Michel Eyquem de Montaigne (1533-1592) was the first philosopher influential enough to lastingly posit that animals are cognitive creatures. His view stirred a fierce controversy, with René Descartes (1596-1650) leading among his many adversaries. Only after it became accepted that animals and humans alike have cognitive abilities, did the research on the influence of conscious awareness and intention on the behavior of an animal become possible in the 20th century. We found the anatomist Andreas Vesalius (1515-1564) to have already rejected the Aristotelian view on the lack of the rational soul in animals in his 1543 opus magnum De Humani Corporis Fabrica Libri Septem. His observation "that there is a difference in size according to the amount of reason that they seem to possess: man's brain is the largest, followed by the ape's, the dog's, and so on, corresponding to the amount of rational force that we deduce each animal to have" resonated some 330 years later when Darwin concluded that "the difference in mind between man and the higher animals, great as it is, certainly is one of degree and not of kind." We conclude that Vesalius was instrumental in breaking with two millenniums of dominance of the concept of lack of animal cognition.

Objectives Physiological disturbances in early life have been shown to increase individual mortality risk and impact health in adulthood. This study examines frailty through analysis of lesion status of two commonly collected skeletal indicators of stress (cribra orbitalia [CO] and porotic hyperostosis [PH]) and their association with mortality risk in the precontact U.S. Southwest. Several predictions are addressed: (a) individuals with active skeletal lesions are the frailest; (b) individuals with healed lesions are the least frail; (c) CO lesions, regardless of status, are associated with increased mortality risk. Materials and methods Odds ratios and Kaplan-Meier survival analysis are used to examine the association between stress indicators and mortality in the U.S. Southwest. This study includes 335 individuals (75 females, 81 males, 20 adults of unknown sex, and 159 juveniles) from precontact New Mexico archaeological sites dating to A.D. 1,000-1,400. Results Active CO and PH lesions are associated with lower survivorship and greater mortality risk than healed or absent lesions. Only juvenile individuals have active CO and PH lesions, as is expected given their physiology. CO lesions in any state are associated with greater mortality risk and earlier ages of death. Discussion Individuals with active lesions are the frailest; while individuals with healed lesions are the least frail. CO and PH likely have different etiologies: CO lesions are associated with increased mortality risk and decreased individual longevity. These results indicate that CO's presence suggests a more severe underlying condition than PH lesions alone.