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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.

Journal of Preventive Medicine and Hygiene, Vol. 61 No. 1s1 (2020): Tuberculosis. The Never Ending Story: past, present and Future Challeng (Parte I)

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.

Introduction Although pre-Hispanic hunter-gatherer and horticulturalist (known as Guarani) societies from the lower Parana River Delta (Argentina) presented differences in diet, pottery decoration, mortuary practices, and places of origin, differences in skeletal morphology between such groups have never been systematically explored. This work focuses on variations in humeral and femoral external linear measurements and derived structural properties of adult individuals from both societies as well as on variations in body mass and stature. Materials and methods Bone length, epiphyseal size, and midshaft breadth were measured in 82 adult humeri and 100 femora from hunter-gatherer and Guarani archeological sites. Epiphyseal and midshaft robusticity, residual strength, midshaft shape and area, stature, and body mass were then estimated. Mann-Whitney tests were run to compare the hunter-gatherer and Guarani samples. Results Male Guarani individuals presented stronger humeri and more robust femoral and humeral proximal epiphyses than hunter-gatherers. In addition, female Guarani individuals showed rounder femoral diaphyses in comparison with female hunter-gatherers. Concerning stature, the Guarani individuals were found to be shorter than hunter-gatherers, regardless of sex. No statistical differences were found in body mass. Discussion Despite the fact that skeletal variations between Guarani and hunter-gatherers could be a consequence of differences in mechanical loadings and genetic composition, bone robusticity is also positively correlated with increased age, but as the age composition of the Guarani sample could not be estimated, skeletal variation between the samples could be a consequence of differences in age distribution.

The aim of this work is to discuss the frequency of traumatic bone injuries in a quite unique skeletal assemblage of enslaved people from Valle da Gafaria, Lagos, Portugal (15th-17th centuries). In all, 30 males, 58 females, and 15 individuals of unknown sex were included in the study. The skeletal remains were macroscopically observed for traumatic lesions. When present, the traumatic bone injuries were classified as having occurred ante or perimortem. The antemortem lesions were also studied through radiological analysis. Traumatic lesions were identified in 11 men (36.7%), 23 women (39.7%) and two individuals of unknown sex (13.3%). From these 36 individuals, 61.1% presented antemortem trauma, 25.0% perimortem trauma and 13.9% exhibited simultaneously ante and perimortem trauma. The mechanism of all traumatic injuries was blunt force trauma. From the 9965 analysed bones, 186 exhibited traumatic lesions (87 antemortem, 97 perimortem, and two with both ante and perimortem lesions). The bone more affected by antemortem trauma was the 5th right intermediate foot phalange (40.0%) and by perimortem trauma was the skull (11.4%), probably related to accidents and interpersonal violence, respectively. When analysed by sex, the only significant differences were found in the skull and the right 5th proximal foot phalanges, men (57.1%) presenting more lesions than women (15.4%). The obtained results are consistent with an arduous life, corroborating historical sources which document labour accidents, physical punishments and hard work in the populations of slaves.

The aim of present report was to briefly review the history of the anatomical studies during the Italian Renaissance and to outline their relationship to the figurative arts, focusing, in particular, on neuroanatomical studies that have been at the center of the medical and philosophical debate from the 14th to 16th centuries. Therefore, we have presented the interpretation of different Renaissance masterpieces for which some references to brain anatomy have been previously reported. We propose a new interpretation, in neuroanatomical key, of the fresco of the universal judgment in the vault of San Giorgio's Cathedral in Ferrara, Italy, painted around the end of the 16th century.

RÉSUMÉ L’histoire nous a appris que les émergences virales ne sont pas des phénomènes nouveaux. La variole, venue d’Asie, est probablement apparue en Europe dès le Ve siècle et la fièvre jaune a émergé en Amérique au XVIe siècle, importée d’Afrique par la traite des Noirs. La dengue est apparue au XVIIIe siècle simultanément en Asie du Sud-est, en Afrique et en Amérique du Nord. Quant à la « grippe espagnole », elle a tué, en 1918–1919, entre 25 et 40 millions de personnes dans le monde. La deuxième moitié du XXe siècle a été marquée par de nombreuses émergences virales dont celle du Sida en 1981. Mais, ce qui caractérise l’évolution récente des émergences virales, c’est que non seulement de nouveaux virus émergent de façon répétée, mais qu’ils ont de plus en plus tendance à envahir de nouveaux pays, voire d’autres continents, et de s’y installer de façon plus ou moins durable. Des exemples de cette situation épidémique nouvelle sont donnés avec les infections à virus Nipah, West Nile, de la fièvre de la Vallée du Rift, du SRAS, du monkeypox, de la grippe aviaire H5N1 et Chikungunya. Les causes, multiples et complexes, de ces émergences et réémergences sont brièvement analysées.

In 1708, Adam Christian Thebesius, a 22-year-old student at Leiden University, presented his graduate thesis, Disputatio medica inauguralis de circulo sanguinis in corde. More than a doctoral dissertation, this groundbreaking work opened new channels into the study of the human coronary venous system. Thebesius' theory about the vascular communication between the coronary arteries and the chambers of the heart helped to advance understanding of hemodynamic principles and to clarify the physiologic pathways of the coronary circulation. The following article—the third in a trilogy about Lower Silesian scientists—provides an overview of the life story and achievements of this Silesian physician and innovator, whose name was immortalized in 2 cardiac eponyms: the Thebesian veins and the Thebesian valve.

This paper integrates our knowledge from traditional Chinese medical texts and archeological findings to discuss parasitic loads in early China. Many studies have documented that several different species of eukaryotic endoparasites were present in early human populations throughout China. Nevertheless, comprehensive paleoparasitological records from China are patchy, largely due to taphonomic and environmental factors. An examination of early Chinese medical texts allows us to fill in some of the gaps and counteract apparent biases in the current archeoparasitological records. By integrating the findings of paleoparasitology with historic textual sources, we show that parasites have been affecting the lives of humans in China since ancient times. We discuss the presence and prevalence of three groups of parasites in ancient China: roundworm (Ascaris lumbricoides), Asian schistosoma (Schistosoma japonicum), and tapeworm (Taenia sp.). We also examine possible factors that favored the spread of these endoparasites among early humans. Therefore, this paper not only aims to reveal how humans have been affected by endoparasites, but also addresses how early medical knowledge developed to cope with the parasitic diseases. Nanyang Technological University Published version This research was fully supported by NAP Start-Up Grant from Nanyang Technological University. We thank our assistant, Zhu Chuan, from the School of Art, Design and Media who provided expertise on illustrating images that greatly assisted the research. We also truly thank the editors from International Journal of Paleopathology for their great works and assistance.

Objectives From a genetic perspective, relatively little is known about how mass emigrations of African, European, and Asian peoples beginning in the 16th century affected Indigenous Caribbean populations. Therefore, we explored the impact of serial colonization on the genetic variation of the first Caribbean islanders. Materials and methods Sixty-four members of St. Vincent's Garifuna Community and 36 members of Trinidad's Santa Rosa First People's Community (FPC) of Arima were characterized for mitochondrial DNA and Y-chromosome diversity via direct sequencing and targeted SNP and STR genotyping. A subset of 32 Garifuna and 18 FPC participants were genotyped using the GenoChip 2.0 microarray. The resulting data were used to examine genetic diversity, admixture, and sex biased gene flow in the study communities. Results The Garifuna were most genetically comparable to African descendant populations, whereas the FPC were more similar to admixed American groups. Both communities also exhibited moderate frequencies of Indigenous American matrilines and patrilines. Autosomal SNP analysis indicated modest Indigenous American ancestry in these populations, while both showed varying degrees of African, European, South Asian, and East Asian ancestry, with patterns of sex-biased gene flow differing between the island communities. Discussion These patterns of genetic variation are consistent with historical records of migration, forced, or voluntary, and suggest that different migration events shaped the genetic make-up of each island community. This genomic study is the highest resolution analysis yet conducted with these communities, and provides a fuller understanding of the complex bio-histories of Indigenous Caribbean peoples in the Lesser Antilles.

Thanks to collaborations with anatomists and the possibility of performing public dissections during the Renaissance period, artists started to represent the human body more accurately and objectively in their drawings. This cultural change provided the basis for subsequent advances in education and learning as well as the institution of an obligatory anatomy course in the Academies of Arts. The encounter in Pavia between the eclectic artist Leonardo Da Vinci (1452-1519) and the physician Marco Antonio Della Torre (1481-1511), Professor of Theoretical Medicine at the University of Padova, who near the end of his short life founded the "Anatomical School" of the University of Pavia, could be considered a perfect example of this collaboration. According to the historian Giorgio Vasari, while Della Torre practiced dissection, Leonardo made a book of drawings with red chalk annotated by pen. All these anatomical drawings by Leonardo, preserved at Windsor Castle as the property of the Queen of England, date from 1513, after the death of Della Torre. During the same period, Leonardo started his own dissections in the crypt of Santa Maria Nuova in Florence with his anatomical knowledge already mature and consolidated. The aim of the present study is to present the life of Della Torre, his intense scientific activity between Padova and Pavia, and his relationship with Leonardo Da Vinci. In particular, we found the only available manuscript of Della Torre in the Marciana library of Venice. Clin. Anat. 32:744-748, 2019. © 2019 Wiley Periodicals, Inc.

Before the Enlightenment, the mentally ill in the Hispanic world received standard medical care. After the foundation of the first hospital for specific treatment for mentally ill in Valencia in 1409, a number of hospitals opened their doors to patients with mental illness across the Iberian Peninsula during the 15th century. This model of medical care for people with mental illness was carried to America and the Philippines soon after the arrival of the Spaniards. The treatment for the mentally ill in the Hispanic World influenced the development of Pinel's moral treatment and the care of the mentally ill during the Enlightenment. This article will explain the circumstances leading to the foundation of a number of specific hospitals for the mentally ill in the Hispanic territories as well as the kind of care that these patients received at the so-called casas de locos.

There is a distinctive Venetian carnival mask with sinister overtones and historical significance to physicians because it belongs to the 'Doctor of the Plague'. The costume features a beaked white mask, black hat and waxed gown. This was worn by mediaeval Plague Doctors as protection according to the Miasma Theory of disease propagation. The plague (or Black Death), ravaged Europe over several centuries with each pandemic leaving millions of people dead. The cause of the contagion was not known, nor was there a cure, which added to the widespread desperation and fear. Venice was a major seaport, and each visitation of the plague (beginning in 1348) devastated the local population. In response, Venetians were among the first to establish the principles of quarantine and 'Lazarets' which we still use today. Plague outbreaks have occurred in Australia, notably in Sydney (1900-1925), and continue to flare up in poorer communities, most recently in Madagascar (2017). Antibiotics are the mainstay of treatment, but there are concerns regarding the emergence of resistant pathogenic strains of Yersinia pestis, and their potential use in bio-terrorism.

Very often, descriptions of the scientific discovery of the lymphatic system start with Gaspare Aselli, probably because of his so captivating account. Nevertheless, there was prior and even very old evidence of the lymphatic vessels, which was of course known to Aselli himself, as he cited most of these antique references. In fact, the first insights were contributed by the Hippocratic School. The Alexandrian School added quite a lot but unfortunately most of that knowledge is not extant and can only be appreciated by translations or citations by other authors such as Galen. The 'dark' middle ages did not add to the anatomical knowledge of the lymphatics, and only the rise of the Renaissance brought new insights. Even at that time, Aselli was not the first to identify at least some components of the lymphatic system, but he was actually the first to present a proper account in a book dedicated to the "lacteal veins". Afterwards the interest rose enormously and cumulated in one of the first priority - or plagiarism - disputes, the Rudbeck-Bartholin feud. Surprisingly, William Harvey, the discoverer of the systemic blood circulation, ignored, at least in part, the progress of the discoveries in lymphatic circulation. This narrative review tries to summarize the major contributions to the anatomical knowledge of the lymphatic system from the ancient times up to the end of the European Renaissance.

The term "azygos vein" is in common use in modern anatomical and cardiovascular textbooks to describe the vein which ascends to the right side of the vertebral column in the region of the posterior mediastinum draining into the superior vena cava. "Azygos" in Greek means "without a pair", explaining the lack of a similar vein on the left side of the vertebral column in the region of the thorax. The term "azygos" vein was utilized firstly by Galen and then was regenerated during Sylvius' dissections and Vesalius' anatomical research, where it received its final concept as an official anatomical term. The purpose of this study is to highlight the origin of the term "azygos vein" to the best of our knowledge for the first time and its evolution from the era of Hippocrates to Realdo Colombo.

Surgeons removed bladder stones by perineal lithotomy in ancient times. The first surgeon who dared to invade a body cavity knew human anatomy and was skilled in the use of surgical instruments. The operation probably originated in India since the Sushruta Samhita, a surgical text, antedates Hippocrates by several hundred years. Sushruta's knowledge of bladder of stones, surgical complications and instrumentation identifies him as originator of vesicolithotomy. Why did Hippocrates advise his students to leave operations for bladder stones to practitioners who were skilled in the art? Who were these practitioners and how did knowledge of vesicolithotomy reach Greece from India? Our research suggests that the operation came to Greece from India over ancient trade routes and with surgeons who accompanied Alexander the Great's army. The Sushruta Samhita was translated in Arabic and may have reached Europe during the dark ages by way of Arabian surgeons such as Albucasis. Chelseldon, an eighteenth century English surgeon, brought Sushruta's vesicolithotomy to a peak of perfection.

Aims and objectives This article reports on diet variability in the Dogon Country (Mali) through a bio-archeological study of pre-Dogon and early Dogon human remains (7th century to 19th century AD) from collective burial caves in the Bandiagara Escarpment. Materials and methods Two hundred and twenty crania from collections curated in Leiden, Paris, and Bamako were studied for dental diseases. In a subset of teeth (n = 175), δ13 C and δ15 N were measured in bulk dentine samples. Results δ13 C and δ15 N values vary widely (-15.4 to -6.0‰ for δ13 C, 6.0-14.8‰ for δ15 N, n = 175), and indicate diets dominated by C4 -based foods with a focus on plants; animal products played a minor role. There are significant differences between the δ13 C values from older (pre-Dogon) and younger (Dogon) periods. Frequencies of caries, antemortem tooth loss, and abscesses increase significantly through time. Individuals from northern caves have more positive δ13 C and δ15 N values than southern ones. Discussion and conclusions The temporal shifts are probably due to progressive diversification of foods, consistent with archeological evidence showing the addition of rice and vegetables to pearl millet. The geographical disparity is explained by a combination of climatic, environmental, and cultural factors. Last, intersite differences imply that different communities (or subsections thereof) disposed of their dead in different caves. Based on a large sample extending over a wider area and longer time frame than previous work, our study shows that diets in the Dogon Country were neither uniform nor continuous through time, as previously proposed. Our results attest to a complex history of settlement and foodways.

Leonardo da Vinci (1452-1519) contributed to the study of the nervous system. His earliest surviving anatomical drawings (circa 1485-93) included studies of the skull, brain, and cerebral ventricles. These works reflected his efforts to understand medieval psychology, including the localisation of sensory and motor functions to the brain. He was also the first to pith a frog, concluding that piercing the spinal medulla causes immediate death. After a 10-year interval in the early 1500s Leonardo resumed his anatomical studies and developed a method to inject hot wax into the ventricular system, creating a cast that showed the shape and extent of the ventricles. During this period he also progressed in his understanding of the anatomy of the cranial nerves. Besides being the first to identify the olfactory nerve as a cranial nerve, his dissections showed him that contrary to previous theories, the nerves do not converge on the lateral or third ventricles. Leonardo also performed detailed studies of the peripheral nervous system. Although his discoveries had little influence on the development of the field of anatomy, they represent an astonishingly sharp break from the field that had seen little if any progress in the previous 13 centuries. His work reflects the emergence of the modern scientific era and forms a key part of his integrative approach to art and science.

This paper describes the morphology of the feet of a population of elite women from the Ming dynasty (1368-1644 CE) in Shaanxi province. This is a social stratum, time, and place in which foot binding was practiced. Among a group of 31 skeletons exhumed from the cemetery, eight were women with well-preserved foot bones. Macroscopic examination revealed that half these women (4/8) had clearly altered foot bones: the metatarsal bones, and the few observable phalanges, were gracile and small, while the tarsal bones exhibited a slight reduction in size but no dramatic change in morphology. The other half of the women (4/8) had apparently unmodified metatarsal bones. T-tests comparing linear measurements of the foot bones between the two groups revealed that metatarsal bones were the most affected by binding, and among the tarsal bones, the talar trochlea and calcaneal dimensions were most impacted. This small group of skeletons reveals that some elite women in Shaanxi apparently still did not practice foot binding in the late Ming dynasty, or practiced a much milder form of foot binding, and that there was considerable variation even among those who did practice it.

Background and Aims Nucleotide Oligomerisation Domain 2 [NOD2] is a key gene of innate immunity which participates in the host defence against pathogens. Several loss-of-function NOD2 mutations are associated with Crohn’s disease [CD]. Their high frequencies in populations of European ancestry suggest a model of balancing selection. Because NOD2 deficiency has been associated with a resistance to Yersinia pseudotuberculosis in mice, we hypothesised that NOD2 mutations have been selected during past plague outbreaks due to the closely related bacterium Yersinia pestis. Methods Contemporary frequencies of the main CD-associated NOD2 mutations [R702W, G908R, and 1007fs], measured in healthy people from European and Mediterranean countries, were collected from 60 studies via a PubMed search. Plague exposure was calculated from a dataset providing outbreaks from 1346 to 1860 in Europe and the Mediterranean Bassin. A plague index was built to capture the intensity of plague exposure in the studied geographical areas. Results NOD2 mutation frequencies were associated with the past exposure to plague. Statistical significance was obtained for the most frequent mutation [R702W, p = 0.03] and for the pooled three mutations [p = 0.023]. The association remained significant when putative demographic biases were considered. Conclusions This result argues for a selection of CD-associated NOD2 mutations by plague outbreaks and further questioned the role of exposure to enteropathogenic Yersinia species in CD.

Background Accurate terms aid clarity in thinking and prevent confusion. In the infant feeding field ‘normal' can be ambiguous as biologically normal may not equate with culturally normal in a given time or place. Similarly, the use of the term ‘intervention' is appropriate if a recommended practice is not perceived as ‘normal' to that culture. Objective This article explores the meaning of ‘normal' in the context of infant feeding, since mothers may not perceive breastfeeding as ‘normal' when this differs from the experience in communities in which it is considered unusual. Methods Historical and recent sources were used to explore the effect of culture and established practice on perceptions of what is ‘normal'. Discussion Iceland and several regions of Europe are used as examples of long-term abandonment of breastfeeding during the late Medieval and Early Modern periods and the 19th century. Ireland, the United Kingdom and the United States are discussed in relation to fluctuations and declines in breastfeeding prevalence in the 20th and 21st centuries. The role of science and the rise of mother-support groups for breastfeeding, interventions to promote breastfeeding, and the possibility of cultural change, are also discussed. Implications for Practice Culture influences the perception of what is ‘normal' and where a culture has abandoned breastfeeding, or where it is in decline, women are unlikely to view it as the normal way to feed an infant. A more appropriate use of language is recommended, describing breastfeeding as ‘biologically normal' or ‘physiologically normal', as it is not always, and has not always been, culturally normal. In this context initiatives to improve breastfeeding rates can correctly be termed ‘interventions'.

Microsurgery is a term used to describe the surgical techniques that require an operating microscope and the necessary specialized instrumentation, the three "Ms" of Microsurgery (microscope, microinstruments and microsutures). Over the years, the crucial factor that transformed the notion of microsurgery itself was the anastomosis of successively smaller blood vessels and nerves that have allowed transfer of tissue from one part of the body to another and re-attachment of severed parts. Currently, with obtained experience, microsurgical techniques are used by several surgical specialties such as general surgery, ophthalmology, orthopaedics, gynecology, otolaryngology, neurosurgery, oral and maxillofacial surgery, plastic surgery and more. This article highlights the most important innovations and milestones in the history of microsurgery through the ages that allowed the inauguration and establishment of microsurgical techniques in the field of surgery.

Skeletal lesions related to metabolic diseases in children have been systematically investigated in paleopathological literature only in recent years. This work presents an infant pathological specimen from the post-medieval cemetery of the St. Mary's Nativity church (15th-18th centuries, Segno, Trento, Trentino, Northeast Italy). The bones belonged to an individual of 9 ± 3 months of age, estimated upon an assessment of the stage of dental eruption. Metabolic diseases were diagnosed with paleopathological criteria according to previous literature. Differential diagnosis of the osteological evidence indicates a disease that might be caused by the lack of vitamin D or C. Comorbidity of vitamin C and D deficiency has been widely studied in clinical literature, particularly in children between 3 months and 5 years of age. The study of ancient osteoarchaeological materials allows us to improve our knowledge on diseases' effects on bone development in children and, in this case, it represents additional evidence of the presence of metabolic diseases in a rural contest of the Italian post-medieval period.

There is an almost innate urge in human beings to represent reality in a visual form. From rock art in the Paleolithic to images of galaxies, the quotidian and the extraordinary have been visually represented through the ages. Medical and scientific disciplines are no exception. Accurate representation of the human body structures and anatomy based on cadaver dissections was almost not possible up to the Renaissance due to ethical, social, and religious beliefs and objections. The works of Leonardo da Vinci (1452-1519) and others and, later, Andreas Vesalius (1514-1564), who produced De Humanis Corporis Fabrica, are considered landmarks in the history of medicine. During the following centuries medical and scientific illustration relied upon the expertise of physician-artists and scientist-artists until a new paradigm appeared in the realm of scientific (medical) illustration: the invention of photography in the 19th century. Two of the medical disciplines most rapidly influenced by photography were dermatology and pathology, both macro- and microscopic. Physicians rapidly started to use photographs as a tool for consultation, documentation, and education, and large collections of images were amassed by individuals and institutions for these purposes. Photographic images are produced by visible light impressing a light-sensitive material such as a silver halide plate, and nowadays a silicon chip. But photons are reflected by nontransparent objects, including the human skin. Developments in science and technology allowed the use of other types of radiation to reveal internal structures in the human body and, most interestingly, noninvasively. Thus today much of the medical diagnosis and treatment is guided by the so-called medical imaging with the use of these techniques, that is, medical photography, endoscopy, x-ray radiography, computer-aided tomography, magnetic resonance imaging, ultrasonography, thermography, and nuclear medicine functional imaging techniques as positron emission tomography (PET) and single-photon emission computed tomography (SPECT). Some of these techniques are being applied at the microscopic level to study cell structure and even functional changes in real time. All these advancements in science and technology applied to medicine and other disciplines pose the question as to what extent physicians are trading their capabilities as clinicians. Ethics issues add to the complexity of this new era governed by constant changes in scientific paradigms.

In the 15th century, Joseon dynasty’s goal for the stabilization of the ruling system, the ideological freedom of the era, and the necessity of medicine due to the introduction of Jin and Yuan dynasty’s medicine led to the increased interest in medicine by the nobility along with tolerant practice. The practice of reading medical books is a good example of this institutional demonstration. However, by the end of the 15th century, a noticeable change had taken place. Within the nobility, there was an ideological rigidity regarding technology other than those of Confucianism, as the nobility became concentrated on the principles of Neo-Confucianism. In addition, as the publication of large-scale editions such as Ŭibangyuch'wi (the Classified Collection of Medical Prescriptions) came to an end, they have become less inclined to nurture talent at the level of the central government as in the previous period. In addition, as the discrimination against illegitimate children became stronger, technical bureaucrats such as medical officials, which were open to illegitimate children, came to be seen in increasingly disdainful and differentiated manners. From the late Sejong period to the early Seongjong period, the entrance of illegitimate sons into the medical bureaucracy solidified the negligence of medicine by the nobility. After then, the medical bureaucracy came to be monopolized by illegitimate sons. As for illegitimate sons, they were not allowed to enter society through Confucian practices, and as such, the only way for them to enter the government was by continuing to gain experience as technical bureaucrats. Technical posts that became dominated by illegitimate sons became an object of contempt by the nobility, and the cycle reproduced itself with the social perception that legitimate sons of the nobility could not become a medical official. Medical officials from the Yi clan of Yangseong had been legitimate sons and passers of the civil service examination in the 15th century. However, in the 16th century, only illegitimate sons became medical officials. The formation of Jungin (middleclass) in technical posts since the middle of the Joseon period is also related to this phenomenon. The Yi clan of Yangseong that produced medical officials for 130years over four generations since Yi Hyoji, a medical book reading official, is an exemplary case of the change in the social perception in the early Joseon period regarding medical bureaucrats.

OBJECTIVES The purpose of this article is to examine the impacts of physical and structural violence on the well-being of early modern enslaved Africans by comparing the growth of children in an archaeological sample recovered from Lagos, Portugal with that of modern children known to have lived under socially oppressive and racist political regimes. MATERIALS AND METHODS The age of 18 individuals was estimated from the length of developing teeth. Long bone lengths for age in the enslaved African sample were compared with two black juvenile known age samples: the Raymond Dart (South Africa) and Hamann-Todd (United States) collections. Z-scores were calculated for all samples using black children in the South Africa Long Bone (SALB) database as the reference. The similarity of growth across the samples was tested and skeletal growth profiles (SGPs) were devised for the three samples. RESULTS The children in the Lagos, Raymond Dart, and Hamann-Todd samples were all small for age compared to the SALB reference. While children in the Dart sample tended to be the smallest for age and in the Hamann-Todd the largest, with the children in the Lagos sample falling between them, the three samples did not show significant differences in growth status. DISCUSSION The growth deficits shown in this study demonstrate the severe impacts of physical and structural violence on the lives of these children. Although uncertainty remains regarding the timing of growth insults relative to arrival, slavery in Portugal as materialized in these individuals was as violent as in other countries.

This study investigates morphological changes in pulp chambers of living and archaeological individuals with past vitamin D deficiency. Living individuals (n = 29), four with detailed medical and dental records and three groups of archaeological individuals (n = 25) were radiographed; selected individuals were further evaluated histologically for the presence of incremental interglobular dentin (IIGD), indicative of deficiency (28 living; 17 archaeological). Measurements of pulp horns/chambers from radiographs were conducted to quantify morphological observations. One group had clear skeletal evidence of rickets from St. Matthew, Quebec (n = 1) and St. Jacques, France (n = 4); a second group had slight skeletal indicators from Bastion des Ursulines, Quebec (n = 6); and a third group lacked both skeletal and radiological evidence of deficiency from St. Antoine (n = 6) and Pointe-aux-Trembles (n = 4). Results showed archaeological individuals with clear and slight skeletal evidence of past deficiency displayed constricted or chair shaped pulp horns. Living individuals with deficiency exhibited similar pulp chamber morphology. Radiographic pulp horn/chamber measurements corroborated morphological findings and significant differences were found in pulp horn/chamber measurements between those with and without deficiency. Results suggest that radiograph assessment of teeth can be used as a screening technique to elucidate patterns of deficiency and select individuals for microCT or histological assessment.

While the discipline of Teratology has existed for about 60 years, there has been a deep interest in the causes of human malformations for millennia. Absent the scientific method and acting on fervent beliefs that made sense to ancient/medieval populations, "mechanisms" were described and prognostications of future events were assigned to terata resulting in tragic (and unwarranted) sequelae. This article examines the collective beliefs and thinking within various eras in the hope of providing lessons to inform future behavior. The eugenics movement is an informative, recent example. Science of the 19th century had unraveled some of the mysteries of development and the role of genetics in determining birth outcomes. There was, however, a deep misunderstanding about the enormous amount of information that had yet to be uncovered. Based on immature science and faulty assumptions, it was suggested that "unfit" individuals be euthanized and their parents sterilized. Such "solutions" would be considered deplorable today. Surprisingly, such a reprehensible program was supported (at least in part) by many intelligent and highly regarded individuals. Today, it is imperative that we enter into the era of molecular biology and gene editing cautiously and perspicaciously. The history of teratology has elucidated our inability to understand where our new technologies and actions might take us and how unintended consequences could disrupt even our most carefully thought-out plans.

Funder: Ministère des Affaires Etrangères; doi: http://dx.doi.org/10.13039/501100003763, Background: The archaeological incidence of ancient human faecal material provides a rare opportunity to explore the taxonomic composition and metabolic capacity of the ancestral human intestinal microbiome (IM). Here, we report the results of the shotgun metagenomic analyses of an ancient South African palaeo-faecal specimen. Methods: Following the recovery of a single desiccated palaeo-faecal specimen from Bushman Rock Shelter in Limpopo Province, South Africa, we applied a multi-proxy analytical protocol to the sample. The extraction of ancient DNA from the specimen and its subsequent shotgun metagenomic sequencing facilitated the taxonomic and metabolic characterisation of this ancient human IM. Results: Our results indicate that the distal IM of the Neolithic ‘Middle Iron Age’ (c. AD 1460) Bantu-speaking individual exhibits features indicative of a largely mixed forager-agro-pastoralist diet. Subsequent comparison with the IMs of the Tyrolean Iceman (Ötzi) and contemporary Hadza hunter-gatherers, Malawian agro-pastoralists and Italians reveals that this IM precedes recent adaptation to ‘Western’ diets, including the consumption of coffee, tea, chocolate, citrus and soy, and the use of antibiotics, analgesics and also exposure to various toxic environmental pollutants. Conclusions: Our analyses reveal some of the causes and means by which current human IMs are likely to have responded to recent dietary changes, prescription medications and environmental pollutants, providing rare insight into human IM evolution following the advent of the Neolithic c. 12,000 years ago. E_CXsNG9ctE_c_B9sn31A9Video Abtract.

New Zealand was among the last habitable places on earth to be colonized by humans

We invite systematic consideration of the metaphors of cycles and circulation as a long-term theme in the history of the life and environmental sciences and medicine. Ubiquitous in ancient religious and philosophical traditions, especially in representing the seasons and the motions of celestial bodies, circles once symbolized perfection. Over the centuries cyclic images in western medicine, natural philosophy, natural history and eventually biology gained independence from cosmology and theology and came to depend less on strictly circular forms. As potent 'canonical icons', cycles also interacted with representations of linear and irreversible change, including arrows, arcs, scales, series and trees, as in theories of the Earth and of evolution. In modern times life cycles and reproductive cycles have often been held to characterize life, in some cases especially female life, while human efforts selectively to foster and disrupt these cycles have harnessed their productivity in medicine and agriculture. But strong cyclic metaphors have continued to link physiology and climatology, medicine and economics, and biology and manufacturing, notably through the relations between land, food and population. From the grand nineteenth-century transformations of matter to systems ecology, the circulation of molecules through organic and inorganic compartments has posed the problem of maintaining identity in the face of flux and highlights the seductive ability of cyclic schemes to imply closure where no original state was in fact restored. More concerted attention to cycles and circulation will enrich analyses of the power of metaphors to naturalize understandings of life and their shaping by practical interests and political imaginations.

Dissections and autopsies are critical for understanding human anatomy, pathology, and uncovering mechanisms of disease. This review presents an historical journey from ancient times until the late Middle Ages. The major steps and developments are summarized with key figures and events presented.

In ancient China, an unobstructed, convenient and efficient transmission system nationwide was established for long-distance transmission of information. The transmission system works to different degrees in different regions, which is an important index to measure the interregional information level. Yet, some minor differences, may not be easily sensed by people subjectively. Identifying and quantifying the influences of information transmission efficiency is the best way to solve this problem. Based on the historical information map visualized by ArcGIS software, this study established a hierarchy evaluation model suitable for the analysis of ancient information transmission efficiency from three aspects of Wei-Suo system, beacon system and post system. The information transmission systems in five different regions of Wenzhou in the Ming Dynasty were quantitatively explored respectively. The results break through the qualitative conclusions of the general studies, and find out that the overall information transmission efficiency of Wenzhou in Ming Dynasty was strong in coastal, northern and southern regions, but weak in inland and central regions, which was closely related to the geographical environment and military defense demands in coastal areas of the Ming Dynasty. The model is proven to greatly contribute to judging the spatial configuration of ancient information transmission system in different regions, and provides a new idea for the study on ancient information transmission system.

While speech and language do not fossilize, they still leave traces that can be extracted and interpreted. Here, we suggest that the shape of the hard structures of the vocal tract may also allow inferences about the speech of long-gone humans. These build on recent experimental and modelling studies, showing that there is extensive variation between individuals in the precise shape of the vocal tract, and that this variation affects speech and language. In particular, we show that detailed anatomical information concerning two components of the vocal tract (the lower jaw and the hard palate) can be extracted and digitized from the osteological remains of three historical populations from The Netherlands, and can be used to conduct three-dimensional biomechanical simulations of vowel production. We could recover the signatures of inter-individual variation between these vowels, in acoustics and articulation. While ‘proof-of-concept’, this study suggests that older and less well-preserved remains could be used to draw inferences about historic and prehistoric languages. Moreover, it forces us to clarify the meaning and use of the uniformitarian principle in linguistics, and to consider the wider context of language use, including the anatomy, physiology and cognition of the speakers. This article is part of the theme issue ‘Reconstructing prehistoric languages’.

Imperial Surgery (Cerrahiyyetu’l- Haniyye), penned by Serefeddin Sabuncuoglu (C.E. 1385–1468), is an impressive medical book that was written in Turkish using the Arabic alphabet, containing color miniature drawings and human figures, depicted in a fantastic style. The purpose of this report is to present this unique contribution to the literature on the known history of hernia surgery. Imperial Surgery is divided into three chapters, each of which is divided into sections that, in general, present patients and diseases in the form of case reports. Some sections detail the procedures to be performed on a patient, the surgical instruments used and the positioning of the patient, which are described in detail with color miniature drawings. Serefeddin Sabuncuoglu was a great surgeon in Turkish medical history. Given all of the hernia-related information in literature, the treatise written by Sabuncuoglu in fifteenth century and its suggested approaches to hernias show clearly the place that he should hold in the history of the art of healing. Hernia surgery is described step-by-step under four headings in two chapters, supported by four miniature drawings, including surgical tools.

Many studies in modern times claim that the name " 100-day cough" is from traditional Chinese medicine, and even think that there is a description of pertussis as early as the Sui Dynasty classics. By reviewing the original texts of the classics, we found that these interpretations are not exactly. The description of the pertussis and the chronological distribution of the literature in traditional Chinese books are similar to those of Western medicine. They started about 500 years ago, and then become more detailed and specific. The domestic medical community has a variety of nomenclature for this disease, and there is no sign or evidence to uniformly use "100-day cough" as the disease name. The literature records suggest that "100-day cough" first became a more recognized disease name in Japan, and through the direct input of medical education, entered the modern medical textbooks of western medicine in China.近现代很多文献持"百日咳"一称出自中国医书的观点，甚至认为早在隋朝典籍中就有关于百日咳的描述。通过回顾典籍原文，可知这些解读有误。中国传统典籍对百日咳的描述和文献年代分布特征与西医学相似，始于约500年前，此后记录愈发翔实具体。国内医界对此病有多种命名，没有统一使用"百日咳"作为病名的迹象和证据。文献记录显示"百日咳"首先在日本成为一个较为公认的疾病名称，并通过医学教育的直接输入，进入中国西医学现代教育课本。.