Dementia in the Ancient Greco-Roman World Was Minimally Mentioned.

Background: The possibility that Alzheimer's disease and related dementias (ADRD) is a modern disease arises from the minimal mention of advanced cognitive decline by ancient Greeks and Romans, who were mainly concerned with the physical frailties of older ages. Objective: Because standard medical histories of elderly health lacked mention of cognitive decline, we examined texts by Greek and Roman authors that mentioned memory loss and dementia. Methods: Primary texts of Greco-Roman authors, 8th century BCE into the 3rd century CE, that mentioned cognitive decline were identified and critically evaluated. Secondary sources were excluded. Results: No ancient account of cognitive loss is equivalent to modern clinical data. The term dementia was occasionally used in antiquity, but not invariably linked to old age. Ancient Greeks and Romans expected intellectual competence beyond age 60. While some memory loss was acknowledged, we found only four accounts of severe cognitive loss that might represent ADRD. The possibility of modest ADRD prevalence in ancient Greece and Rome is consistent with its low prevalence in the Tsimane of Bolivia. These contemporary Amerindians live under conditions of high mortality from frequent infections and minimal cardiovascular disease with physically demanding lives. Tsimane after age 60 had increased mild cognitive impairment; the few cases of dementia were not clinically consistent with AD. Conclusions: The modern 'epidemic level' of advanced dementias was not described among ancient Greco-Roman elderly. The possible emergence of advanced ADRD in the Roman era may be associated with environmental factors of air pollution and increased exposure to lead. Further historical analysis may formulate critical hypotheses about the modernity of high ADRD prevalence.

WHEN QUARTAN FEVER RELIEVED DEPRESSION: THE INCEPTION OF PYRETOTHERAPY IN THE GRECO-ROMAN ANTIQUITY.

OBJECTIVE: The aim: This paper explores the documentation of the effect of quartan fever on, the ancient Greek equivalent of conditions falling nowadays under the spectrum of depression, in Greco-Roman medical sources. PATIENTS AND METHODS: Materials and methods: The authors searched original medical texts written in Greek by physicians who lived and practiced Medicine in the broader Mediterranean region from the 5th century BC to the 7th century AD for records related to quartan fever and neuropsychiatric diseases. CONCLUSION: Conclusions: Quartan fever was used as a treatment for neuropsychiatric conditions until the middle of the 20th century. Although malaria can have severe neuropsychiatric sequelae, the neuroimmunological underpinnings of the effect of fever and heat on depression warrant further investigation.

Specific urogenital disease information-revealing male genital votive offerings dedicated to gods in ancient age sanctuary medicine / Información en los votivos de órganos genitales masculinos sobre enfermedades urogenitales, en las ofrendas a dioses en la antigua medicina para la sanación

OBJECTIVES: The people of ancient age appealed to sanctuaries of different gods and goddesses they believed to have healing powers and consecrated anatomical votive offerings representing their sick or healed organs. Male genital organ votives were also present among these votives. In this article, male genital organ votive offerings presented to gods and goddesses were examined and the votives giving information about the diseases they indicated were revealed in contemporary medicine. METHODS: Information available in written resources on ancient medicine and diseases was reviewed. Main sanctuary healing centers in Anatolia (Asia Minor), Greece and Italy which concurrently hosted similar civilizations were investigated. Male genital organ shaped anatomical votive samples in national and foreign medical history and archaeology museums, galleries and special collections were investigated and examined. RESULTS: It was observed that most male genital organ votives had a healthy and normal structure and didn’t provide any specific information on a urogenital disease. But it was also observed that some votives among genital organ votives consecrated by sick individuals to gods demonstrated some urogenital diseases and conditions. Among this very limited number of genital votives providing disease information, votives indicating phimosis, hypospadias, varicocele, penile hemangioma or condylama, Peyronie’s disease or penile curvature, genital hidradenitis suppurativa, condition of pubic hair and erectile condition of penis were detected. CONCLUSIONS: As proofs of seeking a remedy for diseases or recovering from diseases, anatomical organ votives are very important to understand ancient sanctuary medicine. Among male genital organ votives, very limited number of samples providing specific information on diseases provided us important information so that we can understand some ancient age diseases

OBJETIVOS: Los habitantes de la era antigua acudían a santuarios de distintos dioses con la creencia de que éstos tenían poderes curativos y les entregaban ofrendas votivas de partes anatómicas enfermas, bien para que fueran sanados o como ofrenda una vez sanados. Entre estas ofrendas votivas encontramos órganos reproductores masculinos. En este artículo se han revisado y examinado estas ofrendas votivas de órganos reproductores masculinos y de ello se ha podido obtener información sobre enfermedades que existen en la medicina contemporánea. MÉTODOS: La información presente en escritos de medicina ancestral y enfermedades se revisó. Los principales santuarios de sanación en Anatolia (Asia Menor), Grecia e Italia que de forma concurrente tuvieron diferentes civilizaciones, fueron investigadas. La forma del órgano genital masculino en muestras votivas de historia de la medicina nacional y extranjera, museos arqueológicos, galerías y colecciones especiales, fueron investigadas y examinadas. RESULTADOS: Se observa que la mayoría de votivos de órganos genitales masculinos tenían una forma natural y sana y no proporcionaban ninguna información especial respecto a enfermedades urogenitales. Aunque también se observó que algunos votivos de individuos enfermos a dioses si presentaban algunas enfermedades urogenitales y condiciones especiales. Entre los votivos enfermos, encontramos votivos con fimosis, hipospadias, varicocele, hemangioma peneanos y condilomas, enfermedad de Peyronie o curvatura peneana, hidradenitis genital supurativa, desarrollo de pelo púbico y condiciones eréctiles del pene. CONCLUSIONES: Como prueba del interés por encontrar un remedio a las enfermedades o recuperarse de enfermedades, los votivos de órganos anatómicos fueron muy importantes para entender la medicina antigua. Entre todas estas ofrendas votivas de órganos genitales, a pesar de que un número muy limitado de ellas nos ha proporcionado información concreta sobre enfermedades, la información obtenida en ellas ha sido crucial para entender algunas de las enfermedades de la edad antigua

THE TERMINAL APHONIA OF ALEXANDER THE GREAT, A SILENT HERALD OF AN ORDINARY DEATH

Even though the absence of the body prevents sure conclusions, the death of Alexander the Great remains a hot topic of retrospective diagnosis. Due to the serious mishandling of ancient sources, the scientific literature had Alexander dying of every possible natural cause. In previous works, the hypothesis that typhoid fever killed Alexander was proposed, based on the presence of the remittent fever typical of this disease in the narrations of Plutarch and Arrian. Here we provide additional evidence for the presence of stupor, the second distinctive symptom of typhoid fever. In fact, based on the authority of Caelius Aurelianus and Galen, we demonstrate that the word ἄφωνος, used to describe the last moments of Alexander, is a technical word of the lexicon of the pathology of Hippocrates. Used by him, the word defines a group of diseases sharing a serious depression of consciousness and motility. The association of stupor with the remittent fever strengthens the typhoid fever hypothesis.

Milestones in the History of Pediatric Surgery During the Byzantine Times

During the Byzantine Times, medicine and surgery developed as Greek physicians continued to practice in Constantinople. Healing methods were common for both adults and children, and pediatrics as a medical specialty did not exist. Already Byzantine hospitals became institutions to dispense medical services, rather than shelters for the homeless, which included doctors and nurses for those who suffered from the disease. A major improvement in the status of hospitals as medical centers took place in this period, and physicians were called archiatroi. Several sources prove that archiatroi were still functioning in the late sixth century and long afterward, but now as xenon doctors. Patients were averse to surgery due to the incidence of complications. The hagiographical literature repeated allusions to doctors. Concerns about children with a surgical disease often led parents to seek miraculous healings achieved by Christian Protectors - Saints. This paper is focused on three eminent Byzantine physicians and surgeons, Oribasius, Aetius of Amida, Paul of Aegina, who dealt with pediatric operations and influenced the European Medicine for centuries to come. We studied historical and theological sources in order to present a comprehensive picture of the curative techniques used for pediatric surgical diseases during the Byzantine Times.

Hippocratic concepts of acute and urgent respiratory diseases still relevant to contemporary medical thinking and practice: a scoping review.

BACKGROUND: The collected works of Hippocrates were searched for concepts on the diagnosis, prognosis, and treatment of acute and urgent respiratory diseases, with the objective to trace their origins in the Hippocratic Collection. METHODS: A scoping review was performed to map out key concepts of acute and severe respiratory diseases in the entire Hippocratic Collection. The digital library Thesaurus Lingua Graeca (TLG) was researched for references in the entire Hippocratic Collection regarding the epidemiology, pathophysiology, prognosis, diagnosis and treatment of acute respiratory diseases; then, the relevant texts were studied in their English translation by the Loeb Classical Library. RESULTS: Hippocratic physicians followed principles of treatment for pneumonia and pleurisy, still relevant, such as hydration, expectoration, analgesia and prompt mobilisation. Other approaches, including the inhalation of "vapours through tubes" in angina, can be considered as forerunners of modern medical practice. Thoracic empyema was diagnosed by shaking the patient and direct chest auscultation after "applying your ear to his sides". In case of an emergency from upper airway obstruction, urgent insertion of primitive airway equipment, such as a small pharyngeal tube, was applied. CONCLUSIONS: The main Hippocratic concepts on four still common acute and urgent respiratory diseases -pneumonia, pleurisy, thoracic empyema and upper airway obstruction- were identified and most of them were found to be in agreement with contemporary medical thinking and practice.

Using city gates as a means of estimating ancient traffic flows.

Despite the recent flurry of interest in various aspects of ancient urbanism, we still know little about how much traffic flowed in and out of ancient cities, in part because of problems with using commodities as proxies for trade. This article investigates another approach, which is to estimate these flows from the built environment, concentrating on transport infrastructure such as city gates. To do this, I begin by discussing a new model for how we would expect this kind of infrastructure to expand with population, before investigating the relationship between the populations of sites and the total numbers and widths of city gates, focusing on the Greek and Roman world. The results suggest that there is indeed a systematic relationship between the estimated populations of cities and transport infrastructure, which is entirely consistent with broader theoretical and empirical expectations. This gives us a new way of exploring the connectivity and integration of ancient cities, contributing to a growing body of general theory about how settlements operate across space and time.

The Influence of Gondeshapur Medicine during the Sassanid Dynasty and the Early Islamic Period.

The development of the most active period of Persian medicine occurred in the ancient city of Gondeshapur, between the third and seventh centuries. Rebuilt between 256 and 260 by Shapur I, the second Sassanid monarch, Gondeshapur is said to have welcomed the first hospital and the consequent study of medicine, mainly based on the Greek system. It has also been mentioned that these teachings would be expanded by his successor, Shapur II. However, both statements need solid confirmation. Nestorian priests-professors and other academics expelled from the Byzantine Empire gave fundamental encouragement to cultural and medical development in Gondeshapur. With Khosrow I, Gondeshapur became a cosmopolitan city with studies of medicine, philosophy, eloquence, and music. The medical studies were conducted in an academic setting, and practiced in a hospital, with the documentary support of a library which would be provided with the main texts, mainly of Greek, Syrian, and Indian origin. The Byzantine-inspired hospital system of Gondeshapur with its own management, organic system, and differentiated personnel, was later reproduced in several cities of the Middle East and medieval Europe under Islamic rule. The academic prestige and functionality of Gondeshapur, which peaked in the seventh century, began to decline in the following centuries apparently due to the creation of similar intellectual and hospital centres in Baghdad, by the Caliph al-Mansur, and the subsequent transfer of doctors, technicians, professors and other personnel from Gondeshapur, to ensure there the operation of hospitals and also medical studies. This cultural policy was continued and expanded by al-Mansur successors, in particular by the Caliph al-Ma'mun, until the tenth century.

Plagues and artistic votive expressions (ex voto) of popular piety.

In past centuries, epidemics, the scourge of humankind, caused pain, anger, uncertainty of the future, social as well as economic disorder and a significant impact on their victims, involving also their spiritual sphere. The latter effect led to undoubted effects on participation in the religious and social life of communities. The custom of preparing artistic votive expressions has been lost in the mists of time and evidence of ex voto gifts, offered by believers to pagan gods, has been found in prehistoric archaeological sites. Furthermore, several finds from the Ancient Greek and Roman worlds may be observed in our museums. These remains are generally ceramic and metal artifacts, reproducing limbs and other body parts which had been healed. These elements, according to the belief of those making the offerings, had benefited from the miraculous intervention of a thaumaturgical deity. With the advent of Christianity, some pre-existing religious practices were endorsed by the new religion. Believers continued to demonstrate their gratitude in different ways either to miracle-working saints or to the Virgin Mary, because they thought that, thanks to an act of faith, their own health or that of a family member would benefit from the direct intervention of the divine entities to whom they had prayed. In the Ancient Greek world, it was believed that the god Asclepius could directly influence human events, as testified by the popularity of shrines and temples to the god, especially at Epidaurus. In the Christian world as well, particular places have been detected, often solitary and secluded in the countryside or in the mountains, where, according to tradition, direct contact was established between the faithful and Saints or the Virgin Mary Herself. Manifestations occurred by means of miracles and apparitions, thereby creating a direct link between the supernatural world and believers. Religious communities, in these extraordinary places, responded to the call through the building of shrines and promotion of the cult. Over time, the faithful reached these places of mystery, performing pilgrimages with the aim of strengthening their religious faith, but also with the purpose of seeking intercession and grace. In this case, the request for clemency assumed spiritual characteristics and also became a profession of faith. Accordingly, the shrines in the Christian world are places where supernatural events may occur. In these environments the believer resorted to faith, when medicine showed its limits in a tangible way. For the above reasons, while epidemics were occurring, the requests for clemency were numerous and such petitions were both individual and collective. In particular, by means of votive offerings (ex voto) the believers, both individually and collectively, gave the evidence of the received grace to the thaumaturgical Saint. Through the votive act, a perpetual link between the believer and the Saints or Holy Virgin was forged and a strong request for communion was transmitted. The aim of the present study is to describe the role played by votive tablets (ex voto) in the last 500-600 years, as visible evidence of human suffering. From this perspective, these votive expressions may assume the role of markers because, in accordance with the expressions of popular faith, they allow us to follow the most important outbreaks that have caused distress to Christian communities.

Early contribution of Alexandria medical school to the anatomy, physiology and pathology of the nervous system.

Alexandria's famous medical school was established about 300 BC. It was the seat of learning for many Greco-Roman physicians. The physiologist Erasistratus, the anatomist Herophilus - named the Father of Anatomy were outstanding pioneers. Their work and discoveries of the nervous system, its structure and function, are described. In the 2nd century AD they were succeeded by Rufus of Ephesus - the medical link between Hippocrates and Galen, - and Aretaeus a leading anatomist and physician in this period.

Examining the osteological paradox: Skeletal stress in mass graves versus civilians at the Greek colony of Himera (Sicily).

OBJECTIVES: Bioarchaeologists interpret skeletal stress as evidence of resilience or frailty, where absence of lesions might result from lack of exposure to pathogens (i.e., good health) or extreme vulnerability (i.e., selection). We examine physiological stress in two skeletal series from Greek Himera: (1) nine mass graves from the battles of Himera (480 and 409 BCE) and (2) Himeran civilians (648-409 BCE). Civilians are assumed to have died from multiple causes, including ill health leading to their deaths. Individuals from the battles presumably died while in relatively good health, in battle. More skeletal stress among civilians than battle casualties would support the idea that skeletal stress is a sign of frailty at Himera. We compare variation in skeletal stress between and among civilians and battle casualties. MATERIALS AND METHODS: Cribra orbitalia, porotic hyperostosis, linear enamel hypoplasia (LEH), and sub-periosteal new bone formation, were examined in 474 individuals (mass graves n = 64; civilians n = 410). RESULTS: Chi-square tests showed significantly higher prevalence of LEH (p = 0.04) and sub-periosteal new bone formation (p = 0.05) among young and mid-aged adult male civilians than mass grave casualties. Skeletal stress was also lower in the earlier battle, and varied among civilians with burial style. DISCUSSION: Our findings generally support the hypothesis that skeletal stress is evidence of frailty (i.e., leading to greater risk of mortality). However, the relationship between stress and frailty is complicated by social factors, when considering historical context. In particular, a possible "soldier-class" may have experienced less stress than the overall civilian population.

Cataract couching and the goat's eye.

At the start of the third century, a story told by Claudius Aelianus, Leonidas of Alexandria and pseudo-Galen held that couching originated when a goat with cataract punctured its eye with a thorn. The significance of this story is unknown. We reviewed Graeco-Roman texts to identify the relevance of the goat to the eye. In the works of Hippocrates, Aristotle and Galen, the goat's eye was an eye with intermediate brightness or colour. A dark brown eye with a black pupil was healthy and required no treatment. A bright glaukos eye, with extensive corneal edema or scarring, was not amenable to couching. An eye with a white cataract behind an undilated pupil would appear to have an intermediate brightness and was potentially amenable to couching. The origin myth probably arose when an instructor explained that couching works best for a goat's eye, that is, an eye with intermediate brightness.

The Hippocratic Method of Surgical Cauterization for the Tumescence Spleen in the Rare "Spetses Syndrome".

Spleen in antiquity was considered by the Hippocratic medicine as a viscerous organ of spongy character, which could clear human body of the black bile. According to the Hippocratic doctrine of the 4 humors, black bile could cause a series of diseases. Both the anatomical position and shape of the spleen were also recognized. In the case of a splenic hardening, with simultaneous augmentation of its dimensions and dermal ulceration and/or splenic abscess, some interventions were proposed. Thus, herbal medicine, phlebotomy, and minimal surgery with local cauterization were applied for treatment, to confront a disease that was considered serious but not fatal. The Hippocratic physicians encountered various spleen diseases and among them they most probably confronted a rare splenic pathological entity, named centuries later as "Spetses syndrome," a rare type of thalassemia of the Spetses island of Saronikos Gulf. Although the approach seems in modern terms rather primitive, the ancient Greek medico-philosophers most likely understood the significance of the spleen.

Katharsis of the skin: peeling applications and agents of chemical peelings in Greek medical textbooks of Graeco-Roman antiquity.

BACKGROUND: Recipes for peelings date back to medical texts of old Egypt. The oldest medical papyri contain recipes for 'improving beauty of the skin' and 'removing wrinkles' by use of agents such as salt and soda. The Egyptian Queen Cleopatra (69-30 BC) is said to have taken bathes in donkey's milk to improve the beauty of her skin. However, little is known about other agents and peeling applications in later Greek medical textbooks. OBJECTIVE: We will discover new agents and describe ancient peeling applications. First, we will have to identify ancient Greek medical terms for the modern terms 'peeling' and 'chemical peeling'. Second, on the basis of the identified terms, we will perform a systematic full-text search for agents in original sources. Third, we will categorize the results into three peeling applications: (i) cleansing, (ii) aesthetical improvement of the skin and (iii) therapy of dermatological diseases. METHODS: We performed a full systematic keyword search with the identified Greek terms in databases of ancient Greek texts. Our keywords for peeling and chemical peeling are 'smexis' and 'tripsis'. Our keywords for agents of peeling and chemical peeling are 'smégmata', 'rhýmmata', 'kathartiká' and 'trímmata'. RESULTS: Diocles (4th century BC) was the first one who mentioned 'smexis' and 'tripsis' as parts of daily cleansing routine. Criton (2nd century AD) wrote about peeling applications, but any reference to the agents is lost. Antyllus (2nd century AD) composed three lists of peeling applications including their agents. CONCLUSION: Greek medical textbooks of Graeco-Roman antiquity report several peeling applications such as cleansing, brightening, darkening, softening and aesthetical improvement of the skin by use of peeling and chemical peeling, as well as therapy of dermatological diseases. There are 27 ancient agents for what is contemporarily called peeling and chemical peeling. We discovered more specific agents than hitherto known to research.

Nursing Philosophy 2016, response to Peter Allmark's article, "Aristotle for Nursing".

Preparing to lecture on Aristotle's contribution to Nursing at the International Philosophy of Nursing Conference August 22, 2016, in Quebec City, Quebec, Canada, I came upon the recently published article by my IPONS colleague, Allmark (2016), "Aristotle for Nursing." Allmark (2016) provides a comprehensive and understandable overview of Aristotle's philosophical system including the substantial nature of being and the four causes of change. Nurses using Aristotle to support practice and theoretical research will benefit from a careful reading of Allmark to enrich their use of the realist understanding of knowledge of nature (epistemology) and the matter-form causal relationships within natural being (ontology and teleology). Allmark carefully displays the distinction between good health and flourishing; a distinction sometimes hard to grasp. Nurses are concerned with the end of health, but cannot achieve for others, the fullness of living which is flourishing. We will limit ourselves to expanding three areas that seem important, first, that nursing is much more than a productive science or craft, second, that Aristotle does provide an important note on the persistence of the soul, and, third, while Aristotle does not address the possibility of a personal creative highest being as Allmark says, his references to the divine are worth considering.