Conceptualizing disabilities from antiquity to the middle ages: A historical-medical contribution.

OBJECTIVE: This paper provides some conceptual guidelines for interpreting the phenomenon of impairment-disability between Antiquity and the Middle Ages from an historical-medical perspective. The paper illustrates application of these guidelines in an historical-medical reassessment of a published paleopathological case-study. MATERIALS AND METHODS: The skeletal remains of a woman who experienced bone fusion and osteoarthritis (Rome, VIII century AD) were selected. We first contextualize her impairments through a paleopathological approach, then locate her experience of disability and care within the cultural and social background to which she belongs. RESULTS: This study illustrates the difficulty of reconstructing one consistent single model of disability. CONCLUSIONS: The traditional idea of disability as a parameter of exclusion is not appropriate for every historical context. SIGNIFICANCE: The paper attempts an integrated and transdisciplinary approach to historical reconstruction of lifestyle in the presence of impairments between late Antiquity and the Early Middle Ages. LIMITATIONS: The main research obstacle is the difficulty of going beyond documented Christian interpretation of disability and provision of welfare to identify detail of lived experience for individuals with impairments. SUGGESTIONS FOR FURTHER RESEARCH: The transdisciplinary historical-medical approach can be adapted for inclusion in any bioarchaeological study of impairment in historic times; future applications of this model will lead to its refinement.

Aristotle - Ἀριστοτέλης (ARISTOTÉLES, 384/3- 322/1 BCE) The revelation of tuberculosis in his zoological works.

One of the most challenging issues with the sources of ancient medicine is to be able to identify the correspondence between the diseases we know today and those reported in ancient medical texts. Ancient diseases' definitions rarely help us, and the symptoms described often correspond to more than one disease. This is especially true about tuberculosis, a disease that historians of medicine habitually associates with the Greek words phthi(n)o (φθίνω), verb, phthisis/phthoe (φθίσις/φθόη), noun, phthinodes/phthisikos (φθινώδης/φθισικός), adjective, all etymologically linked to an Indo-European root that expresses the idea of consumption in a broad sense. This article aims to analyze a group of Greek words, branchos/branchia (ßράγχος/ßράγχια), krauros/kraurao (κραῦρος/κραυράω), and katarreo (καταρρέω), that appear in nosological contexts very close to the infectious disease that today we call tuberculosis. Moreover, the paper aims to focus on the transmission pathways of TB being via animal-human contact and some ancient strategies to cure it. The symptoms, transmission pathways and therapeutic approach of tuberculosis belong to a homogeneous pathological picture that emerges from a set of texts that date back to the period between the fifth century BC and the second century AD.

Mythology and rational explanation in the history of medicine The case of molar pregnancy.

OBJECTIVE: To analyse own set of molar pregnancies and to develop clinically relevant procedures. TYPE OF STUDY: Historical article based on the analysis of Greek classic medicine. SETTINGS: History of Medicine Unit; Department of Medico-Surgical Sciences and Biotechnologies; Sapienza-University of Rome, Italy; Unit of Medical Humanities; Department of Cardiac, Thoracic, Vascular Sciences and Public Health; University of Padua, Italy. INTRODUCTION: Molar pregnancy is a specific kind of gestational trophoblastic disease which originates from the placenta. There are two types of molar pregnancy, complete and partial. Complete molar pregnancy derives from a defect in maternal eggs, while an incomplete one derives from a defecting fertilization by paternal sperm. Historical analysis: Molar pregnancy drawn the attention of ancient physicians from the classic period and they widely discussed maternal and paternal roles in causing this condition. Classic doctors drawn from mythology several suggestions and ideas, which indicates that the issue of normal and abnormal conception was a crucial problem since the most ancient past Conclusion: Current scientific studies on molar pregnancy are free from ancient prejudices about male and female “nature” and their reciprocal role in embryogenesis. However, an awareness of the cultural biases that could drive scientific researches, might be useful for scientists and physicians even today.

Social inequalities in the metropolitan area of Rome. A multidisciplinary analysis of the urban segregation of the "formerly-Bastogi" compound.

BACKGROUND: This study tries to evaluate, through a multidisciplinary approach, the relationship between urban structure, isolation and distribution of social determinants of health, in the so-called "formerly-Bastogi, a compound, with more than 1,500 inhabitants, located in north-western Rome, Italy. METHODS: The architectural-urban analysis, conducted through site visits and evaluations of urban situation, showed how strongly the compound is isolated from the neighbourhoods, and structurally degraded. The socio-demographic analysis, based on the National Census data, showed significant differences in the distribution of the social determinants of health between "formerly-Bastogi" and the surrounding areas. RESULTS: The area under study appears to be isolated from the surrounding urban space, both because of social and architectural factors. This situation could have some association with inhabitants' health. CONCLUSIONS: If our preliminary investigation was useful for a diagnosis of the situation, a more complete - qualitative and quantitative - investigation of the context will be needed to plan appropriate multidisciplinary health-promoting interventions.

The Spanish Influenza Pandemic: a lesson from history 100 years after 1918.

In Europe in 1918, influenza spread through Spain, France, Great Britain and Italy, causing havoc with military operations during the First World War. The influenza pandemic of 1918 killed more than 50 million people worldwide. In addition, its socioeconomic consequences were huge. "Spanish flu", as the infection was dubbed, hit different age-groups, displaying a so-called "W-trend", typically with two spikes in children and the elderly. However, healthy young adults were also affected. In order to avoid alarming the public, several local health authorities refused to reveal the numbers of people affected and deaths. Consequently, it was very difficult to assess the impact of the disease at the time. Although official communications issued by health authorities worldwide expressed certainty about the etiology of the infection, in laboratories it was not always possible to isolate the famous Pfeiffer's bacillus, which was, at that time, deemed to be the cause of influenza. The first official preventive actions were implemented in August 1918; these included the obligatory notification of suspected cases and the surveillance of communities such as day-schools, boarding schools and barracks. Identifying suspected cases through surveillance, and voluntary and/or mandatory quarantine or isolation, enabled the spread of Spanish flu to be curbed. At that time, these public health measures were the only effective weapons against the disease, as no vaccines or antivirals were available. Virological and bacteriological analysis of preserved samples from infected soldiers and other young people who died during the pandemic period is a major step toward a better understanding of this pandemic and of how to prepare for future pandemics.

The history of tuberculosis: the social role of sanatoria for the treatment of tuberculosis in Italy between the end of the 19th century and the middle of the 20th.

Since ancient times, the most frequently prescribed remedy for the treatment of tuberculosis was a stay in a temperate climate. From the middle of the 19th century to the middle of the 20th, Europe saw the development of sanatoria, where patients were able to benefit from outdoor walks, physical exercise and a balanced diet. Moreover, the institutionalisation and isolation of patients deemed to be contagious remains one of the most efficacious measures for the control of this type of infection. The first sanatorium opened in Germany in 1854, while in Italy the earliest experiments were conducted at the beginning of the 20th century. At that time, it was widely believed in Italy that pulmonary tuberculosis could improve in a marine climate. By contrast, the scholar Biagio Castaldi described the salubrious effects of mountain air and documented a lower incidence of tuberculosis among mountain populations, which supported the hypothesis of a hereditary predisposition to the disease. In 1898, several local committees (Siena, Pisa, Padua) were founded to fight tuberculosis. The following year, these gave rise to the Lega Italiana (Italian League) under the patronage of the King of Italy, which helped to promote state intervention in the building of sanatoria. The pioneer of the institution of dedicated facilities for the treatment of tuberculosis was Edoardo Maragliano in Genoa in 1896. A few years later, in 1900, the first specialised hospital, with a capacity of 100 beds, was built in Budrio in a non-mountainous area, the aim being to treat patients within their habitual climatic environment. In the following years, institutes were built in Bologna, Livorno, Rome, Turin and Venice. A large sanatorium for the treatment of working-class patients was constructed in Valtellina by the fascist government at the beginning of the century, in the wake of studies by Eugenio Morelli on the climatic conditions of the pine woods in Sortenna di Sondalo, which he deemed to be ideal. In December 1916, the Italian Red Cross inaugurated the first military sanatorium in the "Luigi Merello" maritime hospice in Bergeggi (SV) to treat soldiers affected by curable tuberculosis. In 1919, a specific law mandated a 10-fold increase in funding for the construction of dispensaries and sanatoria. As a result, the Provincial Anti-tuberculosis Committees were transformed into Consortiums of municipal and provincial authorities and anti-TB associations, with the aim of coordinating the action to be undertaken. In 1927, the constitution of an Anti-tuberculosis Consortium in every province became a legal obligation. Despite this growth in social and healthcare measures, tuberculosis in Italy continued to constitute a major public health problem until the advent of antibiotics in the 1950s. Until that time, the sanatorium played a leading role in the treatment of tuberculosis in Italy, as in the rest of Europe.

Historical sources about diseases, death and embalming regarding the family of Jean Antoine Michel Agar, Minister of Finance of Gioacchino Murat.

Among the mummies preserved in the Basilica of San Domenico Maggiore in Naples, there are the bodies of the wife and three children of Jean Antoine Michel Agar, Minister of Finance of Naple's Kingdom during the Monarchy of Joachim Murat (1808-1815). Between 1983 and 1987 paleopathological analyses were performed; in particular, X-ray examination allowed investigation of the health status of the Agar family members and reconstruction of the embalming processes used to preserve the bodies. In addition, an analysis of the historical and archival documents was carried out, to formulate hypotheses about the causes of death, demonstrating how these sources could become important instruments to obtain diagnoses and pathological histories.

A subject with abnormally short stature from Imperial Rome.

In spite of the rich iconographic and literary documentation from ancient sources, the skeletal evidence concerning individuals of abnormally short stature in the Greco-Roman world is scarce. The necropolis of Viale della Serenissima/Via Basiliano in Rome, mostly referable to the II century AD, recently yielded the skeleton of an individual characterized by proportionate short stature, gracile features suggesting female gender, and delayed epiphysial closure, associated with full maturation of the permanent dentition. These characteristics could be compatible with the phenotype associated with female gonadal dysgenesis. The skeletal individual described here, although poorly preserved, represents the first evidence of a paleopathologic condition affecting skeletal growth documented for the population of ancient Rome.

[In venerem ignavus: medicine, impotence and law in modern age]. / In venerem ignavus impotenza, medicina e legislazione in età moderna.

Surgical and forensic medical texts of modern age classifies male impotence according to two different patterns. If both psychological and functional causes can be admitted as responsible of male disfunctions, physical deficiencies only can be regarded as legal reason to obtain divorce.

The ancient origins of obstetrics, a role for women.

Ancient literature, epics and medical texts well testify the existence of a female competence in Obstetrics since the time of Hippocrates. Until the Imperial Age, both in Greece and in Rome, women were the only ministers of the rites involving birth and death: in particular, delivery was the special moment in which a specific female competence was required.

Uroporphyria: some notes on its ancient historical background.

Black urine is recorded in all ancient urology as a negative prognostic sign, often linked with the presence of blood; its presence can also be considered as a sign of massive hemolytic crisis, especially if associated with specific nosological patterns. The Hippocratic case of Epidemics III, 11 has recently been diagnosed as an intermittent acute porphyria. Despite the difficult 'retrospective' diagnosis of an ancient case, it seems likely that the Hippocratic physicians empirically knew clinical associations of symptoms that modern medicine could consider as the first descriptions of porphyria.

Theophilus' Auctoritas: the role of De urinis in the medical curriculum of the 12th-13th centuries.

The three principles to know, to know how and to know how to be are already condensed in the works of Theophilos (7th-9th centuries). Theophilus' De urinis was included in Latin translation in the Articella, probably because of its intermediate position between the texts of high doctrinal value by Hippocrates and Galen (lacking, however, a unifying 'theory of urine') and the epitomes, short manuals without any theoretical background. It thus forms an excellent synthesis of a cultural approach reconciling iatrosophia and techne and offers to the reader a text reconciling the theory and the practice, useful to health workers in hospitals, novice beginners and medical scholars. Thanks to his strong attention to the correlation between symptoms and pathology and to his search for assessment scales, Theophilus became the author on whom the birth of medical medieval studies was founded.

[Surgical Roman instruments in the Museum of History of Medicine of the University of Rome "La Sapienza"]. / Lo strumentario chirurgico Romano del Museo di Storia della Medicina dell'Universita di Roma "La Sapienza".

The Museum of History of Medicine at the University of Rome "La Sapienza" keeps numerous roman surgical instruments, dating from the 1st century A.D. This article offers a short review of the critical literature existing on the topic, together with a temporary catalogue of the instruments.

Phanostrate, Metrodora, Lais and the others. Women in the medical profession.

This article offers a historical view of the women in the medical profession from the Homeric epics to Soranus and Galen until the early Middle Ages, in both the Eastern and Western Mediterranean areas. Recent important medical-historical papers well claify the contribution of women in health care in both the Greek and the Roman world.

[Deaths and death in Italian medieval painting]. / Immagini di morti e di morte. L'angoscia della dissoluzione fisica prima e dopo la peste nera (XIV e XV secolo d.C.).

The role played by great epidemics in the composition of the Triumphs of Death and the Dances of the Deaths in Italy from XIVth to XVth century has been recently well discussed by historiographical licterature. The human body has been linked to the idea of frialty and decomposition already before XIVth century; ascetical and penitential ideals have been joined together with critical economical, social and sanitary conditions. European medieval populations were mown down by endemic illnesses and it certainly is possible that these catastrophic events influenced the composition of Triumphs and Dances.

[Farmaka in antiquity: from Hippocrates to Dioscorides]. / I farmaka nell'antichita: da Ippocrate a Dioscoride.

Informations and suggests for use of pharmaka and drugs from animal, vegetable and mineral kingdom already appear in Corpus Hippocraticum writers; they helped the Hippocratic physician in curing Humors' krasis and in re-establishing their right relation. From Aristotelian Gymnasium to Teophrastus' Historia Plantarum, to Nicander, Praxagoras, Apollophanes and others Hellenistic pharmacologists, the drugs' application finally came to Roman world, where it clashed with the strong opposition of autochthonous traditions. A very active trade with Near and Middle East, but also with the provinces of Africa and Spain developed in Rome; the Roman public, then, began to elaborate again the Greek experience, and found an agreement with his own science. Celsus', Dioscorides', Scribonius', and Plinius' works - they were not always technical writers - well testify Roman pharmacologic science from the first century A.D.