The Knights Hospitaller of Rhodes and the Black Death of 1498: a poetic description of the plague

The study is a presentation of the sole written testimony of the great plague epidemic that struck the island of Rhodes in 1498, at the time when the Order of the Knights of St. John was settled there. The Greek poem "The Thanatikon (i.e., plague) of Rhodes", which was written by Emmanuel Georgillas Limenitis in the late 15th century and recounts the terrible events of the epidemic, was used as a source of information. Among the 644 verses of the poem, elements like the place, time, duration and how the epidemic spread can be identified. Within the historical context of the era, evaluation and analysis of the data reveal the correlation between human activities and the physical history of the disease in the Mediterranean during the 15th century. The Plague of Rhodes confirms the value of non-medical sources in the medico-historical and historico-epidemiological study of the evolution of the disease caused by Yersinia pestis while highlighting an enduring intrinsic weakness of surveillance systems. Despite modern means of epidemiological surveillance, the risk of relaxation of a health system after a long period of absence of an infectious disease constitutes a major factor for future resurgence of the specific disease.

From preparedness to risk: from the singular risk of nuclear war to the plurality of all hazards

Debates on risk have largely assumed risk to be the outcome of calculative practices. There is a related assumption that risk objects come only in one form, and that the reason not everything can be transformed into a risk is because of the difficulties in calculating and creating universal quantitative comparisons. In this article, building on recent studies of preparedness that have broadened understandings of risk, we provide an analysis of how preparedness measures might themselves produce risk, in particular through risk's durable instantiation, or what we call 'concretization'. Our empirical focus is on how government agencies in two countries shifted their attention from the risk of nuclear attack during the Cold War to an all hazards approach to preparedness. Comparing the mid- to late-twentieth century histories of the UK and Switzerland, we show that both countries shifted from focusing from a single risk to plural risks. This shift cannot be explained by a change in prevailing calculative practices, or by the fact that the risks changed historically. Instead, it is driven by historically specific changes in how risks are produced and reproduced in relation to how materializations of risk operate over time.

Commerce, conflict, and contamination: yellow fever in early-independence Veracruz in the US imaginary, 1821-1848

While commercial links between Mexico and the United States through the port city of Veracruz brought significant economic and social advantages in the early nineteenth century, public health concerns around yellow fever produced fascination and fear among US audiences (in southern and eastern port cities) from times of peace until the US invasion and occupation of Mexico (1846-1848). This article addresses the complex linkages between commerce, conflict, and contamination in reference to the port city of Veracruz and the United States in Mexico's early decades of independence. More specifically, this article addresses the concern in early nineteenth-century US periodicals around yellow fever outbreaks and potential contamination, showing the constant presence of yellow fever in Veracruz in the US imaginary.

Lead pollution recorded in Greenland ice indicates European emissions tracked plagues, wars, and imperial expansion during antiquity

Lead pollution in Arctic ice reflects midlatitude emissions from ancient lead-silver mining and smelting. The few reported measurements have been extrapolated to infer the performance of ancient economies, including comparisons of economic productivity and growth during the Roman Republican and Imperial periods. These studies were based on sparse sampling and inaccurate dating, limiting understanding of trends and specific linkages. Here we show, using a precisely dated record of estimated lead emissions between 1100 BCE and 800 CE derived from subannually resolved measurements in Greenland ice and detailed atmospheric transport modeling, that annual European lead emissions closely varied with historical events, including imperial expansion, wars, and major plagues. Emissions rose coeval with Phoenician expansion, accelerated during expanded Carthaginian and Roman mining primarily in the Iberian Peninsula, and reached a maximum under the Roman Empire. Emissions fluctuated synchronously with wars and political instability particularly during the Roman Republic, and plunged coincident with two major plagues in the second and third centuries, remaining low for >500 years. Bullion in silver coinage declined in parallel, reflecting the importance of lead-silver mining in ancient economies. Our results indicate sustained economic growth during the first two centuries of the Roman Empire, terminated by the second-century Antonine plague.

From Northern Ireland to Afghanistan: half a century of blast injuries

Introduction

Throughout the last half century, blast injuries have been a common occurrence to UK military personnel during combat operations. This study investigates casualty data from three different military operations to determine whether survivability from blast injuries has improved over time and whether the tactics used could have influenced the injuries sustained.

Methods

Casualty data from operations in Northern Ireland, Iraq and Afghanistan were reviewed and found to contain a total of 2629 casualties injured by improvised explosive devices. The injury severities were examined and the suitability of comparison between conflicts was considered.

Results

The case fatality rate and mean severity score sustained remained consistent among the operations included in this study. Using the New Injury Severity Score, the probabilities of survival were calculated for each separate operation. The body regions injured were identified for both fatalities and survivors. Using this information, comparisons of injury severities sustained at an Abbreviated Injury Scale of 3 and above (identified as a threshold for fatal injury) were conducted between the different operations.

Conclusions

The data showed that as operations changed over time, survivability improved and the proportions of body regions injured also changed; however, this study also highlights how studying casualty data from different conflicts without taking account for the contextual differences may lead to misleading conclusions.

Love and loss in wartime: An unpublished narrative by Pamela Frankau (1908-67)

This article discusses an unpublished book by the popular and prolific novelist Pamela Frankau (1908-67), which was rejected by her publishers in 1946 as "almost too personal for publication," and which for many years was believed lost. The work is addressed to Frankau's dead lover, Marjorie Vernon Whitefoord (1907-44), a fellow officer in the women's Auxiliary Territorial Service, and takes the form of a letter to Vernon. The article examines what Frankau's unpublished narrative of love and loss in wartime reveals about her life and later novels, and its implications for the official record of her life and writing.

Wounded to the bone: Digital microscopic analysis of traumas in a medieval mass grave assemblage (Sandbjerget, Denmark, AD 1300-1350)

Battle-related mass burials are considered the most unequivocal evidence of past violence. However, most published studies involve only macroscopic analysis of skeletal remains, commonly arriving only at broad conclusions regarding trauma interpretation. The current study considers a possible avenue for achieving both greater detail and accuracy through digital microscopy. Patterns of injury were investigated among 45 individuals from a Medieval Danish mass grave (Sandbjerget, AD 1300-1350). Injuries were recorded on every anatomical element, except hand and foot bones. Each was photographed and cast, facilitating remote evaluations. Macroscopic analysis was compared with digital microscopy in order to test the relative utility of the latter in characterizing skeletal injuries (mechanism, weapon class, direction, timing of injury). The location of 201 observed injuries, mainly sharp force defects, suggested that many lesions were probably not inflicted by face-to-face opponents. Some microscopic features were indicative of a specific lesion type and weapon class. Digital microscopy was therefore demonstrated to be a complementary tool to macroscopic assessment, enhancing feature observation and quantification and serving to compensate for many of the limitations of macroscopic assessment.

Military service, deployments, and exposures in relation to amyotrophic lateral sclerosis survival

BACKGROUND

Military veterans may have higher rates of amyotrophic lateral sclerosis (ALS) mortality than non-veterans. Few studies, with sparse exposure information and mixed results, have studied relationships between military-related factors and ALS survival. We evaluated associations between military-related factors and ALS survival among U.S. military veteran cases.

METHODS

We followed 616 medical record-confirmed cases from enrollment (2005-2010) in the Genes and Environmental Exposures in Veterans with Amyotrophic Lateral Sclerosis study until death or July 25, 2013, whichever came first. We ascertained vital status information from several sources within the Department of Veterans Affairs. We obtained information regarding military service, deployments, and 39 related exposures via standardized telephone interviews. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95% confidence intervals. We adjusted for potential confounding and missing covariate data biases via inverse probability weights. We also used inverse probability weights to adjust for potential selection bias among a case group that included a disproportionate number of long-term survivors at enrollment.

RESULTS

We observed 446 deaths during 24,267 person-months of follow-up (median follow-up: 28 months). Survival was shorter for cases who served before 1950, were deployed to World War II, or mixed and applied burning agents, with HRs between 1.58 and 2.57. Longer survival was associated with exposure to: paint, solvents, or petrochemical substances; local food not provided by the Armed Forces; or burning agents or Agent Orange in the field with HRs between 0.56 and 0.73.

CONCLUSIONS

Although most military-related factors were not associated with survival, associations we observed with shorter survival are potentially important because of the large number of military veterans.

Politics and Health at the WHO Regional Office for South East Asia: The Case of Portuguese India, 1949-61

This paper analyses how the 1950-61 conflict between Portugal and India over the territories that constituted Portuguese India (Goa, Daman and Diu) informed Portugal's relations with the World Health Organization's Regional Office for South East Asia (SEARO). The 'Goa question' determined the way international health policies were actually put into place locally and the meaning with which they were invested. This case study thus reveals the political production of SEARO as a dynamic space for disputes and negotiations between nation-states in decolonising Asia. In this context, health often came second in the face of contrasting nationalistic projects, both colonial and post-colonial.

[The Spanish Red Cross, the repatriation of soldiers during the colonial wars and the development of medical science in Spain, 1896-1950]

This article examines the role played by the Spanish Red Cross (founded in 1864) in the introduction and spread of humanitarian technologies and the development of medical science in Spain, using the case study of medical care for sick and wounded soldiers repatriated during the wars in Cuba, the Philippines and Morocco, and analyzing the impact these measures had on health care and public health among the civilian population. The article shows how this organization set up health care for Spanish soldiers, establishing a network of specialized medical centers that were later also used to provide medical care for civilians and to address new public health problems.

[Technological innovation and humanitarianism in the transport of war wounded: Nicasio Landa's report on a new elastic suspension system for stretchers (Pamplona, May 29, 1875)]

In May 1875, in the midst of a bloody civil conflict in Spain known as the Third Carlist War, Nicasio Landa, a medical officer with Military Health, wrote a report requesting authorization for the Spanish Red Cross, of which he was Inspector General, to adopt a new elastic suspension system for stretchers that he had designed, developed and tested. Intended above all for use in farm wagons - still the most widely-used method of transporting the wounded at the time - it was an inexpensive, sturdy mechanism that improved patient comfort and could also be installed in ambulance carriages, railway carriages and hospital ships. An annotated version of the report is included, preceded by a presentation of its contents.

[A state of need: the Spanish Red Cross in Morocco, 1886-1927]

This article studies the central role of nation-states in the Red Cross during the interwar period. In the late nineteenth century, Spain pioneered the creation of European-style humanitarian institutions in Morocco. However, its perennial instability as a state, aggravated by the colonial disaster of 1898, put an end to the regenerationist project of a Moroccan Red Cross. When the Spanish protectorate was established in 1912, the Spanish Red Cross was overshadowed by competition from its French counterpart, the internationalization of Tangiers and resistance from the local inhabitants. This culminated in the so-called Rif War of 1921-1927, a mixture of anticolonial revolt and international war that vividly exposed the ingrained deficiencies of the Spanish State and its Red Cross.

[Scientific communication and technological innovation in the first Red Cross, 1863-1876]

The early years of the international Red Cross movement coincided with great technological changes in war medicine. The organizational peculiarities of the International Association for Relief of Wounded Soldiers in Campaign, set up by the Geneva Committee, and by the Red-Cross' national committees; the convergence in various professional conferences and publications of doctors from different national societies of this association; and the construction of a body of shared practical expertise tested during the Franco-Prussian War (1870-1871) provide keys for understanding the technological innovations introduced by the Spanish Red Cross during the third and last Carlist War (1872-1876).

Reinventing the political role of health professionals in conflict prevention & reconciliation: the Sudanese model

Given the persistent recurrence of armed conflict, influential actors owe it to the affected communities to take action. The legitimacy of health professionals to mitigate the effects of conflict relates to their ability to save lives and address the physical and mental consequences of armed conflict during which thousands of lives may be lost. Medical professionals have unique and potentially far-reaching skills. These become crucial during wartime and disasters in terms of providing medical services and humanitarian aid. However, they are insufficiently used in one area: involvement in politics as a tool to foster peace. Despite this, Sudanese individuals from medical backgrounds have participated actively in conflict resolution and peace-building processes. In fact, their political actions throughout the last six decades have aimed to prevent conflict at four different levels, which are described by Yusuf et al. in their article on the political involvement of health professionals in prevention. Their stand against President Nimeiri's Sharia laws was primordial prevention of religious conflict at the national level. Their leading role in the second Sudanese Intifada uprising was a key factor in saving the country from civil war, and another example of primary prevention. Sudanese physicians were also involved in secondary prevention by being influentially involved in almost all national peace agreements. Avoiding disputes at the tertiary level represents the weakest link in their repeated efforts. This paper outlines the different roles Sudanese medical personnel have taken in peacemaking. It also critically evaluates them in order to consider new methods of political involvement that suit future challenges.

Impact of 20th Century Wars on the Development of Neurosurgery

The treatment of neurosurgical casualties suffered during the wars of the 20th century had a significant impact on the formation and early growth of neurosurgery as a specialty. This chapter explores how the evolution of military tactics and weaponry along with the circumstances surrounding the wars themselves profoundly influenced the field. From the crystallization of intracranial projectile wound management and the formal recognition of the specialty itself arising from World War I experiences to the radical progress made in the outcomes of spinal-cord-injured soldiers in World War II or the fact that the neurosurgical training courses commissioned for these wars proved to be the precursors to modern neurosurgical training programs, the impact of the 20th century wars on the development of the field of neurosurgery is considerable.

Neurology and Neurologists during the Franco-Prussian War (1870-1871)

The Franco-Prussian War (1870-1871) ended with the firm establishment of the French Republic and with German unity under Prussian leadership. After describing the events leading to the war, we explain how this conflict was the first involving the use of machine guns; soldiers were struck down by the thousands. Confronted with smallpox and typhus epidemics, military surgeons were quickly overwhelmed and gave priority to limb injuries, considering other wounds as inevitably fatal. Here, we present detailed descriptions of spinal and cranial injuries by Léon Legouest and of asepsis prior to trepanning by Ernst von Bergmann. Both the war and the Commune had disastrous effects on Paris. Jean-Martin Charcot continued to work intensely through the conflict, caring for numerous patients at La Salpêtrière Hospital according to his son Jean-Baptiste's account, which we've also excerpted below. As for young Dejerine, he treated the wounded from France who had taken refuge in Switzerland. Désiré-Magloire Bourneville also took heroic initiatives, as did Charles Lasègue, Alfred Vulpian, Alix Joffroy and Victor Cornil.

Psychiatric care at a national mental institution during the Spanish Civil War (1936-39): Santa Isabel de Leganés

The scanty research available regarding the health of the mentally ill during the Spanish Civil War is largely due to the loss of most documents, and to the difficulty in accessing the existing archives for decades. Up to the present time, historiography has described overcrowded facilities for the mentally disturbed and the fact that old buildings such as convents and spas were turned into establishments for treating patients with mental problems during the Civil War. However, research reviewing the institutional life and conditions of psychiatric patients during this war is still rather scarce.The aim of our article is to discuss the characteristics of the patients at Santa Isabel National Mental Asylum between 1936 and 1939, as well as the functioning of this institution located in Leganés, a city to the south of Madrid (Spain). The method for this study includes a review of the medical records, statistical registers and other documents kept in the institution's Historical Archive. In addition, using documents from other Spanish archives, as well as information obtained from contemporary and secondary sources, we attempt to describe similarities to and differences from other mental institutions.

Lady Brilliana Harley (1598-1643): Her medicines and her doctors

Lady Brilliana Harley was the redoubtable chatelaine of Brampton Bryan Castle in Herefordshire during the mid-seventeenth century. Her many letters reveal much about the medications which she dispensed to her family and about the family's medical attendants. Whenever possible the Harleys preferred to consult university-educated physicians rather than the local apothecary or surgeon. These physicians are all known from other sources but Brilliana's letters add to what is known of their provincial practices. In particular, they reveal their willingness to undertake blood-letting, often thought to be the province of the more lowly surgeon, and they emphasise the great distances travelled by these practitioners and the difficulties faced by two of them during the Civil War.