Three-dimensional reconstruction of King Henri IV's paranasal sinuses and mastoid cells

PURPOSE

The preserved head of King Henri IV of France (life 1553-1610, reign 1589-1610) has survived to the present day thanks to high-quality embalming and favorable conservation conditions. The aim of this study was to examine Henry IV's upper resonant cavities and mastoids using an original and innovative forensic three-dimensional segmentation method.

METHODS

The paranasal sinuses and mastoid cells of King Henri IV of France were studied by cross-referencing available biographical information with clinical and flexible endoscopic examination and computed tomography (CT-scan) imaging. The paranasal sinuses and mastoid cells were delineated and their volumes were assessed using ITK-SNAP 4.0 software (open-source). Graphical representations were created using Fusion 360® (Autodesk Inc., San Rafael, CA, USA) and MeshMixer® (Autodesk Inc., San Rafael, CA, USA).

RESULTS

Paranasal sinus tomodensitometry revealed abnormalities in shape and number. Henri IV of France suffered from sinus aplasia. Neither the left sphenoid nor left frontal sinus contrasted sharply, and a remarkable pneumatization of the right clinoid processes extended throughout the height of the right pterygoid process. The total volumes of Henri IV's mastoid air-cells were estimated at 27 and 26 mL, respectively, for the right and left sides, exceeding the normal mean and the maximum of modern subjects by a wide margin. No sign of chronic ear or sinus condition was found.

CONCLUSIONS

An innovative method has been developed in forensic medicine to establish hypotheses about the growth and respiratory conditions of the face.

Scurvy complicated with Capnocytophaga sputigena sepsis as a possible cause of death of king Saint-Louis of France (1270 AD)

The cause of death of Saint-Louis is not known, but recent findings indicated that he presented scurvy and inflammatory jaw disease, which has been associated with infection by oral commensals. Here, we have the exceptional opportunity to analyze the relics of the viscera of King Saint-Louis. A 4.3 g sample from the viscera relics of King Saint-Louis conserved in Versailles' cathedral was subjected to radiocarbon dating, electronic and optic microscopy, and elementary, palynological, molecular, proteomics and microbiological analyses including specific PCR and v3v4 16 S rRNA gene amplification prior to large-scale sequencing using an Illumina MiSeq instrument. The measured radiocarbon age was Cal 1290 CE-1400, which was compatible with that of the viscera of St Louis viscera, considering the addition of lime, incense and vegetables within the human organs. Elemental and palynological analyses confirmed a medieval embalming process. Proteomics analysis identified mainly human muscle and blood proteins. Specific PCR for plague, amoebiasis, shigellosis and typhoid fever was negative. C. sputigena was identified as the main pathogenic species representing 10.8 % of all microbial sequences. In contrast, C. sputigena was found in only 0.001 % of samples sequenced in our center, and the 23 positive human samples showed a dramatically lower abundance (0.02-2.6 %). In the literature, human infections with C. sputigena included odontitis, dental abscess, sinusitis, thoracic infections and bacteremia, particularly in immunocompromised patients with oral and dental diseases consistent with recent analysis of King Saint-Louis' jaw. C. sputigena, a commensal of the mouth that is potentially pathogenic and responsible for fatal bacteremia, may have been the cause of the king's death.

Forensic description of impalement and associated torture lesions by Napoleon troops (Egypt, 1800)

Impalement bone traumas are very rarely described in the medical literature. We here present the first case of such a diagnosis carried out on a skeleton. The patient is Soleyman el-Halaby, executed in June 1800, who was the 24-year-old murderer of the Napoleonic general Kléber. The skeleton is now held in the National Museum of Natural History (Paris). This report describes the traumatic lesions diagnosed after a careful forensic anthropological examination. Such a case is important from a medical point of view, whether the origin of the pelvic or abdominal impalement is accidental or criminal. Forensic examination of skeletons conserved in anthropological collections may help reconstruct the modalities of death, and give data for an eventual repatriation process to the original community.

Which treatment for the French revolutionist Jean-Paul Marat's dermatitis (1793)? A biomedical analysis of his bathtub deposits

The history of medicine makes it possible to understand both the evolution of the conceptualization of pathological processes, but also the modification of therapeutic principles and patient management. In the context of dermatology, we are interested here in the case of Jean-Paul Marat, who was murdered in his bathtub at the end of the 18th century in France and had severe dermatosis. Examination of deposits of pharmaceutical products inside the bathtub in which he spent most of his time made it possible to reconstruct the nosological and therapeutic framework of his dermatosis.

Deep Paleoproteotyping and Microtomography Revealed No Heart Defect nor Traces of Embalming in the Cardiac Relics of Blessed Pauline Jaricot

Scientific examination of the heart of Blessed Pauline Jaricot-a French missionary figure-was carried out in 2022. As tandem mass spectrometry proteotyping has proven to be valuable to obtain the broad taxonomic repertoire of a given sample without any a priori information, we aimed at exploring the conditions of preservation of the relics and possible conditions of death. Metaproteomics and high-resolution microtomography imaging approaches were combined. A dataset comprising 6731 high-resolution MS/MS spectra was acquired and 968 of these spectra could be assigned to specific peptidic biomolecules. Based on the taxonomical information encompassed by the identified peptide sequences, 5 phyla were identified amongst eukaryota (94% of the biomass): Ascomycota (55%), with the species Aspergillus versicolor, Trichophyton mentagrophytes and Aspergillus glaucus, corresponding to expected cadaverous fungal flora; Chordata (42%), represented by a unique species, Homo sapiens; Streptophyta (3%); and Arthropoda (traces). Bacteria (6% of the biomass) were poorly represented. No trace of embalming substance could be retrieved, nor any pathogens. Imaging evidenced no heart defect nor embalming traces. No evidence that was inconsistent with natural and spontaneous conservation could be retrieved. This study prefigures the power of modern molecular techniques such as paleoproteotyping coupled to microtomography to gain insight into historical relics.

Evidence of Cushing's syndrome in a pre-Columbian Mexican statue?

INTRODUCTION

In the absence of skeletons or written narrations, information about diseases in past societies may be acquired from icono-diagnosis. From the observation of a masterpiece presenting pathological features, we tried to make retrospective diagnosis.

MATERIAL AND METHOD

A pre-Columbian Mexican statuette originating from the Chupicuaro culture and dated 600 BC to 200 AD - conserved in the Louvre Museum in Paris (Section of the quai Branly - Jacques Chirac museum) was examined; it was found to display a huge spinal curvature with excessive dorsal kyphosis and obesity.

RESULTS

The appearance of the figurine with large head, shortened stature and limbs, may suggest a form of dwarfism; however, many statuettes in the Chupicuaro culture were found displaying large head and relatively short limbs, suggesting that these pictorial features are more of an artistic style. On the contrary, uncommon kyphosis and obesity led us to diagnose a case of either Pott disease associated with neuro-endocrine complications, or of Cushing's disease.

CONCLUSION

Although icono-diagnosis could have allowed us to contribute to the health mapping of ancient Americas and propose the presence of complicated tuberculosis in central Mexico between 600 BC and 200 AD, we believe "Choupi" portrays here an individual having suffered from hypercortisolism (Cushing's disease). Even though considerations related to cultural and artistic context may constitute limitations to interpretation, iconotopsy/iconodiagnosis are important for a better description of the natural history of diseases, as a complement to morphological analyses of human remains (paleopathology) and laboratory exams (DNA or immunology testing).

Toxicological analysis of a "poison vial" found in the remains of an SS soldier (Maltot, Normandy, France)

In Maltot (Normandy, France), one grave containing the remains of a German soldier, who died in 1944, was excavated amongst other graves and isolated elements. A dozen whole vials were unearthed, resulting in questions about their content. Various screenings were carried out on the contents of one single vial: HPLC-DAD and HR-LC-MS screening after 1/10 dilution in mobile phase, GC-MS and HS-GC-MS after 1/10 dilution in methanol, multi-element research by HR-ICP-MS after total mineralization, and cyanide analysis. Analyzed vial contained approximately 300 µL of a colorless, water-immiscible liquid with a characteristic solvent odor. HPLC-DAD, GC-MS, HR-LC-MS/MS, ICP-MS, and cyanide screenings were negative excluding the presence of cyanide, arsenic, barbiturates, amphetamines, or narcotics. HS-GC-MS analysis highlighted the presence of ethanol, chloroform, and diethyl ether at significant concentrations. Chloroform and diethyl ether were anesthetic products mainly reserved for urgent situations. We hypothesized that the soldier may have been a combat medic working on battlefields. as he was wounded, another possibility could be that he may have used the vials to relieve his pain; however, the immediate severity of the wounds drove us to assess the second hypothesis of delayed death as being less plausible. The high number of vials containing ethanol, chloroform, and diethyl ether, and the massive blood loss leading to quick death led us to support the combat medic or paramedic hypothesis.

Putative native South Amerindian origin of head lice clade F: evidence from head lice nits infesting human shrunken heads

The head louse, Pediculus humanus capitis, is a strictly obligate human ectoparasite with a long history of association with humans. Here, 17 ancient head lice nits were recovered from six shrunken human heads (known as tsantsas) of individuals from the Shuar/Jivaro tribe, a native Amazonian population from Ecuador, South America. Cytochrome b DNA analysis revealed the presence of three known mitochondrial clades. Clade A was the most frequent (52.94%), followed by F (35.29%), and B (11.76%). Eleven haplotypes were found in 17 samples, and nine of the haplotypes were novel, indicating an unusually high genetic diversity. In conclusion, we confirmed the presence of clades A, B and F in South Amerindian population. Moreover, the description of clade F, together with its previous reports in another Amerindian population from French Guiana, strongly support the hypothesis of a native South American origin for this clade, and probably derived from clade B which was carried to America by an ancestral Eurasian Beringian population. Further support to our conclusion and new insights might come from the analysis of a larger collection of modern and ancient native American lice.

The Internal Cranial Anatomy of a Female With Endocrine Disorders From a Mediaeval Population

Gigantism and acromegaly have been observed in past populations; however, analyses usually focus on the morphological features of the post-cranial skeleton. The aim of this study is to characterize the internal anatomical features of the skull (brain endocast anatomy and asymmetry, frontal pneumatization, cranial thickness, sella turcica size) of an adult individual from the 11-14th centuries with these two diseases, in comparison with non-pathological individuals from the same population. The material consisted of 33 adult skulls from a mediaeval population, one of them belonging to an adult female with endocrine disorders (OL-23/77). Based on the CT scans, the internal cranial anatomy was analysed. The sella turcica of OL-23/77 is much larger than in the comparative sample. The endocast of the individual OL-23/77 shows a left frontal/left occipital petalia, while the comparative population mostly had right frontal/left occipital petalias. The asymmetry in petalia location in OL-23/77 comes within the range of variation observed in the comparative population. The individual has high values for cranial thickness. The frontal sinuses of the specimen analysed are similar in size and shape to the comparative sample only for data scaled to the skull length. Enlarged sella turcica is typical for individuals with acromegaly/gigantism. The pattern of the left frontal/left occipital petalia in the specimen OL-23/77 is quite rare. The position of the endocranial petalias has not influenced the degree of asymmetry in the specimen. Despite the large bone thickness values, skull of OL-23/77 does not show any abnormal features. The skull/endocast relationship in this individual shows some peculiarities in relation to its large size, while other internal anatomical features are within the normal range of variation of the comparative sample.

King Charles VIII of France's Death: From an Unsubstantiated Traumatic Brain Injury to More Realistic Hypotheses

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.

Saint Roch and Social Distancing During Pandemics: Lessons to be Remembered

Surprisingly, Catholic hagiography can teach us a lot about medicine. As an example, we present here the history of Saint Roch who is considered, along with Saint Sebastian, one of the two main Saints who act as protectors against plagues and have often been invoked by Catholic people during the recent COVID-19 pandemic. Whereas Saint Sebastian is associated with plagues only symbolically, Catholic tradition considers Saint Roch to have had real contact with the bubonic plague. Indeed, during his pilgrimage to Rome, Saint Roch helped people suffering from the plague and was, subsequently, himself infected. He was then forced to retire in solitary confinement to avoid the plague's spread and followed scrupulously the necessary restrictive measures. Saint Roch's story provides useful lessons about the importance of social responsibility by respecting the restrictive rules during difficult times such as the COVID-19 epidemic.

Clinical agreement with self-report of physical violence and torture in women seeking asylum in France

Women are a particularly vulnerable group among persons seeking asylum but are still required to provide clinical evidence of acts of violence inflicted against them. In this study the authors describe patient histories, dermatological lesions and other injuries arising from physical violence and torture in female asylum-seekers attending a specialist outpatient service in France. Twenty-seven women were assessed during 2016-2018. Clinical corroboration of lesions with patients' self-reports was affirmative in >90% (25/27) of cases. Health care services in recipient countries must be configured and resourced to support women seeking asylum, and health care professionals must be receptive and sensitive to women's self-reported histories.

[Anthropology of Infectious Death]

How do funeral rituals adapt when death is of infectious origin, or when death occurs in an epidemic context? What changes are needed? What anthropological fundamentals are altered, diverted or reversed? We will see, in the following anthropological and historical examples, how the community of the living deals with its fears and metaphysical demands vis-à-vis the community of the deceased, dealing with codes and beliefs. In short, how parallel rituals have been established to satisfy both parties.

Which Saint to pray for fighting against a Covid infection? A short survey

Background

In the absence of a treatment still considered universally effective, and of a vaccine validated by the health authorities, we wanted to know which Catholic saint the European Christian community turned to in the event of infection with Covid-19 to request a miraculous healing.

Methodology

An online survey was carried out on a sample of 1158 adults using social media tools.

Results

All results are presented in this research, with a few saints in the majority, and some dictated by the symptomatology of the Covid-19 infection or the personalities of certain « doctor guru ».

Conclusion

This medico-anthropological study is revealing the psychology of Western patients vis-à-vis the magic-religious means used in the fight against diseases, particularly in the epidemic/pandemic context.

Should we use full analgesic dose of opioids for organ procurement in brainstem dead?

Families facing the growing demand for organ removal from their loved ones are questioning the possible suffering of the brainstem dead patient. A frequent question they ask to coordinating doctors is: Are you sure he will not feel anything? Currently due to the risk of exacerbation of spinal reflexes and abnormal movements following surgical stimuli, it is recommended to use a curarization and an analgesic agent (most often morphine). The doses of opioids are less important than during usual anaesthesia, whereas the person is considered brainstem dead and there is no longer any cerebral integration of the pain. But what assures us that absolutely no more sensibility exists at this precise moment? Should the use of full analgesic dose of opioids not be continued anyway? Could this make the levies more "ethical"?

Evidence of physical violence and torture in refugees and migrants seeking asylum in France

OBJECTIVES

The increasing numbers of migrants and refugees to Europe include persons seeking asylum, many of whom will have experienced physical violence and torture. Here we describe the personal histories and clinical evidence of violence and torture among attendees at a public health specialist service in France.

METHODS

Physicians in a multidisciplinary team conducted examinations to corroborate refugees' skin lesions and other signs of injury with self-reported histories of physical violence and torture to provide evidence for asylum applications.

RESULTS

The 240 asylum seekers assessed between October 2016 and September 2018 were mostly male (89% (213/240)) with median age 29 years (IQR 26-34 years) and originating from north and west Africa. Consultations took place on average 15 months after arrival in France. In most cases (58%) the reason for seeking asylum was political persecution. Almost all attendees (94%) presented with scars. The most common mechanisms of injury were beatings (84%), burns (32%) and cuts/stab wounds (15%). Sexual violence was reported for 37% of women (10/27) and 4% of men (9/213). Police tended to use multiple methods for inflicting injuries, whereas the army and non-state actors mostly inflicted beatings. Sexual violation was most commonly reported for violence inflicted by family members or partners. Corroboration of lesions with patients' histories of physical violence and torture was affirmative in 93% (224/240) of cases.

CONCLUSION

For this ethnically diverse group, a specialist service which can provide clinical corroboration of self-reported histories of physical violence and torture to support asylum applications is an essential minimum.

Chapter 7. What symbolic answers to death in the medical world?

INTRODUCTION

By threatening our lives, death becomes a medical as well as an institutional issue. To remedy the quest of sense, Man develops a culture amongst which the symbols will be the basis of rites. Recent studies have shown a high rate of burnout syndromes and suicide within the medical community. With a qualitative approach, we aimed to answer the following question: do doctor possess symbolic means of personal defence in front of the dissolvent action of death?

METHODS

We built up a questionnaire from key points raised by anthropology and sociology of death. It was addressed to residents of Saint Louis Hospital (Paris, France) during winter 2016-2017.

RESULTS

Twenty comprehensive answers were obtained. Young physicians were between 25 and 33 years old (55% haematologists, 35% oncologists, others general practitioners & internal medicine physicians). We show that, to remedy the quest of sense in presence of death, young physicians reckon having repetitive gestures with corpses, thus elaborating the beginning of a personal rite. We also demonstrate the role of empathy and palliative medicine in diminishing the pain of seeing agony and death. Finally, we weave a tie between the lack of collective catharsis at hospital and the high rate of suicide and depressions within the medical community.

CONCLUSION

In the West, we are out of effective symbolism due to the shift of rituals on less metaphysical symbols. This shift of symbolism also affects hospital which failed to develop or protect means to transcend death in a collective scale.

Hydroxy-chloroquine to treat COVID-19 - infected patients: Some lessons from medical anthropology and history of medicine

It is certainly too early to take stock of Professor Raoult's intuitions, and moreover, that is not the aim of this short article. Nevertheless, experience has shown that in times of unprecedented health crises, prescriptions often turn out to be adventurous, especially when it comes to a new virus. The collective imagination around a remedy often takes the place of a guarantee or, on the contrary, a safeguard. Here, the authors question the implementation of hydroxy-chloroquine treatment in the context of the COVID-19 pandemic. How was his prescription discussed in this context of crisis? What lesson can we learn from medical anthropology and the history of medicine, by witnessing other epidemics and atypical or unconventional substances or behaviors of practitioners?

The Autopsy of the Prophet Muhammad in Dante's Inferno

Dante places the sinners who promoted scandals, schism, and discord in the ninth Ditch of the Inferno. Among those is also the Prophet Muhammad. Describing the Prophet's punishment, Dante resorts to technical terms and vulgar expressions. This poetic representation highlights Dante's medical and anatomical knowledge and reflects 14th c. Christian religious beliefs. At that time, autopsies were performed only on prisoners, prostitutes and people without identity. By comparing the Prophet to an autopsied corpse, Dante associates Muhammad with those bearing the badge of shame. Moreover, this description is a further confirmation that Dante had good medical knowledge.

Systemic Modelling in Bioethics

We present here a new method for bioethics: systemic modelling. In this method, the complex phenomenon being studied (e.g. personalized medicine, genetic testing, gene therapy, genetically modified organisms) is modelled as a whole, to shed light on its organization and functioning, and major (bio)ethical issues and solutions for their resolution are then identified. This systemic modelling method is ideal for use in the identification of solutions, rather than their validation, with other methods then used to test the solutions found. We provide a description and reproducible instructions for the application of systemic modelling in bioethics, together with a brief example of the application of this method to the study of the impact of personalized medicine on French society.

Influence of averaged fetal heart rate in heart rate variability analysis

In high-income countries, fetal hypoxia affects 3 to 8 newborns per 1000 live births with subsequent moderate or severe Hypoxic-Ischemic Encephalopathy (HIE) in 0.5 to 1 per 1000 live births. Visual interpretation of FHR signal issued from a Doppler ultrasound cardiotocography is the gold standard to monitor fetal condition. Unfortunately, its analysis presents a high rate of inter-observer variability and a low specificity to predict poor neonatal outcomes. Under hypoxia, the fetus develops several adaptive mechanisms regulated by the autonomic nervous system inducing changes in the fetal heart rate variability. Though fetal heart rate variability methods demonstrated abilities to predict perinatal asphyxia, most of the Doppler ultrasound technologies used in clinical practice do not provide sufficiently accurate fetal heart rate signals for heart rate variability analysis. Indeed, Doppler ultrasound cardiotocography usually provides fetal heart rate values averaged over 2 or 3 beats which can constitute a limitation for spectral analysis. We developed a fetal heart rate variability analysis method: the Fetal Stress Index (FSI). The objective of this study was to investigate the influence of averaged fetal heart rate on this new index in order to check the feasibility of computing the FSI from the signal issued from Doppler ultrasound cardiotocography.