Dental health status of the medieval silver-mining community from Kutná Hora (Czech Republic, 13th-16th c.): Impact of socioeconomic changes and mortality crises

OBJECTIVE

The aim of the study was to evaluate the pathological conditions in teeth from skeletal remains found in the medieval burial ground at Kutná Hora (13th-16th centuries, Czech Republic). We focused on the effect on dental health of socioeconomic changes associated with the boom in silver mining at the site.

DESIGN

In this study, dental caries and antemortem tooth loss were recorded for 469 sexed adults (10,558 permanent teeth). Pathologies were analysed and presented by teeth and alveoli, and the differences between their frequencies were tested in sex-, age-, and burial context-separated groups (mass vs. individual graves).

RESULTS

The oral conditions were characterised by a low frequency of caries and moderate frequency of antemortem tooth loss (AMTL). For caries, males and females showed the same frequencies while AMTL comparisons indicated a higher rate in females. Most differences emerged between age-separated and burial context-separated groups. The age progression of the pathologies was confirmed for both caries and AMTL. Skeletons from mass burials had higher caries and AMTL frequencies than those buried in individual graves.

CONCLUSIONS

The dataset exhibited low caries and below average AMTL rates compared to other medieval European skeletal series. We think that life in this mining centre had a positive effect on the dental health of its inhabitants. The relatively poorer dental health of those buried in mass graves reflected either the specific composition of the population in the first half of the 14th century or the lower resilience of these individuals when facing mortality crises.

Dogs in Lithuania from the 12th to 18th C AD: Diet and Health According to Stable Isotope, Zooarchaeological, and Historical Data

This article presents the results of research that focused on the nutrition and related health issues of medieval and early modern dogs found in the territory of present-day Lithuania. In this study, we present bone collagen carbon (δ13C) and nitrogen (δ15N) isotope ratios for seventy-five dogs recovered from seven sites which were dated back to the between the 12th and 18th C AD. In addition, by studying the remains of almost 200 dogs, we were able to estimate changes in the sizes and morphotypes of canines across over 600 years. On the basis of stable isotope and historical data, as well as the osteometric analysis, we discuss the dietary patterns of different sizes and types of dogs from the sites related to different social strata and time periods. The results of our study demonstrate that the size, type, diet, and health of canines from different time periods and sociocultural environments varied. Overall, carbon isotopic signals indicate that dogs' diets were based on C3 plant environment foods (cereals and animals), while freshwater fish was more important for some individuals in coastal Klaipėda/Memelburg Castle. The stable isotope analysis supported the historical records, indicating that cereals were highly important in the diet of elite dogs. Meanwhile, urban dogs had a different nutrition. In the Middle Ages, the consumption of plant-based foods was likely higher compared to the early modern period. Our study also revealed that the diets of dogs did not correlate with individual size. Compared to pigs, dogs had a higher intake of animal foods in their diet. In general, the nutrition of the studied canines was similar to that of the rural human population of the same period.

Investigating the association between intestinal parasite infection and cribra orbitalia in the medieval population of Cambridge, UK

OBJECTIVE

Cribra orbitalia is believed to be a skeletal indicator of chronic anaemia, scurvy, rickets or related metabolic diseases. It has been suggested that it may be used as a proxy indicator for intestinal parasite infection, as parasites often cause anaemia today. Our aim is to investigate this association in the medieval population of Cambridge, UK.

MATERIALS

Individuals excavated from the cemeteries of the Augustinian friary and All Saints by the Castle parish church, and aged from 7 to adulthood.

METHODS

We undertook parasite analysis of the pelvic sediment and control samples of 46 burials with intact orbital roofs.

RESULTS

Human roundworm (Ascaris lumbricoides) and/or whipworm (Trichuris trichiura) were identified in the pelvic sediment of 22 individuals, and cribra orbitalia noted in 11 individuals. Barnards test showed no association between parasite infection and cribra orbitalia (p = .882).

CONCLUSION

We found no association between infection and cribra orbitalia infection in this medieval adult population, calling into question this hypothesis, at least for adults.

SIGNIFICANCE

High or low cribra orbitalia prevalence in adults should not be used to infer rates of intestinal parasite infection.

LIMITATIONS

The individuals in the study were over the age of 7, with no younger children. It is possible that only parasites which cause marked anaemia (such as hookworm, schistosomiasis or malaria) may cause cribra orbitalia, while less marked anaemia from roundworm and whipworm may not do so.

SUGGESTIONS FOR FURTHER RESEARCH

Repeating this study in younger children, when most cribra orbitalia appears to form.

Pathological Changes in Early Medieval Horses from Different Archaeological Sites in Poland

The work is the first comprehensive analysis of equine pathological changes from the Polish territory. The research material was collected from 20 archaeological sites, mainly early medieval settlements, such as strongholds, settlements, towns and horse graves. In the material examined, 186 cases of lesions were found. Of these, 26.9% were lesions of the spine, 39.8% lesions of the limb skeleton and 31.7% lesions of the head including dental pathologies. Most of the lesions in the limbs involved their distal segments. The vast majority of pathological cases can be linked to animal use. It was found that horses in which pathological lesions were observed were used under cover. In one case, the observed cranial trauma was the cause of death associated with injury to the nasal auricles and large vessels and consequent blood loss and possible shock. It was found that, in some of the cases, the horses started to be used early which affected their organs of motion and spine.

A case of secondary hypertrophic osteoarthropathy from medieval Tuscany (central Italy, 10th-12th centuries CE)

OBJECTIVES

This study aims to provide a detailed evaluation of a case of secondary hypertrophic osteoarthropathy (HOA) and to explore insights into the presence and consequences of disease in medieval rural Italy.

MATERIALS

The skeleton of a male (US 4405) with an estimated age at death of 51-69 years excavated from the medieval rural site of Pieve di Pava (Siena, Italy).

METHODS

Macroscopic and radiological (x-ray, CT) analyses were performed.

RESULTS

Symmetrical extensive periosteal new bone formation on the diaphyseal and metaphyseal regions of this individual's long bones; the lower limbs were more extensively and severely affected than the upper limbs and the distal segments were more severely altered in comparison to the proximal ones.

CONCLUSIONS

The macroscopic and radiological features are highly consistent with a diagnosis of secondary HOA.

SIGNIFICANCE

The excellent state of preservation allowed the evaluation of rarely noted skeletal manifestations of HOA and provided insight into aspects of rural life in medieval Italy.

LIMITATIONS

Molecular analysis was not successful in sequencing the aDNA of tuberculosis, therefore the underlying primary cause of secondary HOA, whether pulmonary or extrapulmonary, remains obscure in this case.

SUGGESTION FOR THE FUTURE RESEARCH

It is advisable to regularly revisit the data available from osteoarchaeological collections in order to identify further cases of HOA, along with to further investigate the known cases to search for the underlying primary disease.

Animal Resources in the Economy of Medieval Moldova: Archaeozoological Case Study of the Urban Settlement from Târgu Neamț (NE Romania)

This study aims to contribute to the knowledge of the medieval Moldovan economy by evaluating animal resources (e.g., animal husbandry, hunting, fishing) based on the skeletal remains found in archaeologic sites from northeastern Romania and the Republic of Moldova. Animal remains, especially those from the urban settlement of the 14th-16th centuries from Târgu Neamţ (NE Romania), were described in terms of their frequencies (i.e., number of identified specimens and minimum number of individuals), morphometry, and livestock management (i.e., animal selection by age and sex). The results were compared with those obtained from other settlements-rural, urban, and fortress-from medieval Moldova. Correspondence analysis of the identified animals and settlements on the basis of the frequency values reveals associations between the two variables (animal species and settlement).

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.

Caring for the injured: Exploring the immediate and long-term consequences of injury in medieval Cambridge, England

OBJECTIVE

To combine paleopathological and biomechanical analysis to reconstruct the impact that a severe skeletal injury had on an individual's ability to function and participate in medieval society.

MATERIALS

Three medieval individuals from Cambridge, England with ante-mortem fractures to the lower limb were analyzed.

METHODS

Plain X-rays were used to determine the degree of malunion, rotation and overlap of each fracture. Cortical bone architecture of the injured individuals and 28 uninjured controls were analyzed using micro-computed tomography (µCT). Clinical and functional consequences were examined using the Bioarcheology of Care framework.

RESULTS

The mechanism of injury, the secondary complications, and the extent of the care received was reconstructed for each individual. Bilateral asymmetry in the cortical bone architecture revealed the long-term alterations to each individual's gait.

CONCLUSION

Each of these individuals survived a severe injury resulting in chronic physical impairment, though not all would have been considered 'disabled'.

SIGNIFICANCE

This research contributes to the discussion about medieval care provision and social constructions of disability by illustrating how an interdisciplinary approach provides insight into the experiences of those with physical impairments. The integration of µCT imaging within the Bioarcheology of Care model is a novel approach with great potential for application across the field.

LIMITATIONS

Biomechanical analysis was restricted to cortical geometry.

SUGGESTIONS FOR FUTURE RESEARCH

Further study of bilateral asymmetry in trabecular architecture could complement our understanding of altered loading modalities in past societies.

Corrigendum: Bruno da Longobucco (da Longoburgo): The first academic surgeon in the middle ages

[This corrects the article DOI: 10.3389/fsurg.2022.1025987.].

[The "Nastas'in Pestilence": the Great Plague of 1417-1425 in Rus]

The plague pandemic ("The Black Death") that struck Eurasia in the middle of XIV century, "settled" this lethal disease in Europe for a long time. The new outbreaks of this disease, with breaks of several years, occurred in single cities, regions and states, covering sometimes entire continent over the next centuries. However, impression that "The Black Death" made upon minds of European scribes, staggering European society by its inevitability, for a long time determined particular angle of view under which it is accepted to consider the history of plague in Europe in the epoch of Middle Ages and early New Age. The image of The Great Plague of XIV century overshadowed all subsequent outbreaks of this lethal disease, so its subsequent occurrences are traditionally given less attention. The article, being based on on analysis of numerous chronicle evidences, for the first time in Russian historiography analyzes the history of plague in Rus during first decades of XV century and restores chronology of its occurrence and development and determines areas affected by the plague in the first place, estimating caused damage.

Walruses on the Dnieper: new evidence for the intercontinental trade of Greenlandic ivory in the Middle Ages

Mediaeval walrus hunting in Iceland and Greenland-driven by Western European demand for ivory and walrus hide ropes-has been identified as an important pre-modern example of ecological globalization. By contrast, the main origin of walrus ivory destined for eastern European markets, and then onward trade to Asia, is assumed to have been Arctic Russia. Here, we investigate the geographical origin of nine twelfth-century CE walrus specimens discovered in Kyiv, Ukraine-combining archaeological typology (based on chaîne opératoire assessment), ancient DNA (aDNA) and stable isotope analysis. We show that five of seven specimens tested using aDNA can be genetically assigned to a western Greenland origin. Moreover, six of the Kyiv rostra had been sculpted in a way typical of Greenlandic imports to Western Europe, and seven are tentatively consistent with a Greenland origin based on stable isotope analysis. Our results suggest that demand for the products of Norse Greenland's walrus hunt stretched not only to Western Europe but included Ukraine and, by implication given linked trade routes, also Russia, Byzantium and Asia. These observations illuminate the surprising scale of mediaeval ecological globalization and help explain the pressure this process exerted on distant wildlife populations and those who harvested them.

Demography, trade and state power: a tripartite model of medieval farming/language dispersals in the Ryukyu Islands

Hunter-gatherer occupations of small islands are rare in world prehistory and it is widely accepted that island settlement is facilitated by agriculture. The Ryukyu Islands contradict that understanding on two counts: not only did they have a long history of hunter-gatherer settlement, but they also have a very late date for the onset of agriculture, which only reached the archipelago between the eighth and thirteenth centuries AD. Here, we combine archaeology and linguistics to propose a tripartite model for the spread of agriculture and Ryukyuan languages to the Ryukyu Islands. Employing demographic growth, trade/piracy and the political influence of neighbouring states, this model provides a synthetic yet flexible understanding of farming/language dispersals in the Ryukyus within the complex historical background of medieval East Asia.

Medieval Interpretation of Phonation Through the Divine Comedy, by Dante Alighieri

The anatomic and medical knowledge of people throughout history is unexpectedly evident in some of the poems and texts written by intellectuals of the time. This article attempts to understand the conception of laryngology in the Middle Ages by analyzing the Divine Comedy, written by the Italian poet Dante Alighieri (1265-1321) at the beginning of the 14th century. In the text, Dante mentions the throat several times. He recognizes that the larynx has the dual functions of allowing respiration (dead souls recognize that the poet is alive through movement of his throat when breathing) and speech (souls with their throat cut cannot speak). However, Dante does not seem to know of the existence of vocal cords, thinking that it is the tongue that allows for word formation. In general, Dante's poem indicates that the anatomy and function of the throat were known during the medieval period, although this knowledge was not precise.

Bruno da Longobucco (da Longoburgo): The first academic surgeon in the Middle Ages

Bruno da Longobucco (1200-1286 BC) was born at the turn of the 13th Century in Longobucco (Calabria, Italy), at that time named Longoburgo. He was the first academic surgeon of the Middle Ages, a period when surgery was disregarded by mainstream physicians and was the practice of barbers, charlatans and phlebotomists. After training at the medical school of Salerno and the University of Boulogne, he was one of the founders of the University of Padua and became the first Professor of Surgery. His books Chirurgia Magna and Chirurgia Parva, were ones of the most disseminated surgical texts of the Middle Ages and it is argued helped surgery regain its reputation. Despite his importance to late medieval period, he has been essentially overlooked in the records of the history of surgery. Currently, there are no articles in English about his life indexed on PubMed, Scopus or Embase. One solitary article on Bruno's life and influence was published in 1960s in a small journal in Italian, but this is no longer active and there is no electronic means to access the original article. The aim of this article is to provide education and rediscovery of the impact of this critical figure, his works and his historic role to the development and renaissance of surgery for contemporary surgeons.

Morphometry of auditory ossicles in medieval human remains from Central Europe

Human auditory ossicles, the malleus, the incus, and the stapes, are located in the tympanic cavity in the temporal bone and through forming a chain for the sound transmission from the tympanic membrane to the cochlea, they play an important role in the hearing process. Despite their clinical, phylogenetic, and evolutionary significance, the morphometry of the human ear bones has not been examined systematically. The ear ossicles are the smallest bones of the human skeleton, attaining their final size and morphology already at birth. Initially, they have been found to exhibit minimal morphometric variation, but further studies brought the opposite results. The aim of this study was to examine the morphometric variation of human auditory ossicles recovered from medieval and postmedieval subadult skeletons from Poland, Central Europe. The analysis involved in a total of 166 ear bones. Their measurements were performed on microscopic images using CorelDraw x4, according to a protocol of Quam and Rak with modification of Flohr et al. and Wadhwa et al. Our study showed a significant metric variation in the measurements taken at areas of the greatest morphological variability of the ossicles. We found that greater linear dimensions were associated with lower values of angular measurements. These results reveal the inherent variation found in these supposed functionally constrained structures. Representation of even greater number of populations, time periods, and developmental stages are needed. Further study will expand our understanding of the global scope of variation found in ear ossicular morphology and its functional implications for paleoanthropology.

["The pestilence vicious was…": "The Black Death" of XIV century in Rus]

The pandemic of plague, that affected Eurasia in middle of 40s - early 50s of XIV century and remained in history as as "The Black Death", became one of the most death-dealing epidemics that ever stroke humankind and recorded in historical sources. Owing to that many documentary and narrative sources remained intact, the history of this pandemic is considered as well examined. This is evidenced by enormous historiography of the problem, including works of the most different character and orientation. Yet, it should be admitted that in national Russian historiography the issues related to history of this pandemic on the Russian land remain to be insufficiently studied. This condition is related to limitation of source base from one hand and to inadequate development of comprehensive approach to exploration of this page of national history. The article, on the basis of analysis of chronicle texts, reconstructs general picture of the pandemic in the Russian land and characterizes its consequences.

Legacy of Syriac-Aramaic Scholars in Transmitting Neurosurgical Knowledge Between Antiquity and the Middle Ages

The link between ancient Greek medicine and the Arabic translation period in the 9th century cannot be understood without studying the contributions of Syriac scholars. With their mastery of Greek and the related Semitic languages of Syriac and Arabic, they initiated a scientific translation process with methods that prevail to this day. In this paper, we reviewed Hunayn Ibn Isshaq's Ten Treatises on the Eye to elucidate the original contributions of the Syriac physicians to the field of neurologic surgery. We analyzed the oldest known diagram of orbital anatomy along with Hunayn's genuine ideas on the optic nerve anatomy and pathology, optic chiasm, afferent pupillary reflex, and papilledema and venous congestion. We also reviewed the neurosurgical elements found in the Syriac Book of Medicines including the thought process in localizing neurologic deficits based on clinical experience and anatomic dissections and the earliest recorded description of brachial plexus pathology.

An early representation of a gorilla from fifteenth-century Central Asia

The present work describes the earliest known image of a gorilla (Gorilla sp.) to appear outside Africa. This is found in an Asian miniature painted on silk from the second half of the fifteenth century, called Four captive demons. The inspirational source of this painting is obscure and the artist unknown, but it may have been created in the Timurid-Turkmen region of Central Asia. A commercial network linking the African Great Lakes region-where the eastern gorilla (Gorilla beringei) still occurs-and the Swahili ports could have served to facilitate trade in fauna at that time in history. Countless African animals were sent by Egyptian and Eastern African rulers to their counterparts in Central Asia as diplomatic gifts, and a captive gorilla specimen could have been kept in one of the "gardens" of the Timurid-Turkmen rulers and portrayed by an artist working at their courts. This image is intriguing and worthy of attention because it opens up new scenarios regarding the extent of knowledge of Great Apes prior to the Age of Discovery, giving potentially important new insights into human-anthropoid interaction.

Multiple occurrence of premature polyarticular osteoarthritis in an early medieval Bohemian cemetery (Prague, Czech Republic)

OBJECTIVES

To highlight conditions that may cause early-onset degenerative joint disease, and to assess the possible impact of such diseases upon everyday life.

MATERIAL

Four adults aged under 50 years from a medieval skeletal collection of Prague (Czechia).

METHODS

Visual, osteometric, X-ray, and histological examinations, stable isotope analysis of bone collagen.

RESULTS

All four individuals showed multiple symmetrical degenerative changes, affecting the majority of joints of the postcranial skeleton. Associated dysplastic deformities were observed in all individuals, including bilateral hip dysplasia (n = 1), flattening of the femoral condyles (n = 3), and substantial deformation of the elbows (n = 3). The diet of the affected individuals differed from the contemporary population sample.

CONCLUSIONS

We propose the diagnosis of a mild form of skeletal dysplasia in these four individuals, with multiple epiphyseal dysplasia or type-II collagenopathy linked to premature osteoarthritis as the most probable causes.

SIGNIFICANCE

Combining the skeletal findings with information from the medical literature, this paper defines several characteristic traits which may assist with the diagnosis of skeletal dysplasia in the archaeological record.

LIMITATIONS

As no genetic analysis was performed to confirm the possible kinship of the individuals, it is not possible to definitively assess whether the individuals suffered from the same hereditary condition or from different forms of skeletal dysplasia.

SUGGESTIONS FOR FURTHER RESEARCH

Further studies on premature osteoarthritis in archaeological skeletal series are needed to correct the underrepresentation of these mild forms of dysplasia in past populations.

Pervasive Arctic lead pollution suggests substantial growth in medieval silver production modulated by plague, climate, and conflict

Lead pollution in Arctic ice reflects large-scale historical changes in midlatitude industrial activities such as ancient lead/silver production and recent fossil fuel burning. Here we used measurements in a broad array of 13 accurately dated ice cores from Greenland and Severnaya Zemlya to document spatial and temporal changes in Arctic lead pollution from 200 BCE to 2010 CE, with interpretation focused on 500 to 2010 CE. Atmospheric transport modeling indicates that Arctic lead pollution was primarily from European emissions before the 19th-century Industrial Revolution. Temporal variability was surprisingly similar across the large swath of the Arctic represented by the array, with 250- to 300-fold increases in lead pollution observed from the Early Middle Ages to the 1970s industrial peak. Superimposed on these exponential changes were pronounced, multiannual to multidecadal variations, marked by increases coincident with exploitation of new mining regions, improved technologies, and periods of economic prosperity; and decreases coincident with climate disruptions, famines, major wars, and plagues. Results suggest substantial overall growth in lead/silver mining and smelting emissions-and so silver production-from the Early through High Middle Ages, particularly in northern Europe, with lower growth during the Late Middle Ages into the Early Modern Period. Near the end of the second plague pandemic (1348 to ∼1700 CE), lead pollution increased sharply through the Industrial Revolution. North American and European pollution abatement policies have reduced Arctic lead pollution by >80% since the 1970s, but recent levels remain ∼60-fold higher than at the start of the Middle Ages.

The Arrival of Siberian Ancestry Connecting the Eastern Baltic to Uralic Speakers further East

In this study, we compare the genetic ancestry of individuals from two as yet genetically unstudied cultural traditions in Estonia in the context of available modern and ancient datasets: 15 from the Late Bronze Age stone-cist graves (1200-400 BC) (EstBA) and 6 from the Pre-Roman Iron Age tarand cemeteries (800/500 BC-50 AD) (EstIA). We also included 5 Pre-Roman to Roman Iron Age Ingrian (500 BC-450 AD) (IngIA) and 7 Middle Age Estonian (1200-1600 AD) (EstMA) individuals to build a dataset for studying the demographic history of the northern parts of the Eastern Baltic from the earliest layer of Mesolithic to modern times. Our findings are consistent with EstBA receiving gene flow from regions with strong Western hunter-gatherer (WHG) affinities and EstIA from populations related to modern Siberians. The latter inference is in accordance with Y chromosome (chrY) distributions in present day populations of the Eastern Baltic, as well as patterns of autosomal variation in the majority of the westernmost Uralic speakers [1-5]. This ancestry reached the coasts of the Baltic Sea no later than the mid-first millennium BC; i.e., in the same time window as the diversification of west Uralic (Finnic) languages [6]. Furthermore, phenotypic traits often associated with modern Northern Europeans, like light eyes, hair, and skin, as well as lactose tolerance, can be traced back to the Bronze Age in the Eastern Baltic. VIDEO ABSTRACT.

A month in a horse's life: healing process of a fractured third metatarsal bone from medieval Viljandi, Estonia

The remains of a horse's hind foot - a third metatarsal bone and three phalanges - were found in a presumed waste pit of a prosperous medieval household in Viljandi, Estonia, dated from the second half of the 13^th to the beginning of the 15^th century. The metatarsal bone had been broken during the horse's lifetime and showed evidence of partial healing. Using archaeological, zooarchaeological, morphological, microscopic, densitometric and radiographic analyses, we investigated the bones and the healing process in order to understand animal treatment in a medieval urban context. Our results show that the fracture was a complete comminuted fracture that appears to have been closed and stable, caused most probably by a trauma from a strong impact. Based on callus formation and the worn edges of the separated diaphysis, the horse had survived for at least a month and used the injured foot to some extent. We suggest that the horse was treated by splinting the foot and keeping the animal in a standing position during the healing process. Eventually the horse died because of a wound infection, or was killed. The relatively long period of careful treatment indicates the animal's economic or emotional value.

Mental disorders in commentaries by the late medieval theologians Richard of Middleton, John Duns Scotus, William Ockham and Gabriel Biel on Peter Lombard's Sentences

In their commentaries on the Sentences, Richard of Middleton, John Duns Scotus, William Ockham and Gabriel Biel reflect whether mentally-disturbed people can receive the sacraments (Baptism, Eucharist, confession, marriage) and fulfil juridical actions (make a will or take an oath). They consider that the main problem in 'madmen' in relation to the sacraments and legal actions is their lack of the use of reason. Scotus and Ockham especially are interested in the causes of mental disorders and the phenomena which happen in madmen's minds and bodies. In considering mental disorders mostly as naturally caused psycho-physical phenomena, Scotus and Ockham join the rationalistic mental disorder tradition, which was to become dominant in the early modern era and later.

[Old age in Medieval times]

Europe in the Middle Ages had no experience of gerontology as we know it today. The categorisation of old age was based on symbolic relationships with the world, inherited from Antiquity, and resulted in an ambivalent image of this age. Our knowledge in the area is derived mainly from fiction, from scholarly texts of a philosophical, moralising or medical nature, each interacting with the other. This observation is backed up by a moral treatise on the 'four ages of man' written in the 13th century by Philip of Novara.

Ancient DNA reveals the chronology of walrus ivory trade from Norse Greenland

The importance of the Atlantic walrus ivory trade for the colonization, peak, and collapse of the medieval Norse colonies on Greenland has been extensively debated. Nevertheless, no studies have directly traced medieval European ivory back to distinct Arctic populations of walrus. Analysing the entire mitogenomes of 37 archaeological specimens from Europe, Svalbard, and Greenland, we here discover that Atlantic walrus comprises two monophyletic mitochondrial (MT) clades, which diverged between 23 400 and 251 120 years ago. Our improved genomic resolution allows us to reinterpret the geographical distribution of partial MT data from 306 modern and nineteenth-century specimens, finding that one of these clades was exclusively accessible to Greenlanders. With this discovery, we ascertain the biological origin of 23 archaeological specimens from Europe (most dated between 900 and 1400 CE). These results reveal a significant shift in trade from an early, predominantly eastern source towards a near exclusive representation of Greenland ivory. Our study provides empirical evidence for how this remote Arctic resource was progressively integrated into a medieval pan-European trade network, contributing to both the resilience and vulnerability of Norse Greenland society.

Late medieval philosophical and theological discussions of mental disorders: Witelo, Oresme, Gerson

No matter from which perspective Witelo, Oresme and Gerson approach mental disorders, they think that madness usually has a bodily, such as a humoral or organic, origin. They do, however, consider divine or demonic causes as possibly being behind immediate causes. According to Witelo and the Parisians, because of a change in the body, madmen's sensory fantasy is disturbed and in this situation their intellect does not act normally, and their will lacks freedom. It is important to realize that, according to the medieval writers, mentally-disordered people have not lost any parts of their soul or their basic potencies. If this were the case, they would not be human beings by definition.

Modelling Climate and Societal Resilience in the Eastern Mediterranean in the Last Millennium

This article analyses high-quality hydroclimate proxy records and spatial reconstructions from the Central and Eastern Mediterranean and compares them with two Earth System Model simulations (CCSM4, MPI-ESM-P) for the Crusader period in the Levant (1095-1290 CE), the Mamluk regime in Transjordan (1260-1516 CE) and the Ottoman crisis and Celâlî Rebellion (1580-1610 CE). During the three time intervals, environmental and climatic stress tested the resilience of complex societies. We find that the multidecadal precipitation and drought variations in the Central and Eastern Mediterranean cannot be explained by external forcings (solar variations, tropical volcanism); rather they were driven by internal climate dynamics. Our research emphasises the challenges, opportunities and limitations of linking proxy records, palaeoreconstructions and model simulations to better understand how climate can affect human history.

Epilepsy in Hildegard of Bingen's writings: A comprehensive overview

Hildegard of Bingen (1098-1179AD) is one of the most relevant figures of the Middle Ages. She wrote two medical books, Physica (Natural history) and Causae et curae (Causes and remedies). Our aim was to provide a comprehensive account of Hildegard of Bingen's conception of epilepsy, of the remedies proposed to treat it, and of the medical and physiological theories behind their use. We searched Hildegard of Bingen's entire body of writings to identify any possible reference to epilepsy or epileptic seizures. We reported the identified passages referring to epilepsy and discussed their content in light of medieval medical and physiological theories. Most references to epilepsy were found in Physica and Causae et curae. The suggested remedies against epilepsy range from herbal preparations to animal remedies and jewel therapy. Hildegard's conception of epilepsy gives the impression of an original revisitation of the traditional theory of humors, and carries strong moral connotations. Hildegard of Bingen's conception of epilepsy appears strongly rooted in medieval thinking and less in physiological theories. However, it differs in many respects to the traditional medieval beliefs and is a further proof of her unique personality. As living testimony of the past, Hildegard's writings enable us to shed a fascinating light on the beliefs concerning epilepsy in the middle ages.

Competing English, Spanish, and French alabaster trade in Europe over five centuries as evidenced by isotope fingerprinting

A lack of written sources is a serious obstacle in the reconstruction of the medieval trade of art and art materials, and in the identification of artists, workshop locations, and trade routes. We use the isotopes of sulfur, oxygen, and strontium (S, O, Sr) present in gypsum alabaster to unambiguously link ancient European source quarries and areas to alabaster artworks produced over five centuries (12th-17th) held by the Louvre museum in Paris and other European and American collections. Three principal alabaster production areas are identified, in central England, northern Spain, and a major, long-lived but little-documented alabaster trade radiating from the French Alps. The related trade routes are mostly fluvial, although terrestrial transport crossing the major river basin borders is also confirmed by historical sources. Our study also identifies recent artwork restoration using Italian alabaster and provides a robust geochemical framework for provenancing, including recognition of restoration and forgeries.

Beekeeping from Antiquity Through the Middle Ages

Beekeeping had its origins in honey hunting-the opportunistic stealing of honey from wild honey bee nests. True beekeeping began when humans started providing artificial cavities within which the bees could build comb for the queen to lay her eggs and the workers could process honey. By 2450 BCE, the Egyptians had developed sophisticated apiculture, and, within two millennia, beekeeping with horizontal hives had spread throughout the Mediterranean. During Europe's Middle Ages, honey and wax became important commodities for trade, and beekeeping in skep, log, box, and tree hives flourished to meet the demand. Other species of honey bees contributed to the development and spread of beekeeping in Asia beginning around 300 BCE. Meanwhile, beekeeping evolved independently in Mesoamerica with the stingless bee Melipona beecheii, as documented by archaeological finds and written accounts that survived Spanish conquest.

Maternal and paternal genetic diversity of ancient sheep in Estonia from the Late Bronze Age to the post-medieval period and comparison with other regions in Eurasia

Sheep were among the first domesticated animals to appear in Estonia in the late Neolithic and became one of the most widespread livestock species in the region from the Late Bronze Age onwards. However, the origin and historical expansion of local sheep populations in Estonia remain poorly understood. Here, we analysed fragments of the hypervariable D-loop of mitochondrial DNA (mtDNA; 213 bp) and the Y-chromosome SRY gene (130 bp) extracted from 31 archaeological sheep bones dated from approximately 800 BC to 1700 AD. The ancient DNA data of sheep from Estonia were compared with ancient sheep from Finland as well as a set of contemporary sheep breeds from across Eurasia in order to place them in a wider phylogeographical context. The analysis shows that: (i) 24 successfully amplified and analysed mtDNA sequences of ancient sheep cluster into two haplogroups, A and B, of which B is predominant; (ii) four of the ancient mtDNA haplotypes are novel; (iii) higher mtDNA haplotype diversity occurred during the Middle Ages as compared to other periods, a fact concordant with the historical context of expanding international trade during the Middle Ages; (iv) the proportion of rarer haplotypes declined during the expansion of sheep from the Near Eastern domestication centre to the northern European region; (v) three male samples showed the presence of the characteristic northern European haplotype, SNP G-oY1 of the Y-chromosome, and represent the earliest occurrence of this haplotype. Our results provide the first insight into the genetic diversity and phylogeographical background of ancient sheep in Estonia and provide basis for further studies on the temporal fluctuations of ancient sheep populations.

A brief history of hysteria: From the ancient to the modern

In this paper we discuss the history of hysteria from the Babylonian and Assyrian texts through to the situation as it appears to us at the end of the 19th century. We note the shifting emphasis on causation, earlier ideas being linked to uterine theories, later speculations moving to the brain, and then the mind. We note the persistence of the condition referred to as hysteria over the millennia and the fascination that the condition has held for physicians, neurologists, and psychiatrists since the origins of known medical texts.

Ars Moriendi: Coping with death in the Late Middle Ages

OBJECTIVE

The Ars moriendi was a book written in the early 15th century with the goal of assisting friars in their work of helping the dying. The aim of our study was to review the current literature on the Ars Moriendi concerning the field of medicine, to analyze the psychological mechanisms for coping with death anxiety within Ars Moriendi, and to explore parallels between the strategies used in the medieval book and in contemporary literature about death and dying.

METHOD

A review of literature using Pubmed, EMBASE, JSTOR, Project MUSE, and the New York Public Library was undertaken first. The primary source was then interpreted from a medical/psychological point of view.

RESULTS

Seven articles were selected by literature review. These works comment on the importance of the Ars Moriendi in its historical context and explore the possibility of retrieving the principles of the text in contemporary society. The original text of Ars Moriendi, the primary source, presents death as a relief from the sufferings of earthly life and a gateway to eternal glory. According to the author, a good death implied the triumph over five demonic temptations in agonizing people: a lack of faith, despair, impatience, pride and greed.

SIGNIFICANCE OF RESULTS

Analyzed from a modern psychiatric perspective, the Ars Moriendi offers descriptions of behavioral manifestations compatible with delirium, mood and anxiety disorders that characterize people with terminal illnesses. Moreover, we also explored parallels between the strategies used to cope with death anxiety in the Late Middle Ages and in contemporary society.

Intensive woodland management in the Middle Ages: spatial modelling based on archival data

Firewood played an indispensable role in European socio-economic systems from prehistory until the nineteenth century. Recent research has shown that in European temperate lowlands the most important management form to produce firewood was coppicing. In spite of the growing body of research on traditional woodland management, there remain large gaps in knowledge. Detailed studies of individual sites or smaller areas have provided a wealth of information on the methods of medieval coppicing, and at such sites the long-term effects of coppicing on vegetation structure and composition have also been examined. However, little is known about the distribution and extent of coppicing at the landscape scale, and forming a coherent picture of the spatial extent rather than the management details of coppicing in larger regions remains a challenge. This paper investigates the distribution and extent of coppice management in Moravia (eastern Czech Republic, ca. 22,300 km²) in the Late Middle Ages. We created an extensive database of written sources that contained information on the presence of coppice woods at the parish level. Subsequently we used the MAXENT algorithm to create a model of the distribution of coppicing over the entire area. With the help of wood production and consumption estimates, we also calculated the minimum area of managed woodland for the study period. Results show that coppicing was predominant in the lowlands and often occurred at higher elevations as well, where neither natural conditions nor tree species composition were favourable. The paper also highlights the potential of spatial models based on archival data for historical landscape reconstructions.

Dante and cardiology: Physiopathology and clinical features of cardiovascular diseases in the Middle Ages

Ancient non-medical texts can unexpectedly provide useful information on the development of knowledge about the heart and its diseases throughout history. The 750th anniversary of the birth of the Italian poet Dante Alighieri (1265-1321) provides a timely opportunity to analyze medical references in his works, in particular, focusing on literary descriptions that may be attributed to cardiovascular disorders. Dante's high level of medical knowledge, probably derived from his academic studies, is testified by his affiliation to the Florentine Guild of physicians and pharmacists. In all his works, the poet shows a deep interest for the heart. However, his anatomical and physiological knowledge of the circulatory system appears to be poor, probably due to it being based on theories and concepts brought forth by Aristotle and Galen, which were taught in medieval universities. Despite this, accurate descriptions of some symptoms (emotional syncope, orthopnea, dyspnea on exertion) and signs (ascites, paleness), which may be attributed to cardiovascular disorders, can be easily found in Dante's works, particularly in his masterpiece, the Divine Comedy. The literary and historical analysis of cardiovascular signs and symptoms allows us to assume that clinical features due to alterations of heart function were probably known by medieval physicians, but their etiology and pathophysiological mechanisms were not completely understood in that period. Historians of cardiology and clinicians should consider analysis of non-medical texts (including poetry) as an opportunity to better investigate the evolution of their discipline throughout the ages.

The influence of theory on the formation of the infirmary during antiquity and the Middle Ages in the West

The modern infirmary is the evolutional product of the dialectic interface between medical theories at each time and the outcome of their application in clinical practice. The infirmary as we know it today did not exist during antiquity, but the different precursors of the modern hospital emerged as a result of the interaction between medical theory and practice. During antiquity the Hippocratic work decisively contributed to the creation of the Asklipieion, an institution with predetermined structure created to heal diseases. Later in antiquity new types of infirmaries appeared along with the evolution of private practice for physicians. Establishment of the first modern hospitals was an outstanding contribution of Islamic medicine during reign of the Islamic Empire. Although there was little progress in the development of medical theory in medieval West, evolution of the infirmary continued and was mostly influenced by Christian religion and charity. In Constantinople large medieval infirmaries were built, but patient care was frequently offered in monasteries by clergymen. Later on medicine and treatment of diseases were taken over by physicians and taught in universities, and medical theory continued on its course of evolution. It is obvious that the modern infirmary is not only a place for treating diseases, but rather the upshot of a series of advancements in science, the relations between people or even countries, and the way humanity perceives its nature and the future. Our research is focused on the interactive relationship between the evolution of medical theory and the infirmary as an institution during antiquity and the Middle Ages with particular emphasis on the Western World.

(NE-Italy) during early and central Middle Ages

Isotope variations were studied in necropolises of the early (6th to 7th century CE) and central (10th to 11th century CE) medieval period located in Fruili-Venezia Giulia (Northeastern Italy). The two periods each shortly followed two great barbarian invasions that changed the politics and economy of Italy: the arrivals of Langobards in 578 CE and the Hungarian incursions from the end of the 9th to the first half of the 10th century. These events had a tragic effect on the economy of Friuli-Venezia Giulia: severe depopulation and the partial abandonment of the countryside with fall of agricultural production.

[Eligius, the patron of veterinarians]

Saint Eligius became the saint patron of farriers and veterinarians in the 13th century. This was first mentioned by Jordanus Ruffus, emperor Frederic the 2nd's equerry, who refers to a gregorian hymnal dedicated to Eligius. The legend says that Eliguis amputated a horse's foot, shoed it and placed it back on the horse's leg. This legend might have replaced the Germanic cult described in the incantations of Merseburg. In Switzerland the veneration of Eligius is particularly spread in the canton of Lucerne.

Anatomical knowledge among medieval folk artists: osteological interpretation of two Dance of Death motifs

Anatomy has a long history that started with dissection of animals and then expanded and flourished thanks to dissections performed on human bodies. Artists had a crucial role in uncovering the secrets of human anatomy. While most studies have focused on the influence of famous Renaissance artists on human anatomy studies, the anatomical drawings by pre-Renaissance artists and local craftsmen have remained in their shadow. One of the most popular artistic genres in which complete or parts of human skeletons appear is the Dance of Death (Danse Macabre). This article is an anthropological study of two medieval Dance of Death frescoes that are unusual in being relatively early as well as accurately datable. A comparative morphological analysis of the two late 15th century works present in Istria has been conducted. The two works were painted by two local masters and show how the artists filled the gaps in their knowledge of human anatomy mostly with insights into animal bones and imagination. Their artworks, even though only 16 years apart, demonstrate substantial differences in the representation of the skeletons. The article argues that the history of medicine and of art could make good use of osteology and physical anthropology in attempts to define and understand how anatomical knowledge developed among pre-Renaissance and post-Renaissance artists and local people.

Abandonment of terminally ill patients in the Byzantine era. An ancient tradition?

Our research on the texts of the Byzantine historians and chroniclers revealed an apparently curious phenomenon, namely, the abandonment of terminally ill emperors by their physicians when the latter realised that they could not offer any further treatment. This attitude tallies with the mentality of the ancient Greek physicians, who even in Hippocratic times thought the treatment and care of the terminally ill to be a challenge to nature and hubris to the gods. Nevertheless, it is a very curious attitude in the light of the concepts of the Christian Byzantine physicians who, according to the doctrines of the Christian religion, should have been imbued with the spirit of philanthropy and love for their fellowmen. The meticulous analysis of three examples of abandonment of Byzantine emperors, and especially that of Alexius I Comnenus, by their physicians reveals that this custom, following ancient pagan ethics, in those times took on a ritualised form without any significant or real content.

Toward a virtue-based normative ethics for the health professions

Virtue is the most perdurable concept in the history of ethics, which is understandable given the ineradicability of the moral agent in the events of the moral life. Historically, virtue enjoyed normative force as long as the philosophical anthropology and the metaphysics of the good that grounded virtue were viable. That grounding has eroded in both general and medical ethics. If virtue is to be restored to a normative status, its philosophical underpinnings must be reconstructed. Such reconstruction seems unlikely in general ethics, where the possibility of agreement on the good for humans is remote. However, it is a realistic possibility in the professional ethics fo the health professions where agreement on the telos of the healing relationship is more likely to arise. Nevertheless, virtue-based ethics must be related conceptually and normatively to other ethical theories in a comprehensive moral philosophy of the health professions. If he really does think there is no distinction between virtue and vice, why, sir, when he leaves our house, let us count our spoons. Samuel Johnson

Human action and God's will: a problem of consistency in Jewish bioethics

The religious legitimacy of medical practice was an issue of serious contention amongst medieval Jewish scholars. For Nahmanides, altering the patient's fate through manipulation of natural causality amounts to circumventing divine judgment. For Maimonides, however, human accomplishment is part of God's providential design; this view generally prevails in contemporary Jewish bioethics. But the doctrine of deligitimizing human intervention continues, even while unacknowledged, the underlie certain contemporary positions. These include arguments within Jewish bioethics about end-of-life decisions, which are therefore imbued with inconsistencies. It is suggested that, given the overall endorsement of modern medicine, the Nahmanidean approach must be explicitly confronted.

The concept of the person in the parens patriae jurisdiction over previously competent persons

This article reviews the medieval law background of the parens patriae jurisdiction of the state as it has been exercised over incompetent persons who formerly were competent adults, concluding that the fiduciary standard implied in the statute De Prerogative Regis (1324), which is the basis for modern guardianship status, requires that the court and guardian adopt an attitude of respectful friendship toward the incompetent person, just as though they were to be accountable to the person himself, were he to recover his faculties and become competent once more. This fiduciary responsibility, originating in the device of the "use" or trust employed for the management of the estates of lunatics, contrasts with the self-interested feudal guardianship used for the custody of "natural fools" or "idiots", who were under paternalistic arrangements. The article argues that because the determination of legal incompetence and the consequent transfer of custody of the person and property of an incompetent person to the state would result in a drastic forfeiture of liberty and property interests were it not for the fiduciary obligation owed by the state to the incompetent, the state is under an obligation to exercise its fiduciary duties in good faith and may not impose states policies or advance state interests of its own in the supervision of the affairs of incompetent persons, apart from interests arising legitimately out of the state's institutional interest in providing competent administration for the benefit of the incompetents themselves.

Care of the dying: an ethical and historical perspective

OBJECTIVE

To provide a historical perspective, from ancient Greece to the middle of the 20th century, on ethical issues and principles commonly associated with medical care for the dying in Western civilization.

SOURCES

Writings of noted philosophers, historians, ethicists, and physicians, as well as published legal and ethical guidelines. INFORMATION EXTRACTION: The sources used highlight the origins of various ethical principles associated with care of the dying. They also identify the opinions of prominent individuals throughout the history of medical ethics.

SUMMARY

Devotion to medical beneficence, concern for the quality of life, and respect for the sanctity of life are all expressed in the earliest medical and philosophical writings of ancient Greece. With regard to care of the dying, these considerations led to a wide acceptance of avoiding or terminating treatment in hopeless cases. They also led to active debate regarding medicine's role in hastening the dying process. The rise of Christianity during the Middle Ages markedly suppressed such debate by strongly reinforcing the principle of sanctity of life. Later, the optimism of the enlightenment added the hope of prolonging life. Finally, modern advances in medical science have made that hope a reality of complex ethical dimensions.

CONCLUSIONS

Ethical debates regarding appropriate care for the dying are as old as medicine itself. Although beneficent concerns have characterized the medical community in almost every period of history, tensions have repeatedly arisen as diverse religious and philosophical ideologies have produced varying standards to define such beneficence. In the Christian world, the sanctity of life was often extolled as the paramount standard. For the ancient Greeks and Romans, and again in many post-Renaissance philosophies, quality of life considerations assumed equal or greater importance. Modern life-prolonging technologies heighten the debate by allowing these two standards to dramatically conflict, particularly in the critical care setting.

Systems ethics and the history of medical ethics

This paper reviews the current conclusions in medical ethics which have followed the 1969-1970 Medical Ethics Discontinuity, a break that challenged the Hippocratic way of thinking about ethics. The resulting dislocations in quality of care and the medical value system are discussed, and an alternative medical ethics is offered: Systems Ethics. A methodology for a Systems Ethics analysis of cases is presented and illustrated by the case of a physician-assisted suicide. The advantages, both theoretical and clinical, of a Systems Ethics approach to medicine, which is an expansion of the Hippocratic tradition in medical ethics, are developed. Using Systems Ethics, it is possible to avoid the dangers of legalism, bureaucratic ethics, utilitarian cost cutting, and "political correctness" in medical ethics.