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Between the seventeenth and the nineteenth centuries, Japanese scholars and commercial authors wrote extensively about lamps, lanterns, and candles. The forms of intellectual curiosity for lights presented in this chapter reveal original paths in Tokugawa Japan’s history of investigations and discoveries. On the one hand, they point at homegrown innovations that remove Japan from the orbit of Western knowledge; on the other, they illuminate connections with important global trends. The history of the early modern curiosity for illumination points at revolutions in knowledge that encompass the small and the large, the local and the global, and scramble the timeline of Japan’s enlightened modernity.
Aristotle had a decisive impact on the development of ancient medicine. He and his followers conducted a dialogue about life and living beings, body and soul, and health and disease with doctors from the Classical period down to late antiquity: interlocutors who included key figures like Galen and the Hippocratic commentator Stephanus of Alexandria. Philip van der Eijk's magisterial and attractively written book describes and analyses this dialogue and argues that Aristotle strategically positioned himself within these discussions while making important and innovative contributions to them. The author further uncovers unpublished evidence showing how Aristotle's philosophy itself – and also the way it was elaborated by its later advocates and exegetes – was influenced by its close engagement with medical theory and practice. This important and much-anticipated book will transform both the study of Aristotle and his followers and that of Greek and Roman medicine.
Discrepancies between preoperative echocardiographic diagnosis and intraoperative surgical findings for incomplete atrioventricular septal defects are frequently encountered. We assess the frequency of diagnostic discordance and its impact, focusing on subtype-specific predictors of the postoperative course.
Methods:
We reviewed 172 patients post repair of incomplete atrioventricular septal defects at a single institution between November 2000–February 2025, including transitional atrioventricular septal defects (n = 74), partial atrioventricular septal defects (n = 71), and primum atrial septal defect with isolated left atrioventricular valve cleft (n = 27). Preoperative echocardiographic diagnoses were compared with intraoperative surgical diagnoses to determine diagnostic discordance and assess impact.
Results:
Baseline characteristics were similar across subtypes. Transitional atrioventricular septal defects were associated with a higher prevalence of syndromic diagnoses (52.7% versus 33.8% versus 22.2%, p = 0.008) and greater preoperative ventricular dilation (LVIDd Z-score −0.88 versus −1.70 versus −1.70, p = 0.031). Diagnostic discordance occurred most frequently in partial atrioventricular septal defects (74.6%), followed by primum atrial septal defect with isolated left atrioventricular valve cleft (37.0%) and transitional atrioventricular septal defects (13.5%) (p < 0.001). Transitional atrioventricular septal defect repairs were associated with longer cardiopulmonary bypass and cross-clamp times, prolonged ventilation, and longer hospital stays (all p < 0.05). Residual shunt was more frequent in transitional atrioventricular septal defects early postoperatively and at the last follow-up (p < 0.001). One death was observed in the partial atrioventricular septal defects group, reintervention rates were similar across subtypes (p = 0.643), and follow-up duration differed modestly between groups (p = 0.047).
Conclusion:
The high rate of diagnostic discordance reflects inherent challenges in preoperative classification and suggests that a simplified, clinically oriented nomenclature may improve communication, surgical planning, and outcome prediction.
This chapter explores how early modern understandings of deafness were shaped by the interaction of new anatomical knowledge with older medical theories. Advances in the study of the ear helped to establish deafness as a primarily physical condition rather than a marker of impaired intellect. The speechlessness of deaf people was seen as the consequence of deafness, rather than a cognitive disability. Humoural medicine influenced the interpretation of these discoveries, and suggested that all forms of deafness existed along a single continuum. This fluidity may have softened the legal implications traditionally attached to prelingual deafness. At the same time, because age-related deafness was the most common form of deafness, this was the lens through which most people imagined prelingual deafness. The chapter argues that this combination of medical theory and social experience profoundly influenced how deafness was conceptualised in early modern England.
Chapter 2 considers how the diagnosis of frenzy – in its standard definition, an inflammation of the brain or meninges – both shaped and was shaped by anatomical knowledge. Reading the work of the anatomist Thomas Willis (1621–1675) alongside his various sixteenth- and seventeenth-century interlocutors, it situates his anatomical work within a longer tradition of brain–mind cartography. The chapter argues that Willis’s determination to map the functions of the brain onto its structures was driven, in part, by his clinical experiences of frenzy. His explicit hope was that his anatomy would be the foundation stone on which a new, clinically useful ‘Pathologie of the Brain and nervous stock, might be built’. But not all of his hopes for the project were medical in nature, or even this-worldly. Willis also sought to shore up two vital truths, both of which frenzy seemed to undermine: first, that there was a categorical difference between the human soul and that of all other living beings, and second, that the human soul alone would survive the death of the body.
Rib fractures are the most common fracture by number in the abused child. While posterior rib fractures bear the highest specificity for child abuse, rib fractures are rare in infants and young children from accidental trauma. In the absence of overt underlying bone disease or reliably witnessed trauma, any rib fracture in an infant or young child is worrisome and indicates the need for further evaluation.
Normal rib anatomy is presented. Rib fractures may occur at any location in the rib from rib head proximally to costochondral junction distally. Abusive rib fractures may be acute or, more commonly, in the healing state at presentation. Rib fractures are commonly accompanied by other abusive injuries. Lower rib fractures are not infrequently seen when there is abusive visceral trauma.
Cardiopulmonary resuscitation in infants may cause rib fractures; however, such fractures are characteristically buckle fractures of the anterior or anterolateral upper and middle ribs and show no evidence of healing at presentation.
This article examines Charles Bell’s experimental practices by drawing historiographical attention away from the priority disputes over the spinal nerve functions for which he was most famous. I argue that Bell’s primary research interest was the expression of emotions. To this end, he developed a programme of vivisection that explored the underlying mechanisms of emotion. However, this also resulted in a profound contradiction between his experimental practices and his worldview – conducting painful experiments on beloved animals despite moral revulsion towards animal experimentation. This opens up three interconnected areas. Firstly, it allows an exploration of disciplinary identity in medicine, particularly the way that disciplines demanded specific practices and behaviours. Secondly, vivisection more generally required methods and ethics that opposed the growing anti-cruelty voice. Here, a combination of animal choice and the importation of techniques from the slaughterhouses was critical. Thirdly, vivisectors navigated a complex emotional landscape between their professional obligations and broader cultural sensibilities. These three areas are linked together using Boddice’s concept of moral economies, the affective frameworks that structured feelings. Particularly important were the sentimental and Romantic economies, both of which impacted Bell and his research. At the same time, Bell always struggled to reconcile the tensions between his disciplinary identity and his sentimental and Romantic beliefs, ultimately leading him to abandon experimentation after his assistant John Shaw’s death. I conclude by identifying the guarantees provided by character for licensing ostensibly cruel behaviours, thus allowing for the maintenance of probity within competing moral economies.
Hearts with a double-inlet and double-outlet right ventricle are infrequent. Due to their infrequency, it is unclear whether there are natural patterns in hearts like this. A systematic review was performed to identify published cases of double-inlet double-outlet right ventricle. Characteristics for individual reported hearts were collated and entered into a cluster analysis. Hearts with double-inlet, double-outlet right ventricles tended to fall into two clusters largely based on aortic atresia and systemic venous connections.
Endoscopic lens fogging is a frequent problem during diagnostic nasal endoscopy, often necessitating scope withdrawal and increasing patient discomfort. This study compared the defogging efficacy and nasal mucosal tolerance of Savlon and warm sterile saline.
Methods
In this prospective pilot comparative study, 40 adult patients undergoing diagnostic nasal endoscopy with a 0° rigid endoscope were randomly assigned to Savlon or warm sterile saline as the defogging agent. Lens fogging severity, patient-reported discomfort, mucosal irritation and need for repeat defogging were assessed.
Results
Both agents demonstrated comparable effectiveness in preventing lens fogging. However, the Savlon group reported significantly higher nasal discomfort and showed greater mucosal irritation compared with the warm saline group.
Conclusion
Warm sterile saline offers effective lens defogging with improved mucosal tolerance and patient comfort compared with Savlon during routine nasal endoscopy.
This chapter examines the ways in which classical influences intersected in Italian Renaissance culture with modernizing impulses in an era of rapid social and material change. The early sixteenth century in Italy brought a series of devastating wars and a loss of political independence at the same time that Italian culture was absorbing significant novelties, such as the introduction of printing in Europe and the geographical ‘discoveries’ of the period, especially that of the transatlantic New World. The chapter foregrounds the sense of novelty and progress that was a marked feature of the later Renaissance in Italy, balancing humanism’s reverence for classical antiquity. This dialectic is examined through detailed case studies of the histories of geography and cartography, of the theory and practice of anatomy, of art-historical writing and conceptions of artistic progress, and of the social and cultural impact of print.
This leading textbook introduces students and practitioners to the identification and analysis of animal remains at archaeology sites. The authors use global examples from the Pleistocene era into the present to explain how zooarchaeology allows us to form insights about relationships among people and their natural and social environments, especially site-formation processes, economic strategies, domestication, and paleoenvironments. This new edition reflects the significant technological developments in zooarchaeology that have occurred in the past two decades, notably ancient DNA, proteomics, and isotope geochemistry. Substantially revised to reflect these trends, the volume also highlights novel applications, current issues in the field, the growth of international zooarchaeology, and the increased role of interdisciplinary collaborations. In view of the growing importance of legacy collections, voucher specimens, and access to research materials, it also includes a substantially revised chapter that addresses management of zooarchaeological collections and curation of data.
Sanctity intersected with medicine during the early modern period because the remains of aspiring saints could offer evidence of divine favor. By studying examples of extreme asceticism, bodily incorruption, and other anatomical wonders, this chapter reveals how medical expertise became a crucial part of Catholic canonization efforts.
Long assumed to have no real function, we now understand the importance of the prefrontal cortex for a wide range of cognitive functions, including decision-making. Some of the earliest understanding of the role of the prefrontal cortex came from the famous case study of Phineas Gage. Through a mining accident, Gage’s prefrontal cortex was extensively damaged. He showed no observable impairments in motor, sensory or memory skills. He however did show marked differences in personality and planning. Over the following decades, research built upon understanding of the role of the prefrontal cortex. Today, the prefrontal cortex as a region is recognised across many species and is considered the most evolutionarily advanced in humans. The current consensus is that prefrontal cortex is an integration area, integrating information from all over the brain.
This paper examines the history of the ‘lower cavity’ of the gastrointestinal tract, a distinctive anatomical feature in Greco-Roman medicine that described a second stomach-like organ in the large intestine. It traces how a bipartite model of the digestive system emerged in fourth-century bce Greek medical and philosophical thought and persisted in the works of influential figures such as Galen, Vesalius, and Glisson, despite shifts in terminology, anatomical observations, and physiological theories. The study demonstrates that this understanding arose primarily from three complementary factors: a specific terminology that paired the stomach with a lower cavity, systematic animal dissections that revealed pronounced caeca in certain species, and emerging physiological theories that required separate bodily receptacles for digested food and residues. Through this case study, the paper illuminates how premodern anatomical knowledge was articulated by a constant negotiation between animal bodies, human bodies, and past textual authorities, facilitating the surprising longevity of ideas like the ‘lower cavity’ in the gastrointestinal tract.
Chapter 2, Stereotyped Knowledge, examines irregular practitioners’ global trade in cheap manuals on venereal disease, sexual debility, and fertility problems. While previous scholarship has largely focused on these manuals’ lurid depictions of weakened male bodies, this chapter emphasizes their origins in respected publications: often calling themselves “consulting surgeons,” a term from hospital practice, irregular practitioners combined verbatim sections from textbooks and treatises aimed at medics with snippets from works in other genres to construct their own “popular treatises.” Some of these productions were issued in several different languages and circulated around the globe. At home and abroad, they offered readers an affordable means of acquiring modern information about sex reproduction, derived from the science of anatomy, and their authors a means of cultivating trust in their expertise and advertising more expensive products and services. Examining other medical practitioners’ responses, this chapter argues that these manuals and their makers were seen as both an economic and existential threat to regular medicine.
The important role of the saccule is the sensing of gravity. In other words, gravity always stimulates the macula of the saccule.
Objectives
The aim of this study was to clarify whether nystagmus and dizziness occur by intentional changes upon stimulation to the saccules.
Methods
The subjects were eight healthy humans. Experiment 1: Subjects were asked to maintain a supine position to check for nystagmus and dizziness. Experiment 2: Subjects were asked to tilt their heads 45º to the left in the supine position to check for nystagmus and dizziness. Experiment 3: Subjects were asked to maintain a left-ear-down 90º position to check for nystagmus and dizziness.
Results
In all the experiments, no one revealed nystagmus and no one complained of dizziness.
Conclusion
Neither nystagmus nor dizziness occurs by intentional changes in the stimulation to the saccules.
Respiratory regulation comprises respiratory rhythmogenesis, formation of the respiratory motor pattern, control of blood oxygen and carbon dioxide, increase of minute ventilation during physical activity, adaptation of respiration to the sleep-wake cycle, coordination of breathing with swallowing, cough, sneezing, choking and voluntary activity such as speech or singing. Other factors such as growth and maturation, emotion, pregnancy, injury, disease, body temperature, pain and aging lead to changes in respiration. The presence of a respiratory rhythm generator in the brainstem is now known to be a common feature of all vertebrates. Knowledge about respiratory regulation is mainly derived from animal models, but respiratory regulation in humans is subject to an increasing number of physiological, electrophysiological, neuroradiographic, histopathological and genetic studies. This chapter provides an overview of respiratory regulation, focused on neuroanatomical, neurophysiological and clinical apsects.
Comprehensive knowledge of the anatomy and physiology of the respiratory system is crucial in respiratory medicine. A profound understanding of physiology allows the practitioner to deduce pathological processes and initiate therapeutic steps based on rational decisions. The choice of a suitable ventilation mode or setting typically stems from an understanding of the pathophysiological processes. Understanding the respiratory chain at the cellular level, ventilation and perfusion, as well as the delicate interplay of macroscopic and microscopic mechanisms, supports the development of precise and individualized ventilation strategies. Knowledge of mucociliary clearance and the various lung volumes is also crucial to ensure optimal management of tracheobronchial secretions, oxygen supply and CO2 elimination.
This is a standard question, but one which contains a lot of anatomical detail. It may be useful to practise drawing a simple explanatory diagram. The oral may be linked to intracranial aneurysms and their management, and it may also include physiological aspects of cerebral perfusion, the problem of cerebral vasospasm following subarachnoid haemorrhage or briefly the subject of intracranial pressure (ICP).
Protestant attacks against papal corruption of the cult of saints and falsification of miracles led the Post-Tridentine Church to reform the processes of saint-making through an intensified collaboration with medical science. The alignment of faith and science at the nexus of the human body culminated in the eighteenth century under Benedict XIV Lambertini (r. 1740–58). Benedict published a monumental treatise, still influential today, that codified canonization proceedings on the basis of modern medical expertise, and he was a preeminent patron of scientific and medical institutions and practitioners for the advancement of medical knowledge and public health. The imperatives of the Counter-Reformation, canon law, experimental science and medicine, and the burgeoning Enlightenment coalesced, albeit uneasily, in his vision of a reformed Church, for which natural and saintly bodies became primary emblems in defense of the authority of the Catholic Church in a world increasingly resistant to it.