[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.

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.

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.

Blood, perceptions, resource and ownership: When transfusion illustrates the complexity

Blood is apart from the rest of the tissues as this fluid is overseen by basic and applied life and humanistic sciences. Blood is the essence of human functioning. It is the object of one of the most commonly known cancers, leukemia. It is life-saving in transfusion - a property that also gives blood a special credit and questions blood as a valuable merchandise or as no ones' property but common good. But blood is also scandalous after the tainted blood affair in the 1980s and 1990s. Blood is further inseparable from most religious practices, both forefront and hidden (magic cults). It is frightening as it is versed in legitimate and illegitimate combats; it is poured to compensate offenses or debts in many civilizations. Any time blood comes forefront, rationale science leaves it to irrational digressions. Even the very same life-saving transfusion, is beaten by groups of opponents on religious grounds. Further, at a time blood cells and molecules are scrutinized, no one can claim having a complete understanding of what blood is, off the vasculature, as - to study it - one has to alter it. The study of blood is fascinating for all colleges of an academy and not many topics can share this property: chemists, physicists, geneticists, physiologists, medical doctors, philosophers, ethicists, theologians, artists, historicists, anthropologists, sociologists, etc. have all contributed to depict different, specific, aspects of blood. The present review aims at merging different aspects of blood to give pathophysiologists a platform to better understand fears and hopes related to this special tissue, when dealing with patients of theirs.

Influence of Wilson Ce nter Terminal on fetal electrocardiography acquisition

The acquisition of a standard 10-leads electrocardiography (ECG) is performed using the Wilson Center Terminal (WCT) reference with a normalized electrode positioning. However, in the case of non-invasive fetal ECG (fECG) acquisition, there is no standardization on the positioning of the electrodes on the abdomen and many authors suggest an acquisition with or without a WCT. The use of the WCT for the acquisition of the fetal heart rate (FHR) is not justified. The objective of this paper is to quantify the influence of this reference compared to a direct measurement. For this purpose, we developed a device allowing the acquisition of the fECG and compared the two configurations on 6 volunteer pregnants. The noise levels and the fetal QRS morphology were compared, showing no superiority of the WCT acquisition compared to a direct differential measurement.

A 1810 skull of Napoleon army's soldier: a clinical-anatomical correlation of steam gun trauma

INTRODUCTION

In the following article, we are presenting a clinical observation of Baron Larrey. In 1804, Larrey was the inspector general of health, as well as the chief surgeon of the imperial Napoleonic Guard. He participated in all of Napoleon's campaigns. A paleopathological study was performed on a skull from Dupuytren's Museum (Paris) with a long metal stick in the head. We report here a clinical case as well as the autopsy description of this soldier's skull following his death. We propose a different anatomical analysis of the skull, which allowed us to rectify what we believe to be an anatomical error and to propose varying hypotheses regarding the death of soldier Cros.

MATERIALS AND METHODS

The skull was examined, observed and described by standard paleopathology methods. Measurements of the lesion were performed with metric tools and expressed in centimeters. Historical research was made possible through the collaboration with the Museum of Medicine History-Paris Descartes University.

RESULTS

Following the above detailed anatomical analysis of the path of the metal rod, we propose various possible lesions in soldier Cros due to the accident. At the inlet, the frontal sinuses could have been damaged. At the level of the second portion of the intracranial path, all of the anatomical elements present in the cavernous sinus could have been injured (cranial nerves III, IV, V1 and V2, VI, internal carotid artery and cavernous sinus). The exit orifice of the foreign body passes through the left condylar fossa of the occipital bone, points to a highly probable lesion of the left hypoglossal nerve (12th cranial nerve).

CONCLUSION

The paleopathological study of human remains, when combined with anatomical and clinical knowledge of the pathologies of the head and neck, can rectify diagnoses of the past.

Comparison of multiple cardiac signal acquisition technologies for heart rate variability analysis

Heart rate variability analysis is a recognized non-invasive tool that is used to assess autonomic nervous system regulation in various clinical settings and medical conditions. A wide variety of HRV analysis methods have been proposed, but they all require a certain number of cardiac beats intervals. There are many ways to record cardiac activity: electrocardiography, phonocardiography, plethysmocardiography, seismocardiography. However, the feasibility of performing HRV analysis with these technologies and particularly their ability to detect autonomic nervous system changes still has to be studied. In this study, we developed a technology allowing the simultaneous monitoring of electrocardiography, phonocardiography, seismocardiography, photoplethysmocardiography and piezoplethysmocardiography and investigated whether these sensors could be used for HRV analysis. We therefore tested the evolution of several HRV parameters computed from several sensors before, during and after a postural change. The main findings of our study is that even if most sensors were suitable for mean HR computation, some of them demonstrated limited agreement for several HRV analyses methods. We also demonstrated that piezoplethysmocardiography showed better agreement with ECG than other sensors for most HRV indexes.

AcCorps: A low-cost 3D printed stethoscope for fetal phonocardiography

The analysis of fetal heart rate provides valuable information regarding the fetus wellbeing. Fetal phonocardiography is a low-cost and passive method allowing the acquisition of fetal heart rate by recording acoustic vibrations on the mother's abdomen. However, most of available stethoscopes are not optimized for a robust acquisition of fetal heart sound. In this publication, we investigated a new design of low-cost and 3D printed stethoscope. This device was optimized to provide an acoustic amplification especially in the low-frequency band which corresponds to the fetal heart sounds. This device was tested i) in silico, ii) on a test bench and iii) on 5 pregnant volunteers.

The mandible of Saint-Louis (1270 AD): Retrospective diagnosis and circumstances of death

INTRODUCTION

Recent paleopathological cases have shown the usefulness of interdisciplinary odontological studies in the investigation of historical figures.

OBSERVATION

A macroscopic examination of the mandible of Saint-Louis (13th c. AD), conserved in the cathedral of Notre-Dame (Paris, France) was carried out, and compared with biographical data about the life and death of the King, and contemporaneous cases of infectious/inflammatory diseases. We found post-mortem tooth loss associated with moderate signs of infectious and inflammatory diseases, which precise diagnoses are discussed facing historical chronicles and sources: main diagnosis is scurvy, potentially associated with bacterial infection.

DISCUSSION

Our results support the identification of the relics, and improve the knowledge about the saint's circumstances of death related to metabolic deficiencies and infections.

Lessons from the Past: Some Histories of Alpha-1 Antitrypsin Deficiency Before Its Discovery

A1AT deficiency- a genetically inherited autosomal codominant disease with more than 120 identified alleles- was first identified by Laurell and Eriksson in 1963. The most common hereditary disorder in adults, A1AT causes an increased risk of developing pulmonary emphysema and liver disease. In A1AT patients, lung disease generally presents at a younger age than "usual" chronic obstructive pulmonary disease (COPD) and it may be misdiagnosed as asthma. Because A1AT deficiency patients can show the same clinical features as non-deficient COPD (including increased evidence of bronchiectasis, frequent exacerbations, impaired health status and a degree of reversibility of airflow obstruction), the World Health Organization recommend to test every patient with a diagnosis of COPD or adult-onset asthma for A1AT deficiency. Despite these recommendations, the epidemiology of A1AT deficiency remains uncertain. Although recently discovered A1AT deficiency has affected human populations since antiquity. By using scientific data and recently studied skeletons and historical cases, we show that it is now possible to reconstruct the natural history of pathological processes, whether due to genetic, infectious or environmental factors. We believe that the evolution of disease in patients and research to elucidate the relationship between social science and environmental are pertinent contemporaneous subjects.

Did Blaise Pascal have autism spectrum disorder and a genetic predisposition for skull deformities?

Many world-renowned scientists and artists had autism spectrum disorder (ASD). We suggest that the French mathematician and physicist Blaise Pascal (1623-1662) also had ASD. As a boy, he demonstrated his mastery of language, mathematics and science. He showed single-mindedness and obsessive interests in the pursuit of science in his younger years and later he pursued with religion with the same determination. Pascal neglected social interactions; he was cold and aloof and had an obsessive revulsion to any expression of emotional attachment. As shown by his funerary mask and the autopsy report Pascal had craniosynostosis (primary nonsyndromic oxycephaly) with atrophy of the right half of the face. Congenital facial asymmetry due to craniosynostosis has a genetic basis. This suggests that Pascal's facial deformity may betray his propensity to suffer from genetically determined diseases including ASD. Despite the intrinsic limitations of a diagnosis based only on biographical information, we surmise that Pascal had the three key symptoms (obsessive interests, difficulty in social relationship and problems in communicating) that characterize ASD individuals.

Schizophrenia: four examples of historical retrospective diagnosis

It is difficult to know precisely the history of a functional disease, unlike the natural history of infectious agents, tumour processes or poly-malformative syndromes. In the case of psychiatry, and especially schizophrenia and psychotic disorders, a retrospective look at artistic productions (writings and drawings) makes it possible to reconstitute a whole section of this pathological context. Through four medieval and modern examples, we will see how it is possible to do a paleo-psychiatry: Opicinus de Canistris (14th c.), the Voynich manuscript (15th c.), Hieronymus Bosch (15th-16th c.), and the Codex Seraphinianus (20th c.).

Charité Hospital and infectious diseases

Films are useful for medical education and introduce Science fiction movies or historic documentaries and pioneering scientists who developed the field of infectious disease research. Between the late nineteenth and early twentieth centuries, expert talents such as von Behring, Koch, and Ehrlich were present at the Charité Hospital. These individuals contributed significantly to the scientific study of infections, their prevention, treatment, and social impact. Here, we compare the relative impact of infectious disease research centers during the study period (late nineteenth and early twentieth centuries) by assuming that the number of publications listed on Wikipedia about the individual scientists working in London, Paris, and Berlin is Poisson distributed. We show that using reference counts that appear after individuals' names on Wikipedia is a useful tool to assess the impact of centers of excellence in the study of infectious diseases. However, the accumulation of talent in Berlin during a relatively short period, even though historically the protagonists did not interact or support each other, lead to greater advances in the treatment and prevention of infections in humans than the work of individuals such as Pasteur in Paris or Lister in London.

[Sudden death in Versailles: A review of a cardiovascular treatrise by Dionis (1710)]

In 1710, the surgeon Pierre Dionis publishes a Dissertation on sudden death. Echoing and expanding the work of his Roman colleague Jean Marie Lancisi, he describes and analyzes dozens of cases of sudden death observed by him. A large number of cases was followed by autopsies allowing clinicopathological confrontation. Are proposed causes of death (pulmonary embolism, myocardial infarction, hemorrhagic stroke, arterial rupture, etc.), pathophysiological mechanisms based on the ancient theory of humors, and preventive actions to avoid these unexpected deaths. In this article, we oppose these old data to those of current literature.