Belly fat or bloating? New insights into the physical appearance of St Anthony of Padua

Over the centuries, iconographic representations of St Anthony of Padua, one of the most revered saints in the Catholic world, have been inspired by literary sources, which described the Saint as either naturally corpulent or with a swollen abdomen due to dropsy (i.e. fluid accumulation in the body cavities). Even recent attempts to reconstruct the face of the Saint have yielded discordant results regarding his outward appearance. To address questions about the real appearance of St Anthony, we applied body mass estimation equations to the osteometric measurements taken in 1981, during the public recognition of the Saint’s skeletal remains. Both the biomechanical and the morphometric approach were employed to solve some intrinsic limitations in the equations for body mass estimation from skeletal remains. The estimated body mass was used to assess the physique of the Saint with the body mass index. The outcomes of this investigation reveal interesting information about the body type of the Saint throughout his lifetime.

Pharmacology in a Cup of Coffee The Virtue of Coffee and Vitamins Learned from the History of Scurvy and Dropsy

Scurvy, a vitamin C deficiency, was rampant during the age of discovery in Europe. In the mid-17th century, “Pasqua Rosée,” the first coffee house in London, put an ad in the newspaper “Publick Adviser” clearly stating, “It (coffee) is excellent to prevent and cure dropsy, gout, and scurvy.” A Netherlands trade merchant carried the information to Nagasaki, Japan, along with coffee beans harvested in the Netherlands’ new territory, Java Island. A Japanese physician in Nagasaki, Dr. Kai Hirokawa, translated the information into Japanese in his new book, “Dutch Medicines,” published in 1803. According to the ancient documents stored in Wakkanai City, Japan, the coffee beans were distributed to Tsugaru Clan soldiers who were guarding the northern coastline from 1855 to 1856. The purpose of the distribution was the prevention of scurvy and dropsy. As the result, none of the soldiers died from scurvy during the winter of 1855-1856. This paper discusses the pharmacological relationship between coffee micronutrients and vitamin deficiency syndrome.

[Quincke and his oedema]

Heinrich Irenaeus Quincke (1842-1922), the son of a physician, was born in Frankfurt but was educated in Berlin where he also completed his medical studies in 1864. After a 'grand tour' that took him to Paris, Vienna and London, he was trained in Berlin, first in surgery and later in internal medicine, under Von Frerichs (1819-1885). In 1878, he became a professor of internal medicine in Berne; from 1883 he held the chair of medicine in Kiel, which he would hold for the next 30 years. In 1882, he published a synthesis of several observations of 'acute, circumscribed oedema of the skin'. Quincke accurately described the clinical features and distinguished the familial from the sporadic forms. He was correct in attributing the condition to increased vascular permeability, but he surmised the causal factors were neurogenic rather than humoral, according to current insights (excess of bradykinin due to external factors or hereditary deficiency of C1-esterase inhibitor). Quincke not only contributed to several other clinical observations, but also pioneered the lumbar puncture, initially not for diagnostic purposes, but to relieve headache in hydrocephalic children.

Henri-Francois Secretan (1856-1916) and his syndrome

Henri-François Secretan (1856-1916) was a Swiss physician, who in 1901 described a medical condition characterized by a hard, sometimes cyanotic oedema (Charcot's blue oedema) on the back of one or both hands and forearms. This condition was later known as Secretan's disease or Secretan's syndrome. This report discusses Henri Secretan and the syndrome that bears his name.

[The medical history and the death cause of Young-Jo based on the Seungjeongwon Ilgi : royal secretariat logs)]

Young-Jo, 83 years old, was the longest lived king of the Chosun Dynasty. Seungjeongwon Ilgi gives more detail about the diseases and prescriptions of Young-Jo. We could close look at what the Annals of the Chosun Dynasty just described that king received medical attention. In inspecting Jung-Jo`s constitution, to examine his medical history is very important. Yong-jo had a weak constitution, but he was always concerned about health care. Youn-jo complained of colic syndrom and heart fire when young; ascris and shoulder pain since middle age; severe fatigue and gait disturbance caused by edema in his latter years. During his last 20 years, he had taken and resorted to Ken-GongTang, the reason was not psychological disposion, but physical disease. Also, Yong-Jo's condition just before death could be assumed in Seungjeongwon Ilgi and Jonhyeongak Ilgi. According to continuous complaints such as edema of the lower limbs, faint(lethargy) and eating disorder caused by abnormal rising of GI (anorexia), we could presume that the cause of death was uremia. In addition, it has significance to correct feasible misconceaption about the cause of death grounded on The Annals of the Chosun Dynasty.

[The history of the disease of Taras Hryhorovych Shevchenko]

The authors analyzed the symptoms of the disease of T. H. Shevchenko for the period of 1847-1860. January-February disease manifestation is stressed in the article. The cause of the poet's death is substantiated in the article.

Chagas today

The study of the history of Chagas disease has undergone a revival in recent years. Questions about how that history ought to be investigated have aroused passionate debate in Brazil, England, and Germany. This article is intended as a contribution to a debate initiated by several colleagues. "Chagas Today": an ironic title for a serious debate.

Bloodletting as a Cure For Dropsy: Heart Failure Down the Ages

BACKGROUND

Dropsy was a term used to describe generalized swelling and was synonymous with heart failure. Its treatment options were scanty and were aimed to cause "emptying of the system" or to relieve fluid retention. These remedies were rudimentary, erratic in action, and associated with inconvenient side effects.

METHODS AND RESULTS

Bloodletting, either by venesection or by leeches, was a popular way to alleviate symptoms from dropsy. Although bloodletting, purgatives, cauterization, and Southey tubes were drastic, their use demonstrated that physicians were not powerless to help people with severe heart failure. Several centuries of intensive investigations in different areas of heart failure ended with the development of new therapeutic strategies that made bloodletting obsolete.

CONCLUSION

In an era when adequate treatment of heart failure has become a reality, it is appropriate to acknowledge those who paved the way to such great progress.

Ippolito Albertini and Michael Albertus: disparate old and innovative theories on dropsy and edema

The concept of edema and dropsy as a part of heart and renal failure developed in the 17th and 18th centuries with the observations of Albertini, who realized that two clinical entities were derived from the blood rather than the tissues. Albertus, who lived in the same period, was the last physician to interpret fluid accumulation according to the old, scholastic and dogmatic procedures of medicine. The fundamental concepts of Albertus held little in addition to the classification and categories of the physicians of the Middle Ages. Bloody congestions were distinguished from stagnation: the former have the purpose of reducing superfluites of blood and occurred in plethoric patients. Plethora in turn is caused by the ancient villain, inculpated since Hippocrates and Galen: suppressed hemorrhoids, suppressed menstrual evacuation and cutaneous eruption driven inward. Because of its suppression, transfer of blood occurs toward the chest, which impedes thoracic expansion and contraction, then asthma and dyspnea occur. On the contrary, Albertini with his clinical and autoptic observations and pronouncements filled in the anatomical and clinical picture of fluid accumulation and created the rudiments of diagnostic criteria. Edema, dropsy, asthma, dyspnea were, according to Albertini, the signs and symptoms of heart and renal failure. Albertini was the first to point out that dyspnea is apt to arise with special rapidity when a lesion occurs in the left atrial chamber and ventricle and by implication the mitral valve. In modern physiopathological terms, he discovered the picture of pulmonary edema. To this important discovery, he added a number of extremely important comments: changes in the respiratory organs are secondary to changes in the cardiovascular system; edema that is accompanied by dyspnea also affects the viscera, most especially the lungs, and finally dropsy of the lungs must be differentiated anatomically and clinically from dropsy of the chest (hydrothorax). In other words, he depicted the anatomical and clinical picture of congestive heart failure in modern terms.

The pathophysiology of syringomyelia - historical overview and current concept

Various ideas and hypotheses have been brought forward to explain the development of syringomyelia in the past two centuries. None of them offers a sufficient basis to serve as a concept for the treatment of all affected patients. Apart from a discussion of the different hypotheses this paper proposes a new pathophysiological concept based on clinical, experimental and literature studies. Syringomyelia is understood as a state of chronic interstitial edema of the spinal cord due to accumulation of extracellular fluid (ECF). This accumulation is caused by a cascade of events starting with obstruction of cerebrospinal fluid (CSF) flow and/or spinal cord tethering which ultimately alter ECF flow and increase ECF volume. Treatment should be targeted against the pathological process which causes CSF flow obstruction and cord tethering to inhibit this pathophysiological process at a decisive point.

The Jones compression bandage. Review and clinical applications

Lower-extremity edema is a common condition that can be caused by many pathophysiologic processes. Control of edema associated with surgery or trauma is important and will help minimize pain and discomfort and prevent wound complications and blisters. Many techniques are used to control edema. The Jones compression dressing is an excellent tool that has been used successfully by the senior author for 18 years. It continues to be a primary treatment technique for the control of edema.

[On the etymology and the semantics of the medical term: Istiska']

This article deals with the etymology and semantics of the term istiska' which was interpreted as cirrhosis in some studies. The meaning of the term in the old medical texts and dictionaries was studied by quoting examples from original sources. It is concluded that istiska was used for dropsy, that is, an abnormal accumulation of serous fluid in tissue or in a cavity of a body, such as the abdomen, pleura, thorax, peritoneum etc.; and in the 19th and 20th centuries it meant hydrax and, was used as the prefix hydr- or hydro-. The text also describes the various forms of istiska' found in the Turkish terminology.

Edema in the Corpus Hippocraticum

In this paper, we analyze the collection of ancient Greek treatises ascribed to Hippocrates (460; between 371 and 350 BC), in order to determine whether or not edema can be traced. As a result of reading these works on the Greek text, we recognize some symptoms of edema in those called oidêma (swelling) and udrôps (dropsy) in the oldest treatises of the Corpus; in some cases, it seems also possible to recognize its description as the uremic coma. The dysfunction of edema had not been identified as such, however, even though the phenomena associated with the above symptoms received a specific explanation, which was fully hypothetical. This theoretical explanation also justifies the therapies prescribed for the treatment of the phenomena among which edema appears. Significantly enough, the treatment changed during a period which corresponds to that of Hippocrates' life: it changes from the four-quality system to that one of the four humors, but not necessarily under the influence of Hippocrates himself.

A history of edema and its management

The obvious disfigurement caused by clinically evident edema has been a matter of medical concern for ages. Most of the early writings on the subject (Sumerian, Babylonian, Egyptian, Greek) center on dropsy, its causes and management. While reference to the heart is made in the ancient texts, much of the focus is on the abdominal (ascitic) accumulation of fluid. The role of the heart and "dropsy of the chest" began to be differentiated and attract attention sometime by the end of the seventeenth century, and were well appreciated by the eighteenth century. By the beginning of the nineteenth century the reports of John Blackall and Richard Bright provided new insight by differentiating dropsy into that of cardiac and renal origins. The role of salt, initially measured and thought in terms of its anion chloride, began to be appreciated by the middle to late nineteenth century. Its mobilization, however, remained problematic. The "cure de dechloruration", which gained fame by the end of the nineteenth century, was not always a successful undertaking. The treatment of dropsy, which centered on augmenting secretions (diaphoretics, purgatives) or mechanical removal of body fluids (bleeding, leeching, lancing), remained a frustrating and chancy undertaking for much of the time that medicine has had to deal with it. Although mercury had been advocated as a diuretic in the sixteenth century, even the organic mercurials that were introduced after World War II were limited in their effectiveness. The discovery of sulfanilamide-induced sodium bicarbonate diuresis in the late 1940s was to provide the first step in the new age of clinically effective diuretics, which began in the 1950s with the introduction of chlorothiazide, the first orally effective agent to mobilize sodium chloride. The subsequent introduction of more potent diuretics was made possible by concurrent advances in renal physiology and the understanding of the sodium handling by the kidney.

Unravelling dropsy: from Marcello Malpighi's discovery of the capillaries (1661) to Stephen Hales' production of oedema in an experimental model (1733)

A modern understanding of oedema formation traditionally begins with Starling's description in 1898 of hydrostatic and oncotic forces acting on the capillary membrane. Clearly, hypotheses of oedema formation predating the knowledge of the existence of capillaries must have been incomplete. Marcello Malpighi first described capillaries in 1661, but although he displayed a good grasp of the principles of the Harveian circulation and believed that oedema fluid (the clinical entity dropsy) was derived from the blood rather than the tissues, we have found no evidence that he realised the central role played by his discovery. However, only 60 years later, Stephen Hales' Haemastaticks reveals the creation of an experimental model for dropsy which led him towards an understanding of oedema formation not far behind Starling.

John Blackall (1771-1860): failure to see the obvious in dropsical patients with coagulable urine?

Despite his success in publishing a book which was widely read and which drew attention to the fact that some cases of dropsy are associated with coagulable urine, John Blackall failed to make the link between this phenomenon and disease of the kidneys. Thus, to Richard Bright must go the credit for providing the critical understanding of the phenomenon. The single most probable reason for Bright's success and Blackall's failure was that Bright carried out post mortem examinations of almost all of his patients. In addition, Bright was ruthlessly systematic in documenting his autopsy findings, and not least was the fact that he possessed the rare talent of being objective in looking at his data, without being influenced by the preconceptions of the times.

Edema and uremia from 1827 to 1905: the first faltering steps of renal pathophysiology

After Richard Bright's studies, both edema and uremia were thought to be due to a renal retention of urinary substances; but if so why were they so rarely associated with each other? To solve this dilemma, a few clinicians turned to physics and chemistry. In 1897, Korànyi measured the freezing point depression (FPD) of the urine during water restriction. He found that in advanced renal disease it was lower than normal, approaching that of plasma, a phenomenon which he named isothenuria. He introduced the concept of renal insufficiency when, whatever the lesions, urinary excretory function does not adapt to the needs of the body. In the same year Achard and Castaigne found that in uremia, the excretion of methylene blue into the urine was delayed. In contrast, the dye was normally excreted in edematous patients with proteinuria. In 1902 Strauss and Widal, using a new steel needle to obtain blood, each studied the chemistry of plasma and performed water, chloride and nitrogen balances. They revealed that in advanced nephritis without edema there was a retention of nitrogen metabolites but not of chloride, whereas in proteinuric edematous patients the blood urea was normal, and there was a retention of chloride and then of water. Physical chemistry and its objective results had been introduced into renal medicine. Modern renal pathophysiology was now launched.

The origins of American nephrology (1800-1850)

Within a few years of its occurrence, American clinicians became aware of the discovery by Bright in 1827 that albuminuria in edematous patients was associated with granular degeneration of the kidney. Yet, there was a paucity of important original observations in nephrology from American in the first half of the 19th century. By the mid-19th century, however, the primitive concepts of clinical nephrology, renal physiology, and renal pathology were becoming established in the United States, after enlightenment from Europe. Because of the dreadful course of anasarca and uremia and stimulated by the advantages of innovations in microscopy, renal disease began at that time to attract the attention of eminent American clinician-pathologists. Their early observations would add to the knowledge base on which later developments such as bacteriology, radiology, clinical chemistry, and other scientific advances would build.

Thomas Sydenham, 1624-1689

Thomas Sydenham, widely regarded as the leading English physician of the second half of the 17th century, was a soldier before he became a physician. This may account for his very practical attitude to medicine, which he believed should be learned by observing patients rather than by reading books. His treatment was largely traditional and he tended to ignore contemporary advances in medical science, but his meticulous records of patients and of their response to treatment paved the way for the clinical approach which was to prevail in the future.

Henri-Francois Secretan

Henri-Francois Secretan was a Swiss physician. He described hard edema of the hand in 1901 in a report that went unnoticed until interest in this condition revived in recent decades.