The history behind the biological, mechanistic, and clinical insights into concussion provides awareness of the current understanding and future areas for study. Although the initial description of concussion appeared in the 10th century, the potential long-term structural consequences were first defined by Harrison Martland, M.D., who performed a postmortem study of former boxers in 1928. He found evidence of perivascular microhemorrhage that he believed eventually evolved into a \"replacement gliosis\" underlying a clinical syndrome that he named \"punch drunk,\" which was characterized by acute confusion with chronic cognitive and physical symptoms developing in those with prolonged exposure. Further research into the potential long-term consequences of repetitive concussions, particularly in athletics and the military, led to an understanding of chronic traumatic encephalopathy. To ameliorate possible long-term risks, research has been focused on preventative and therapeutic measures for concussion. In this review article, the authors present the history of concussion and the long-term sequelae of repeated head injury. Specifically, they consider how the understanding of concussion has evolved from antiquity into the modern era, and how this change in understanding of head injury has led to an appreciation of the fact that its long-term implications sometimes manifest as the clinical and histopathological entity of chronic traumatic encephalopathy.

A thorough literature search was done in PubMed and Google Scholar as well as in physical books in libraries to summarize the literature on the history and evolution of medicine and orthopedics. The philosophical ideas that emerged in ancient Greece served as a foundation for the development of medicine. In the 5th century BC, the schools of Knidos and Kos emerged as influential centers for the development of medical thinking. The field of orthopedics can be traced back to early human civilizations. Ancient Egyptians perpetuated the tradition of employing splinting techniques. Hippocrates provided insights for the diagnosis, correction and treatment of many musculoskeletal entities. The field of medicine experienced a period of limited advancement during the Middle Ages. The Renaissance provided for the foundation of modern orthopedics and important contributions to the understanding and implementation of antisepsis. The discovery of x-ray and advancements in infection control and anesthesia have shown substantial progress in the domain of orthopedics and have contributed to the development of orthopedic subspecialization. Orthopedic surgery holds a historical lineage deeply entrenched in ancient practices and early human civilizations. Physicians specializing in orthopedics should be aware of the historical origins of their discipline and continue to evolve through further subspecialization and enhanced research.

OBJECTIVE: Dental disease is frequently used as a proxy for diet and overall health of individuals of past populations. The aim of this study is to investigate dental disease in a sample of enslaved African individuals recovered from an urban dump (15th-17th centuries) in Lagos, Portugal.
METHODS: In all, 81 African individuals (>12 years old) were analysed (19 males, 49 females, and 13 of unknown sex), in a total of 2283 alveoli, 2061 teeth, and 2213 interdental septa. Analysed oral pathologies include dental caries, periodontal disease, and ante-mortem tooth loss. Dental wear was also recorded.
RESULTS: Dental caries affected 52.0 % of the teeth, although only 31.9 % were cavitated lesions. In all, 96.3 % of the individuals presented at least one cariogenic lesion. Gingivitis and periodontitis were recorded in 56.7 % and 19.0 % of the septa, respectively. Only one male individual had all septal areas healthy. Ante-mortem tooth loss was recorded in 38.3 % of the individuals, in a total of 96 teeth lost (4.2 %). Regarding occlusal wear, 70.8 % of the surfaces were recorded with grades 1-3.
CONCLUSIONS: The frequencies of the oral pathological conditions observed may not only reflect a cariogenic diet (rich in starches and with a high frequency of meals) but also the conditions during the maritime voyage of the first victims of the North Atlantic slave trade (xerostomia due to lack of water, sea sickness and vomiting, vitamin C deficiency, poor hygiene), and also the impact intentional dental modifications had on the dentitions.

From the mid-seventeenth century, resorption of a testicular \"ferment\" and resorption of some part of the semen constituted reputable accounts of secondary sexual characteristics. Only in the early twentieth century was the latter, \"recrementitious secretion\" theory, explicitly considered superseded by one of internal secretion, an advance ushering in the hormone era. A reconstruction of these proto-endocrinological concepts is offered onward from the first, 1490 print edition of Galen\'s On Semen. Early modern physicians picking up from Galen deliberated widely on the medium and pathway of male and female testicular influences on \"the entire body,\" including the mind, causing \"femininity\" and \"masculinity\" in physical, mental-temperamental, and behavioral terms. A switch is discernible from \"heat and strength\" (Galen) to blood-borne \"virility\" or testicular vapor (such as proposed in 1564 by Tomás Rodrigues da Veiga), to iatrochemical postulations of a \"seminal ferment\" (suggested in the late 1650s, perhaps independently, by Thomas Willis at Oxford and Lambert van Velthuysen in Utrecht), finally to a \"seminal recrement\" or \"reabsorbed semen\" concept soon after (emergent in the posthumous work of Giovanni Alfonso Borelli, among others). During the late eighteenth century, mounting controversy surrounded both the very idea of that concept and the involved anatomical pathways, informed by multiple experiments.

Natural and human-induced toxic elements can accumulate in the environment, posing significant risks to human health and ecosystems. This study explores cave bat guano, an unconventional and relatively under-researched environmental repository, to reveal historical pollution trends and sources. Through trace elements analysis of a 1.5-m-thick guano deposit from Zidită Cave (Romania), we track changes in mining and metallurgy from 1000 CE-2012. We identified substantial pollution primarily from porphyry copper and Au-Ag-Te mines, but also impacts from usage of leaded gasoline and agricultural practices. Our record shows disruptions caused by the Bubonic plague around 1250 CE and a major surge ∼ 1500 CE. After the decline triggered by the European silver market collapse in 1525 CE, our study reveals a brief mining revival. This resurgence was followed by a continuous decline lasting until the early 1800s, driven by socio-economic upheavals and recurrent outbreaks of the bubonic plagues. The Industrial Revolution sparked prolonged growth that lasted until 1989 CE, only briefly interrupted by the Great Depression and World War II. Consequently, cave bat guano proves to be a critical resource for understanding spatial pollution patterns, both locally and regionally, and for identifying specific pollution sources.

High rates of suicide continue to plague the modern world, with clinicians, researchers, and policymakers working urgently to ameliorate what has been recognized as a worldwide public health crisis. Under American Law, individuals- including health care providers, could generally not be held liable for causing the suicide of another person. This article presents a review of suicide law in the United States in the context of a recent civil case in which a physician with expertise in mental health was sued for the death of an ex-partner who committed suicide in his home. Historical events and landmark legal cases spanning the 15th century to now are examined and presented as a narrative review to inform society and mental health clinicians a-like towards interpreting the changing medical-legal landscape. As modern advances in science continue to discern the critical biopsychosocial factors that contribute to the act of suicide, there is an inevitably growing concern that suicide may no longer be an incomprehensible nor irrational event as has been assumed for centuries. Thus, it may be considered that individual with expertise and qualification to treat a group of individuals at higher risk of suicide (severe mental illness) may be subject to a different standard than the average individual. This article seeks to present a complex matter where no simple or broad-sweeping conclusions can yet be drawn, however remains a critically important matter for mental health clinicians.

Cancer is often wrongly considered to be a modern disease in many popular medical venues. Cancers have been known to humanity since ancient times. In fact, its antiquity can be identified through the application of palaeopathological methodologies. The present perspective demonstrates by means of a historical and palaeopathological analysis how oncological manifestations were present long before the emergence of anatomically modern humans and addresses the epidemiological transition from ancient times to the contemporary world. The final section of the article examines breast cancer and its identification in ancient human remains.

From the time of Hippocrates to the early 19th century, knowledge advanced but that was an uneven process. Anatomy was basically defined by Galen and remained cast in stone until the early 16th century. Neuroanatomy was described by Galen but had little practical value, as brain surgery was not possible. The anatomy of the cranium was known and was largely correct. Care was taken to avoid the frontal air sinuses and the venous sinuses and the temporal region. The role of the brain in consciousness was not understood. It was considered the seat of the soul but there was a lack of understanding that damage to it could induce clinical symptoms such as stupor or paralysis. These were variously attributed to injuries to the meninges or the bone. This error was finally corrected in the 18th century when the brain was identified as responsible for much of the clinical disturbance following cranial trauma. All awareness that post traumatic neurological deficit was contralateral was ignored until the late 18th century, although several authors noted it. Likewise, the presence of CSF had to wait until the 18th century until it was recognized. Fissures were treated with trepanation, because of a perceived risk of infection developing between the bone and the dura. Depressed fracture fragments were elevated, replaced, or removed according to the details of the injury. Finally, for centuries surgeons blocked patients ears to reduce the sound of drilling, despite the fact that such a blocking would amplify the noise.

Realistic images became available for the first time. The first major figure was Berengario da Carpi (1460-1530). He made contributions to knowledge. He stated the dura was attached all over the interior of the cranium not just at the sutures. He also noted that deterioration following traumatic hematomas was speedier the deeper within the brain the bleed had occurred and he noticed that post-traumatic neurological deficits were contralateral. Moreover, he introduced new instruments of a practical design. Specifically, he launched trepanation using a brace and bit handle. This instrument required two hands and rotated the trepan in the same direction all the time. In addition, he illustrated a crown trepan in which the bits could be interchanged. He also developed an improved elevator. He also provided the first drawing of a lenticular. The next illustrations came from Vidus Vidius (1509-1569). The illustrations in his text were elegant and realistic but some of them were impractical or unusable. Ambroise Paré (1510-1590) was a major surgeon. He designed an improved brace and bit trepan with a collar to control penetration. He also introduced instruments for expanding a cranial opening by biting up the bone and for depressing the dura to enable material to escape more easily.

The authors of the texts described in this chapter will have had access to the anatomy of Vesalius; a marked step forward. However, there was no equivalent advance in physiology. Harvey\'s book on the circulation of the blood was published in 1628 but it took many years for its contents to be accepted as standard teaching. The century saw the development of instruments some of which look more like instruments a modern surgeon would recognize. The two major technical advances were the acceptance of a single-handed trephine and the design of crown trepans with a conical shape and blades extending up the sides. Moreover, the crown trepan had once again become the favored instrument for gaining access to the interior of the cranium. In terms of technique there was a worrying trend that surgeons could feel when they had penetrated the inner table of the skull without the need to probe. All the way back to Hippocrates, it had been customary to use probes to assess depth while trepanning. Thus, the abandonment of this safety measure if it was real, is cause for concern. However, it is not impossible that probing was continued and simply not mentioned as it was so obviously necessary as not to require comment. The lenticular illustrated remains of the triangular shape first illustrated by Vidius. It is important to note that it was not used to incise the skull but to smooth of rough edges and spicules.