The present article summarises the historical and palaeopathological evidence of tetanus, an ineradicable yet vaccine-preventable infectious disease caused by Clostridium tetani. The antiquity of the disease is described thanks to historical written sources, artistic references and very recent palaeogenetic data. A recollection of now long-supplanted therapies is offered together with a focus on the introduction of an effective vaccine. Moreover, a potential identification of tetanus in the Bible is analysed and general considerations on the current health relevance of tetanus are presented.

Aim of the study: Several previous experimental studies simulated ancient Egyptian mummification of human bodies using the embalming protocol described by Herodotus. Besides two human experiments, several animal studies have been performed with very different species, mostly over short observation periods. We used a human-sized piglet model that matches closely to humans and undertook a long-term experiment with two detailed examination time points over 13 years. This was conducted to test the efficacy of the Herodotus embalming method in the long term. Material and Methods: An 88 kg piglet, 1.30 m body length, obtained from a veterinary practice was chosen as the skin is similar to humans. Using the described formula, the carcass was cleaned, eviscerated, filled with spices and natron sachets, and then covered with 240 kg of natron for 40 days. It was then reopened, and most of the sachets were removed. The surface was cleaned with wine, the body cavity partly refilled with sachets and spices, the surface treated with oils, wax, honey and bitumen, and finally sealed with linen bandages. The body weight was regularly monitored over the 13-year period. At 7 and 13 years, re-examination, with a protocol including CT scanning, histology and microbiology, was performed. Results: The monitoring of the body weight showed a rapid loss of weight within the first year, gradually slowing, reaching more than 66% of its weight. In the final 6 years, the body weight was reduced by only 1.7 kg. The CT scans at 7 years and 13 years showed that the structures of the heart, muscle, skin, and soft tissue were well preserved, and the body significantly shrunken; only the musculature showed air inclusions. Histology and microbiology (examined at baseline, 7 years and 13 years) revealed excellently conserved tissue with anaerobic microbe spores, very limited tissue destruction, and no significant fungal or parasitic invasion. However, the preserved kidneys and internal genitalia had disappeared. Conclusions: This ongoing long-term project confirmed excellent mummification with near-perfect body conservation at 13 years, supporting the efficacy of the described Herodotus technique. This model is suitable for the assessment of special preservation techniques recently suggested for individual soft tissue organs.

The multidisciplinary study of the well preserved cadaver of the so-called “air-dried chaplain” from the church crypt of St. Thomas am Blasenstein (Upper Austria) not only solved the “mystery” of the excellent preservation of the trunk of this unusual mummified human body, but also provided circumstantial information about this historic individual, his life and disease history, and conclusion of his cause of death. The mummy of a 35–45 year old male, radiocarbon dated to the period 1730–1780 CE is most likely that of the local aristocratic parish vicar Franz Xaver Sidler von Rosenegg who had been temporarily delegated to St. Thomas parish from his mother monastery of Waldhausen im Strudengau (Upper Austria). He had a high-quality diet based on terrestrial animal products, showed no signs of major physical work load, was most likely a pipe smoker and suffered from chronic active pulmonary tuberculosis with peripheral and central (hilar) calcifications (primary tuberculous complex) and a right lower lobe cavity with focal heterotopic ossification and potential active inflammation. This latter may have caused acute pulmonary hemorrhage which may have been the cause of death. Most surprisingly, we detected, in the otherwise completely intact abdominal (and pelvic) cavity, extensive packing with foreign material which was identified as a mixture of wood chips, fragmented twigs, large amounts of fabric of various types including elaborate embroidered linen, and even pieces of silk. Furthermore, this embalming method seems to have included high level zinc-ion solution impregnation (most likely zinc-chloride with small amounts of arsenic) and the addition of copper. The packing was inserted into the abdominal body cavity through the rectum. It led to an excellent state of conservation of the trunk, while the face (and skull) and peripheral extremities were less well preserved.

OBJECTIVE:A case of traumatic strabismus was painted in two portraits of Franz Josias, Duke of Saxe-Coburg-Saalfeld (1697-1764). Both canvases are held by the Art Collection of Veste Coburg (Accession numbers: M.076 & M.363). METHODS:Resorting to the "Guidelines for Iconodiagnosis", a careful comparison of the portraits of the Duke pre-dating an accident with those showing evidence of an ocular trauma afterwards, was performed. An analysis of the historical and biographical written sources was carried out as well. RESULTS:At the age of 32 years, while playing battledore and shuttlecock (in French "jeu de volant", a forerunner of badminton), Duke Franz Josias sustained a traumatic left eye injury. This did not heal with time and was depicted in contemporary paintings of the Duke. CONCLUSION:Combining both biographical and artistic sources, a diagnosis of post-traumatic strabismus due to injury of the left inferior rectus muscle was proposed with an Iconodiagnosis level of evidence II.

Following the restoration of the crypt of the Attel monastery in Southern Germany, the human remains of 16 out of 40 monks were exhumed and underwent anthropological and palaeopathological investigations. These skeletal remains were of individuals who lived between 1700 and 1750 CE. In some cases, thanks to the documentary sources, it was possible to identify individual monks and partially reconstruct their biographies and lifestyles. This situation in particular, applied to Gregorius Lechner (1672-1732 CE), Oeconomus major of the monastery. He was affected by severe gout, as shown radiographically (X-ray and CT-scan). Our findings were corroborated by the archival documents, which indicate that at the time of his death Gregorius Lechner was affected by gout and dropsy. Acute renal failure was the ultimate cause of his demise. Very interestingly close to his right arm, a typical «fontanela» plate, used to treat gout in the 18th century, was also found. The presence of this instrument found in close contact with the remains of a gouty Gregorius Lechner confirms its use in 18th century medical practice in Southern Germany.

Very recently, a comprehensive re-evaluation of the medical facts and observations surrounding the death of Empress Elisabeth “Sisi” of Austria (1837–1898) was published. The Empress was assassinated in Geneva by the anarchist Luigi Luccheni or Lucheni (1873–1910). In parallel to this recent publication, our study group came across an almost unknown letter from Dr. Golay, who was one of the examining doctors of Empress Elisabeth. In this publication we add relevant additions based on this letter and provide further insights regarding the attempts at resuscitation.

The Flood is the first pictorial scene that Michelangelo Buonarroti painted on the ceiling of the Sistine Chapel in the Vatican. On the right side of the fresco a woman with abnormal breast morphology is presented and the nature of her disease is considered using the Guidelines for Iconodiagnosis. A team of experts covering art history, art expertise, medicine, genetics, and pathology undertook the process and concluded that the pathology shown is probably breast cancer, most likely linked to the symbolic significance of an inevitable death as expressed in the Book of Genesis.

This interdisciplinary investigation of the human remains of Balduin Helm, one of the most important abbots of the Fürstenfeld monastery, provides novel information on this historic individual. This is particularly interesting since Balduin, during the early 18th century, was involved in the renovation of this large Bavarian monastery. Metastatic prostate cancer was found as evidenced by multiple mixed osteolytic–osteoblastic bone lesions in all available vertebral bodies, fragments of both os coxae, and isolated metastases in skull bones. Distribution, radio- and histomorphology, and especially the immunohistochemical detection of prostate-specific antigens in those metastases definitively confirm this diagnosis. Further investigation, especially by stable isotope analysis, showed a balanced high-level diet with considerable contribution from animal protein and significant freshwater fish. These additional findings suggest a significant radiocarbon reservoir effect as an explanation for a “too old” radiocarbon date. Finally, the obviously high-level protein diet may have contributed to the tumorigenesis which caused the death of the abbot at an advanced age.

The well preserved skeleton of Joseph Huber, a very well-known historical character of the 19th century Munich, also nicknamed “Finessen-Sepperl”, is the starting point of the reconstruction of life and death of this historical individual. He was known as a postilion d´amour (love’s messenger) of the Royal Bavarian capital with numerous comments and anecdotes and a few biographical sketches that indicate he remained well until the last few years of his life where requests for his duties lessened. The skeleton shows a small-sized male individual with almost complete loss of teeth, but otherwise very well-mineralized bone, having suffered from three episodes of trauma – an old-healed incomplete femoral neck fracture leading to severe osteoarthrosis, a clavicle fracture of the medial third with a few weeks old callus formation, and fresh serial rib fractures along with severe skull trauma with fractures of the os temporale and petrosum, presumably leading to intracranial bleeding and finally death. The type and distribution of these latter two injuries are in agreement with a murderous attack – which was retrospectively reported several years after his death, while the old-healed femoral neck fracture may have caused reduction in Joseph´s walking activities but not reduced requests for his services. Paleopathology not only identifies the terminal decline, but also previous diseases of this Old Bavarian character and thereby completes his story.

Background. - This report discusses the patholo-anatomical features of a typical Jael Syndrome shown in the portrait of a 16th century Hungarian Hussar Captain named Mark Baksa that is currently part of the "Wunderkammer" of Ambras Castle Museum, Innsbruck, Austria. It shows the soldier severely wounded by a lance that perforates the skull entering into his right eye and leaving at the neck. Methodology. - This study was carried out following the published methodological procedures and recommendations that shall be applied when performing iconodiagnosis. Results/discussion. - This injury was sustained at the siege of Gyor in 1598 CE, from which he was reported to survive following treatment by skilled military surgeons. The true weapon was probably a jarid, an Ottoman throwing spear. Reconstruction of the presumed trajectory through the skull and neck assumed that no vital organ or structure was injured given that Baksa survived the attack. Conclusion/perspectives. - The portrait of Mark Baksa highlighted the bravery of the Hungarian military during the 16th century Austro-Hungarian-Turkish war in the Balkans and used as an icon of their prowess. This multidisciplinary investigation shows that iconodiagnosis coupled with the analysis of historical documentary sources and modern-day medical imaging can be of help in determining the authenticity of traumatic lesions in individuals from the past. (c) 2024 Elsevier Masson SAS. All rights reserved.

Background. - This case report discusses the possible incidence of a neuro-ophthalmological tumour identified in a high quality mummy portrait of a woman from Roman Egypt at the Toledo Museum of Art, USA (1971.13). Methodology. - This analysis employs the published methodological procedures and recommendations for iconodiagnosis. Results/Discussion. - Careful observation allows the identification of neuro-ophthalmological signs possibly consistent with a neuro-ophtalmological tumour. Differential diagnosis includes post-traumatic condition. Conclusion/Perspectives. - This case is another example of a neuro-ocular pathology in a funer-ary mummy portrait of a woman who lived over 1,800years ago and adds to the few cases of medical conditions so far identified in portrait paintings from Roman Egypt. (c) 2024 Elsevier Masson SAS. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Perciaccante, Antonio MD; Donell, Simon T. MD; Nerlich, Andreas G. MD, PhD; Cucu, Andrei I. MD; Charlier, Philippe MD, PhD; Asensi, Victor MD; De Vincenti, Monica PhD; Bianucci, Raffaella PhD Author Information

In 2018, Riccomi and Giuffra1Riccomi G Giuffra V First portrait of a syphilitic patient: Ulrich von Hutten.Am J Med. 2018; 131: 714-715Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar reported on the portrait of the German humanist, chevalier, and theologian Ulrich von Hutten (1488-1523) suffering from syphilis. He can be regarded as the first European patient to be known to have suffered from that disease and to have written about his own illness. Von Hutten's description of his ailments proves so rich and clinically detailed that he is rightly considered the best-known post-Columbian syphilitic.1Riccomi G Giuffra V First portrait of a syphilitic patient: Ulrich von Hutten.Am J Med. 2018; 131: 714-715Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar Although the portrait by Holbein the Younger clearly depicts skin lesions suggestive for syphilis, not all historians agree on the identification of Portrait of a Young Man as a representation of Ulrich von Hutten in the year of his death. The portrait shows a young adult, and interpretative problems exist with the character's clothes. Other representations of Ulrich von Hutten, particularly on his deathbed (Figure2Wellcome Collection. Image: Ulrich von Hutten in bed, suffering from syphilis. Available at: https://commons.wikimedia.org/wiki/File:Ulrich_von_Hutten_in_in_bed,_suffering_from_syphilis._Wellcome_L0005341.jpg. Accessed February 9, 2023.Google Scholar), are considerably different. Hutten's disease, which is often referred to in French as Jeune Lépreux (the Young Leper),3Boeckl CM Images of Leprosy. Disease, Religion, and Politics in European Art. Truman State University Press, Kirksville, Mo2011: 200Google Scholar may have presented variably, although we acknowledge that "leprosy" was an umbrella term for many cutaneous conditions in the past. Finally, the osteological reference to the Hug 1971 study4Hug Erik Das Grab des Ulrich von Hutten.Bull la Société Fribourgeoise des Sci Nat. 1971; 60 ([in German]): 100Google Scholar appears problematic in the light of newly published anthropological information. In 1959, the Swiss anthropologist Erik Hug first found a skeleton on the island of Ufenau, Switzerland's largest island (Lake Zurich, now part of Canton of Schwyz), which, however, did not present osseous sequels of syphilis and finally had to be excluded to be Ulrich von Hutten. In a new search in 1968, a skeleton was found that corresponded to the known descriptions of Hutten, and a forensic superimposition of the portrait and the skull showed sufficient similarities. The skeleton showed exactly the syphilis lesions described by von Hutten. Therefore, Hug assumed that he had finally found the body of Ulrich von Hutten. Although a historical sensation and of great importance for medical research, the topic vanished quietly. The 2 skeletons were reburied in 1970 and, apart from a report in a local journal, the subject suddenly disappeared.4Hug Erik Das Grab des Ulrich von Hutten.Bull la Société Fribourgeoise des Sci Nat. 1971; 60 ([in German]): 100Google Scholar Recent examinations published by Goujon et al5Goujon AFC Turck R Janosa M Gantenbein UL Haeusler M Ulrich von Huttens Grab: Ist es wirklich Hutten?.in: Giesemann B Heimatkalender 2023. Naumann, Gelnhausen2023: 45-59Google Scholar on this skeleton, exhumed again in 2016, have shown that anthropologically and genetically (verified by 3 independent ancient DNA tests), this individual is clearly and unequivocally a female with a reconstructed stature of 154-155 cm (a little more than 5 feet), who died in her mid-thirties (anthropological age class: mature adult).5Goujon AFC Turck R Janosa M Gantenbein UL Haeusler M Ulrich von Huttens Grab: Ist es wirklich Hutten?.in: Giesemann B Heimatkalender 2023. Naumann, Gelnhausen2023: 45-59Google Scholar Radiocarbon dating, the authors report, is quite compatible with the times and life of Ulrich von Hutten.5Goujon AFC Turck R Janosa M Gantenbein UL Haeusler M Ulrich von Huttens Grab: Ist es wirklich Hutten?.in: Giesemann B Heimatkalender 2023. Naumann, Gelnhausen2023: 45-59Google Scholar These results do represent a major identification problem and leave 2 scenarios open. In the first one, scientists are faced with a female individual who happened to live and die in conditions and areas comparable with von Hutten's and showed a similar morphology of the syphilitic lesions. This would make a positive match between autobiographical and osteological sources, as mentioned by Riccomi and Giuffra,2Wellcome Collection. Image: Ulrich von Hutten in bed, suffering from syphilis. Available at: https://commons.wikimedia.org/wiki/File:Ulrich_von_Hutten_in_in_bed,_suffering_from_syphilis._Wellcome_L0005341.jpg. Accessed February 9, 2023.Google Scholar simply impossible. In the second scenario—obviously much more historically complex, controversial and ultimately difficult to prove—Ulrich von Hutten's maleness should rather be seen as the result of a phenomenon of wartime and crisis cross-dressing known during the Middle Ages and Early Modern Era.6Dekker R Van de Pol L Frauen in Männerkleidern. Weibliche Transvestiten Und Ihre Geschichte. Klaus Wagenbach Verlag, Berlin1990Google Scholar The most recent classic instance of such a social exchange of gender is that of Maria Teresinha Gomes (1933-2007), a woman who was uncovered by chance only after 20 years in the role of an off-duty male general in 1992. Should this be the case, Riccomi and Giuffra's1Riccomi G Giuffra V First portrait of a syphilitic patient: Ulrich von Hutten.Am J Med. 2018; 131: 714-715Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar global phenotypic description would still be correct, but a female von Hutten would inevitably open a massive historical and social debate. Either from an anthropological perspective or limiting any discussion to von Hutten's syphilitic condition, this famous historical patient's case remains open to interpretations and further studies. Two authors of this article (MEH and FMG) took part in the exhumation of the alleged remains of Ulrich von Hutten on November 8, 2016 on Ufenau island. However, they specify that currently they are no longer part of that project and are not involved with the team of authors and their institutions mentioned at reference 5 of this work.

Stephan Schätzl was the parish priest of Viechtwang, Upper Austria. He lived in the aftermath of the Peace of Augsburg in a period of schism between Roman Catholics and Lutherans. His portrait, depicted only 6 days before his demise in 1590, shows that he had extreme ante mortem cachexia. Documentary sources detailed his life and ill-health and it is proposed that he had chronic gastro-duodenal ulcerative disease which ultimately led his to death.