This study aims to place trepanation in a medieval therapeutic context by addressing its medical use in neurological disorders and by testing the existence of particular dietary care for the sick. MaterialsSix cases of trepanation found at the St. Cosme priory (La Riche, France) dated from the 12th-15th centuries. MethodsNeurological health was explored by geometric morphometrics by comparing the six cases to 68 skulls and 67 endocraniums belonging to individuals from the same period and geographical area. Trepanned diet was investigated by carbon and nitrogen isotopes and compared to 49 individuals from the same site. ResultsThe study of shapes suggests a possible pathological state for four subjects. The diet of the trepanned is not different from the rest of the population. ConclusionsThe treatment of neurological disorders emerges as the main therapeutic motivation in the corpus, contrary to the reports from the ancient surgical treatises. A specific diet for the sick is not highlighted. SignificanceGeometric morphometrics is rarely used in paleopathology and the results suggest a potential of this type of analysis in the identification of pathological cases. The results on therapeutic motivations and diet do not fit the descriptions from ancient medical sources. LimitationsThe study of forms did not lead to definitive diagnosis. The isotopic study does not allow us to appreciate all the aspects of the diet. Suggestions for Further ResearchA geometric morphometric study of the skulls and endocraniums of individuals with a known neurological condition would allow a better appreciation of the link between shapes and pathologies.

The Longobard necropolis of Castel Trosino dates from the 6th to the 8th century CE. Among the tombs excavated, the skull of an older female shows the first evidence of a cross-shaped bone modification on a living subject. Macroscopic, microscopic, and CT scan analyses revealed signs of at least two sets of scraping marks.Specifically, SEM analysis shows that perimortem bone-scraping traces are present on the skull. Both healed and non-healed defects suggest that the woman has received at least twice intentional bone modifications to address her condition. This is the first evidence of a cross-shaped therapeutic intervention on a living subject.

To identify the pathology causing the severe facial dysmorphia of a medieval individual from the site of Rigny (Indre-et-Loire, France) and to evaluate its functional repercussions on the subject's hearing and social life. MaterialsOne individual from Rigny for the osteological study, 69 individuals from the region for the Ct-Scan study and 48 individuals from the site for the isotopic analysis. MethodsMacroscopic analysis was performed using standard osteological methods. Consequences of pathology on hearing were assessed by CT-scan. Dietary behaviour was analysed by stable carbon and nitrogen isotope analysis of bone collagen. ResultsThe individual is a woman who was over 50 years of age at the time of her death with a severe form of Treacher-Collins syndrome that resulted in deafness. No osteological signs of maltreatment were observed and there is no evidence that this individual's diet was different from that of the rest of the community. ConclusionsAll information testifies to the full integration of this individual into the village population. SignificanceThis study is the first archaeological description of Treacher Collins syndrome. It shows the ability of the paleopathological approach to help identify the attitudes of societies for which written sources are most often lacking. LimitationsIn the absence of palaeogenomic analysis it is not possible to identify the origin of this case. Suggestions for further researchIncrease the paleopathological semiology by CT-scan in order to specify the consequences of pathologies and integrate isotopic analyses to enrich discussion about perceptions of disease.