Disability in a medieval village community: A unique case of facial dysmorphism.

OBJECTIVE: 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. MATERIALS: An 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. METHODS: Macroscopic 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. RESULTS: The 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. CONCLUSIONS: All information testifies to the integration of this individual into the village population. SIGNIFICANCE: This 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. LIMITATIONS: In the absence of palaeogenomic analysis it is not possible to identify the origin of this case. SUGGESTIONS FOR FURTHER RESEARCH: Increase 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.

3D reappraisal of trepanations at St. Cosme priory between the 12th and the 15th centuries, France.

OBJECTIVE: 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. MATERIALS: Six cases of trepanation found at the St. Cosme priory (La Riche, France) dated from the 12th-15th centuries. METHODS: Neurological 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. RESULTS: The 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. CONCLUSIONS: The 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. SIGNIFICANCE: Geometric 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. LIMITATIONS: The 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 RESEARCH: A 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.