Calcified uterine leiomyoma from an 18th-century nunnery in North Italy.

OBJECTIVE: To develop a differential diagnosis of a mass retrieved alongside skeletal remains in the crypt of the church of Santissima Annunziata of Valenza (Province of Alessandria, Northern Italy). MATERIAL: A calcified mass measuring 40 × 39 mm and 17.62 × 16.3817.62 × 16.38 mm. METHOD: The analysis utilized macroscopic assessment and histologic examination (including histochemical and immunohistochemical analyses). RESULTS: Morphological traits include an irregular and spongy external surface. Holes of different sizes lead toward the inner part of the object. A section of the mass shows an "intertwined bundle" pattern, confirmed by microscopic examination. CONCLUSIONS: Differential diagnosis determined the mass to be consistent with calcified leiomyoma. SIGNIFICANCE: Identifying uterine leiomyoma adds to the paucity of paleopathological literature on the condition and to calcified tumors more broadly. It also allows for an important discussion of women's gynecological health in the past and potentially among nulliparous women. LIMITATIONS: Neither histochemical staining nor immunohistochemical analysis demonstrated the certain muscular nature of the specimens due to the rehydration and decalcification processes, for which there are no gold standards. SUGGESTIONS FOR FURTHER RESEARCH: Calcified masses are common in the clinical literature but remain rare in paleopathological literature. Careful excavation and improved recognition of apparently calcified masses are necessary to improve recognition, diagnosis, and interpretation.

Elongated styloid process of an autopsied skull from the Cemetery of Santa Maria Maggiore in Vercelli, 18th-19th century (Piedmont, northern Italy).

We discuss the coexistence of a postmortem cut and a pathological alteration, recorded on a skeleton belonging to an adult man that was discovered during the archaeological investigations of the cemetery of the Church of Santa Maria Maggiore in Vercelli (northern Italy, 18th-19th century). The skull presents an oblique cleft, which from the top of the frontal bone bends towards the occipital, and the left styloid process is elongated compared to normal values (48 mm). The elongated styloid process is due to the ossification of the styloid ligament which has several possible causes. To increase the knowledge about this pathological condition in the past, it was necessary to compare all the data present in the literature today and consider the few cases published in the paleopathological field. In this paper, our main goals are: i) to investigate the reasons for which the craniotomy was performed; ii) to examine the possible cause of the ossification of the styloid process, described as Eagle's syndrome; iii) to enrich the archaeological literature of elongated styloid process cases and iv) to investigate the presence of a hypothetical relationship between the autopsy cut and the diagnosed Eagle's syndrome on this skull.

A possible case of orbital osteomyelitis from the medieval cemetery of Sant' Agostino in Caravate (Varese, Northern Italy).

OBJECTIVES: This paper aims to present one of the first osteoarchaeological cases of orbital osteomyelitis and provides the best diagnostic criteria to identify its pathophysiological changes. MATERIALS: A well-preserved skeleton of an adult male from the medieval cemetery of Sant' Agostino in Caravate, Italy. METHODS: Macroscopic, tomographic, and histological analyses were performed using standard methods. RESULTS: The skeleton shows irregularities in the architecture of the left supraorbital margin. CT analysis reveals the presence of a radiotransparent area involving the diploe and the external cranial table. This area is lateromedially oval-shaped and bordered by a thick irregular radiodense rim, associated with the presence of a cloaca on the roof of the orbit and surrounding periosteal reaction. Microscopic examination shows the formation of a thin layer of cortical bone and an osteoid-like matrix. CONCLUSION: A careful differential diagnosis based on macroscopic, radiological, and histological evidence suggests a case of orbital osteomyelitis. SIGNIFICANCE: This case study represents one of the few osteoarchaeological evaluations of ocular chronic osteomyelitis diagnosed using macroscopic skeletal, computed tomography, and histological analysis. As such, it provides a reference and an investigative criterion for future cases. LIMITATIONS: The diagnosis cannot be stated with certainty, and only probable diagnoses can be proposed. Although we referred especially to clinical literature, it is necessary to consider that the severity of conditions may be modified by modern medical intervention. SUGGESTION FOR FURTHER RESEARCH: This case provides further insights into the presence of this condition in the past.

A possible case of "kissing" osteochondroma and multiple enchondromas in a medieval skeleton from the church of Sant' Agostino in Caravate (Northern Italy).

This work presents the neoplastic bone changes found in the lower limb of a medieval skeleton from the church of Sant' Agostino in Caravate (Northern Italy). After briefly assessing the individual's overall pathological picture, a differential diagnosis for the neoplastic changes is now proposed. These changes were analysed macroscopically and radiographically and subsequently evaluated considering the paleopathological and clinical literature available. The differential diagnosis allowed us to recognize a tibiofibular osteochondroma and some enchondromas in the medullary cavity of the tibia. The results presented here highlight the importance of radiological analyses in the recognition and study of bone neoplasms in the paleopathological field, further contributing to our knowledge of the presence of neoplasms in Medieval Northern Italy.

Overcoming doubt in vaccinations. The end justifies the means?

Controversies and skepticism about vaccination have existed as long as vaccination itself. Today and yesterday, the authority of religious leaders has a fundamental role to convince members of their congregations to accept or reject vaccination. Our contribution tells of the stratagem used by the Italian doctor Luigi Sacco to make the faithful lean towards the vaccination using their faith as a means. The history of yesterday's end of today opens a current debate on the role and responsibility of religion around vaccination practice. As COVID-19 vaccine mandates grow, so are requests for religious exemptions.

Accessory sacroiliac joints and the iliosacral complex: two case studies from a medieval and post-medieval cemetery in northern Italy.

The detection of parturition markers on archaeological pelvic bones is relevant for the reconstruction of the biological profiles of female individuals, in whose life history pregnancy represents a crucial biological event. During a preliminary study on a sample of 18 individuals from the medieval and post-medieval cemetery of San Biagio in Cittiglio (northern Italy), two skeletons exhibited evidence of noteworthy bony projections at the sacroiliac level. In clinical studies, these occurrences can be connected to several biological variables such as age, obesity, and multiple births, suggesting that they are a possible consequence of weight-bearing stresses. Here, we address two cases of accessory sacroiliac joints and the iliosacral complex found in two female individuals. The study is part of the anthropological analysis of the sample from the cemetery of Cittiglio (78 individuals have been investigated to date) and, in particular, of the examination of female and male pelves in order to highlight the expression and aspect of pelvic features in both sexes.

A Severe Case of Biparietal Thinning in a Medieval Skull From a Northern Italy Necropolis.

ABSTRACT: This study aims at presenting a case of symmetrical and bilateral thinning observed in a skull belonging to the skeleton of a mature woman from the medieval cemetery of Caravate (north Italy). Macroscopical, radiological, and histological analyses were performed to investigate the condition. The analyses allowed us to detect a progressive loss of both the outer table and the diploe, and the sparing of the inner table. As a controversial condition in the clinical and paleopathological literature, this case poses some difficulties in discussing the differential diagnosis. However, the sex determination, estimation of the age-at-death and different characteristics observed at the level of the postcranial bones, in particular the fractures recorded on different vertebral bodies, allowed us to correlate the biparietal thinning found in this subject to ageing and osteoporosis.

The fate of stillborns. Perceptions from a historical, anthropological and bioethical reasoning.

Introduction: Issues of disposal of fetal remains and related parental distress do not concern only the present. This contribution aims at offering a glimpse of what grieving management concerning perinatal death must have been in ancient times. The discussion of the topic of death and treatment of perinatal remains is based on historical, anthropological, and bioethical reasoning, in a dialogue that contributes to the current debate on fetal personhood.Methods: We have considered written and archaeological sources to investigate the response of past societies to perinatal death, in parallel with today's bioethical and legislative issues on fetal identity.Results: From historical evidence and archaeological findings, it emerges that lay community compassion and mercy often far exceeded the Church's norms, which for centuries have denied the burial of fetuses and stillborn infants in consecrated cemeteries. Over the centuries, the practices implemented by people have led to a theoretical reflection on the dignity to be recognized to infants.Conclusions: This contribution highlighted how issues about the treatment and burial of infants have interrogated women and men over the centuries. In the past, the development of rituals, even far from ecclesiastical norms, allowed people to endure mourning for the death of their children.Recent legislative initiatives by some States on the burial of embryos and fetuses within cemeteries have reopened the long-standing debate on the value to be attributed to the life of the fetus. The challenge of reaching an agreement on ethically controversial questions gives vigor to the research for strategies capable of settling different needs: the respect for the choice of women, the need to identify forms of protection of human life after death, the development by the community of rites capable of welcoming and accompanying parental mourning.

The teaching of the History of Medicine in Italy: a path in progress.

BACKGROUND: The increasing attention to the potential application of technology in medicine represents a dangerous warning in the direction of a reductionist approach. The academic system should therefore be strongly engaged to ensure even in medical practice the greatest enhancement of the human dimension. Targets: How much space is offered to the teaching of History of Medicine (HM) in Italian Universities? This work aims to answer this question through an in-depth analysis of the teaching plans of the degree courses in Medicine and Surgery (CLMC) activated in Italy. MATERIALS AND METHODS: The survey was carried out through the consultation of information, relating to the year 2019-2020, contained in the UniversItaly portal of the Italian Ministry of Education, University and Research, created to accompany students in their studies, as well as through the information published in the web portals of the various universities. RESULTS AND DISCUSSION: In Italy in 43 out of 97 Universities there is the Degree Course in Medicine and Surgery for a total of 66 degree courses; some Universities have activated more degree courses depending on the number of learners or on issues of territorial distribution. The teaching of HM is present in the curricula of 54 CLMC (82%) and in these is mandatory. In 93% of the cases, it is included in integrated courses (CI) and for only 4 CLMC it results as autonomous teaching. For the most part (86%) it is included in the first year's educational plan. The typology of the different CIs is extremely varied, both in terms of denomination, year and content, as well as in the overall CFUs assigned. The current teaching staff is divided as follows: 6 full professors; 12 associate professors; 13 Researchers (RU/RD); 20 contract professors. 19 are the researchers/professors engaged in the scientific field of the HM (MED/02). CONCLUSION: Those findings indicate that the HM subject in the Italian medical education programs is not yet universally recognized as able to stimulate medical students to a holistic view of the person and illness and therefore not sufficiently valued.

Taking care of life: the new Italian law on post-mortem donation for study purposes, training and scientific research.

Anatomical dissection is considered a fundamental practice in the medical curriculum. Not only does it help students to familiarize themselves with the various bodily organs and to refine their surgical practice, it also fosters an attitude of awareness and respect towards death and the values of solidarity. On 10th February 2020, the Italian Parliament passed a new law entitled "Rules on the disposition of one's own body and post-mortem tissues for study purposes, training and scientific research". Here, we outline the main ethical and legal aspects of this law and suggest initiatives to encourage body donation. Through careful analysis of the law, we intend to open a discussion on the main ethical issues and to make comparisons with the international situation. The new legislation fills serious gaps in an area of great ethical relevance; not only does it endorse fundamental ethical principles, it also provides important guidelines for strengthening body donation, such as: ensuring respect for the dignity of the deceased, providing express consent, appointing a trustee, promoting information for both doctors and the community, and banning all forms of trade in bodies or body parts. This law is certainly an important milestone on the road to overcoming the scarcity of bodies for study and research. However, it is also essential to promote a favourable attitude to body donation and to strive to overcome obstacles to this practice by supporting continuous dialogue between anatomical institutes and the community. Further studies are necessary in order to assess the impact of the new law.

BETWEEN MEDICINE AND FAITH. THE HISTORY OF THE ALLEGED BLESSED ALBERTO BESOZZI AND THE AUTHENTICITY OF HIS RELICS

The monastery of Saint Catherine of Sasso was built overhanging the eastern shore of Lake Maggiore in the municipality of Leggiuno (VA). In particular, our paper concerns the relics housed in the Sacellum of the church of St. Caterina. According to the tradition, the first Sacellum dedicated to the saint was built before the 16th century over a medieval hermit's refuge. The chronicle, the Historieta, remembers that, in the 12th century, a merchant of Arolo, Alberto Besozzi, survived the lake crossing shipwreck and made a vow to St. Catherine of Alexandria. He decided to retreat in prayer in a cave on that part of the coast. The Sacellum, now incorporated in the monastery complex (at the bottom of the central nave of the church), preserved human remains of Blessed Alberto in the past. We present the important role that the Sacellum and the relics have played not only for the faith, but also for the devotion of pilgrims and local people. In this context, this monument is related to the sense of religiosity and spirituality that pervaded medieval life, where every form of prayer is to be materialized in the physicality of a tangible creation.

Male circumcision: ritual, science and responsibility.

INTRODUCTION AND OBJECTIVES: In Italy, four minors have died in the last year as a result of male circumcision (MC) procedures performed for cultural and religious reasons by unqualified persons in unhygienic conditions. RESULTS AND DISCUSSION: After illustrating the historical and ethical outlines of the moral admissibility of MC within a comparative perspective, we examine the features of the Italian healthcare system with particular regard both to the heterogeneity of services available in the various Regions and to the risks engendered by excluding MC from the public health setting. CONCLUSION: In order to adequately safeguard public health, particularly that of minors, there is a pressing need for thorough discussion of whether the National Health Service should perform MC on minors free of charge or, at least, for a reduced fee. The implementation of targeted campaigns may raise awareness of the importance of proper safety measures in MC.

How Italy has moved from anatomical studies in the sixteenth century to body donation in the twenty-first century.

INTRODUCTION: The anatomical dissection plays a fundamental role in the students' formation as well as in the specialists' updating. In contrast to what happened in the sixteenth century, when medical students and professors from all over the Europe were used to come in Italy, today Italian surgeons have to go abroad to attend training courses, with inevitable economic costs and personal inconveniences. The reason for this circumstance lies in the existence of obsolete and even ethically unacceptable legal rules. The recent unanimous approval by the Italian Senate of the bill on postmortem body donation opens important perspectives. MATERALS AND METHODS: The authors, after having reviewed the main historical stages in anatomical dissection, examine the above mentioned recent bill n. 733 (XVIII Legislature) concerning the disposition of one's body and post-mortem tissues for the purposes of study, training and scientific research, taking into consideration also the international context. DISCUSSION: The bill aims to fill the serious legislative gap, not only offering the possibility of satisfying the noble needs of human solidarity, but also giving to future doctors a contact with death capable of promoting human and ethical values such as the respect for life. CONCLUSIONS: The Italian legal system presents - right now - serious operational gaps which make body donation practically unapplied. While waiting for the bill to finally see light, it is necessary to engage in educational activities that can promote the culture of this "gift" and, at the same time, that of respect for the body of the deceased person. KEY WORDS: Anatomical dissection, Body donation, Study and research.

Cosmotellurism in Lombroso's work.

BACKGROUND AND AIM OF THE WORK: Few know that Lombroso was also involved in epidemiological research. In particular, Lombroso's scientific reflections on Medical Geography were addressed to the theme of climate influences and meteorological conditions on human conduct. The authors analyze the scientific production and the works of Lombroso devoted to medical geography. DISCUSSION: Lombroso carried out accurate epidemiological investigations using the statistical method with great modernity, combining health data with geographical and climatic data to demonstrate the relationship between man, the environment and health in a social vision of preventive and curative medicine. CONCLUSIONS: The theory of Cosmotellurism in Lombroso's work is not only a source of unquestionable interest in the History of Medicine. The heritage of Medical Geography within the pre-bacteriological medical culture can continue with its teachings to correctly address the clinician's thinking even in the current historical context in which endemic and epidemic pathologies re-emerge in various parts of the world. (www.actabiomedica.it).

Osteological evidence of metabolic diseases from a post medieval North Italy archaeological site.

Skeletal lesions related to metabolic diseases in children have been systematically investigated in paleopathological literature only in recent years. This work presents an infant pathological specimen from the post-medieval cemetery of the St. Mary's Nativity church (15th-18th centuries, Segno, Trento, Trentino, Northeast Italy). The bones belonged to an individual of 9 ± 3 months of age, estimated upon an assessment of the stage of dental eruption. Metabolic diseases were diagnosed with paleopathological criteria according to previous literature. Differential diagnosis of the osteological evidence indicates a disease that might be caused by the lack of vitamin D or C. Comorbidity of vitamin C and D deficiency has been widely studied in clinical literature, particularly in children between 3 months and 5 years of age. The study of ancient osteoarchaeological materials allows us to improve our knowledge on diseases' effects on bone development in children and, in this case, it represents additional evidence of the presence of metabolic diseases in a rural contest of the Italian post-medieval period.

Do certain rituals adapt to psychology or does psychology adapt to rites? Post mortem photography: the last "picture of life" in "death".

In death and mourning, why should we think that rites adapt to psychology and not vice-versa? Or believe that psychological workings grow into a rite or ritual? When analysing practices related to rites of passage, death emerges as a rupture - or breakage - of social status.

Study, conservation and exhibition of human remains: the need of a bioethical perspective.

Today, the recovery, study and exposition of archaeological human remains are subjected to new discussions. Human remains preserve a clear record of past life to later generations. These remains, even if dated hundreds or thousands of years ago, maintain their human dignity and force the community to reflect on the ethical issues related to their analysis, curation and display. Such a topic stimulate a continuous dialogue between the different actors of the bioarchaeological/osteoarchaeological/anthropological (physical and forensic) field: archaeologists, anthropologists, bioethicists, museum curators and other figures in order to give voice to a broad range of approaches and identify shared paths on the management of human remains that respect human dignity and different cultural values of community. As a "culturally sensitive material", human remains collections must be acquired and handled with respect regardless of their age and legitimacy of provenance. The opening up to disciplines quite far from the expertize of museum curators is an essential prerequisite to increase awareness towards ethical issues and to develop guidelines that take into account the dignity of the person and the cultural values of community to whom human remains belonged. Accordingly, the authors stimulate the increase of the discussion and try to identify solutions sensitive to the issue.