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Dead medieval woman "gave birth" to the baby in the coffin

Small bones in the coffin below the mother's pelvis.
Photo: A. Pasini et al., 2018 / World neurosurgery

Italian archaeologists have discovered a medieval grave in which the remains of a woman and a fetus lie between her legs. It's a grim example of a "casket birth," the researchers say, but there's more to this terrible tragedy of the Middle Ages.

Archeology is often very similar to forensics. Investigators encounter a scene and then have to use the available evidence to compile what happened. Take this latest research as an example.

In 2010, archaeologists in Imola, Italy, discovered a strange funeral from the Middle Ages, dated to the 7th or 8th century AD. The stone-lined tomb contained a skeleton of an adult woman lying on her back, indicating a proper, intentional funeral. But the archaeologists also discovered a pile of small bones below the basin. In addition, the woman's skull had a small hole, which made the scene even more complicated.

This extraordinary discovery has enabled further research by researchers from the Universities of Ferrara and Bologna, the results of which have now been published in the science journal World Neurosurgery . Based on the evidence, the researchers say the scene is an example of "coffin birth" or "postmortem fetal extrusion." This is a well-known but rare phenomenon that occurs during the decomposition phase. About two to five days after the death of a pregnant person, gas builds up in the body, eventually forcing the fetus to leave the vaginal canal, resulting in postmortem delivery. Researchers say the fetus had already died when the mother was buried.

It sounds like a horror movie, but there are other examples in the scientific literature (see here, here and here)

The grim burial scene.
Photo: A. Pasini et al., 2018 / World neurosurgery

According to the new analysis, the woman was between 25 and 35 years old when she died and the fetus was 38 weeks old two weeks full time). The baby's legs were still in the mother's body, but the head and torso had fallen under the pelvic cavity. The fetus was already in the head-down orientation (head position) and was positioned for birth.

The hole in the woman's skull was 4.6 mm wide and was near a small cut on the forehead. The researchers say this is evidence of trepanation, an ancient form of brain surgery. The type of wound suggested a surgical origin rather than a heavy impact. The woman lived about a week after the trepanation, as her skull showed the first signs of bone healing.

The suggestion that medieval physicians perform a primitive form of brain surgery in a 38-week patient may seem bizarre, if not entirely inappropriate, but researchers have a very plausible explanation: trephination was performed to treat the woman Eclampsia – a hypertensive pregnancy disorder. This condition, which is characterized by high blood pressure and protein in the urine, is a more severe form of pre-eclampsia. Eclampsia affects women after the 20th week of pregnancy and is one of the most common (until today) pregnancy illnesses and the main cause of maternal mortality.

Importantly, Trepanation was used in the Middle Ages to treat symptoms that are very closely related to the symptoms triggered by eclampsia. In this case, a frontal trepanation was used to relieve the intracranial pressure of the woman.

The proof of a trepanation.
Photo: A. Pasini et al., 2018 / World Neurosurgery

"In the past, trephination was used to treat multiple symptoms and disorders such as cranial injuries, high intracranial pressure, spasms and high fever, which are also caused by eclampsia "Alba Pasini, co-author of the study and researcher of the Department of Biomedical and Special Surgical Sciences at the University of Ferrara, said in an interview with Gizmodo. "Scientific literature – both medical and archaeo-anthropological – certifies that [these symptoms] was treated by trepanation from prehistory to the present day.We are certain, as reported in the newspaper, that this treatment did not heal the woman as it only The first signs of an osteologic response confirm the beginning of the bone's healing process, indicating that the woman has survived one week of surgery at the most. "

Pasini said his team was surprised in the same Grave To find traces of trepanation and a coffin birth, since in the early Middle Ages only a few cases of this type of brain surgery had been documented, while coffin births in the archaeological records are exceptionally rare. Pasini says, however, that the explanation of eclampsia is only a hypothesis and that there may be other reasons for this finding, such as another health condition that caused the trepanation. The cause of death could not be determined; the woman may have died as a result of brain surgery, eclampsia, or complications arising during birth.

Nevertheless, the discovery of these two rare phenomena in a single person furthers our understanding of how pregnancy-related disorders were treated during that time. If you cut a hole in the head of a pregnant woman, it may sound barbaric, but these medieval Italians did their best to save this woman's life.

[World Neurosurgery]

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