Differentiating between rhinosinusitis and mastoiditis surgery from postmortem medical training: A study of two identified skulls and hospital records from early 20th century Coimbra, Portugal

Abstract

Differentiating between medical procedures performed antemortem, perimortem or postmortem in skeletal remains can be a major challenge. This work aims to present evidence of procedures to treat rhinosinusitis (RS) and mastoiditis, suggest criteria for the diagnosis of frontal sinus disease, and frame the individuals described in their medical historical context. In the International Exchange collection, the skull (878) of a 24-year-old male, who died in 1933 due to frontal sinusitis and meningitis, presents evidence of a trepanation above the right frontonasal suture, and micro/macroporosity on the superciliary arches. The available Coimbra University Hospitals archives reported that 46 females and 59 males (aged 15 months-84 y.o., x− = 35.33) underwent surgery to treat RS, primarily by trepanation (94.3%). In a search for similar evidence in the collection, the skull of a 42-year-old female (85), who died in 1927 due to sarcoma in the abdomen, shows four quadrangular holes located above the right supraorbital notch, right and left maxilla, and left mastoid process. The number/location of the holes and cut marks point to postmortem medical training (possible dissection). This paper discusses the value of information from historical contexts to differentiate between surgery and medical training in the paleopathological record.

Evidence of otitis media and mastoiditis in a Medieval Islamic skeleton from Spain and possible implications for ancient surgical treatment of the condition

“…A similar perforation described by Brothwell (1974) in a Roman individual from York was attributed to surgical intervention using a trepan. In addition, two other publications present possible cases of mastoidectomies in modern, yet pre-antibiotic, populations from Italy and Portugal (Vercellotti et al, 2010;Magalhães et al, 2017). The latter case on the left mastoid process has an almost identical location to the present case and has been interpreted as having occurred during post-mortem medical training (Magalhães et al, 2017).…”

“…2) its location and dimensions, and 3) the possible presence of a mastoidectomy. Similar cases have been identified in bioarcheology, whilst the clinical literature offers many examples (Kvestad et al, 2000;Garap & Dubey;2001;Vercellotti et al, 2010;Boljunčić & Hat, 2015;Dourado et al, 2016;Magalhães et al, 2017).…”

“…In addition, two other publications present possible cases of mastoidectomies in modern, yet pre-antibiotic, populations from Italy and Portugal (Vercellotti et al, 2010;Magalhães et al, 2017). The latter case on the left mastoid process has an almost identical location to the present case and has been interpreted as having occurred during post-mortem medical training (Magalhães et al, 2017). A review of the medico-historical literature of Medieval Islam shows that physicians had the knowledge to perform interventions, as they were well versed in ear infections and anatomy of the ear (Azizi, 2007;Liñán et al, 2014;Hajdu, 2016).…”

The Importance of Historical Medical Records Review in the Interpretation of Dry Bone Lesions on Identified Skeletal Remains

“…Trepanation canal behind the right ear through the mastoid process represents a standard procedure (mastoidectomy) at the beginning of the 20th century for the treatment of inflammation of the middle ear, complicated by mastoiditis. 16,17 The condition of the trepanation canal, along with the description in the autopsy protocol, suggests that inflammation in the middle ear continued to occur and the trepanation was never closed from 1909 until his death 31 years later in 1940. However, no bacteriological examination was performed at autopsy.…”