title: Pulverized human skull in pharmacological preparations: possible evidence from the "martyrs of Otranto" (southern Italy, 1480).
abstract: BACKGROUND
  Ever since the Late Medieval Ages historico-medical literature has attested the use of cranium humanun as an ingredient in pharmacological preparations for the treatment of epilepsy. Some authors suggest the use of pulverized bone obtained from individuals who died a violent death and were not buried.
  
  
  METHODS
  The skeletal remains of hundreds of male inhabitants from Otranto, killed by the Ottomans in a mass execution on 14 August, 1480, are preserved in the Chapel of Martyrs in Otranto Cathedral (Apulia, southern Italy). The so-called "martyrs of Otranto" were beatified in 1771 and canonized by Pope Francis on 12 May, 2013. A cranial vault with 16 holes of different sizes, with regular rounded shape, was noticed among the skeletal remains, symmetrically arranged behind five large rectangular windows. Eight of the 16 holes, which exposed the diploe without reaching the endocranial surface, are incomplete perforations, while 8 holes are complete perforations; no evidence of bone reaction is visible.
  
  
  RESULTS
  The lesions are the result of a multiple trepanation performed by using an instrument equipped with a large rounded tip. This tool could not produce bone discs, but only bone powder. It is impossible to establish with certainty the reasons for these multiple trepanations, but several hypotheses can be advanced, ranging from experimental surgery to a procedure designed to obtain relics. However, saint bones are very likely to have been regarded as having medicinal properties. As a matter of fact the martyrs of Otranto died a violent death and were not buried, and the pulverized bone obtained from their skulls might have been considered a particularly powerful ingredient for pharmacological preparations, as attested in the historico-medical literature.
  
  
  CONCLUSIONS
  The skull of Otranto might represent a unique evidence of multiple trepanations carried out to obtain bone powder as ingredient for therapeutic preparations.
authors.affiliation: Division of Paleopathology, Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Via Roma 57, 56126 Pisa, Italy; Center for Anthropological, Paleopathological and Historical Studies of the Sardinian and Mediterranean Populations, Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/B, 07100 Sassari, Italy. Electronic address: v.giuffra@med.unipi.it.
authors.forename: Valentina
authors.initials: V
authors.lastname: Giuffra
authors.affiliation: Division of Paleopathology, Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Via Roma 57, 56126 Pisa, Italy; Center for Anthropological, Paleopathological and Historical Studies of the Sardinian and Mediterranean Populations, Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/B, 07100 Sassari, Italy. Electronic address: gino.fornaciari@med.unipi.it.
authors.forename: Gino
authors.initials: G
authors.lastname: Fornaciari
mesh_terms: D049668:History, 15th Century; D049669:History, 16th Century; D049670:History, 17th Century; D049671:History, 18th Century; D006801:Humans; D007558:Italy; D008297:Male; D011208:Powders / Q000266:history* / Q000627:therapeutic use*; D012068:Religion and Medicine; D012886:Skull / Q000737:chemistry*
chemical_list: D011208:Powders
keywords: Apulia; Cranium humanum; Epilepsy; Renaissance; Therapy; Trepanation