Health, trauma, and social care in a medieval rural community: the evidence of remodeled severe bone lesions in the necropolis of Santa Maria (Idanha-a-Velha, Portugal)

The Santa Maria necropolis (Idanha-a-Velha), primarily dated to the twelfth and thirteenth centuries, represents a rare and securely dated medieval skeletal assemblage from the interior of Portugal. Twenty-seven out of the 44 adult individuals exhumed (61%) show evidence of at least one pathological skeletal condition, reflecting a high prevalence of disease and trauma in this rural community. Here, a general overview of skeletal alterations in the adult sample is provided, with particular emphasis on seven individuals (five men, one female, and one sex-indeterminate) displaying unusual bone alterations which contribute to remedying the scarcity of medieval historical, medical, and archaeological evidence in this territory. The analysis included macroscopic and imaging (X-rays and CT scans) paleopathological evaluation. Conditions identified include osteochondritis dissecans, post-traumatic osteomyelitis, avascular osteonecrosis, and Dieterich's or Mauclaire’s disease. One middle-aged male presented a healed high-energy left femoral fracture and a right femoral parosteal osteosarcoma—a rare finding in the paleopathological record. Most alterations are consistent with repetitive (micro)traumas associated with physically demanding activities such as farming, hunting, and cattle pastoralism. The severity of these conditions, combined with their healing status, reflects social and familial networks of care, as well as individual resilience in the face of rudimentary medical practices.