The first known occurrence of embalming practices in the chrono-cultural context of Medieval Western Europe dates back to the death of Charles II the Bald in 87714. This post-mortem treatment was first reserved to the king, then to the elite of the kingdom. It aimed to slow down the decomposition processes and restrain their exhalations for the time needed to transport and/or display the body. From the 13th century onwards, the process was also intended to disperse the remains of the eviscerated corpse by burying them in different places, thereby showing favour to different religious establishments14,15. According to the medical literature and bioanthropological sources, the operation involved successive phases including opening of the cavities and removal of the viscera, preparation of the viscera, internal treatment of the cavities, external application of liniment and wrapping of the deceased. Among the viscera, the brain and the heart appear to have been especially valued as representing part of the identity of the deceased. The composition of the products used to preserve them has been documented based on archaeobotanical and chemical analyses performed on mummified remains2,5,8. Whereas the procedures associated with the treatment of these soft tissues are relatively well understood, historical sources deliver little information on the practical modus operandi. How the heart was extracted is still uncertain: it may have been done by laparotomy (opening the abdomen leaving no trace on the bones), by thoracotomy (opening of the thorax at the level of the ribs) or by sternotomy (opening of the sternum). Since surgical encyclopedias barely mention these acts of evisceration and the areas affected outside the head and chest, bioarchaeological studies are the only source that can provide an insight into the practical aspects of these post-mortem treatments. Therefore, the study of the Les Milandes collection makes a significant in-depth contribution to our knowledge of the modus operandi and to the documentation of the tools used during the embalming process.
Although the Milandes collection is older, the techniques and tools used seem to be remarkably similar to those illustrated by Dionis (1708) and identified by Signoli and colleagues16 on an 18th century autopsy case from Marseille. The first step consists of scalping the skull using the scalpel A or B (Fig. 12a) mentioned in the work of Dionis17, according to which the operator “will make a longitudinal incision from the root of the nose to the nape of the neck and another transverse incision from one ear to the other cutting the scalp and the pericranium (...), making a cross on the top of the head: he will then lift these four parts which he will separate from the skull, which will fall down leaving the skull uncovered” (Fig. 12b).
[Fig. 12]
The cut into the cranium then appears to be partially stereotyped, with a circular oblique cut starting in the frontal region in 7 of the 9 sawn crania (except cranium F and cranium E), as in numerous documented cases from the West European record, e.g. cases from the medieval cemetery of La Madeleine in Orléans, France10, from the church of Saint-Hubert in Haccourt, Belgium18 and from the chapel of Saint Laurent in the Cathedral of Strasbourg, France14. In cranium E, the cut begins on the parietal bone, a lateral approach beginning in the asterion area19, also noted in the Sens collection from the end of the 15th century. Cranium F, in addition to the classic circular oblique cut, exhibits an atypical antero-posterior cut in the sagittal plane, probably made with a curved blade, such as tool D shown in Fig. 12, before manual removal of a large cranium fragment. In Fig. 12, the tool is identified by Dionis (1708), the author, as an élévatoire, or trepanning lever, although its shape differs somewhat from the usual pattern for these tools, which were classically used to lever off the calvarium in the final stage of its removal, rather than to cut into the cranial vault (Fig. 12a, tool D). Only one occurrence of such a procedure involving sagittal sawing and manual bone fracturing has been reported previously, in the medieval sample from the church of Notre-Dame de Cléry-Saint-André20. Therefore, and paradoxically, the great care taken to preserve the integrity of the brain, which is illustrated by the frequent manipulations of the head aiming to avoid damage to the underlying soft tissues, did not prevent the operator from employing a very straightforward procedure in this case. Cutting of the vault is, however, not systematically observed in embalming cases from the bioarchaeological record. Cases of thoracic openings without removal of the brain are documented, for example, in the collection from the Jacobin convent of Rennes (France, 16th century9).
Regarding the method of evisceration and removal of the heart, three procedures are documented historically: (1) laparotomy, (2) sternotomy and (3) thoracotomy. Laparotomy, i.e. opening of the abdomen to perform visceral exeresis, generally does not leave any trace on bones. Sternotomy involves cutting the sternum along its median plane, so that the two parts of the thorax can be moved apart to reach the heart. The two parts of the sternum would then remain attached to the ribs by the cartilage, enabling the body to be returned to its full volume after the operation. This technique is attested only in rare cases, such as the sawn-off sternums in the tomb of Louis XI in Cléry-Saint-André, in the Ganagobie priory of Saint-Martin des Champs (Paris) and in the funeral chapel of Marguerite of Scotland in the church of Saint-Laon in Thouars21. Thoracotomy, on the other hand, aims to expose the rib cage, separating the sternum from the ribs by severing the connecting cartilage and removing the sternum to gain easy access to the thoracic cavity. In this case, there is no need to section the ribs, and the sternum is removed during the operation. In the Château des Milandes, there are very few cutmarks on the ribs and no sawn rib or complete or fragmented sternum were found, which could support the hypothesis of a thoracotomy. The fact that the few cutmarks observed on the ribs are found on their external surface could indicate that they are associated with the prior removal of soft material, and their small number would reflect the care taken in the procedure. This practice would also be consistent with the textual documentation for this chronological period: post-medieval medical and surgical encyclopedias focusing on embalming practices all describe thoracotomy as the most appropriate method for retrieving the heart (Georges, 2006).
A crucial finding of our study is that the embalming process involved an extremely thorough defleshing procedure including the upper and lower limbs down to the tips of the fingers and toes. The operator detached muscle and adipose tissue from the appendicular skeleton by making incisions perpendicular or oblique to the axis of the diaphysis of the long bones and in specific anatomical regions (specifically the mid-diaphysis of the femur, tibia, humerus, radius and ulna, as well as the superior surface of the clavicle). While the method for restoring the volume of the thorax is known and documented, the techniques used to restore the volume lost through the removal of the limb muscles are still unclear, since the procedure may have been concealed by covering clothin worn during the presentation of the body. Another finding of particular interest is the transverse section in the anterior region of the third cervical vertebra, probably corresponding to the cut of the trachea, previously reported only at the cervico-thoracic junction in the mummy of Louis Bruslon du Plessis from the Jacobin convent in Rennes9.
Since the embalming of children is extremely rare in this chronocultural context, the Les Milandes collection seems to be exceptional, with at least five immature individuals who died before 14 years of age, including three who died between 6 months and 4 years of age. Therefore, one of the main outcomes of the analysis consists of the precise documentation of a protocol for very young children that seems similar to that for adults from the same lineage, and equally careful. The section of the cranial vaults of the individuals who died between the 1 and 4 years of age, an extremely delicate step given the thinness of the bone tables, was performed with special care to preserve the brain as well, as evidenced microscopically by the shallower grooves on cranium I belonging to a child in this age group. In the few archaeological cases of embalming of young children reported in the literature, removal of the brain does not appear to have been systematic, as also observed in adult individuals9. In the Medici family group, for example, the perinate underwent craniotomy, but the five year-old child apparently did not6.
In the collection from the Château des Milandes, the cutmarks on the infracranial skeleton of the children are located in the same anatomical regions as in the adults (mid-diaphysis of the long bones, upper surface of the clavicle). The presence of cutmarks on the anterior surface of the ilium of one infant is indicative of complete evisceration and defleshing of the internal cavities. The fact that the incisions appear somewhat more pronounced in children is probably due to their thinner soft tissues. The care taken in the post-mortem treatment of these children probably indicates that the corpse was exhibited, and thus reflects a particularly high social status, regardless of the age at death.
The recurrence and homogeneity of the gestures observed suggest a certain stereotyping of the protocol and even a kind of local savoir-faire or know-how, which suggests the existence of systems for transmitting (in writing but maybe also orally?) the details of the modus operandi during the time the chapel was in use, probably for one to two centuries.