Porotic hyperostosis in a Late Upper Palaeolithic skeleton (Villabruna 1, Italy)

Porotic hyperostosis (PH) is a well‐recognised skeletal indicator of physiological stress occurring during the early years of childhood growth. Although frequently found starting from the Neolithic, PH is poorly documented among earlier Palaeolithic hunter–gatherers. This study reports a case of PH in a Late Upper Palaeolithic skeleton (Villabruna 1) from northern Italy. Macroscopic and radiographic examinations of the skeleton show symmetric porotic lesions of the cranial vault, hair‐on‐end appearance, thinning of the cortical bone, diploic expansion and very slight cribra orbitalia (CO). All lesions are highly remodelled and suggest a condition suffered long before death. A differential diagnosis, carried out in order to discriminate between infectious and acquired conditions, points to anaemia as likely aetiology for the changes observed. Absence of postcranial involvement, lesion healing and survival to adulthood suggest a diagnosis of acquired anaemia. Among acquired anaemias, both dietary and infectious models are discussed in light of the individual's skeletal characteristics, as well as geographic location, paleoenvironmental data, subsistence modality and dietary information. The combined analysis of these data suggests that parasitic infestation resulted in megaloblastic anaemia in this individual. Copyright © 2009 John Wiley & Sons, Ltd.     

Leprosy in a skeleton from the 7th century necropolis of Vicenne‐Campochiaro (Molise,Italy)

Analysis of the skeleton from tomb 144 of the early medieval necropolis of Vicenne‐Campochiaro in Central Italy revealed several features indicative of leprosy. The skeleton belongs to a male estimated to be between 20 and 25 years of age at death. The distal halves of the 1st and 2nd left metatarsals present acro‐osteolysis and both legs show severe subperiosteal bone reaction. The facial skeleton shows changes compatible with a chronic inflammatory process, possibly due to an infectious disease. The anatomical distribution of the lesions and their association with other skeletal lesions seems to be compatible with a near‐lepromatous form of leprosy. A differential diagnosis is made, and the skeletal traits pathognomonic of leprosy are discussed. Copyright © 2005 John Wiley & Sons, Ltd.     

A sacral anomaly from the Quaker Cemetery,Kingston‐upon‐Thames,England

A rare defect of the sacrum was observed in the skeleton of an adult female from the Quaker Cemetery (1663–1814 CE) in Kingston‐upon‐Thames, England. This is an isolated finding in the skeletal collection and no other elements in this individual were similarly affected. After eliminating post‐depositional damage and skeletal asymmetry, a differential diagnosis resulted in the consideration of two conditions: hemivertebra and sacral agenesis, both of which are rare developmental defects that originate during foetal growth. Although the defect is interesting from an embryological, genetic and palaeopathological perspective, it would have resulted in few clinical symptoms for the individual. This case adds to the limited knowledge of the morphological variability of the sacrum, and will aid in future diagnoses of these rare pathological conditions. Copyright © 2009 John Wiley & Sons, Ltd.     

A Roman Skeleton with Possible Treponematosis in the North‐East of the Iberian Peninsula: A Morphological and Radiological Study

The main goal of this paper is to describe and discuss pathological lesions observed in a Roman skeleton (between 2^nd and 3^rd century AD) from the north‐east region of the Iberian Peninsula (St Nicasi 18–24 site. Gavà, Barcelona), which may be compatible with treponematosis. Most of the skeleton, with the exception of the neurocranium, was recovered. Only the left tibia was affected, whereas the rest of the recovered skeletal remains were unaffected. Macroscopic examination revealed a male individual between 25 and 30 years of age at death with a sabre‐shaped left tibia. The proximal half of the diaphysis was pitted and the bone overall enlarged. The surface of the tibia showed occasional vascular impressions where, in some instances, small raised plaques of new bone appeared to bridge over them, specifically in the most affected area of the proximal half of the tibia. No destructive lesions were observed. Radiographic examination and gross inspection at the cross section of the tibia showed encroachment into the medullary cavity of coarse cancellous bone and cancellization of the cortex. The observed lesions indicate that the tibia was affected by a chronic infectious disease. Differential diagnoses were considered, and these included other infectious diseases, fibrous dysplasia, Paget's disease, chronic varicose ulcers affecting bone and trauma, with the conclusion that the disease affecting the tibia could have been treponematosis. This could be significant in the history of the treponematoses being one of the oldest examples of treponematosis in pre‐Columbian Europe. Copyright © 2011 John Wiley & Sons, Ltd.     

A case of short‐root anomaly in a female from medieval Istria

Dental examination of a young female skeleton from medieval Istria revealed very short‐roots of both maxillary central incisors. This developmental pathological condition is known in the literature as short‐root anomaly, occurring mostly in maxillary incisors. In affected teeth, the crown:root ratio is 1:1.6. Although the prevalence of this condition has been reported in modern populations, this appears to be the first documented case of the anomaly from the medieval period. Unfortunately, fragmentary preservation of the skeletal material prevents us from making a full diagnosis of possible aetiology. Copyright © 2006 John Wiley & Sons, Ltd.     

Cribra orbitalia and porotic hyperostosis in a Greek colonial population (5th to 3rd centuries BC) from the Black Sea

Cribra orbitalia and porotic hyperostosis in Greek skeletal remains have typically been attributed to a genetic anaemia, most notably thalassemia due to the presence of endemic malaria in the Mediterranean region. This paper reports the results of an analysis of cribra orbitalia and porotic hyperostosis in a Greek colonial population (5th to 3rd centuries BC) from the Black Sea. Archaeological evidence, stable isotopic data, and other skeletal indicators of physiological stress are examined to determine the most likely cause(s) of these lesions. While the possibility that some of the colonists of Apollonia suffered from thalassemia cannot be entirely discounted, the skeletal evidence examined in this study is not consistent with a diagnosis of thalassemia. We must therefore be cautious in assuming that cribra orbitalia and porotic hyperostosis in Greek skeletal remains, and indeed skeletal remains from any region where malaria was endemic in the past, is always indicative of this condition. Nutritional deficiencies and exposure to infectious diseases probably played an equally, if not more, important role in the development of these lesions. Copyright © 2006 John Wiley & Sons, Ltd.     

Retracted: A Possible Case of Hypopituitarism in Neolithic China

A human skeleton with a possible case of hypopituitarism is reported. The individual (burial M53) is from the site of Guanjia, a Neolithic settlement in northern China, dated to the Late Yangshao period (6000–5500 bp ). On the basis of the fully erupted third permanent molars and moderate occlusal dental wear resulting in substantial exposure of dentine, the initially estimated age‐at‐death was placed between 26 and 33 years. However, dimensions of the postcranial skeleton fall significantly below and outside the range from contemporaneous adult populations, and along with delayed epiphyseal fusion present throughout the skeleton, the postcranial age is concordant to that of an 11‐ to 13‐year‐old child. Most long bone epiphyses display incomplete fusion or are entirely unfused, but a lack of microporosity in the metaphyseal areas near growth plates indicates a cessation of longitudinal bone growth. Because no signs of porotic hyperostosis, cribra orbitalia, periosteal lesions or linear enamel hypoplasia are observed, the restricted growth of this individual is likely caused by a growth hormone disorder and is unrelated to nutritional deficiencies or systemic infection. Copyright © 2011 John Wiley & Sons, Ltd.     

Humerus Varus in a Subadult Skeleton from the Medieval Graveyard of La Madeleine (Orléans,France)

The skeleton of a subadult individual from the medieval graveyard of La Madeleine (Orléans, France) exhibits varus deformity of its right humerus. The affected bone is shortened, the diaphysis is angulated and the head is grossly deformed. The skeleton is otherwise normal. Several diagnoses are debated, including mucopolysaccharidoses, thalassemia, infection and trauma, the latter being preferred. The severity of the bone changes suggests that the growth disturbance occurred early in the life of the individual. We therefore suppose that the causative trauma occurred at the time of birth or during the early postnatal period. Copyright © 2011 John Wiley & Sons, Ltd.     

Metastatic carcinoma in a 14th–19th century skeleton from Constância (Portugal)

During 2002, the extensive archaeological excavations of the ancient Constância necropolis (Centre of Portugal), dated from 14th–19th centuries, resulted in the exhumation of 151 individuals. Among the several paleopathological cases, a middle‐aged female skeleton with osteolytic lesions in her skull, axial skeleton, upper limbs and femurs was observed. These pathological findings are characterised by an asymmetric pattern with osteolytic focus of distinct size and irregular shape. Some skeletal elements display both osteolytic and osteoblastic lesions. The latter exhibit deposition of fine layers of woven bone. Lesions were observed macroscopically and radiology was used as a complementary method of scrutiny, especially in cases of unclear observation. The case was diagnosed as that of a probable metastatic carcinoma due to the multifocal distribution of the lesions in areas of intense haematopoietic activity, their morphology and some osteoblastic responses, as well as the presence of pathological fractures in the ribs. The skeleton's sex and age at death are in agreement with the proposed diagnostic, constituting the first case of malignant carcinoma detected in non‐identified Portuguese human skeletal remains. Copyright © 2009 John Wiley & Sons, Ltd.     

A Probable Case of Thalassemia Intermedia from Tell Masaikh,Syria

In this report, we describe the first potential case of hereditary anaemia from the Middle Euphrates valley (Syria). The skeletal changes identified in the studied specimen were consistent with marrow hyperplasia, and the distribution, especially the involvement of the facial bones, the sternum and ribs, was suggestive of thalassemia. The identified haplotype indicates M4b1 haplogroup suggesting that the analysed specimen was either a newcomer from Asia or a descendent of Asian origin in the maternal line, most likely from the Indian Peninsula where characteristic mutations of mtDNA can be identified today. The genetic data might explain a case of thalassemia in the Syrian lower Euphrates valley. Copyright © 2015 John Wiley & Sons, Ltd.     

Better a Broader Diagnosis Than a Misdiagnosis: The Study of a Neoplastic Condition in a Male Individual who Died in Early 20th Century (Coimbra,Portugal)

The paleopathological record of neoplastic conditions in the past is considered scarce. The detection of tumours in ancient populations is hindered by the quality and quantity of signs visible on the skeleton, the methodological approach, the preservation of remains, and by difficulties of differential diagnosis. The aims of this paper are to report the extensive and multiple osteolytic lesions observed in an adult male and to discuss the possible etiology of these lesions. The individual, a 71‐year‐old male who died in 1932, is part of the Coimbra Identified Skeletal Collection. Records indicate that he died of a ‘heart lesion’. The present study used macroscopic, radiological, and computerized tomography examinations to analyse the skeletal remains of the individual number 439. The type and pattern of the lesions detected, which were most prominent on the skull, were compared with both clinical and paleopathological diagnostic criteria for different nosologic groups. The differential diagnosis addresses problems expressed both in clinical and in paleopathological literature with regard to the difficulties in distinguishing metastatic tumours from multiple myeloma. The nature of the lesions represented by this individual precludes an exact diagnosis. Therefore, we employed a broader category, neoplastic condition, instead of choosing a more specific diagnosis that would likely have resulted in a misdiagnosis due to overlapping features on this individual's condition. Further investigations are necessary to establish more replicable indicators and to improve confidence in retrospective diagnosis of these types of conditions. Copyright © 2011 John Wiley & Sons, Ltd.     

Multicentric osteosarcoma associated with DISH,in a 19th century burial from England

Osteosarcoma is a rare type of malignant neoplasm that is most frequent in adolescents and young adults although it can develop at any age. It can metastasize from a primary site in bone to other bones and soft tissues. Usually the disorder causes a single bone‐forming lesion (unicentric) but some cases have multicentric, bone‐forming lesions. Some of these lesions develop at different sites at different times. In a second variant of multicentric osteosarcoma, synchronous bone‐forming lesions develop at multiple sites. Distinguishing between these two types of multicentric osteosarcoma is challenging in a clinical context and the criteria for doing so are unlikely to be met in an archaeological burial. Wolverhampton burial HB 39 was excavated from an early‐nineteenth century cemetery site in England. It consists of the incomplete skeleton of an adult male of at least 45 years of age with multicentric osteosarcoma. The individual represented by this burial also had diffuse idiopathic skeletal hyperostosis (DISH). Three of the bone‐forming lesions associated with osteosarcoma developed on the bony outgrowths related to DISH. Copyright © 2010 John Wiley & Sons, Ltd.     

Skeletal metastatic carcinoma: A case from 15th–20th century Coimbra,Portugal

This paper discusses the differential diagnosis of unusual and distinct pathological changes in the skeletal remains of a 40+‐year‐old female from 15th–20th century Coimbra (Portugal). The most affected area seems to have been the skull, but multiple lesions, lytic and/or blastic, have been found throughout the post‐cranial skeleton, more specifically in the scapulae, clavicles, humerus, sternum, ribs, sacrum, innominates and femurs. The differential diagnosis of the lesions gave rise to several possible pathological conditions, namely, Langerhans cell histiocytosis (granulomatosis or Histiocytosis X), multiple myeloma and metastatic carcinoma. Various macroscopic and radiological aspects lead us to consider metastatic carcinoma as the most probable diagnosis. Despite the argumentative identity of the possible primary lesion, age, sex and the mixed nature of the osseous response are consistent with cancer of the breast but do not exclude other carcinomas, namely lung cancer. With temporal and regional differences emerging in the frequency of malignant tumours, the identification of new cases becomes important, particularly from geographic areas where few cases have been reported. In fact, the present report adds to the only case of metastatic carcinoma detected in non‐identified Portuguese human skeletal remains until now. Copyright © 2009 John Wiley & Sons, Ltd.     

Severe vertebral collapse in a juvenile from the graveyard (13th/14th–19th centuries) of the São Miguel church (Castelo Branco,Portugal): differential palaeopathological diagnosis

Diseases that culminate into vertebral collapse are of intricate diagnosis both in palaeopathology and modern clinical practice. When analysing human skeletal remains from the archaeological record this difficulty is amplified due to the absence of complementary medical diagnostic information. This is especially evident when the distinction between tuberculous and pyogenic spondylitis is intended. Taking into consideration this challenging task and based on the macroscopic and radiological study of the skeleton number 8, a specimen exhumed from the East necropolis (13th/14th to 19th centuries) of the São Miguel church, at the Portuguese city of Castelo Branco, the aims of the work here presented are to discuss the range of possible aetiological factors, especially infectious ones, ascribable to the striking pathological changes noticed on this 12‐year‐old individual. These included alterations on the axial skeleton, namely extensive vertebral destruction, presenting as a gibbus deformity, and correlated thoracic deformities. Consubstantiated on palaeopathological and clinical research, tuberculous spondylitis seems to be the most probable cause for the reported lesions. However, the scrutiny between this condition and other pyogenic spinal infections is of extreme complexity when analysing ancient human remains and deserves in‐depth future investigations. Within the framework of the Portuguese archaeological record, the specimen here presented is of major relevance since the pattern and severity of the spinal osseous changes observed were not previously reported. Further, if tuberculous spondylitis is assumed as the most probable diagnosis, the case here presented represents one of the earliest skeletal evidence of this condition in Portugal. Copyright © 2009 John Wiley & Sons, Ltd.     

A possible case of coccidioidomycosis from the Los Muertos site,Tempe, Arizona

Coccidioidomycosis is a fungal disease endemic to southwestern North America and parts of Central and South America. Coccidioidomycosis frequently disseminates to the human skeleton and produces mostly lytic skeletal lesions. However, this disease is infrequently described within archaeological populations. As a result, it is important to report potential cases in order to improve current understanding of the appearance and distribution of lesions resulting from coccidioidomycosis in archaeological specimens. This study describes skeletal lesions in an adult male recovered from the Los Muertos site, Tempe, Arizona (AD 500–1450). These lesions are present on the inferior border of the left scapular spine, the medial portion of the left first metacarpal head, and the medial portion of the right first metatarsal. The lesions are predominantly lytic with sclerotic and, in some cases, healed cortical bone distributed around their margins. Evidence of skeletal healing is recorded within the destructive focus of one lesion. Geographical information on pathogen endemism, overall lesion distribution, and agricultural‐era Hohokom behaviour suggest that coccidioidomycosis is the most likely diagnostic option for these lesions. Mounting evidence for possible infections in the palaeopathological literature, combined with high frequencies of nutritional stress levels in endemic regions, suggests that coccidioidomycosis contributed at least moderately to morbidity in the American Southwest. Copyright © 2006 John Wiley & Sons, Ltd.     

Further aspects of fur trade life depicted in the skeleton

Osteobiographies were reconstructed from the skeletal remains of four adults from Fort Edmonton, a 19th century trading post of the Canadian fur trade. Three males were Caucasoid and probably ethnic Scots, given the usual origin of fur traders in this region. The lone adult female in the sample was Mongoloid, either Indian or Métis, and likely the ‘country wife’ of a fur trader, since she was buried in the European tradition in the fort cemetery. The cause of death is not discernible from any of the skeletal remains and none of these individuals exhibit any evidence of chronic infectious disease, malnutrition or neoplasia. Trauma, arthritis and other indicators of physical stress do appear, however, and present an opportunity to expand our understanding of the effects of fur trade life on the skeleton. Viewed in the context of historical accounts of life at the fort in the early 19th century, stress markers on the skeletons of three males have led to the conclusion that they were voyageurs who engaged in trading trips by canoe or boat. Lesions of the capsule attachment area at the proximal tibio‐fibular articulation appear unilaterally in two males and may be associated with ‘mushing’ or driving a dog sled in winter. The musculoskeletal lesions on the one preserved female skeleton are consistent with the arduous domestic activities documented at the fort, which include milking cows, churning butter, stirring lye soap, and harvesting grain and root vegetables by hand. Since specific occupations or behaviours cannot be precisely determined from muscular attachment and other stress markers, these interpretations are made cautiously and only in the culture‐historical context of the skeletal sample. Copyright © 1999 John Wiley & Sons, Ltd.     

Childhood scurvy in a medieval burial from Mačvanska Mitrovica,Serbia

The type and distribution of abnormalities in the skeleton of a child 2 years of age indicates that the child likely suffered from scurvy at the time of death. The burial is from the archaeological site of Zidine, Mačvanska Mitrovica, Serbia dated to the Medieval Period. Abnormal porosity and reactive woven bone formation are present affecting both the axial and appendicular skeleton. This case of scurvy is important because archaeological evidence of scurvy in this geographical location and at this time period is unknown. It is also important because the relative completeness of the skeleton and the widespread evidence of skeletal abnormalities provide additional insight regarding the skeletal manifestations of scurvy in young children. Copyright © 2009 John Wiley & Sons, Ltd.     

Skeletal and Surgical Evidence for Acute Osteomyelitis in Non‐Adult Individuals

Osteomyelitis is a non‐specific infection of the bone and bone marrow. In the past acute osteomyelitis (AO) led to high mortality especially in non‐adults. Nevertheless, its diagnosis in archaeological populations is rare. Documented individuals with known cause of death offer a unique opportunity to study this condition. This article aims to describe the bone lesions in non‐adults diagnosed with AO at the Coimbra University Hospital (CUH) and now belonging to the Coimbra Identified Skeletal Collection (CISC). Moreover, mortality rates and demographic profiles for individuals aged ≤18 years old and diagnosed with AO in the CUH, between 1923 and 1929, were also determined. The 5 (1%) non‐adults in the CISC with AO listed as cause of death were selected for this study, and their bones were analysed macroscopically and radiologically. The skeletal remains of one individual revealed a small area of new bone formation in the shaft of the left femur. Radiography of this bone showed a radio‐opaque area in the diaphysis. The other four individuals show evidence of surgical treatment, responsible for many cases of disability in the past. In the 7‐year period under analysis, 122 juveniles were diagnosed with osteomyelitis and admitted for surgery at the CUH, 43 (35.2%) of which were diagnosed with AO. Sixty‐five per cent of the cases of AO occurred between the ages of 8 and 15 years, with boys twice as frequently affected as girls, and lower limb bones were involved in 91% of AO cases. AO was responsible for 76.9% of the deaths. This study of pre‐antibiotic non‐adults may help to recognize skeletal signs of AO and their surgical treatment in unidentified skeletal remains. Copyright © 2012 John Wiley & Sons, Ltd.     

Terminal Pleistocene Later Stone Age Human Remains from the Mlambalasi Rock Shelter,Iringa Region,Southern Tanzania

This paper introduces research at the Mlambalasi rock shelter in the Iringa Region of southern Tanzania. The deposits are composed of a historic and Iron Age occupation, a microlithic Holocene Later Stone Age (LSA), and then a macrolithic Late Pleistocene LSA. Middle Stone Age deposits are also present on the slope in front of the rock shelter. Excavations in A.D. 2002, 2006, and 2010 yielded fragmentary human remains as well as pottery, iron, stone tools, faunal bone, and glass and ostrich eggshell beads. Among the human remains, four individuals are present: two adults and a juvenile were found in the same LSA context, and another adult associated with the Iron Age/historic period. The most complete skeleton is an adult of indeterminate sex that was found in situ in an LSA deposit. Charcoal in proximity to the bone was AMS radiocarbon dated to 12,925 cal BC (OxA‐24620), which is consistent with radiocarbon dates on giant land snail shells from above and below the remains. The skeleton exhibits a series of pathological changes such as extensive dental wear and carious lesions, as well as damage most likely caused by termites, post‐mortem. The most striking aspect of this individual is its small size; stature and body mass estimations place it in the range of historic Khoesan from southern Africa. Consequently, this research adds to the discourse regarding the existence of small‐bodied people in the East African LSA. Findings from this new skeletal sample will contribute to studies of human biology and variation in Africa during the terminal Pleistocene and Holocene. Copyright © 2013 John Wiley & Sons, Ltd.