Adult scurvy in skeletal remains of late 19th century mineworkers in Kimberley,South Africa

Throughout history, scurvy has been a well‐known disease which develops due to restricted resources of fresh fruit and vegetables. The condition results from an extended limited intake of vitamin C. Although skeletal lesions associated with infantile scurvy have been well described by many authors, very little literature is available on adult scurvy and the resulting skeletal lesions. The purpose of this study was to investigate the skeletal remains of a 19th century mining population from Kimberley, South Africa, for any skeletal lesions that may be indicative of adult scurvy. Scurvy was well documented as being extremely prevalent in this population. The skeletal remains of 107 individuals, presumed to have died around 1898, were studied. The majority of these individuals were males between 19 and 45 years of age. It is likely that most individuals were migrant workers at the diamond mines. All bones were visually assessed for macroscopic indications of pathological bone alterations associated with healed scurvy. Bone samples were also taken from ambiguous lesions in order to perform histological investigations. Lesions indicative of possible healed adult scurvy were observed in 16 individuals. These lesions included bilateral ossified haematomas, osteoperiostitic bone changes and periodontal disease. Histological investigation confirmed the presence of ossified haematomas on the anterior tibiae of some individuals. Hospital records and historical documents describing the incidence of scurvy in the local hospitals and the daily diet of the black mine workers supported these findings. Copyright © 2009 John Wiley & Sons, Ltd.     

Pathological Evidence in Newborn Children from the Sixteenth Century in Huelva (Spain)

Archaeological infant remains rarely appear in the palaeopathological literature; above all there are few references to neonatal individuals. This work presents four infant pathological specimens from the crypt of the Ermita de la Soledad (sixteenth to nineteenth century, Huelva, Spain). The bones analysed—one right hemifrontal, two humeri and a femur—belong to at least two individuals of between 0 and 6 months of age. The differential diagnosis of the lesions—mainly detachments of the outer layer of cortical bone, areas of juxtametaphysial osteolysis and epiphysial destructuralization—supports the hypothesis of an infectious aetiology, such as congenital treponematosis and haematogenous osteomyelitis, although illness caused by a deficiency, such as scurvy or rickets, cannot be ruled out.     

Scurvy in adults and youngsters: the Dutch experience. A review of the history and pathology of a disregarded disease

Prior to the Dutch maritime expansion of the 17th and 18th centuries, scurvy was known in the Low Countries as an endemic disease. From the end of the 16th century the disease started to draw much more attention due to increasing long sea journeys of sailors. Already in the Dutch medical literature of the 16th century, a strong relation was expressed between the prolonged taking of foodstuffs of poor quality and the risk of contracting scurvy. Although from that time, many Dutch physicians recommended oranges, scurvy grass and brook‐lime, it took 200 years before inadequate therapy on the fleet was replaced by systematic prevention. Why did the old time effective recommendations for the therapy of scurvy stay inadequate for mariners? To understand, maritime and medical history were unfolded and evaluated with respect to palaeopathological findings reported for 39 cases of active scurvy and one case of healed scurvy. The palaeopathology of scurvy in adults and still growing youngsters was investigated from the remains of 50 Dutch whalers who had been buried during the 17th and 18th centuries on an island of the Spitsbergen Archipelago. Conforming the clinical literature, the original haematomas from scurvy were found as a black staining at the tips of dental roots. In the weight‐bearing bones of the lower extremities large black stains were positioned bilaterally around endofractures of the metaphyses, bilaterally on joint surfaces and bilaterally at epiphyseal discs of youngsters. In the non‐weight‐bearing bones they were often found unilaterally, such as at insertions of muscles. Immunoenzymatic staining of microscopic sections proved that the black stains were from remnants of denatured haemoglobin. No microscopic bone repair activities had happened. In a case of healed scurvy it could even be demonstrated how many times the recovery process had taken place from the layers of appositional bone which had replaced the original subperiosteal haematomas. Copyright © 2004 John Wiley & Sons, Ltd.     

A case study of possible differential diagnoses of a medieval skeleton from Denmark: leprosy,ergotism, treponematosis,sarcoidosis or smallpox?

This paper uses macroscopic and radiological examinations to provide differential diagnoses of pathological lesions in the skeleton of a young woman, 20–25 years of age, which triggered the Danish palaeopathologist Vilhelm Møller‐Christensen's interest in leprosy. The skeleton was incomplete, but the majority of bones of the upper body, as well as the skull, were present. The pathological changes consisted of medullary and cortical lytic foci, periosteal reaction and enhanced cortical density. The lesions were most extensive on the left side, especially around the elbow, wrist and scapula. Treponematosis, leprosy, smallpox, ergotism, rheumatoid arthritis, tuberculosis and sarcoidosis are all reviewed with regard to bone and joint pathology and their likelihood of being the correct diagnosis. We concluded that the most plausible diagnosis is treponematosis, but neither sarcoidosis nor smallpox can be completely excluded. Copyright © 2007 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 case of treponematosis from pre‐Columbian Chaco Canyon,New Mexico

Although numerous cases of treponemal infection have been identified in prehispanic New World skeletal remains, none has been reported from Chaco Canyon, New Mexico. Chaco Canyon was the epicentre of a broad culture system that spanned the Four Corners region of the pre‐Columbian Southwestern United States. A burial recovered from the central Great House of Chaco Canyon, Pueblo Bonito, exhibits lesions indicative of treponematosis. However, the pathological condition of this individual has heretofore been only tentatively diagnosed because the skeleton was collected from a commingled context and distributed across four separate catalogue numbers. Now reassociated, these remains exhibit a pattern of pathological changes strongly indicative of treponemal disease. This case not only adds to the growing body of literature on the clinical expression and geographic distribution of pre‐Columbian treponematosis, but also demonstrates the utility of painstaking reassociation of commingled human remains. 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.     

Metastatic carcinoma in a leper skeleton from a Medieval cemetery in Chichester England

Both leprosy and metastatic cancer are well documented in the literature on human skeletal palaeopathology. The manifestation of both pathological conditions in a single archaeological skeleton has not been reported. A case from a Medieval site in Chichester, England exhibits bone lesions and patterns of skeletal involvement indicative of both these diseases. Evidence of leprosy is largely restricted to the lower tibiae, fibulae and the bones of the feet. Fine destructive foci and reactive fibre bone associated with metastatic cancer are distributed in many of the remaining areas of the skeleton. There is minimal overlap in the areas of the skeleton involved in the two pathological processes.     

Periostitis and osteolysis in a medieval skeleton from South‐West Hungary: (Leprosy,treponematosis, tuberculosis or hypertrophic osteoarthropathy) A diagnostic challenge!

This paper uses macroscopic and radiological examinations to provide differential diagnoses of pathological lesions in the well‐preserved skeleton of a young male from the medieval site of Zalavár in South‐West Hungary. Macroscopic inspection of the skeleton revealed conspicuous thickening of the tibiae and fibulae with ‘tree bark’ appearance of the cortex. Periosteal proliferations are also found on the calcanea and on the posterior part of the femora. The metatarsals showed bony proliferation and bone dissolution. No alteration of the axial skeleton or the skull was noted. Radiographs showed thickening of the cortex of tubular bones due to a multilayered type of periosteal apposition. The likelihood of these symptoms being the result of melorheostosis, hypervitaminosis A, fluorosis, thyroid acropachy, endosteal hyperostosis, tuberculosis (TB), hypertrophic osteoarthropathy (HOA), treponematosis and leprosy is reviewed. None completely explains the entire spectrum of pathological lesions in the current individual, but the individual may have suffered from two co‐existent diseases. As a clinical entity, the changes in the metatarsals are compatible with leprosy, whereas the periosteal proliferations of the lower limbs point to a diagnosis of HOA as a secondary syndrome. Thus, a combination of leprosy and TB is suggested as a potential diagnosis. Although not definitive, our differential diagnosis was able to exclude a number of conditions producing periosteal apposition. Copyright © 2011 John Wiley & Sons, Ltd.     

Pre-Columbian congenital syphilis from the late antiquity in France

Today, exactly 500 years after the discovery of America, there is still a lot of controversy about the history of syphilis in Europe, especially about the Columbian and pre-Columbian hypotheses. This paper presents evidence for the presence of venereal treponematosis in the late Antiquity in France. The case that we examined comes from the necropolis of Costebelle (3rd-5th centuries AD; Hyères, Var, France). Grave no. 1 contained the well-preserved skeleton of a relatively old woman with the skeletal remains of an approximately 7-month-old fetus in her pelvic cavity. The osseous lesions of the fetal remains can be described in four groups: periosteal appositions on the skull vault (frontal and parietal); signs of periostitis on the long bones (bilateral cortical irregularities, predominantly on the left side, which affect first of all tibiae, femora, fibulae, radii and humeri, particularly in the metaphyseal region); some infraperiosteal detachment reminiscent of an infraperiosteal haematoma surrounding the distal extremity of the left forearm and the left hand; and finally, the irregular lesions of the humeral distal and proximal tibial metaphyses reminded us radiologically of Wimberger's signs. The most probable diagnosis of all the lesions mentioned above is that of a precocious congenital syphilis. This case consists of an argument against the epidemiological theories about the migration of Treponema pallidum from the New World back to the Old World starting at the end of the 15th century.     

Compensatory bone remodelling in moose: a study of age,sex, and cross‐sectional cortical bone dimensions in moose at Isle Royale National Park

We studied interrelationships among age, sex, and cross‐sectional cortical bone dimensions using quantitative computed tomography (QCT) scans of metatarsal bones of 180 moose (Alces alces) that died in Isle Royale National Park, Michigan. As a large‐bodied quadruped with demanding ecological constraints on movement and behaviour, a moose experiences different weight‐bearing and mechanical stressors than humans, to whom most existing studies of mechanical adaptations of bone pertain. In moose, both sexes showed significant subperiosteal expansion and an increase in medullary area, with an overall increase in cortical bone area over time. Female moose did not exhibit cortical thinning or reduction in cross‐sectional area with age, rather they showed an increase in cortical bone area with periosteal apposition exceeding endosteal resorption, similar to the males. We also found that moose undergo changes in bone geometry through remodelling of bone similar to humans, suggesting a compensatory mechanism for increasing bone strength under conditions of decline in bone mineral density with age. Copyright © 2002 John Wiley & Sons, Ltd.     

Scurvy‐related Morbidity and Death among Christopher Columbus' Crew at La Isabela,the First European Town in the New World (1494–1498): An Assessment of the Skeletal and Historical Information

This article explores the living conditions and specifically the possible etiologies of subperiosteal reactions among those seafarers who did not survive Christopher Columbus' second voyage to the Americas and died at La Isabela, the first permanent European settlement in the New World, which is located in the present‐day Dominican Republic. The town was founded in 1494 by Christopher Columbus (1451–1506) and occupied for only 4 years. This study analyses the macroscopic and histological evidence of the skeletal series excavated from this contact cemetery, which is presently curated at the Museo del Hombre Dominicano. Twenty of the 27 systematically scored individuals reveal subperiosteal bone accretions, and in at least 15 individuals, these accretions appear bilaterally. The morphology, distribution and healing stages of the majority of these lesions provide new, direct evidence suggesting severe adult scurvy, a condition caused by sustained vitamin C deprivation, which was common among seafarers before the 18th century. The historical context surrounding the individuals' death at the European contact settlement and the conditions and duration of Christopher Columbus' second transatlantic voyage to the New World represent key elements in the interpretation of these lesions. In this case, the evidence also corroborates the known failure of Columbus' crew to exploit the locally available foods rich in vitamin C. Scurvy probably contributed significantly to the outbreak of sickness and collective death within the first months of La Isabela's settlement, an aspect that inflects the current discussion about the degree of virulence of New World infections that decimated the European newcomers, who we conclude to have been already debilitated and exhausted by scurvy and general malnutrition. Copyright © 2014 John Wiley & Sons, Ltd.     

Multiple Cases with Probable Treponemal Infection from 16th to 19th Centuries Romania

In this paper, we describe pathological lesions identified in seven skeletons discovered in the Saint Sava necropolis in Bucharest, Romania, dating to the Late Medieval/Early Modern period. The pathological changes observed in the skeletons were analysed using macroscopic examination. Additionally, computed tomography scanning was performed on two individuals displaying advanced lesions on the cranial surface. For the differential diagnosis, we took into consideration treponemal infection, tuberculosis, osteomyelitis, leprosy, fluorosis, melorheostosis, hypertrophic pulmonary osteoarthropathy, Paget's disease and mycotic infection, along with the possibility of multiple afflictions occurring simultaneously. The morphology and distribution of the lesions are suggestive of treponematosis, which, to our knowledge, makes this the first case of this disease on the Romanian territory in archaeological populations. Copyright © 2015 John Wiley & Sons, Ltd.     

Pre-Columbian treponematosis in medieval Britain

There has been much debate regarding the origins of treponemal disease and, in particular, acquired syphilis. Greater numbers of skeletons with apparently diagnostic bone lesions in the New World than in the Old have given rise to the postulate, particularly advanced by American workers, that the disease originated there prior to AD 1492 and was carried back to the Old World by Columbus's sailors. This paper presents evidence for the presence of treponemal disease in medieval Norwich prior to AD 1492, however. The dating of the site is good and the skeleton concerned comes from a well-sealed context. Others in the group have similar lesions and there are four individuals with evidence of leprosy. All were buried in a communal cemetery. The individual has widespread, bilateral, florid periostitis, especially of the tibiae and fibulae, and the radiographic changes support the diagnosis of treponemal disease. Differential diagnosis and geographical situation suggest that this skeleton displays evidence of syphillis.     

Possible cases of leprosy and tuberculosis in medieval Sigtuna,Sweden

In Sigtuna, Sweden, a medieval cemetery, including 227 skeletons, was analysed in 2006. On the outskirts of the churchyard, six skeletons with bone changes indicating systemic inflammatory disease were observed. Two out of three individuals with well‐preserved facial bone regions displayed signs of rhinomaxillary remodelling. Four of the afflicted exhibit severe bilateral alterations of the lower legs and phalanges of the feet and concentric atrophy of the metatarsals. In addition, one of the individuals exhibited a kyphosis in the lumbar vertebrae. In a discussion about alternative diagnoses, lepromatous leprosy and tuberculosis were identified as the causes of the destructive lesions in two individuals. Though the skeletal changes of the lower legs and feet in four cases demonstrate a close resemblance to secondary lesions of leprosy, the disease could not be confirmed. The skeletal changes of the last individual were unspecific and the possible causes several, rendering diagnosis difficult. The burial locations imply that the afflicted persons belonged to a lower social stratum. Due to the significantly higher frequency of pathological changes in the cemetery compared to other cemeteries in the town, the individuals could be regarded as fellow sufferers among others with various medical conditions. The bioarchaeological identification of systemic infectious diseases of a group of individuals of this size is unique to north of Scania in Sweden, where only a few cases of leprosy and tuberculosis have previously been diagnosed. The significance of the present study is emphasised by the interconnection between the afflicted, the archaeological context and the knowledge of the medieval society in Sigtuna. Copyright © 2010 John Wiley & Sons, Ltd.     

Manual for the Preparation and Staining of Embedded Natural Dry Bone Tissue Sections for Microscopy

In the last decade, the use of light microscopy has been firmly established for the investigation of exhumated human bone tissue. As a rule, these remains cannot be decalcified; thus, they are most commonly prepared for microscopic analysis as ground thin sections. These ground sections are of great value in diagnosing disease, in estimating age or in assessing taphonomic alteration. As bone is sometimes fragile and can be damaged by the grinding process, the specimen is occasionally supported by an embedding medium. In contrast to the vast amount of research conducted on embedded and unembedded unstained bone material, the use of histological stains on undecalcified dry bone tissue has been long neglected. In this article, a new method for embedding, sawing and grinding dry bone tissue is presented. The produced sections are subsequently stained with haematoxylin. The results show that even ground sections of fragile bone can be made in a quick and easy manner. Staining these sections enhances the envisioning of micro‐architecture and taphonomical processes. In addition, the sections stay open for inspection under polarized light. The results were consistent throughout the used bone material. To keep the method as accessible and comprehensive as possible, a step‐wise manual is provided. An additional troubleshooting paragraph discusses the most often encountered problems and provides solutions. Copyright © 2011 John Wiley & Sons, Ltd.     

Septic bone changes in leprosy: A clinical,radiological and palaeopathological review

Infective lesions of bone in leprosy are of two types. In the rhinomaxillary syndrome, superficial infective changes in the bones of the maxilla are due to the presence of Mycobacterium leprae. Lytic foci in the medulla or the outer cortical surface may be due to Mycobacterium leprae at the site as granulomatous lesions. The most frequent infective bone changes in leprosy are, however, sequelae of regional anaesthesia and soft tissue ulceration. The bone lesions are due to pyogenic bacteria and the nature of these infective lesions is similar to that in non-leprous conditions. The pyogenic lesions in leprosy are restricted to the bones of the hands, feet and lower legs.     

Assessing Post‐traumatic Time Interval in Human Dry Bone

The post‐traumatic status of antemortem fractures in human dry bone remains is currently defined as being either ‘healing’ or ‘healed’. However, detailed ‘dating’ of the related post‐traumatic time interval would be desirable, since it would aid in assessing individual medical status and care at the time of death. Within forensic pathology practice, fresh tissue healing phases are routinely used as an intrinsic parameter for the length of the post‐traumatic time interval. Unfortunately, the direct application of such a method is hampered when applied to dry bone skeletal material. This study explores the possibility of applying a fracture dating system, drawn forth from the traditional forensic pathology method, on dry bone remains. More specifically, the aim is to establish the extent to which various histomorphological features indicative of specific time intervals of healing are consistently detectable. Human dry bones with fractures and amputations in various phases of healing were studied. Results show that the complementary use of radiological and histological investigation techniques improves the differentiation between various healing phases and thus allow for a more detailed dating of lesions. For future use, healing features that have proven to be consistently detectable and their related post traumatic time intervals are listed. The system aids in demarcating a considerably more ‘narrow’ post‐traumatic time interval than usual. Copyright © 2012 John Wiley & Sons, Ltd.     

Genetic sexing to determine the optimal discriminant functions for the analysis of archaeological remains from El Hierro (Canary Islands)

A correct sex assignment of a given bone or bone fragment is of paramount importance for the archaeologist, anthropologist and in forensic medicine. Discriminant functions, combining several anthropometric measurements obtained from individuals with known sex are useful tools for this purpose, but it is essential to know exactly the sex from which the measures are obtained. This is an easy task in modern populations, but it is problematic in ancient ones, since even when the entire skeleton is available, diagnosis of sex is not 100% accurate. Sexing by genetic methods by amplifying the first intron of the amelogenin gene constitutes a much more accurate method for sexing bones and may be the gold standard for further elaboration of discriminant functions which may serve for sexing new bones dug up in future excavations. With this aim we have genetically sexed 52 (out of 59) tibiae belonging to the prehispanic population of El Hierro, in the Canary Islands, identifying 18 women and 34 men, and then, performed discriminant functions combining several anthropometric variables. These functions show a high accuracy in sex diagnosis (94.2%; area under ROC curve = 0.954 with the best of the functions), so that they allow correct sexing of tibiae or tibiae fragments (only proximal third, distal third or midshaft). Thus, genetic sexing obviates the problem of finding an accurate gold standard for the elaboration of discriminant functions for ancient bones. This method could be applied to other populations of different antiquity and different ethnicity.     

Analysis of Neolithic human remains discovered in southern Italy

The authors describe the discovery of the remains of two unidentified skeletonised individuals in a small town located in southern Italy. The bodies were discovered while workers were preparing to lay an oil pipeline. The two individuals were found at a depth of 2 meters, and in very close proximity to one other. The recovery process of the skeletonised remains and their related findings, carried out by a team of forensic anthropologists and archaeologists, is described here.Archaeological examination determined that the remains date back to the 4th millennium B.C. Forensic anthropological and odontological examinations were performed to determine the biological profile of the skeletal remains by estimation of age and height, as well as the determination of sex. Age determination was performed by the Kerley and Ubelaker (1978, Revision in the microscopic method of estimating age at death in human cortical bone. Am. J. Phys. Anthropol., 49, 545–546) histological method using a 1 mm thick piece of bone tissue taken from the diaphyses of femur in both individuals. Dental age was estimated by examining root transparency. In order to determine the height of the individuals, various research methods based on the dimensional values of particular skeletal structures were applied. DNA analysis showed genotype differences of all the systems as compared to the haplotypes of present day subjects. This provided confirmation that the skeletal remains were from individuals of an ancient population (4th millennium B.C.). In addition, radiocarbon dating provided useful information as to the approximate period of death of the individuals. Interpretation was further enhanced by analysis of various bone fragments from each of the skeletons by high resolution mass spectrometry. 3D computerized imaging was used to analyse the patterns of skull fractures present, which resulted in supporting the hypothesis that the fractures were caused by stoning.