Dry-bone manifestations of rickets in infancy and early childhood

Rickets and osteomalacia are the subadult and adult expressions of a disease in which the underlying problem is a failure to mineralize bone protein (osteoid). The most common cause of this disease is a physiological deficiency in vitamin D. The associated problems include deformed bones and this condition is well known in pre-modern medical texts and documents as a fairly common cause of morbidity. Given these facts, it is surprising that the literature on palaeopathology provides very little evidence of this disease in archaeological human skeletal samples. The medieval sample (N=687) of human remains from Wharram Percy, North Yorkshire, England contains a remarkable subsample of eight burials in which a spectrum of pathological features is expressed. The subsample includes infants ranging in age from 3 to 18 months at the time of death. Ten abnormal bone features were identified in the subsample, including: (i) cranial vault porosity; (ii) orbital roof porosity; (iii) deformation of the mandibular ramus; (iv) deformation of arm bones; (v) deformation of leg bones; (vi) flared costo-chondral ends of ribs; (vii) irregular and porous cortex of the costo-chondral ends of the ribs; (viii) abnormality of the growth plates of long bones; (ix) irregular and porous surfaces of the metaphyseal cortex; (x) thickening of the long bones, particularly in the metaphyseal areas. Not all of these features were found in all of the cases. Nevertheless, the overall pattern of skeletal abnormality fits well with the anatomical and radiological conditions associated with rickets. © 1998 John Wiley & Sons, Ltd.     

Thalassaemia: Its diagnosis and interpretation in past skeletal populations

The diagnosis of thalassaemia in archaeological populations has long been hindered by a lack of pathogonomic features, and the non‐specific nature of cribra orbitalia and porotic hyperostosis. In fact, clinical research has highlighted more specific diagnostic criteria for thalassaemia major and intermedia based on changes to the thorax (‘rib‐within‐a‐rib’ and costal osteomas). A recent re‐examination of 364 child skeletons from Romano‐British Poundbury Camp, Dorset revealed children with general ‘wasting’ of the bones and three children who demonstrated a variety of severe lesions (e.g. zygomatic bone and rib hypertrophy, porotic hyperostosis, rib lesions, osteopenia and pitted diaphyseal shafts) that are inconsistent with dietary deficiency alone, and more consistent with a diagnosis of genetic anaemia. Two of these children displayed rib lesions typical of those seen in modern cases of thalassaemia. The children of Poundbury Camp represent the first cases of genetic anaemia identified in a British archaeological population. As thalassaemia is a condition strongly linked to Mediterranean communities, the presence of this condition in a child from England, found within a mausoleum, suggests that they were born to wealthy immigrant parents living in this small Roman settlement in Dorset. This paper explores the diagnostic criteria for genetic anaemia in the archaeological literature and what its presence in ancient populations can contribute to our knowledge of past human migration. Copyright © 2010 John Wiley & Sons, Ltd.     

Ossified haematomas and infectious bone changes on the anterior tibia: histomorphological features as an aid for accurate diagnosis

Examination of the histological structure of bone not only helps investigators to estimate age at death but can also aid in the diagnosis of palaeopathological lesions. The purpose of this paper is to assess whether histological features as described in the literature can confirm the macroscopic diagnoses of ossified subperiosteal haematomas associated with healed scurvy and syphilitic bone changes observed on the anterior tibiae of individuals from a 19th century mining community from Kimberley South Africa. The frequent occurrence of these two diseases amongst the deceased was well established in related hospital documents and governmental documents. A section of bone was removed from lesions on the tibiae of 14 individuals. These bone changes were macroscopically diagnosed as being indicative of either treponematosis ossified subperiosteal haematomas or non‐specific periostitis. Cross‐sections were prepared for microscopic investigation using a manual ground section technique. Ossified haematomas were histologically identified in seven individuals. These sections were characterised by normal cortical bone an intact original periosteal surface and newly formed radiating trabecular bone apposing it. Three phases of ossified subperiosteal haematoma formation and remodelling could be distinguished. Infectious bone changes most likely associated with treponematosis were observed in one individual. These were characterised by lysis and numerous resorption holes/channels. No clear distinction could be made between the internal spongy cortical or newly formed bone. Histological features described by some authors as characteristic of this condition could not be identified. In addition three individuals presented with microscopic features indicative of both the aforementioned bone affections and three did not show any pathological changes on microscopic level. It was concluded that although specific pathological conditions can most likely not be diagnosed purely on the basis of histomorphological observations broad distinctions could be made between lesions caused by the ossification of subperiosteal haematomas and bone changes due to infectious diseases. Copyright © 2009 John Wiley & Sons Ltd.     

Porotic lesions in immature skeletons from Stara Torina,late medieval Serbia

Porotic lesions of immature skeletons have been attracting scientific attention for more than a century. These changes have been documented worldwide and are considered to be one of the indicators of health and/or nutritional status of past human populations. These lesions have frequently been referred to as a nutritional stress indicator, a manifestation of iron‐deficiency anaemia, and a condition caused by chronic infections. In this study, 327 immature skeletons from the medieval graveyard of Stara Torina (Serbia) were examined for macroscopic signs of four types of porotic lesions: cribra orbitalia, femoral cribra, humeral cribra, and porotic hyperostosis. Femoral cribra was observed in 83.25% of femora, humeral cribra in 58.46% of cases, cribra orbitalia in 46.12% of orbits, while porotic hyperostosis was recorded in only 2.94% of skulls. The majority of skeletons affected by cribra presented symmetrical lesions. Association between all types of cribra was recorded in 33.33% of skeletons. Historical data supported the hypothesis that the investigated population was exposed to frequent infections, especially parasitic ones, which led to the development of porotic bone lesions via several mechanisms: parasite‐induced blood loss and diarrhoea (both iron and magnesium malabsorption) or anaemia as a hepcidin‐mediated body adaptive response to infection. Copyright © 2008 John Wiley & Sons, Ltd.     

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.     

Skeletal Manifestations of Skin Ulcer in the Lower Leg

Skin ulcers of the lower leg are known to cause both destructive and, more commonly, bone‐forming lesions. Typically, bone‐forming lesions in this disorder have clearly defined margins although there may be extensive reactive bone formation involving much or all of the adjacent diaphysis. These lesions are best described in patients from tropical areas, and in these environmental contexts, these are known as tropical ulcers, but leg ulcers can be caused by a variety of diseases and conditions, of which vascular insufficiency plays an important role among the elderly. The lesions are important clinically because of the disability associated with the ulcer and because of complications that can develop including osteomyelitis and cancer. In most cases, the bone lesions caused by ulcer are easily diagnosed in archaeological human skeletal remains and provide some insight into the prevalence of this disorder in antiquity. In this paper, we review the gross and radiological manifestations of bone lesions resulting from overlying skin ulcer in tibiae of 13 cases including archaeological and modern medically documented skeletons. In two of the cases, there is medical documentation regarding the presence of a chronic ulcer on the lower leg. The objectives of this paper were to explore the diversity of bone lesions associated with ulcers of the tibia and to provide an improved basis for the diagnosis of this disorder in human skeletal remains. 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.     

Injuries to the skeleton due to prolonged activity in hand-to-hand combat

Two complete skeletons from the Hamman-Todd collection of the Cleveland Museum of Natural History (CMNH) show a suite of pathological lesions that suggest the individuals had been involved in boxing or other hand-to-hand combat. These lesions were studied and compared with medical and autopsy records. The aims of the research were to estimate the accumulated damage to the bones over time, to characterize the different types of the damage, and to establish criteria for hand-to-hand combat or violence for archaeological material. Our inspections showed that besides the muscle markings developed and the numerous healed fractures that are expected when someone is involved in such activities, other types of lesion are present that are helpful for a proper differential diagnosis. These are: degenerative changes at the lesser tuberosity of the humerus; focal necrotic changes/bone growth on the trochlea of the humerus; necrotic changes on the distal head of the ulna; bony patches on upper limb bones only; secondary centres of ossification failing to fuse (mainly in vertebrae and acromion); a huge conoid tubercle on the clavicle; bony spurs on the distal articular head of the metacarpals; necrotic changes on the femoral head next to the fovea and on the roof of the acetabulum; and a developed bony ridge for the attachment of the iliotrochanteric ligament. Finally, we propose a set of criteria that will help to identify people in archaeological material who were involved in hand-to-hand combat.     

The Ba/Sr ratio,carious lesions,and dental calculus among the population buried in the church La Concepción (Tenerife,Canary Islands)

Certain trace elements may accumulate in bone in relation to dietary habits, so some of them are of interest in paleodietary analysis. This is the case with strontium (Sr) and barium (Ba), whose potential value as paleodietary indicators is enhanced by their relatively inert metabolic behaviour. The presence of carious lesions may indicate consumption of sugar and vegetables, whereas the etiology of dental calculus deposition is multifactorial, although some authors consider this as an indicator of protein consumption. Based on these facts we analysed (1) Ba, Sr, and calcium (Ca) content of inner cortical bone obtained from the ramus mandibularis, by atomic absorption spectrophotometry, (2) presence of teeth with carious lesions, and (3) presence of teeth with calculus deposition in 62 mandibles. All samples were obtained from the church La Concepción, an 18th century burial place in Tenerife. Gender was assessed by analysing genetic expression of amelogenin in some cases (14), and by inspection of pelvic bones when available (41 cases). We found (1) Carious lesions in 32 cases, and dental calculus, in 39; no association was observed between sex and presence of dental caries or calculus deposition, nor between the sex and the proportion of carious teeth nor the proportion of teeth with calculus deposition; (2) people buried near the altar (priests and individuals of the highest social class) showed a significantly higher proportion of teeth with dental calculus deposition (χ² = 5.36, p = 0.021); (3) bone Sr and bone Ba were significantly higher than the values observed in a control group of 10 modern omnivorous individuals; the lowest Sr values were observed among people buried near the altar; and (4) the Ba/Sr ratio was directly related with the proportion of teeth with carious lesions. These data suggest that there were differences in dietary pattern among the individuals belonging to different social classes; overall, consumption of vegetables was widespread, as shown by the high proportion of carious lesions, in relation with raised Ba/Sr ratio, whereas consumption of marine products was scarce.     

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.     

Study of stafne's defects in Late Neolithic,Late Roman,Medieval and Modern skeletal samples from Portugal

Lingual mandibular cortical defects (Stafne's defects) are relatively uncommon in recent as well as past populations, but while this condition is often discussed in clinical reports, they are rarely the subject of anthropological research. In this paper, the prevalence of Stafne's bone defects in skeletal samples from Late Neolithic, Late Roman, Medieval and Modern Portugal is investigated (N = 704 complete mandibles and 111 incomplete mandibles). The aims of this paper are threefold: (1) to present and analyse for the first time in Portuguese osteological record prevalence data on Stafne's bone defect, (2) to analyse variations in defect prevalence between skeletal samples from a wide temporal array and (3) to verify if more tenuous lesions in which resorption of the lingual cortex was not yet extensive had the classic radiographic appearance described by Stafne in order to validate the hypothesis that lesions are present clinically in many more cases than published figures indicate. In all cases, differential diagnosis against other conditions that mimic Stafne's defects, namely odontogenic lesions, cysts and neoplasms, was done. In all samples, the evidence of Stafne's defect occurred in 12 individuals (1.7%), and males (2.84%) were more frequently affected than females (0.61%). When incomplete mandibles were considered, only one left fragment (0.90%) exhibited Stafne's defect. Accurate identification of all examples of Stafne's bone defects in antiquity is thought to represent an important contribution to elucidate which factors may be responsible for this trait's cultural, ecological, temporal and geographical patterning. Copyright © 2010 John Wiley & Sons, Ltd.     

Preservation and Rescue: Challenges and Controversies in the Protection of Archaeological Resources

Abstract

Data from 44 pit-structures excavated as a part of the Dolores Archaeological Program are used to test two hypotheses about the relationship between the ritual use of a structure and the manner in which that structure was abandoned. The pit structures all date to 860–900 A.C. and are associated with large Pueblo villages located along the Dolores River in what is now SW Colorado. Three basic levels of ritual use have been defined for these structures based on the number and type of features associated with the structures. Those structures with evidence of the most important ritual usage are significantly associated with a mode of abandonment in which the structure was purposefully burned down. Those having ritual features that appear to be of secondary importance are significantly associated with an abandonment mode in which the roof of the pit-structure was intentionally collapsed to bury human individuals on the structure's floor. It is more difficult to characterize the abandonment mode of structures which represent the simplest level of ritual use, though it is most common to have a simple abandonment in which the roof simply deteriorated and collapsed with time. The recognition of a probable hierarchy of ritual usage in early Pueblo pit-structures and the association of special abandonment modes with each type of ritual pit-structure specifically allow a better glimpse of ritual activities in early Pueblo societies. In a more general sense these data show that it is possible to archaeologically detect patterned associations between a structure's use and its mode of abandonment.     

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.     

Cribra orbitalia and cribra cranii in Roman skeletal remains from the Ravenna area and Rimini (I–IV century AD)

Cribra orbitalia and cribra cranii are considered good indicators of the health and nutritional status of ancient populations, as their presence is often associated with chronic acquired anaemia. The distribution of these lesions in two Roman samples from the Ravenna area and Rimini was considered as a measure of health in relation to their respective environments. Enamel hypoplasia was also assessed as it is symptomatic of childhood physiological stresses such as malnutrition, infectious diseases, physiological traumas, and the like. The differential analysis suggests that the lesions observed are due to chronic acquired anaemia, probably caused by a poor diet, worm infestation, infections and parasitic diseases. Copyright © 2004 John Wiley & Sons, Ltd.     

Rickets in a High Social Class of Renaissance Italy: The Medici Children

Exploration of the Medici Chapels in the Basilica of San Lorenzo in Florence revealed the burials of nine juvenile members of the Medici family (16th–17th centuries). The estimated children's skeletal ages ranged from newborns to 5‐year‐olds, showing a series of bone abnormalities, in particular diffuse periosteal new bone and bowing of long bones. The comparable pathological lesions, including porosity evident on the skull, orbital roofs, costocondral ribs and growth plates between metaphyses and epiphyses, enlargement of metaphyses and sternal rib ends, and long bone bending, are interpreted as the skeletal manifestation of rickets. The diagnosis of a metabolic disease linked to vitamin D deficiency would appear to be unexpected for children brought up at the court of a Renaissance elite class family like the Medici of Florence. Analysis of the historical and social background is particularly helpful to understand the causes of the onset of the disease in this aristocratic group. Documentary sources, supported by ¹³C and ¹⁵N bone collagen analysis, attest that weaning of these children took place when they were around 2 years old. With a prolonged breast‐feeding and a delay in introducing solid food in the diet, vitamin D deficiency is expected to rise considerably, in particular if the other main risk factor, namely inadequate sunlight exposition, is associated with this human milk‐based diet. Copyright © 2013 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.     

A case of concha bullosa mucopyocele in a medieval human skull

The term ‘concha bullosa’ refers to the pneumatisation of the intranasal turbinates. The pneumatisation can occur at any level (superior, middle, inferior), but the term is typically used to describe the aeration of the middle turbinate. This case report concerns a medieval skull from Tomb Chamber Number One in St. Nicholas's Church in Głogów, Poland. The burial dates from the 13th or 14th century. Direct measurements of the skull according to Martin's technique and computed tomography (CT) were made. The skull is from a male whose age was estimated as 40–55 years. In the nasal cavity, a large bony formation with the appearances of a tumor, a lesion of the maxillary sinus wall, and a significant curvature of the nasal septum were found. The CT scan demonstrated changes that could be described as a type IV concha bullosa, according to Krzeski's classification. This anatomical variation was first described by Zuckerkandl in 1893. The symptoms that were often associated with concha bullosa include nasal obstruction or congestion, facial pain, and headache. Concha bullosa can result in recurrent sinusitis, mucocele, or mucopyocele. In the case of the Głogów skull, an extensive lesion and inflammatory changes in the maxillary sinus and destruction of the orbital floor suggests the presence of a mucopyocele that arose from a concha bullosa. Copyright © 2009 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.     

Endocranial lesions in non‐adult skeletons: understanding their aetiology

Reactive new bone on the endocranial surface of the skull in non‐adults has recently received a lot of attention in the palaeopathological literature. These features appear as layers of new bone on the original cortical surface, expanding around meningeal vessels, as isolated plaques, ‘hair‐on‐end’ extensions of the diploë or, as ‘capillary’ impressions extending into the inner lamina of the cranium. These lesions are commonly found on the occipital bone, outlining the cruciate eminence, but have also been recorded on the parietal and frontal bones, and appear to follow the areas of venous drainage. Although recognized as resulting from haemorrhage or inflammation, their precise aetiology is still a matter of controversy. This paper outlines their possible causes and examines their nature and distribution in a group of non‐adults from four archaeological sites in England. It is recommended that, when recording these lesions in the future, additional skeletal pathologies, the age of the child, and nature and distribution of the lesions also be taken into account. Copyright © 2004 John Wiley & Sons, Ltd.