High performance liquid chromatography (HPLC) in the investigation of gout in palaeopathology

Gout is a disease caused by the abnormal accumulation of uric acid in the body, which can result in sodium urate crystals forming tophi at joints, with associated erosion of bone and cartilage. Only two examples of tophi have been reported from archaeological individuals, and the diagnosis of gout based on dry bone manifestations can be difficult. This paper presents preliminary results of a new technique to aid the diagnosis of gout in palaeopathology, namely high performance liquid chromatography (HPLC). Five archaeological skeletons with suspected gout (diagnosed using visual and radiological analysis) and three controls were analysed. Two of the gouty individuals had a white powder in their erosive lesions. HPLC showed the presence of uric acid in bone in four of the five individuals with evidence of gouty arthritis and was negative for uric acid in bone from the three controls. The white powder was also positive for uric acid. With reliance on the presence of articular erosions, cases of gout will be missed in archaeological human bone. HPLC measurement of uric acid could prove useful in the differential diagnosis of erosive arthropathy in archaeology. It may also be useful in identifying individuals with an increased body pool of uric acid, linked to conditions included in the term ‘metabolic syndrome’. As a result, HPLC uric acid measurement also has the potential to provide additional information on health and lifestyle in past communities. Copyright © 2008 John Wiley & Sons, Ltd.     

Identification of urate crystals in gouty individuals

In paleopathology cases of gout have traditionally been identified using the character of erosive bony lesions, but in clinical medicine identification of monosodium urate crystals in joint fluid plays a central role in diagnosis. Work undertaken on three skeletal individuals who had been buried, demonstrates that crystals can be identified using polarising microscopy. The crystals were identified as monosodium urate. Results from this study appear to demonstrate that identification of monosodium urate crystals could be used to assist in the diagnosis of gout in paleopathology. Further work is required to establish the full range of spatial and temporal contexts from which such crystals might be found.     

Using microscopy to improve a diagnosis: an isolated case of tuberculosis‐induced hypertrophic osteopathy in archaeological dog remains

The use of histology to estimate age, understand taphonomic history and diagnose disease in human skeletal and mummified remains is a well‐known method. Even though non‐human animals experience stress and disease similar to humans, microscopy is rarely applied to faunal remains to obtain a diagnosis. Histological results from a 16^th‐century Iroquoian dog which had previously been diagnosed by macroscopic and molecular methods with tuberculosis‐induced hypertrophic osteopathy (HPO) are presented here. Comparisons indicate that canid microscopic skeletal manifestations of HPO are reminiscent of human alterations caused by this condition. In addition, the microscopy reveals an aggressive form of HPO that was chronic in nature which could not be identified by either macroscopic or molecular methods. By providing an extension to the original diagnosis, the impact of a chronic case of tuberculosis is discussed. This study helps to emphasise the utility of palaeohistopathology in both biological anthropology and zooarchaeology, as it allows for a deeper discussion of the manifestation of HPO and the impact of tuberculosis on both dogs and humans. Copyright © 2008 John Wiley & Sons, Ltd.     

An Unusual Erosive Arthropathy from Medieval England

In palaeopathology, diagnosis of skeletal disease is classically made with reference to changes wrought by known diseases in modern or recent cases. This report presents a skeleton from medieval England which shows a form of erosive arthropathy. A more precise diagnosis is problematic because the alterations appear inconsistent with any of the principle forms of erosive arthropathy in current clinical classification. The distribution of lesions in the axial and appendicular skeleton resembles that in seronegative spondyloarthropathies. The nature of the lesions however, which are almost entirely lytic and concentrated principally at synovial articulations rather than entheses, is inconsistent with seronegative spondyloarthropathies and is more consistent with pathophysiology of rheumatoid arthritis. These observations raise the possibility that the manifestations of erosive arthropathies may have altered over time and/or that our clinical understanding of the skeletal distribution of lesions in these diseases may be incomplete. These scenarios would have profound implications for our ability to identify the various forms of erosive arthritis in archaeological populations, but further work investigating erosive arthritis in patients, together with systematic studies of skeletal cases, would be required before firm conclusions can be made. Copyright © 2016 John Wiley & Sons, Ltd.     

Cultural racism: Something rotten in the state of Denmark?

Cultural racism has found fertile territory in a post-industrial Europe experiencing economic crisis and social disintegration, but its manifestations vary between countries. Denmark, a country traditionally regarded as liberal and tolerant, experienced a fundamental shift in attitude during the early 1980s that has seen it emerge potentially as one of the most racist countries in Europe. Paradoxically, liberal values are used as justification for negative representations of 'others'. This paper examines the place-specific manifestations of cultural racism in Denmark, which can be identified as essentially anti-Muslim and anti-refugee. Through the use of interviews with minority women, newspaper extracts and material propagated by far-right organizations, the paper traces the evolution of this discourse, identifying its key actors as: specific far-right anti-immigration groups; the media; and a culturally deterministic academic research tradition. The subtle manifestation of cultural racism in Denmark, coupled with inadequate anti-racist opposition or legislation, have rendered it particularly damaging, and 'legitimated' a range of racist policies and practices.     

Sclerosing Bone Dysplasia from 16th Century Sardinia (Italy): A Possible Case of Camurati–Engelmann Disease

The skeletal remains of a male aged 45–55 years displaying several bone anomalies were unearthed from the Alghero (Sardinia) plague cemetery ‘lo Quarter’, a burial site dating back to the 1582–1583 AD outbreak. The skeleton, whose stature is about 165 cm, presents a bilateral hyperostosis with increased diameter of the diaphyses of all the long bones of the upper and lower limbs; the metaphyses appear to be involved, while the epiphyses are spared. Marked thickening of the cranial vault is also evident. Radiological study showed irregular cortical thickening and massive endoperiosteal bone apposition; sclerotic changes are observed in the diaphysis of some metacarpals. Computed tomography (CT) cross sections of the long bones displayed a thickening of the cortical portion and endoperiosteal bone apposition. The individual was affected by a sclerosing bone dysplasia, a genetic disease characterized by increased bone density. In differential diagnosis, several sclerosing bone dysplasia, such as hyperostosis corticalis generalisata, craniodiaphyseal dysplasia, craniometadiaphyseal dysplasia, pachydermoperiostosis and Camurati–Engelmann disease, as well as other disorders characterized by sclerosing manifestations, such as Erdheim–Chester disease, mehloreostosis and skeletal fluorosis, need to be considered. The anomalies observed in skeleton 2179 fit with the features of Camurati–Engelmann disease, which is the most likely candidate for final diagnosis. It is highly challenging to evaluate how such a condition may have influenced the individual's lifestyle in terms of development, mobility and quality of life. This individual was probably symptomatic and must have experienced common clinical symptoms, such as pain in the limbs and fatigability. However, the strong development of the muscular insertions and the degenerative changes in the upper limbs suggest that the mobility problems should not have prevented him from reaching a mature age and from performing essential daily activities. The presented case is the unique paleopathological evidence of Camurati–Engelmann disease so far diagnosed. Copyright © 2015 John Wiley & Sons, Ltd.     

Friedrich Heinrich Lewy (1885-1950) and his work

In 1912, Friedrich Heinrich Lewy first described the inclusion bodies named after him and seen in paralysis agitans (p.a.). Tretiakoff had found (1919) that the nucleus niger is most likely to be affected but in a subsequent large-scale series of post-mortem examinations (1923). Lewy was able to confirm this for a minority of cases only, with the exception of those that displayed postencephalitic Parkinsonism (and an unknown number of atypical Parkinson syndrome cases not identified until the 1960s). In a speculative paper (1932), he saw similarities between inclusion bodies in p.a. and viral diseases like lyssa and postulated a viral genesis of p.a. In a historical review of basal ganglia diseases (1942), he did not mention the putative significance of the inclusion bodies for the post-mortem diagnosis. It seems that their importance was seen only after Lewy's death, long after Tretiakoff's initial naming of the 'corps de Lewy'. Lewy, however, had already described their diffuse and cortical distribution (1923). An identification of diffuse Lewy body disease or dementia followed much later. Lewy's career in many diverse branches of neurology and internal medicine was strongly affected by World War I and the difficult situation faced by Jews in Germany. Shortly after the Neurological Institute was founded in Berlin in 1932 (as a clinic and research institute), he was forced, in 1933, to emigrate. His exile in England and the United States mirrors the fate of many German Jews and academics in the first half of the 20th century.     

Animal palaeopathology: Possibilities and problems

A brief account of the range of pathological disorders affecting the skeleton and certain other tissues of animals (mainly mammals) is given to indicate a broad picture of the sort of lesions which might be encountered in archaeological contexts.Though palaeopathological bone specimens have been described since the 18th century, it is only recently that an interest in archaeozoological material has encouraged the tentative interpretation of such specimens. Despite the pessimism of some workers in the field, it has been shown that this material does persist in archaeological samples, and that while diagnosis is not always clear cut, some of the spectrum of bone changes induced by disease processes has been documented.As early as 4000 years ago an awareness of some of these diseases was recorded, with several early societies adopting preventive and therapeutic measures to deal with them. As advanced human communities came into more intimate contact with animals, transmission of infectious diseases was facilitated. Husbandry practices, too, are seen to be directly related to the incidence of certain conditions, the occurrence of which in archaeological material can yield an insight into animal keeping.Diverse data of archaeological significance is, in fact, retrievable not only from osteological remains, but from organic material which may be preserved under certain conditions. The impact of animal disease is far-reaching, with important implications not only for the economy but also for human health.     

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.     

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.     

Historical perspective: The British contribution to the understanding of neurocysticercosis

Neurocysticercosis, or brain infestation with the larval stage of Taenia solium, is the most common risk factor for epilepsy in many endemic regions of the world. Hardly any cases are seen in Western developed countries, including Britain. However, a sizeable number (n = 450) was seen among British soldiers returning from deputation to India, then a British colony, first reported by Col. MacArthur at the Queen Alexandria Military Hospital in 1931. Here, we review the influence of the perceptive observations of British Army medics on the understanding of the parasitic disorder. The majority of these people presented with epilepsy. Among the contributions of the army medics were establishing the diagnosis, initially by histological examination of subcutaneous and muscular infestation, and later by radiography, clarifying the prognosis and the role of medical and surgical treatments and uncovering the close relationship between the larval (cysticercosis) and adult (intestinal tapeworm) stages of T. solium.     

THE POTENTIAL MISUSE OF GENETIC ANALYSES AND THE SOCIAL CONSTRUCTION OF 'RACE'AND 'ETHNICITY'

The analysis of genetic material (such as DNA) has been attracting considerable attention for at least a decade. Recent years have seen the first application of genetic analysis to archaeological problems. In some circles DNA seems to be seen as a panacea for all ills. There is, however, little consideration of the methodological problems inherent in extrapolating from genetic information to ancient populations. In particular the assumption that genetic differences equal ethnic differences is challenged. The ethical implications for such research do not seem to have been addressed within the archaeological community.     

A Possible Case of Hydrocephalus in a Medieval Child from Doonbought Fort,Co. Antrim,Northern Ireland

Hydrocephalus is a condition that is rarely found in the palaeopathological record. It has been demonstrated in a modern study of untreated cases of hydrocephalus that 50 per cent of children suffering from the disease die within the first 18 months of life. It is probable that the situation was the same in archaeological populations and that the delicate nature of neonatal and infant crania accounts for the paucity of palaeopathological evidence. As far as the author is aware there are approximately 30 possible cases of hydrocephalus known in the archaeological record throughout the world and only two of these cases originated in the British Isles. The following report presents evidence of a case of possible hydrocephalus in a 6–7-year-old juvenile from Northern Ireland. The skeleton was recovered from a post-thirteenth century context during excavations at the secular medieval fort of Doonbought, Co. Antrim. The diagnosis of hydrocephalus has been made on the basis of the abnormal and enlarged morphology and increased cranial capacity of the cranium. The only other palaeopathological lesion present in the remains was cribra orbitalia.     

George III: a revised view of the royal malady

George III of England's episodic psychotic illness is described. The data has previously been used to substantiate the diagnosis of an unlikely hereditary metabolic disease, porphyria. A scientific perspective, aimed at removing psychiatric diagnosis from dependence on subjective evaluations, is corrected by the diagnosis of a mood disorder. His unipolar mania of late onset is a syndrome, the sine qua non of bipolar disorder, in this instance complicated by the toxicity of quinine, antimony, and purgatives.     

Crimes against cultural heritage in Timbuktu

On 3 March 2016, Ahmad al‐Faqi al‐Mahdi sat in a courtroom at the International Criminal Court (ICC) and became the first person to be prosecuted for the destruction of cultural sites as a war crime. In this article, the author argues that it is no coincidence that the first case the ICC has brought to justice involves a UNESCO World Heritage site. She charts the history of the relationship between Mali and UNESCO and the history of Islam in Mali. Through taking a historical perspective, current events can be seen as part of an ongoing ‘conversation’ about the future of the country. The ICC trial also has wider ramifications for the anthropological study of material culture and cultural heritage as it resists a plural understanding of people’s entanglement with sites and objects and demands instead a return to certainty.     

Textual Authority and Its Naturalization in Liang Shuming's Dong–Xi wenhua ji qi zhexue

This article discusses how Liang Shuming's Dong–Xi wenhua ji qi zhexue (Eastern and Western Cultures and Their Philosophies) adopted a genealogical mode of textual authorization which took shape in its depiction of Chinese history as a failure to live up to an ideal way of life imagined by Confucius. Implied in this discourse was the idea that Liang himself had been the first Confucian to understand what Confucius had truly meant. This genealogical discourse authorizing Liang and his text by linking them directly to Confucius was further strengthened by a rhetoric which naturalized the discourse passed down from Confucius to Liang, distinguishing it from other forms of discourse seen as artificial. Finally, the text's genealogical discourse also managed to incorporate the May Fourth critique of Confucianism by rejecting the historical manifestations of Confucianism before salvaging an ideal imagined by Confucius which was presented as uncontaminated by history and Confucianism's enmeshment in state power.     

Paget's disease in pre‐contact Florida? Revisiting the Briarwoods site in Gulf coast Florida

This report presents results of a reanalysis addressing the presence of Paget's disease (Osteitis deformans) in the pre‐contact Safety Harbour Briarwoods site (8PA66), a burial mound in Pasco County along Gulf coast Florida, dating around 1000–1500 AD. Due to the paucity of published histological and radiological analyses as well as the suspect nature of this Paget's disease report, a new study was conducted. The diagnosis was suspect for three reasons. First, the original diagnosis was based on five skeletal fragments from five different burials making the results questionable. Secondly, Paget's disease is very similar to treponemal disease and can possibly be misdiagnosed. The characteristic histological mosaic pattern found in Paget's disease provides the most definitive differential diagnosis. Thirdly, Paget's disease is found primarily in European populations and this is a pre‐contact site. Histological sections from the suspected Pagetic bones were analysed for the presence of the mosaic pattern. Macroscopic and microscopic analyses were unable to support or deny the presence of Paget's disease due to the fragmentary nature of the skeletal elements as well as extensive diagenesis resulting from exposure to the environment. The presence of Paget's disease could not be confirmed or refuted at Briarwoods due to extensive taphonomic damage. However, it is suggested that the presence of treponemal disease should be investigated because although not originally reported, the presence of saber‐shin tibiae consistent with this disease are present at this site. Copyright © 2009 John Wiley & Sons, Ltd.     

Science, gender, and the emergence of depression in American psychiatry, 1952-1980

Between the first (1952) and the third (1980) editions of psychiatry's Diagnostic and Statistical Manual of Mental Disorders, depression emerged as a specific disease category with concrete criteria. In this article, I analyze this change over time in psychiatric theory and diagnosis through an examination of medication trials and category formation. Throughout, I pay particular attention to the ways in which psychiatrists and researchers invoked science in their clinical trials and disease theories, as well as the ways in which gender played an important but largely unspoken role in the formation of a category of depression.