Palaeo‐otology of cholesteatoma

A cholesteatoma is a collection of dead epithelial cells in the ear which becomes infected with low‐grade pathogenic microorganisms. The lesion tends to cause resorption of the surrounding bone, which potentially permits its recognition in skeletal remains. Cholesteatoma may occur in the middle or the outer ear. Using two examples of cholesteatoma in skeletal remains from British archaeological sites, the differential diagnosis of cholesteatoma from other aural diseases is demonstrated. Some of the differences in bony lesions caused by middle ear and external ear canal cholesteatoma which may enable the two to be distinguished in palaeopathological specimens are discussed. Attention is drawn towards the importance of making this distinction in ancient skeletal remains; middle ear and external ear canal cholesteatoma have a different array of causes and very different impacts upon health status. Copyright © 2005 John Wiley & Sons, Ltd.     

Limited yet informative: pathological alterations observed on human skeletal remains from third and second millennia bc collective burials in the United Arab Emirates

While syntheses of palaeopathological studies have been undertaken in many parts of the world, until recently little was known about human health in the past in the United Arab Emirates (UAE). Focusing on skeletal pathologies, this paper documents the results of the first synthetic palaeopathologlcal study for this country. The collections of archaeological human skeletal remains come from three sites dating to the third and two sites dating to the second millennia bc and consist predominantly of disarticulated, partially fragmented and often cremated remains. The paper initially discusses potential explanations for the neglected study of human skeletal remains from the UAE. This discussion is followed by an outline of the types of burial practices employed in the past in this region and their effects on preservation. The nature of the collections and the methodology employed in their study are described. Using specific headings, the pathological findings are then documented, followed by a discussion of the results of the skeletal analysis in light of the available archaeological evidence. Finally, it is shown that although limited by preservation, analyses of human skeletal remains provide valuable details about the types of diseases that affected people in the past in the UAE. While less detailed than some palaeopathological syntheses, the results presented in this paper lay the foundations for further work on humans in the past in eastern Arabia. Copyright © 2001 John Wiley & Sons, Ltd.     

Inter-observer variation in coding osteoarthritis in human skeletal remains

Thirty-eight participants at the VIIIth European Meeting of the Paleopathology Association took part in a study of inter-observer variation in scoring osteoarthritis in human skeletal remains. Ten specimens representing different joints were used and five criteria of osteoarthritis were scored. Eleven of the 38 participants ranked themselves as beginners, 13 as experienced and six as very experienced; the data were subsequently examined using the results from these 30, comparing beginners with experts. Agreement as to whether or not changes were present on the specimens and on the degree of change was seldom complete but was greater when scoring eburnation and the presence of new bone on the joint surface than for the three other criteria. There was little difference between beginners and experts. Although all the specimens were chosen to meet our published criteria for osteoarthritis, the experts were unanimous is agreeing the diagnosis in only three cases and the beginners in only one. These results suggest that more work needs to be done to develop operational definitions for the classification of disease in palaeopathology and that great care must be taken when comparing disease frequencies between studies.     

Selenium in skeletal remains

Contents of selenium (Se) were determined in human skeletal remains of prehistoric populations by in situ trapping of Se hydride by ET AAS (atomic absorption spectrometry with electrothermal atomisation). Dr Korunová worked out a method of determination of Se in preparation. The method of determination of Se was verified by means of radioactive indicator ⁷⁵Se incorporated in the tissues of laboratory animals. Detection limit of the method was 23 pg Se. Se is another element suitable for dietary reconstruction in past populations as it relates to the consumption of meat in a similar way to zinc. Through the analysis of Se, we were able to distinguish between Eneolithic archaeological cultures (Corded Ware ceramic, Bell Beaker culture) and Bronze Age cultures (Protounětice, Starounětice, Unětice cultures). Significant differences were found in the levels of Se in the bones of individuals derived from the Bell Beaker and Uneětice Cultures, to the 95% confidence interval. Copyright © 2010 John Wiley & Sons, Ltd.     

The distribution of osteoarthritis of the hands in a skeletal population

The distribution of osteoarthritis of the hands was studied in 101 skeletons from archaeological sites in England. The results are similar to those found in epidemiological studies of modern populations. Osteoarthritis of the hands was more common in females than in males, and in females tended to involve a greater number of joints. The distal and proximal interphalangeal joints were commonly affected, the former more frequently than the latter, but otherwise the disease was largely confined to the first ray of the hand, centred on the trapezium. It is concluded that the pattern of osteoarthritis in the hand has probably not changed greatly over several hundred years.     

The diagnosis of pituitary disease from human skeletal remains

The purpose of this study was to determine whether the radiological criteria once widely used when investigating pituitary disease in the living can be applied to early man. The material examined forms part of the assemblage of skulls in the Duckworth Collection in Cambridge. It proved possible to measure the sella turcica from the radiographs of 88 of 155 predynastic adult Egyptian skulls with an intact base. These were compared with the measurements from 41 of 76 adult Burmese skulls of more recent origin and those of a randomly selected sample of living Caucasian adults. There was a wide range of sellar volumes in all three groups. The results were subjected to statistical analysis. Opportunities to apply the results of this study have been limited to the assessment of sellar erosion in a predynastic Badarian, review of the diagnosis of acromegaly in a, presumed, early Egyptian and the investigation of a hydrocephalic skull. The radiological examination of human skeletal remains thought to show evidence of pituitary disease or hydrocephalus can make palaeopathological diagnoses more secure.     

Supra‐acetabular cysts in a medieval skeletal population

This study is an investigation of supra‐acetabular cysts in non‐arthrotic hips in a large Medieval British skeletal series. Lesions were found to occur in 10% of adult innominates, and were more common in males. Evidence is presented for an aetiology of trauma. Copyright © 2005 John Wiley & Sons, Ltd.     

Diagnostic criteria for developmental dislocation of the hip in human skeletal remains

Dislocation is the most severe form of developmental dysplasia of the hip (DDH). It significantly impairs hip function in the young, and may lead to debilitating early‐onset osteoarthritis in adults. To our knowledge no thorough study of a large skeletal population has ever been undertaken to determine the wide range of diagnostic criteria for this condition in pathological specimens. To identify these criteria we have analysed the cases of developmental dislocation from a large series of 6000 individuals (6580 hips) from the medieval cemetery at Spitalfields in London, UK. We describe the changes at the true acetabulum, and have created a four‐stage classification of the false acetabulum. The skeletal response to the altered biomechanics and limb shortening that occurs in developmental dislocation is described in the pelvis, lower limb and spine. This includes asymmetric growth in childhood, and asymmetric degenerative change in adulthood. We conclude with a discussion of the clinical literature on developmental dislocation of the hip that will aid palaeopathologists to estimate the symptoms that an excavated individual may have experienced during their lifetime. Copyright © 2007 John Wiley & Sons, Ltd.     

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.     

The identification of chronic ear disease in the dried skull

Ear disease, and in particular chronic ear infection, has received scant attention in the palaeopathological literature. This paper describes the chronic infection known as cholesteatoma and how it may be identified in the archaeological specimen. A survey is made of the incidence of the condition in a series of pre-dynastic Egyptian skulls.     

Identification of historical human skeletal remains: a case study using skeletal and dental age,history and DNA

Excavation of an early historical (circa 1900) church cemetery in Cochrane, Alberta, Canada, revealed the graves of six individuals. All but one had been previously excavated and the individuals were re‐interred elsewhere. The remaining grave contained a coffin burial of an infant including most of the skeleton, crowns of forming deciduous teeth, scalp and hair. The remains were excavated and historical research was carried out to determine possible families who had used the cemetery. Skeletal and dental age estimates pointed to a particular individual described in historical records. This identification was confirmed through more precise ageing by dental microstructure, sex determination using DNA, and finally, maternal relatedness by comparison of mtDNA with a living female relative. In addition to describing the analytical methods used, this paper demonstrates the importance of accurately identifying historical burials, particularly when living relatives remain in the community. Copyright © 2004 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.     

Developing stages of subacromial humeral‐impingement facets in the skeletal remains of two human populations

The humeral impingement disorder (HID) results from degenerative changes in the rotator cuff tendon which allows the humerus to press against the acromion and produce pressure facets on both the acromion and the greater humeral tubercle. A previous study of those below 55 years of age in the two populations defined a system of three morphological categories of subacromial features. The first two categories were postulated to be pre‐impingement while the third, distinguished by erosive pitting at the point of attachment of the cuff to the greater tubercle, was regarded as indicative of degenerative change in the cuff and, therefore, of HID. Extending the study to those over 55 years of age has now added two categories of more advanced HID change. Those on the right side, of dominant use, were always more severe, thus enabling a less severe Category 4 to be distinguished from Category 5, the chief feature of which was a raised facet which could be large or small. Confirmation of the earlier study's conclusions was achieved: the degenerative changes of Category 3 began to be common by 40 years of age in both sexes of the Scottish island people, living physically‐stressed lives; in the more wealthy and sedentary Londoners, this does not occur until 10 years later. Nevertheless, in both sexes in both populations, virtually all those over 65 years of age showed Category 4 or 5 change. It seemed likely that a higher proportion of the Londoners reached advanced ages than among the islanders and so had more time for the progressive disorder to show its full effects; for instance, there were 16 Londoners known to be over 80 years of age. Individuals of that age cannot be distinguished by methods for estimating age from those 15 years or so younger but it was regarded as unlikely that there were more than two or three octogenarians among the islanders. Copyright © 2000 John Wiley & Sons, Ltd.     

Skeletal distribution of degenerative changes in vertebral osteophytosis,vertebral osteoarthritis and DISH

In order to comprehend the condition of vertebral osteophytosis, vertebral osteoarthritis and DISH (diffuse idiopathic skeletal hyperostosis) with respect to diagnosis and aetiology, the vertebral and peripheral (appendicular) frequency and distribution pattern of degenerative joint changes of 176 rather affluent citizens were analysed from the late medieval city of Dordrecht in Holland. Patterns of frequencies with respect to age and sex were found to be similar essentially to those of a present-day Dutch suburban village population. Frequencies for vertebral osteophytosis were twice those for vertebral osteoarthritis, and both increased with age in both sexes. The individual pattern of vertebral osteophytosis and vertebral osteoarthritis seems to indicate that each disorder possesses its own progressive identity. From the distribution pattern and frequency of peripheral osteoarthritis it was concluded, with respect to the vulnerability of developing this complication under physically moderate life conditions, that causal factors for vertebral osteophytosis are less important than those for vertebral osteoarthritis. Osteoarthritis presented itself as a systemic disorder, affecting synovial joints in general. Finally it was appreciated that, with increasing age, bony outgrowths from joint degeneration become anatomically masked by para-articular ossifications from DISH.     

Recording dental caries in archaeological human remains

Dental caries is an important condition to record in archaeological collections, but the way in which recording is carried out has a large effect on the way in which the results can be interpreted. In living populations, dental caries is a disease that shows a strong relationship with age. Both the nature of carious lesions and their frequency change with successive age groups from childhood to elderly adulthood. There is also a progression in the particular teeth in the dentition which are most commonly affected and, in general, the molars and premolars are involved much more frequently than the canines and incisors. Lower teeth are usually affected more than upper, although the condition usually involves the right and left sides fairly equally. In the high tooth wear rate populations represented by many archaeological and museum collections, there is a complex relationship between the form of lesions and the state of wear, which adds yet another range of factors to the changing pattern of caries with increasing age. In the same populations, chipping, fracture and anomalous abrasion of teeth are also common, and these contribute similarly to the distribution and forms of carious lesion observed. Amongst the living, the pattern of ante‐mortem tooth loss is important in understanding caries and, in archaeological material, there is also the complicating factor of post‐mortem tooth loss. Finally, there is the question of diagnosis. There are diagnostic problems even in epidemiological studies of living patients and, for archaeological specimens, diagenetic change and the variable preservation of different parts of the dentition add further complications. For all these reasons, it is difficult to define any one general index of dental caries to represent the complete dentition of each individual, which would be universally suitable for studying a full range of collections from archaeological sites or museums. Variation in the nature of collections, their preservation, tooth wear, and ante‐mortem and post‐mortem tooth loss mean that when such a general index appears to differ between sites, there could be many other reasons for this, in addition to any genuine differences in caries incidence and pattern that might have been present. It is suggested here that the best approach is instead to make comparisons separately for each tooth type, age group, sex, lesion type and potential lesion site on the tooth. Copyright © 2001 John Wiley & Sons, Ltd.     

Quantitative computerized tomography for the diagnosis of osteopenia in prehistoric skeletal remains

In this study, we examine the value of bone density assessed by computed tomography (QCT) of the right tibia in the diagnosis of low bone mass in prehistoric bones. Trabecular bone mass (TBM) was assessed by histomorphometry in undecalcified bone sections of a small part of the proximal epiphysis of the right tibia of 78 prehispanic individuals. Bone density was also assessed in the proximal epiphysis of the right tibia, in an area of cancellous bone immediately adjacent to the wedge which was destined to histomorphometry, with the aid of a Tomoscan 60 TX™ (Philipps Medical System, Eindhoven, The Netherlands) using a phantom of hydroxyapatite included in plastic resin at three known concentrations (50, 100 and 200 mg/cc) and ethanol as fat equivalent. Bone density (as bone hydroxyapatite concentration in milligram per cubic centimeter) was calculated by means of a specific software tool (QCT Bone Mineral Analysis System, Image Analysis, California). We compared bone density assessed with QCT with TBM in these individuals, and also, with the results obtained from a modern control group. We calculated the median TBM of the prehispanic sample and tested the sensitivity, specificity, and overall accuracy of QCT in diagnosing TBM values below the median. We later performed the same analyses on 24 more prehispanic individuals. Both QCT (t = 5.61, p < 0.001) and TBM (t = 3.79, p < 0.001) were significantly lower among the prehispanic individuals than among the control ones. QCT showed a significant relationship with TBM (r = 0.41, p < 0.001). QCT values below 100 mg/cc serve to establish a diagnosis of low TBM values with a sensitivity of 82.1% and a specificity of 41%. In the test group sensitivity was 83.3% and specificity, 50%.