Multiple bone tuberculosis in a child from predynastic Upper Egypt (3200 BC)

Tuberculosis, one of the most ancient human diseases, was present in ancient Egypt and has been observed since predynastic times. Excavations in the predynastic to early dynastic necropolis of Adaima, Upper Egypt (3500–2700 BC) led to the discovery of a number of remarkably well‐preserved skeletons of children. The skeletal remains of a 4.5–5‐year‐old child dated from Nagada III A2 (3200–3100 BC) displayed various lesions on the post‐cranial skeleton: spondylitis on the thoracic (T12) and lumbar (L1) vertebrae, partial lytic destruction of the right radio‐ulnar joint, lytic lesions on the scapula and a clavicle, dactylitis on the short bones of hands and feet, enlargement (spina ventosa) and periosteal new bone formation on the long bones. Radiographs show well‐defined radiolucent (cyst‐like) lesions in the metaphysis and the diaphysis of long tubular bones (ulna, radius, femur, tibia, fibula). The lesions recorded during macroscopic and radiological analysis strongly suggest a case of multiple bone tuberculosis. The occurrence of this case of tuberculosis in a child provides a picture of a period where tuberculosis must have been endemic throughout the population living during the origins of urban settlement in Upper Egypt during the predynastic period. Copyright © 2009 John Wiley & Sons, Ltd.     

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

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

Healed bone fractures in a jomon skeletal population from the Yoshigo shell mound,Aichi Prefecture,Japan

Healed bone fractures were quantitatively analyzed in an ancient Japanese population. The sample studied consisted of the skeletal remains of 160 adult individuals from the Yoshigo shell mound (ca. BP 3400‐2400), Aichi prefecture, Japan. Healed fractures were diagnosed from the presence of callus formation and/or angular deformity. Fractures were frequently seen in small bones of the hand and foot such as the metacarpals, rather than in large long bones such as the clavicle, humerus, radius, ulna, femur, tibia and fibula. Of a total of 517 intact large long bones, only four fractures (0.8%) were recognized. The prevalence and pattern of bone fractures in the Yoshigo population reflects the relative lack of stress in their life‐style. Copyright © 1999 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.     

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.     

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.     

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.     

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

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

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

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

Foot amputation by the Moche of ancient Peru: osteological evidence and archaeological context

Three probable cases of foot amputation, with healing, in skeletal remains associated with the Moche culture (AD 100–750) of northern coastal Peru are described. Each case exhibits non‐functional tibio‐talar joints with proliferative bone occupying the normal joint space. The robusticity of the tibiae and fibulae suggest renewed weight‐bearing and mobility following recovery. The osteological evidence is consistent with details shown in Moche ceramic depictions of footless individuals. A footless Moche skeleton with wooden prostheses, described in 1913 by Peruvian physician Vélez López, appears to represent a fourth example of this procedure. The Moche surgical approach was similar to a technique that would be pioneered in western medicine by the Scottish surgeon Sir James Syme some 1500 years later. Copyright © 2000 John Wiley & Sons, Ltd.     

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.     

The distribution of skeletal lesions in treponemal disease: is the lymphatic system responsible?

The differential diagnosis of bone lesions in treponemal disease is well established in palaeopathology. However, the actual mechanism responsible for the characteristic distribution of bone involvement is not as clear. Two mechanisms are proposed in the literature. Firstly, that bone lesions are the result of direct extension from the skin rash of the secondary stage of disease. Secondly, that bones situated closer to the skin are more vulnerable to local trauma and therefore more likely to elicit a subperiosteal bone response. We propose an alternative explanation for the characteristic distribution of bone lesions in treponemal disease. This explanation is based on the close association between the lymphatic and skeletal systems and the pathogenesis of treponemal disease. This paper argues that the position of the lymphatic nodes and vessels, with little soft tissue intervention between bone tissue, mirrors the characteristic pattern of skeletal involvement in treponemal disease. Copyright © 2002 John Wiley & Sons, Ltd.     

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

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

Differential diagnosis of an unusual tibial pathology from Peru

During an osteological analysis of human skeletal remains from the site of Punta Lobos (Huarmey Valley, northern coastal Peru), an unusual erosive lesion of the cortex with periosteal reaction was observed on a right tibia. The authors undertook a review of paleopathological and medical literature to arrive at a differential diagnosis. The lesion is determined to be a non‐malignant growth, possibly a large periosteal ganglion, though a diagnosis of periosteal chondroma (a benign neoplasm) or other uncommon neoplasm could not be definitively ruled out. Copyright © 2010 John Wiley & Sons, Ltd.     

Bone weight: new reference values based on a modern Portuguese identified skeletal collection

Skeletal weight and/or weight of the different bones of the human skeleton are currently used in a wide range of applications such as archaeological cremations and forensics. Still, few reference values are available that compare the mean weights for the different skeletal parts. In this paper we present new reference values for total skeletal weight, including the weight of the different skeletal bones based on a modern Portuguese Identified Skeletal Collection (CEI) curated in the Museum of Anthropology of the University of Coimbra (Portugal). The mean weight of the entire skeleton for the CEI pooled sample is 3323.8 ± 779.6 g. Sex and age differences were investigated. As expected, males display heavier bones, at a statistically significant level. The mean weight of the male skeletons is 3850 g, and 2797.6 g for the female sample. Age differences were found, especially for the female samples in the 29–39 versus 50–59 and/or >60 age groups, probably as a consequence of age‐related bone loss in post‐menopausal women. For the male sample, no clear age‐related trend was observed but for the unexpected result that the second highest bone weight recorded is in the oldest age group (>60 years). This could result from high mechanical loadings and thus greater bone robusticy and amount of cortical bone. The percentage of weight of the different parts of the skeleton was also calculated. These new values can be quite useful in the study of very fragmentary and/or commingled human remains, recovered from historic or forensic contexts, since the complete identification, by side, of the remains is not necessary. Copyright © 2008 John Wiley & Sons, Ltd.     

Metastatic Cancer in the Middle Age: The Possible Case of a Female Skeleton from Bormio (Italy)

Secondary signs of cancer are difficult to assess in the archaeological context, as other lesions may mimic metastases on dry bones. Furthermore, the low life expectancy, lower level of environmental cancer risk factors and pollution than the present times can contribute in limiting the frequency of signs of cancer in archaeological populations. This study focuses on a female adult skeleton from the necropolis of Bormio (North Italy), dating back to Middle Ages, which shows multiple lytic lesions on cranium, upper limbs, ribs and pelvis; lesions are oval in shape, with a diameter ranging from 1–2 to 80 mm. The lesions appearance and distribution at macroscopic and radiographic level, together with sex and age indications, suggest the diagnosis of metastatic cancer. Possible diagnostic hypotheses of the possible sites of original cancer were performed as well, based on modern epidemiological data. Copyright © 2017 John Wiley & Sons, Ltd.     

Skeletal manifestations of vitamin D deficiency osteomalacia in documented historical collections

The frequency with which changes related to vitamin D deficiency are recorded in juvenile bone from archaeological contexts makes it clear that conditions conducive to such deficiency were fairly widespread at a number of points in the past. Although changes will take longer to be manifest in the adult skeleton than in juveniles, and may not be as obvious, the scarcity of reported cases suggests that it is likely that cases of osteomalacia are being overlooked in archaeological human bone. Vitamin D is probably better described as a hormone, rather than a vitamin, and the production of vitamin D within the body following exposure to sunlight allows adequate mineralisation of bone to take place. Lack of exposure to sunlight, which can be caused by a range of factors, is probably one of the main causes of vitamin D deficiency. The result of such a deficiency is a general weakening of the skeleton. The range of skeletal changes recorded across different bones of the skeleton in two documented historical pathology collections (the Galler collection, Basel, and the collection of the Federal Museum for Pathological Anatomy, Vienna), are discussed for scapulae, vertebrae, ribs, sterna, pelves and femora. The likelihood of each feature being preserved in archaeological skeletal material is considered. Although the changes associated with osteomalacia may lead to fragmentation of the skeleton, the presence of characteristic changes on bones from across the skeleton should make the condition identifiable using macroscopic examination, even where the skeleton is not well preserved. The identification of cases of osteomalacia in archaeological skeletal material is potentially significant because of the socio‐cultural information that can be implied from diagnosis of the condition. Copyright © 2005 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.     

Bioarchaeology in the United Arab Emirates*

Physical anthropology and bioarchaeology (one of the newer interdisciplinary sub‐disciplines) are alive and well in the U.A.E. Older analytical approaches that rely on subjective observations and non‐systematic study of human remains are being replaced with more biocultural and processual approaches that integrate biological data from human remains within a broader archaeological and cultural context. With the publication of a major synthetic work based on analysis of the human remains from Jebel al‐Buhais, a new era of skeletal analysis in the U.A.E. has been heralded. This short review examines the ways that skeletal analysis can be integrated within broader archaeological contexts.