DISH and the monastic way of life

Diffuse idiopathic skeletal hyperostosis (DISH) is common condition and its prevalence increases markedly with age. This paper describes the pathology and aetiology of the condition; DISH seems to be related to obesity and type II diabetes and is probably a multisystem hormonal disorder. DISH occurs frequently in human skeletal remains, particularly in those recovered from monastic sites. Evidence is presented to confirm this association and the causes are discussed. We also present criteria for the diagnosis of DISH in human remains, which we suggest would permit valid inter‐study comparisons. Copyright © 2001 John Wiley & Sons, Ltd.     

Co‐occurrence of DISH and HFI in the Terry Collection

Diffuse idiopathic skeletal hyperostosis (DISH) and hyperostosis frontalis internus (HFI) are both characterised by abnormal bone growth, a late age of onset, and an association with obesity, acromegaly and various metabolic disorders. In this study we examined the co‐occurrence of DISH and HFI in a sample of 406 black and whites aged 40–102 years old from the Terry Collection, National Museum of Natural History, Smithsonian Institution. Fisher's exact tests showed the co‐occurrence was significant for females. DISH was present in 19.6% of black and 29.6% of white females with HFI versus 4.76% and 2.38% of control females without HFI. A similar frequency of DISH was seen in males with HFI (20% black and 27.3% white), but this was not significantly different from the male controls without HFI (16.8% and 18.9%). The risk of developing DISH for females with HFI was nearly 8.78 times greater (CI = 2.56–30.1) than for females without HFI. Logistic regression of the female data showed HFI was a significant determinant (p = 0.001) of the presence of DISH but age was not (p = 0.744). We suggest that similar metabolic, genetic and environmental risk factors in the pathogenesis of the two conditions explain the observed comorbitity. Copyright © 2010 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.     

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.     

Diffuse idiopathic skeletal hyperostosis in Late Jomon Hokkaido,Japan

The purpose of this study is to describe and analyse the evidence for diffuse idiopathic skeletal hyperostosis (DISH) in samples of human skeletal material recovered from Late Jomon (ca. 1500–300 BCE) and Okhotsk (CE 500–900) cultural period sites, northwestern Hokkaido, Japan. Two individuals from the Jomon period assemblage (n = 14) exhibited lesions consistent with DISH, while the larger Okhotsk sample (n = 39) was free of this condition. The aetiology of this condition is reviewed with reference to the clinical and bioarchaeological literature, in addition to behavioural and environmental considerations specific to this region and these time periods. Copyright © 2006 John Wiley & Sons, Ltd.     

The prevalence of,and the relationship between some spinal diseases in a human skeletal population from London

The prevalence of osteoarthritis, osteophytosis, intervertebral disc disease and diffuse idiopathic skeletal hyperostosis (DISH) was determined in a group of skeletons excavated from the crypt of Christ Church, Spitalfields. Age-specific prevalence rates were calculated from the group of skeletons for which age at death was known from intact coffin plates. Osteoarthritis of the facet joints occurred most frequently in the cervical and upper thoracic regions and was also common in the lower lumbar spine. The disease was more frequently bilateral in the lumbar spine than in upper regions. Osteophytes were common in the thoracic and lumbar spines, whereas intervertebral disc disease was confined almost completely to the cervical region. Diffuse idiopathic skeletal hyperostosis seemed to be underrepresented in this group, but was more common in males than in females. Age correlated significantly with all the conditions except DISH. Multiple regression analysis was carried out using each of the conditions as the dependent variable in turn. Age accounted for more of the variance than any of the other conditions added as independent variables.     

Changes in the distribution of osteoarthritis over historical time

A total of 2635 skeletons recovered from different sites in England was examined for the presence of osteoarthritis (OA); 206 were from pre-medieval sites, 1453 from medieval sites and 976 from post-medieval sites. Where OA was considered to be present in a joint, the site was noted and for each time period the total number of anatomical sites with the condition was determined and the number of major sites with OA (10 in number) was expressed as a proportion of this total. There were no differences in the distribution of osteoarthritis between the pre-medieval and medieval periods but there were between the medieval and post-medieval periods. In the post-medieval period the proportion of osteoarthritis of the knee increased whereas that of the hip decreased; the proportion of osteoarthritis of the hands also increased whereas that of the wrist decreased. Other data presented indicate that patellofemoral disease is about twice as common as tibio-femoral disease in both medieval and post-medieval periods and that lateral compartment disease is almost as common as medial compartment disease.     

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.     

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.     

Further aspects of fur trade life depicted in the skeleton

Osteobiographies were reconstructed from the skeletal remains of four adults from Fort Edmonton, a 19th century trading post of the Canadian fur trade. Three males were Caucasoid and probably ethnic Scots, given the usual origin of fur traders in this region. The lone adult female in the sample was Mongoloid, either Indian or Métis, and likely the ‘country wife’ of a fur trader, since she was buried in the European tradition in the fort cemetery. The cause of death is not discernible from any of the skeletal remains and none of these individuals exhibit any evidence of chronic infectious disease, malnutrition or neoplasia. Trauma, arthritis and other indicators of physical stress do appear, however, and present an opportunity to expand our understanding of the effects of fur trade life on the skeleton. Viewed in the context of historical accounts of life at the fort in the early 19th century, stress markers on the skeletons of three males have led to the conclusion that they were voyageurs who engaged in trading trips by canoe or boat. Lesions of the capsule attachment area at the proximal tibio‐fibular articulation appear unilaterally in two males and may be associated with ‘mushing’ or driving a dog sled in winter. The musculoskeletal lesions on the one preserved female skeleton are consistent with the arduous domestic activities documented at the fort, which include milking cows, churning butter, stirring lye soap, and harvesting grain and root vegetables by hand. Since specific occupations or behaviours cannot be precisely determined from muscular attachment and other stress markers, these interpretations are made cautiously and only in the culture‐historical context of the skeletal sample. Copyright © 1999 John Wiley & Sons, Ltd.     

The pattern of spondylosis deformans in prehistoric samples from west‐central New Mexico

A Pre‐Columbian skeletal sample (n=42) from two ancestral Pueblo sites in the Rio Grande valley of west‐central New Mexico was examined for frequency and severity of spondylosis deformans (vertebral osteophytosis). No significant sex differences were detected. Degenerative changes in the collective sample are generally confined to no more than well‐defined horizontal lipping at the joint margins. Advanced proliferative osteophytic change is infrequent even in the oldest age category. Not surprisingly, the lumbar vertebrae were the most frequently and most severely involved vertebral segment for all three adult age cohorts defined. The cervical vertebrae were the least involved. This pattern generally conforms with observations made on other archaeological samples from west of the Mississippi River, but it contrasts with the general pattern of more extensive cervical involvement in Pre‐Columbian North American samples from the Eastern Woodlands. This possible east–west difference is hypothesized (Bridges, P.S. 1994. American Journal of Physical Anthropology 93: 83–93) to be related to differential burden bearing habits. Copyright © 2000 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.     

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.     

Spinal degenerative lesions and spinal ligamentous ossifications in ancient Chinese populations of the Yellow River Civilization

Rheumatological diseases, whether inflammatory or degenerative, are ubiquitous among modern Asian people but very few palaeopathological studies have been performed in Asia on this subject. Since 1996, we have been carrying out a palaeoepidemiological survey of rheumatic diseases in ancient Chinese and Japanese skeletal populations. Findings on the spinal column in ancient Chinese populations (ca. 5000 bc –ad 1644) in Henan Province (centre of the Yellow River Civilization) are reported in this study. The examined number of the people over 20 years old was 365 (185 males, 169 females and 11 unsexed). Of these, 248 were young adults, 98 were middle adults and 19 were old adults. Crude prevalence (number/100) in total population of vertebral osteophytosis/facet osteoarthritis was 17.5/7.7, 17/3.7 and 44.6/21.1 at the cervical, thoracic and lumbar spine, respectively. That of ossified anterior longitudinal ligament (OALL) or Forestier's disease was around 3 at each of the cervical, thoracic and lumbar spine. Ossification of the posterior longitudinal ligament (OPLL) of the cervical spine was observed in five out of 114 skeletons with cervical spine preserved, while it did not exist in any thoracic and lumbar segment. Ossification of the ligamentum flavum (OLF) was predominantly observed in the thoracic spine, the crude prevalence of which was 36.7. Overall spinal degenerative lesions seemed to have been more prevalent and spinal ligament ossifications less prevalent in ancient Chinese populations than in modern people. None of the inflammatory lesions like rheumatoid spondylitis, as well as seronegative spondyloarthropathies, were detected. This is the first palaeopathological study in which the prevalence of OPLL and OLF, the two clinically important spinal ligamentous ossifications causing myelopathy in modern mankind, was surveyed in ancient skeletons. Copyright © 2000 John Wiley & Sons, Ltd.     

Skeletal Evidence for Otitis Media in Mediaeval and Post‐Mediaeval Children from Poland,Central Europe

In palaeopathological research, otitis media (OM) is a rarely reported disease, although it is one of the most common diseases of childhood, with potentially severe consequences resulting in physical and social impairment, or even death. The episodes of OM are often preceded by upper respiratory tract infections, though the aetiology of OM is multifactorial, with significant role of environmental factors. In archaeological skeletons, middle ear inflammation is identified as erosive lesions and new bone formation of auditory ossicles. The aim of this study was to examine the skeletal signs of OM in children from a mediaeval early urban site (Cedynia) and a post‐mediaeval rural site (Słaboszewo) located on the territory of Poland. Among the entire sample (N = 435), ear bones were present in 99 skeletons. The total of 168 ossicles were examined. The general frequency of individuals with eroded ossicles was 47.5% (53.4% in Cedynia and 39.0% in Słaboszewo). In the total sample, 33.9% of ear bones showed pathological changes, with the incudes being most frequently affected. The frequency of altered ossicles was significantly higher in the early urban site than in the rural settlement (42.2% vs 25.9%, respectively; Fisher exact test, p = 0.0339). The children aged 0–3 years old tend to have a higher frequency of altered ear bones than the children aged 4–11 years old. The majority of the mastoid processes of the subadults with ear bone erosion show abnormal pneumatisation pattern. The results indicate that the environmental and socio‐cultural conditions in the stronghold likely made their inhabitants more prone to upper respiratory tract infections than the inhabitants of the village. A variety of factors may be responsible for this pattern, such as exposure to dust, environmental pollution, indoor pollution, wood smoke, occupation, population density, sanitation and quality of housing. Copyright © 2016 John Wiley & Sons, Ltd.     

The rhinomaxillary syndrome in leprosy: A clinical,radiological and palaeopathological study

The rhinomaxillary syndrome consists of a group of maxillary bone changes, which may be present in part or in total, in lepromatous and near-lepromatous leprosy. The changes are a composite mixture of erosive, absorptive and proliferative bone reactions. The anatomical zones involved are the alveolar process of the maxilla, the anterior nasal spine, the palatine process of the maxilla, intranasal osseous structures, and the margins of the nasal aperture.     

Mandibular hypodontia and osteoarthritis in prehistoric bighorn sheep (Ovis canadensis) in eastern Washington State,USA

Mandibular hypodontia of the p2 was found to occur in 3 out of 21 individual prehistoric Rocky Mountain bighorn sheep (Ovis canadensis canadensis) from Moses Coulee Cave in eastern Washington State, similar to its frequency of occurrence in modern bighorn. There is no evidence of lumpy jaw (mandibular osteomyelitis) in the Moses Coulee Cave collection. Evidence from Moses Coulee Cave aligns with the hypothesis that low frequencies of hypodontia and lumpy jaw occur in healthy, evolutionarily old (maintenance) populations in order to maintain the occlusal area and thus maximise efficiency of food procurement and processing. Osteoarthritis was found to occur in 1 out of 70 individual Rocky Mountain bighorn sheep (Ovis canadensis canadensis) astragali in the Moses Coulee Cave collection. This prevalence is unsurprising given a population dominated by prime‐age individuals. Osteoarthritis was likely selected against given that individuals must be agile to effectively use rugged terrain to escape predation and as a general measure suggests a healthy population. Copyright © 2009 John Wiley & Sons, Ltd.     

Syndactyly in Pigs: A Review of Previous Research and the Presentation of Eight Archaeological Specimens

This paper reviews evidence for the rare condition of porcine syndactyly. It describes eight archaeological examples from Britain, Northern Ireland and France. Syndactyly refers to the partial or complete fusion of two or more adjacent phalanges on the medio‐lateral border. The degree and character of fusion are variable, but phalanges frequently unite to create a single skeletal element. This condition has been identified by veterinarians, zoologists and naturalists in individuals and populations in a range of species, but in spite of substantial research on the condition in humans and to a lesser extent cattle, it remains relatively poorly understood in other mammals. Syndactyly is generally agreed to be primarily congenital in origin, although factors affecting its incidence remain far from fully understood. In light of the general paucity of discussion of specific conditions of animal palaeopathology, this paper presents an analysis of these newly discovered syndactyle pig specimens, offers a review of research with particular reference to pigs and discusses the etiology of the condition. Copyright © 2011 John Wiley & Sons, Ltd.     

Congenital anomalies of the vertebral column: a case study on ancient and modern Egypt

The aim of this paper is to identify the frequency of congenital anomalies of the vertebral column in ancient Egyptians. The material for this study consisted of 272 skeletons excavated from Giza and belonging to the Old Kingdom (the time of the early pyramid builders). The vertebral columns of these skeletons were examined for the different types of congenital anomalies that affect the vertebrae. Nine cases (3.33%) were affected with spina bifida occulta, while six cases (2.22%) had transitional vertebrae at the lumbosacral joint. These frequencies are compared with other ancient populations. Copyright © 2006 John Wiley & Sons, Ltd.