Traumatic bowing deformities in tubular bones

Is bowing in long bones from an archaeological context representative of postmortem damage or genuine antemortem pathology? Bowing deformities (also known as traumatic bowing deformities, plastic bowing deformities, plastic bowing fractures and acute bowing fractures in the clinical literature) are true pathological entities that have only recently been recognized by clinicians. Bowing in long bones results from a force that exceeds the elastic properties of a given bone, producing a new plastic (bowing) response phase. These subtle deformities commonly affect the radii and ulnae in children and less frequently other tubular bones of the skeleton. Traumatic bowing should be considered as a possible diagnosis whenever abnormal curvature of a long bone is observed. This presentation illustrates two cases of traumatic bowing isolated from two ossuary populations from Ontario, Canada and addresses differential diagnostic concerns. © 1998 John Wiley & Sons, Ltd.     

Evaluation and interpretation of residual rickets deformities in adults

Recent research has considerably improved the recognition and recording of rickets and osteomalacia in archaeological human bone, but the recognition and recording of residual deformities of rickets present in adults is still limited. The aim of this study was to assist with differential diagnosis of residual rickets deformities and determine which of the deformities that are characteristic of rickets could be identified in the adult skeleton. Long bone deformities were investigated, with research focusing on deformities of the leg bones. One hundred and thirty‐five adults from the historic cemetery of St Martin's, Birmingham, where vitamin D deficiency was known to have been widespread, were analysed. Deformities of leg bones were three times as frequent as arm bone deformities, and deformity of both the femur and tibia was the most frequently recorded combination of leg bones. Medial bending of the tibiae and anterior bending of femora, both at the proximal end, were the most frequently recorded types of deformities. A review of a range of conditions that can cause bowing deformities, and comparison of bowing recorded in children with rickets and the present cases, concluded that the most likely cause of the deformities recorded was residual changes linked to rickets. In this community, bowing deformities linked to rickets were quite common amongst adults and probably did not have adverse social consequences, but further studies are required to determine whether this attitude to deformity was more widespread. Copyright © 2008 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.     

Lysis at the anterior vertebral body margin: evidence for brucellar spondylitis?

Recently, palaeopathologists have begun to diagnose brucellosis in skeletal remains from minor lytic lesions located on the anterior margins of one or some few vertebral bodies, taking these lesions to represent brucellar epiphysitis. However, review of the literature indicates that these lesions have been sporadically noted for some time by palaeopathologists and various different interpretations have been placed upon them. In view of this, a study of these vertebral marginal lesions (VML) was undertaken in a large series of archaeological skeletons from England, with the aim of characterising their morphology and frequency and shedding light upon their causes. In the study material, VML were found only in the lumbar spine, where they occurred with a prevalence of approximately 4%. It was argued that VML are consistent with two principal alternative diagnoses: brucellosis and traumatic anterior disc herniation. Differentiating these possibilities for the VML in the study material was difficult, but the balance of the evidence seemed to favour traumatic anterior disc herniation as the more likely cause. It is concluded that VML should not be used to identify the presence of brucellosis in skeletal remains unless there is further evidence, in the form of additional skeletal lesions or biomolecular evidence for residual brucella bacterial DNA, to support such a diagnosis. Copyright © 2007 John Wiley & Sons, Ltd.     

Thalassemia: macroscopic and radiological study of a case

Differentiation of the genetic and the acquired anaemias, particularly in areas of the world where they may co‐exist, has been a challenge for palaeopathologists for over 100 years. In this paper we present macroscopic and radiographic skeletal lesions that are associated with the thalassemias in a 14‐year‐old girl from a modern reference collection of the University of Athens. This individual is of known sex, age, cause of death, place and dates of birth and death. The case is examined in terms of epidemiology, growth, distribution and severity of lesions and differential diagnosis. The entire skeleton is affected by marrow hyperplasia: lesions of the axial skeleton are extreme, and the appendicular skeleton is severely affected as well. The odontofacial manifestations that are diagnostic of thalassemia and differentiate it from other anaemias are present and include: maxillary and mandibular hyperplasia, reduced sinuses, displacement of maxillary dental structures, overbite, and generalised osteopenia. The development of extreme bone lesions and the ‘advanced’ age‐at‐death of this individual is explained as either the result of thalassemia major under a low transfusion regimen that was the norm during her lifetime, or to a form of thalassemia intermedia that allows survival to later life at the expense of gross skeletal alterations. The present status of skeletal studies in Greece does not support the identification of a genetic anaemia in past populations. The potential contribution of the current analysis in differentiating the anaemias in antiquity is evaluated. Copyright © 2006 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.     

Metaphyseal fibrous defects in juveniles from medieval Norwich

Two juvenile skeletons excavated from medieval Norwich each have a well‐defined cystic cavitation. One involves the distal femur and the other the proximal tibia. The dry bone and radiographic appearance, as well as the location and age of the individuals, support a diagnosis of metaphyseal cortical defects. Although well‐known in clinical practice, especially in children, this appears to be the first published evidence for the condition in British archaeological material. No other anomalies were detected on the two skeletons. However, the occurrence of two cases in the same cemetery raises the possibility of a genetic influence in the condition. Copyright © 2002 John Wiley & Sons, Ltd.     

A possible fatal wounding in the prehistoric Pacific Islands

This paper reports two cases of prehistoric interpersonal violence from Taumako Island, southeast Solomon Islands. The first case is a young child with a bone point found in situ in a lower lumbar vertebra. It is concluded that this child most likely died as the result of the injury. The second case is a male of advanced age with a well‐remodelled depression fracture on the frontal bone of the skull. This individual also has a remodelled penetrating wound to the left iliac crest of the pelvis. Warfare is thought to have been endemic in much of the Solomon Islands before European arrival. However, besides the two cases reported here there is little other evidence of trauma in the Taumako population. The young child is the first case of an in situ weapon reported from the prehistoric Pacific Islands. Copyright © 2000 John Wiley & Sons, Ltd.     

Earliest evidence of spinal tuberculosis from the Aneolithic Yayoi period in Japan

Tuberculosis has existed from early prehistoric days to modern times. The main causative agents of tuberculosis worldwide are Mycobacterium tuberculosis (M. tuberculosis) and M. bovis, along with M. africanum, M. cenettii and M. microti; these species make up the ‘M. tuberculosis complex’. This worldwide infection has been of special interest to palaeopathologists due to its characteristic bone lesions as well as its great antiquity. Historically, tuberculosis has been recognised in Japan for more than a thousand years. However, the origin and early prevalence of tuberculosis remain unknown. In the present study, we present the earliest evidence of skeletal tuberculosis found in the Aneolithic Yayoi period in Japan (ca. 300 BC to AD 300). The skeletal remains showing typical pathological changes of spinal tuberculosis were dated to between 454 BC and AD 124 by dendrochronological methods using coburied arrow-shield board and house columns made of Japanese cedar. We discuss the early prevalence of this infectious disease and its influence on the population history of the Japanese from prehistoric to Aneolithic times. Copyright © 2006 John Wiley & Sons, Ltd.     

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.     

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.     

System of measurement of the severity of periodontal disease in past populations

This paper presents a review of the antiquity of periodontal disease, discussing past aetiological concepts in comparison to current research on the causes of this condition. As periodontal disease is analysable on dry bone specimens, it is possible to document its natural history. To date, little work has been done on an actual system of measurement for periodontal disease in such specimens. A new system of measurement is proposed, which is confined to evaluating the periodontal status of post-mortem skulls. The system is a modification of the Ramfjord index for periodontal disease (PDI) and can be adapted for both individual specimen measurement and for population studies. Seven skulls, ca. AD 500–700, from the Varden Site at Long Point, Ontario, were examined using the proposed system. Mean attachment loss was computed for each of the seven specimens. The results revealed one specimen with early periodontitis, four with moderate periodontitis and two with advanced periodontitis. This system provides a concise method for classification of the severity of periodontal disease in dry bone specimens that will be useful in documenting the history of this disease.     

Bone changes in the human skull probably resulting from scurvy in infancy and childhood

Scurvy in children is poorly known in the palaeopathological literature despite biomedical references indicating that bone changes do occur in some cases and should be observable in human skeletal remains. Research on infants' and children's skulls in museum and anatomical collections in the USA and Europe reveals a complex of features on the external surface of the greater wing of the sphenoid and adjacent bone tissue that may be caused by scurvy. The lesions are bilateral and are characterized by porosity and, in some cases, hypertrophic bone formation. These abnormal bone changes are probably the result of a reaction to chronic haemorrhage in the deep vasculature associated with temporalis muscle function. While these lesions resemble those seen in anaemia and infection, their distinctive anatomical location and association with chewing should differentiate them, in most cases, from other disease conditions. These features are also associated with porous, hypertrophic lesions of the orbital roof and provide additional evidence that caution is needed in attributing porous lesions of the orbital roof solely to anaemia. © 1997 John Wiley & Sons, Ltd.     

Reconsideration of criteria for differentiating faunal assemblages accumulated by hyenas and hominids

Zooarchaeologists have established several criteria for differentiating hominid‐ and hyena‐derived faunal assemblages. In some cases, however, the patterns of skeletal part representation and bone surface modification on which these criteria are ultimately based have been observed in fossil bone assemblages of unknown origin, rather than in modern assemblages of known origin. When the proposed criteria are evaluated within an actualistic framework, only three are able to differentiate between hominid‐ and hyena‐created faunal assemblages. I suggest that only these three criteria—proportions of carnivores to ungulates in the assemblage, the preserved condition of long bone specimens (either as whole cylinders or as splintered shaft fragments), and the types of bone surface modifications—should be retained as important factors in a diagnosis of the ancient bone‐collector. The remaining four criteria—the relative proportion of horn pieces in the assemblage, the relative representation of podial bones, the relative representation of small and large bovid skeletal parts, and bovid mortality profiles—are not relevant or applicable to the problem of differentiating hominid‐ from hyena‐derived faunal assemblages. Copyright © 2002 John Wiley & Sons, Ltd.     

Cleft Lip Case in a Middle Bronze Age Young Man from Altai,Russia

Oral cleft (OC) is a common congenital anomaly in humans, which occurs in approximately one per 700 live births. However, cleft skulls are found relatively seldom in archaeological specimens, especially for the bc period. Mortality of infants with OC was apparently high because of breastfeeding difficulties and culturally sanctioned rejection of them in the past. This paper presents one of the most ancient cases of OC in Eurasia. The finding comes from the Middle Bronze Age pastoralists' cemetery in Altai, Russia. The skeletal remains have been radiocarbon dated to 1883–1665 cal bc . Cranial and dental measurements, computed tomography and radiography have been used to examine this malformation. The facial sculpting reconstruction has been performed to visualise the ante mortem appearance of the cleft face. Besides, δ¹³C and δ¹⁵N isotope analysis was used for a comparative study of the diet of the cleft individual. It has been established that a young man from Altai was affected by complete bilateral cleft lip and alveolus, which is a very rare form of typical OC. This defect is associated with dental anomalies such as hypodontia, microdontia, and ectopia as well as with dysmorphology of the facial complex outside the cleft area, including mild hypertelorism, hypoplasia of nasal bones and antheroposterior maxillary deficiency. Furthermore, aplasia of the frontal sinuses and the sacral spina bifida occulta have been observed. These findings are consistent with clinical data indicating strong correlation between development of a major defect and multiple minor anomalies. The results of the study also suggest that there was tolerant attitude towards the facial deformities among the ancient Altai pastoralists. Copyright © 2016 John Wiley & Sons, Ltd.     

Stafne's defects in two mandibles from archaeological sites in Croatia

Salivary gland inclusions in the mandible are relatively uncommon in recent as well as archaeological populations. This condition is well known to oral surgeons, but less so to anthropologists, osteologists and skeletal biologists. At present a limited number of reports pertaining to this condition in ancient populations are available in anthropological and palaeopathological literature, although scattered reports of cases in recent populations are found in dental journals. This paper analyses the prevalence of Stafne's bone defect in a large composite Croatian archaeological series (n = 4250 mandibles), and reports on two cases in which computerised tomography was performed, in order to draw the attention of anthropologists, osteologists and skeletal biologists to this condition when faced with differential diagnosis of odontogenic lesions, cysts and neoplasms in the area of the angle of the mandible. Copyright © 2009 John Wiley & Sons, Ltd.     

An investigation of historical and archaeological evidence for age‐related bone loss and osteoporosis

A growing awareness of the problems caused by osteoporosis‐related fractures has led to increased investigation of the condition in past populations. The present study seeks to examine the ways in which osteoporosis‐related fractures may be explored through different approaches; modern clinical information, historical records of fractures and analysis of archaeological bone may provide fuller information on the condition. The three types of fractures upon which this study focuses are fractures of the femoral neck, Colles' fractures and vertebral compression fractures. The results of the investigation clearly demonstrate the way in which the various sources produce a slightly different picture of the condition. The archaeological significance of the different types of fractures was found to be the reverse of that which would be suspected in the light of information derived from historical sources and the clinical literature. To date vertebral crush fractures have been the most commonly found osteoporosis‐related fracture in archaeological material, but their significance to people in the past is likely to have been minimal. In contrast hip fractures have rarely been reported from archaeological bone material, but historical information makes it clear they were well known, and knowledge derived from clinical sources emphasizes the serious consequences of such a fracture for the affected individuals. The results indicate the value of undertaking a multi‐disciplinary approach where possible. Copyright © 2002 John Wiley & Sons, Ltd.