Osteological and Biomolecular Study of Two Possible Cases of Hypertrophic Osteoarthropathy from Mediaeval England

Two skeletons from Mediaeval Wharram Percy, England, show osteological lesions consistent with hypertrophic osteoarthropathy. The primary cause of hypertrophic osteoarthropathy is generally chronic pulmonary disease, usually either cancer or infection; in the pre-antibiotic era it was predominantly the latter. Biomolecular analyses indicate the presence of Mycobacterium tuberculosis DNA in one of the specimens, strongly indicating that pulmonary tuberculosis was the eliciting factor in this case. This is the first time that a primary cause for hypertrophic osteoarthropathy has been firmly identified in an ancient skeleton and illustrates the potential of a dual approach using both osteological and biomolecular techniques for enhancing our understanding of early disease. The other specimen proved negative for M. tuberculosis complex DNA, however the presence of infectious rib lesions allowed us to suggest that some non-tuberculous pulmonary infection was likely the primary cause of hypertrophic osteoarthropathy in this case.     

Death of a President and his Assassin—Errors in their Diagnosis and Autopsies

On July 2, 1881, Charles Julius Guiteau shot President James Abram Garfield in the right flank. The President died because of infection produced by the unsterile fingers and probes repeatedly inserted into the wound. The major complaint of the wounded President was intractable pain in his legs and feet. This symptom failed to alert the doctors to the possibility of vertebral and spinal cord injury. Garfield died with sepsis after 80 days of intense national concern, and for the patient there was psychological, physical, and nutritional deprivation. His autopsy revealed the bullet was not in the pelvis as his doctors had expected, but adjacent to the first lumbar vertebra it had shattered. The trial and execution of Guiteau split the medical community into those that considered him insane and those who felt execution was justified. Guiteau was delusional and his brain revealed chronic inflammation and histological features suggestive of syphilis. At the time, and since, the propriety of the execution has been questioned.     

Death of a president and his assassin--errors in their diagnosis and autopsies

On July 2, 1881, Charles Julius Guiteau shot President James Abram Garfield in the right flank. The President died because of infection produced by the unsterile fingers and probes repeatedly inserted into the wound. The major complaint of the wounded President was intractable pain in his legs and feet. This symptom failed to alert the doctors to the possibility of vertebral and spinal cord injury. Garfield died with sepsis after 80 days of intense national concern, and for the patient there was psychological, physical, and nutritional deprivation. His autopsy revealed the bullet was not in the pelvis as his doctors had expected, but adjacent to the first lumbar vertebra it had shattered. The trial and execution of Guiteau split the medical community into those that considered him insane and those who felt execution was justified. Guiteau was delusional and his brain revealed chronic inflammation and histological features suggestive of syphilis. At the time, and since, the propriety of the execution has been questioned.     

Ancient-DNA reveals an Asian type of Mycobacterium leprae in medieval Scandinavia

Leprosy is a chronic infection of the skin and peripheral nerves caused by the pathogen Mycobacterium leprae. Its impact on human populations and societies of the past as well as its phylogeographic patterns around the world – at least in modern times – has been well documented. This slow growing bacterium has been shown to exist in distinct ‘SNP types’ that occur in relatively defined parts of the globe. The routes that the disease followed in the past are, however, still uncertain. This study of ancient-DNA typing of archaeological human remains from Sweden dated to early Medieval times provides genetic evidence that a transmission of M. leprae ‘SNP subtype’ 2G – found mainly in Asia – took or had already taken place at that time from the Middle East to Scandinavia. This finding is unique in the history of leprosy in Europe. All human specimens from this continent – both modern and ancient – that have been tested to date showed that the one responsible for the infection strains of M. leprae belong to ‘SNP type’ 3, whereas our results show that there were some European populations that were hosts to bacteria representing ‘SNP type’ 2 of the species as well.     

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.     

Maxillary Sinus Infection in a 19th‐Century Almshouse Skeletal Sample

In 1984, the Monroe County Parks Department in the Highland Park section of Rochester, New York, accidentally unearthed part of an unmarked cemetery while landscaping. The cemetery was in use from approximately 1826 to 1863 and was associated with the Monroe County Almshouse. Anthropological examination of dental and skeletal pathology revealed a high incidence of dental infection, known to occasionally be a causal agent of maxillary sinus infection. Therefore, maxillary sinus infections in this sample were studied to ascertain their relationship with dental infections, sex, and age at death. The maxillary sinuses of 99 skeletons were examined for evidence of infection. The presence, location, type and extent of dental infections in the posterior teeth were also recorded. Half the sample exhibited bone remodelling in the maxillary sinus (54 individuals). Dental infections were observed in 82 individuals. Forty‐eight demonstrated signs of dental infection and maxillary sinusitis. Statistical analysis revealed that dental infection and maxillary sinus infection were not statistically related. Rather, a rhinogenic method of infection seems likely, which would appear related to the squalid air quality the 19th‐century poor were exposed to in the almshouse and city tenements. Copyright © 2016 John Wiley & Sons, Ltd.     

Porotic lesions in immature skeletons from Stara Torina,late medieval Serbia

Porotic lesions of immature skeletons have been attracting scientific attention for more than a century. These changes have been documented worldwide and are considered to be one of the indicators of health and/or nutritional status of past human populations. These lesions have frequently been referred to as a nutritional stress indicator, a manifestation of iron‐deficiency anaemia, and a condition caused by chronic infections. In this study, 327 immature skeletons from the medieval graveyard of Stara Torina (Serbia) were examined for macroscopic signs of four types of porotic lesions: cribra orbitalia, femoral cribra, humeral cribra, and porotic hyperostosis. Femoral cribra was observed in 83.25% of femora, humeral cribra in 58.46% of cases, cribra orbitalia in 46.12% of orbits, while porotic hyperostosis was recorded in only 2.94% of skulls. The majority of skeletons affected by cribra presented symmetrical lesions. Association between all types of cribra was recorded in 33.33% of skeletons. Historical data supported the hypothesis that the investigated population was exposed to frequent infections, especially parasitic ones, which led to the development of porotic bone lesions via several mechanisms: parasite‐induced blood loss and diarrhoea (both iron and magnesium malabsorption) or anaemia as a hepcidin‐mediated body adaptive response to infection. Copyright © 2008 John Wiley & Sons, Ltd.     

Social Movements and the Politicization of Chronic Poverty

Discussions of chronic poverty emphasize the extent to which poverty endures because of the social relationships and structures within which particular social groups are embedded. In this sense chronic poverty is a socio‐political relationship rather than a condition of assetless‐ness. Understood as such, processes of social mobilization become central to any discussion of chronic poverty because they are vehicles through which such relationships are argued over in society and potentially changed. This article explores the ways in which social movements, as one form of such mobilization, might affect chronic poverty. Four domains are discussed: influencing the underlying dynamics of the political economy of poverty; challenging dominant meanings of poverty in society; direct effects on the assets of the poor; and engaging with the state. The inherent fragilities of social movements limit these contributions, the most important of which is to destabilize taken‐for‐granted, hegemonic discourses on poverty and its reduction.     

Serial craniectomies for intracranial infection 5.5 millennia ago

A skull found in a burial cave near Jericho with evidence of craniectomies dating approximately 5500 years ago had signs of frontal sinusitis and intracranial infection. The location of the three craniotomies in the frontal bone of this skull and evidence of the infection bursting from the sinus intracranially suggest that this is the oldest known cranial surgery performed due to symptoms of a medical aetiology : epidural infection.     

Marital instability in a rural population in south-west Uganda: implications for the spread of HIV-1 infection

"The aim of this study was to examine people's beliefs about the causes of marital instability in a rural population cohort in south-west Uganda. Results from a baseline survey of HIV-1 infection in the cohort of over 4,000 adults (over 12 years old) showed a twofold increase in risk of infection in divorced or separated persons when compared with those who are married. A purposive sample of 134 respondents (seventy-two males, sixty-two females) selected to represent different ages, religions and marital status were asked in semi-structured interviews to comment on the reasons for continuing marital instability in their community. The most common reasons suggested for marital instability were sexual dissatisfaction, infertility, alcoholism and mobility....HIV infection was not mentioned as a direct cause of separation, but a small independent study revealed that seven out of ten couples separated on learning of a positive HIV test result of one or both partners. Marital instability is not uncommon in this population; there is evidence that HIV infection is making the situation worse." (SUMMARY IN FRE)     

HEALTH SELECTION EFFECTS IN CHINA'S INTERNAL MIGRATION

Drawing data from the 2008 survey of Internal Migration and Health in China, we compare various health indicators among current rural-to-urban migrants, rural residents who never migrated, return migrants, and urban citizens. Two health-selective mechanisms, the healthy migrant hypothesis and the salmon bias hypothesis, are empirically tested. Results provide empirical support to both these hypotheses. After controlling for individual's age, sex, socioeconomic status and major health-related behaviours, current rural-to-urban migrants are still better off than rural residents who never migrated regarding their self-rated general health, chronic diseases, self-perceived physical discomfort and lung capacity. Current rural-to-urban migrants are also less likely to have chronic diseases or to report physical discomfort than return migrants. Except for self-reported chronic diseases and abnormally high heart rate, there is no significant difference between rural-to-urban migrants and urban residents regarding the health measures used in this study.     

A possible case of ‘poll‐evil’ in an early Scythian horse skull from Arzhan 1, Tuva Republic,Central Asia

Occipital bone lesions on an Iron Age horse cranium from the burial mound of Arzhan 1, Tuva, Central Asia, are described and interpreted. Cavitations around the nuchal ligament attachment site on the skull are interpreted as foci of inflammation and necrosis following local infection. It is suggested that the pathology represents a case of ‘poll‐evil’, most likely due to a bacterial infection. The significance of such an interpretation is discussed, including its implications for disease ecology and the possible infection risks to contiguous animal and human communities of the first millennium BC in Central Asia. Copyright © 2009 John Wiley & Sons, Ltd.     

Two cases of facial involvement in probable treponemal infection from late prehistoric coastal North Carolina

This paper describes two late prehistoric burials from coastal North Carolina with cranial and postcranial lesions characteristic of treponemal infection. Each case exhibits facial lesions consistent with clinical reports of treponemal infection, but which have not previously been documented in these populations. The suite of facial lesions in one case and a mandibular lesion in the other serve to illustrate the variability inherent in treponemal infections. © 1998 John Wiley & Sons, Ltd.     

Cribra orbitalia and cribra cranii in Roman skeletal remains from the Ravenna area and Rimini (I–IV century AD)

Cribra orbitalia and cribra cranii are considered good indicators of the health and nutritional status of ancient populations, as their presence is often associated with chronic acquired anaemia. The distribution of these lesions in two Roman samples from the Ravenna area and Rimini was considered as a measure of health in relation to their respective environments. Enamel hypoplasia was also assessed as it is symptomatic of childhood physiological stresses such as malnutrition, infectious diseases, physiological traumas, and the like. The differential analysis suggests that the lesions observed are due to chronic acquired anaemia, probably caused by a poor diet, worm infestation, infections and parasitic diseases. Copyright © 2004 John Wiley & Sons, Ltd.     

The rise and decline of tonsillectomy in twentieth-century America

This article explores the rise and decline of tonsillectomy/adenoidectomy (T&A) in twentieth-century America. Between 1915 and the 1960s, T&A was the most frequently performed surgical procedure in the United States. Its rise was dependent on novel medical concepts, paradigms, and institutions that were in the process of reshaping the structure and practice of medicine. The driving force was the focal theory of infection, which assumed that circumscribed and confined infections could lead to systemic disease in any part of the body. The tonsils in particular were singled out as "portals of infection," and therefore their removal became a legitimate therapy. Nevertheless, what kinds of evidence could prove that tonsils were portals of infection? How could the effectiveness of tonsillectomy be determined? An inherent difficulty was the absence of any consensus on the criteria that would be employed to judge its efficacy. Yet tonsillectomy persisted despite ambiguous supportive evidence. Although criticisms of the procedure were common by the 1930s, its decline did not begin until well after 1945 and involved debates over the nature of evidence, the significance of clinical experience in the validation of a particular therapy, and the role of competing medical specialties.     

An analysis of chronic osteomyelitis of the tibia in a pre-columbian human population using radiographic–pathological correlation

Radiologic-pathologic correlation is employed in pre-Columbian tibia specimens as a means of understanding the characteristic alterations induced by untreated chronic osteomyelitis.     

A history of transboundary storm water flows: flooding,tunnels, and the spatial incongruity of the U.S.–Mexico border

The benefits of transnational flows and the concern for national security have framed development in the U.S.–Mexico borderlands since the formative beginnings of both nations. As national discourses, trade and security work against each other in borderland spaces, the former requiring openings in the border, the later seeking to control it. This paper considers the material implications of these discourses on the border landscape with particular attention to historical boundary development, urbanization, and impacts of chronic flooding. It argues that material discursive dynamics not only constitute the contemporary landscape, but create spatial incongruities that influence the impacts of natural processes, such as storm water flow. Using the southern Arizona border as a case study, the paper uses archival research to explore the historical geography of chronic flooding in the twentieth century and the shift in dynamics of flooding due to border boundary build up.     

ON FUTURES AND ENDINGS: NARRATOLOGICAL REFLECTIONS ON CONTEMPORARY FORMS OF CRISES*

The article examines the changing relationship of the present to the future from a narratological perspective. It argues that three dominant narrative schemas structure the contemporary experiences of temporality in the Western social imaginary: the modern crisis narrative, the apocalyptic narrative, and the chronic crisis narrative. In its first part, the article shows how the modern sense of crisis, which emerged in the late eighteenth century, sedimented into a powerful narrative template by knitting together the past, the present, and the future into a unified plot. The second part focuses on the resurgence of apocalyptic stories in the Western social imaginary and humanities discourse. The final part highlights the special contribution of aesthetics of precariousness to the Western imaginary of time and temporality. It argues that the “chronic crisis narrative” deflates the teleological narrative arc of the modern crisis paradigm while also shunning the end-time discourse of the apocalyptic narrative.     

Engaging in the disablement process over space and time: narratives of persons with multiple sclerosis in Ottawa, Canada

This article presents an interpretive analysis of the narratives of 15 men and women who have been diagnosed with multiple sclerosis (MS) living in the city of Ottawa, Ontario, Canada. Relatively little is known about how people who are affected by MS cope with the challenges posed by social and physical barriers in their environment. Our research investigates two objectives: (1) to explore how those who have developed MS cope with their disease and resulting impairments, both in terms of the bodily experiences of becoming a chronically ill person and in terms of how they cope with changing relationships, changing identities and challenges in their physical environment; and (2) how they engage in the process of disablement over time and space as a result of these changing social and spatial relationships. We argue that the physical body and its social placings in public and private spaces are intertwined and both affect experiences of health, ability, impairment, disability and chronic illness. We further argue that these relationships are experienced across time and space, and in place, as people who have developed a chronic illness, such as MS, engage in, with and through the process of disablement. This article demonstrates the need for researchers to pay more attention to the role and significance of the simultaneity of space, place and time in shaping the experiences of people with disabilities and chronic illnesses, as it has been shown that these variables played a significant role in regulating the everyday experiences of this study's respondents.     

Knee Ankyloses Associated with Tuberculosis from the Medieval Hungary – Differential Diagnosis Based on Medical Imaging Techniques

Osseous ankylosis of large joints that occurs secondary to infection is rarely described in developed countries, thanks to diagnostic techniques that allow early detection and treatment of the underlying infection. Evidence of the natural history and progression of the disease is now primarily studied through the observation and analysis of osteoarcheological specimens, and medical reports or books dating from the pre‐antibiotic era. This report illustrates several cases where modern medical imaging techniques and ancient medical literature were successfully interpreted to diagnose rare, advanced‐stage tuberculous alterations in osteoarcheological specimens. Two skeletons from the Bátmonostor cemetery (Hungary) demonstrate complete unilateral ankylosis of the knee. Macroscopic and radiographic examinations were undertaken to assess the extent of skeletal changes and determine their cause. Data obtained from computed tomography (CT) were constructed in 2D and 3D. The 2D CT images revealed cavities involving both the metaphyses and the epiphyses. The 3D reconstructions allowed us to reconstruct the more precise volumetric morphology of the circumscribed lytic lesions, as well as clear ‘image‐mirror’ lacunar volumes. On the basis of the macroscopic and radiological analyses, extra‐spinal tuberculous infection seems to have been the most probable etiology of these two cases. Copyright © 2012 John Wiley & Sons, Ltd.