Stable isotope analysis of a medieval skeletal sample indicative of systemic disease from Sigtuna Sweden

In Sigtuna, Sweden, several medieval cemeteries have been excavated, from which approximately 800 skeletons have been excavated and analysed. Archaeological finds and anthropological analyses have exposed social differences between the cemeteries. Stable isotope analyses have shown that the inhabitants of the town consumed a mixed diet. Significant differences in dietary patterns between the cemeteries may be related to social stratification.In the outskirts of a churchyard excavated in 2006, bone changes showing systemic inflammatory disease indicative of leprosy were observed in six individuals. The burial location suggests that the affected belonged to a lower social stratum. Bone samples were taken from these six individuals, 19 other human skeletons and five animals from the same cemetery for analysis of the stable isotope composition of carbon (C), nitrogen (N) and sulphur (S).The results showed no significant differences in δ¹³C and δ¹⁵N values between the groups, i.e. the seemingly healthy humans and the humans affected by severe inflammatory disease appear to have had similar diets. Nor was a significant difference observed in δ³⁴S data between the six affected individuals and the rest of the sample, implying that no difference in origins could be observed between the two groups studied. However, a comparison between the present study and the previous analysis resulted in significant differences in carbon values.Based on the results obtained in this investigation it is suggested that if a dietary difference existed between people in the outskirts of a cemetery (for example those suffering from leprosy) and people buried in higher ranked regions, it was not a difference in food source but rather in other parameters. Instead dietary differences and possibly social variations are demonstrated between cemeteries. The results from the present study highlight the hierarchical arrangements of social classes in the early medieval society.     

Pre-Columbian treponematosis in medieval Britain

There has been much debate regarding the origins of treponemal disease and, in particular, acquired syphilis. Greater numbers of skeletons with apparently diagnostic bone lesions in the New World than in the Old have given rise to the postulate, particularly advanced by American workers, that the disease originated there prior to AD 1492 and was carried back to the Old World by Columbus's sailors. This paper presents evidence for the presence of treponemal disease in medieval Norwich prior to AD 1492, however. The dating of the site is good and the skeleton concerned comes from a well-sealed context. Others in the group have similar lesions and there are four individuals with evidence of leprosy. All were buried in a communal cemetery. The individual has widespread, bilateral, florid periostitis, especially of the tibiae and fibulae, and the radiographic changes support the diagnosis of treponemal disease. Differential diagnosis and geographical situation suggest that this skeleton displays evidence of syphillis.     

Leprosy in a skeleton from the 7th century necropolis of Vicenne‐Campochiaro (Molise,Italy)

Analysis of the skeleton from tomb 144 of the early medieval necropolis of Vicenne‐Campochiaro in Central Italy revealed several features indicative of leprosy. The skeleton belongs to a male estimated to be between 20 and 25 years of age at death. The distal halves of the 1st and 2nd left metatarsals present acro‐osteolysis and both legs show severe subperiosteal bone reaction. The facial skeleton shows changes compatible with a chronic inflammatory process, possibly due to an infectious disease. The anatomical distribution of the lesions and their association with other skeletal lesions seems to be compatible with a near‐lepromatous form of leprosy. A differential diagnosis is made, and the skeletal traits pathognomonic of leprosy are discussed. Copyright © 2005 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.     

The treatment of leprosy in 19th‐century London: a case study from St Marylebone cemetery

A young adult male, context [825], exhibiting a suite of proliferative and erosive skeletal changes, was excavated from the old burial ground of St Marylebone, London, in 2005 by the Museum of London Archaeology Service (MoLAS). Although pathognomonic rhinomaxillary changes were absent, a number of lesions were of a type previously recorded in individuals suffering from lepromatous leprosy, including resorption of the alveolar process of the maxillae and the digits of the right hand, osteomyelitis in the left ulna and collapse of the left ankle. Whilst this infectious disease was widespread in medieval Britain, it had declined by the 19th century, and has been identified in only one other post‐medieval archaeological context. The right leg of [825] had been surgically amputated. This form of intervention was a recognised treatment for the complications of the disease, where neuropathic damage of limbs led to life‐threatening infection. The healing of the amputation demonstrates the success of the operation, and the skill of the surgeon. Although the identity of the affected individual is unknown, burial within St Marylebone cemetery implies a level of status not frequently associated with leprosy sufferers in the past. Copyright © 2008 John Wiley & Sons, Ltd.     

Chronic Maxillary Sinusitis in Medieval Sigtuna,Sweden: A Study of Sinus Health and Effects on Bone Preservation

Frequencies of maxillary sinusitis in the population of the medieval town Sigtuna, Sweden, were examined. The first aim was to explore the occurrence of sinus conditions in this urban population, and the second was to investigate the effects of preservation in relation to these changes. The skeletal sample consisted of 274 adolescent and adult individuals buried ca 970–1530 AD. The maxillary sinuses were examined for different types of skeletal change related to sinusitis. The severity and location of these changes were recorded, together with the preservation of the sinus. When the diagnostic criteria for bone preservation from previous studies was used, i.e. the preservation of at least one complete antral floor, the results showed that 97.7% (n = 157) of the individuals were affected, with older individuals showing more severe bone changes. In the entire (i.e. more fragmented) sample, 94.5% (n = 259) showed signs of sinusitis. Again, older individuals showed more severe bone changes, and males were more frequently affected. Also, an increased frequency over time was found. The maxillae were subdivided into groups of bone preservation, and the results showed that there was a significant relation between preservation and the registered presence and severity of sinusitis. The results may be used as a cautionary note against investigating the occurrence of maxillary sinusitis without considering the skeletal preservation factor. There was no correlation between preservation and sex or age groups. This suggests that the differences between younger and older and male and female were not a result of preservation alone and could be considered as trustworthy. Copyright © 2011 John Wiley & Sons, Ltd.     

Metastatic carcinoma in a leper skeleton from a Medieval cemetery in Chichester England

Both leprosy and metastatic cancer are well documented in the literature on human skeletal palaeopathology. The manifestation of both pathological conditions in a single archaeological skeleton has not been reported. A case from a Medieval site in Chichester, England exhibits bone lesions and patterns of skeletal involvement indicative of both these diseases. Evidence of leprosy is largely restricted to the lower tibiae, fibulae and the bones of the feet. Fine destructive foci and reactive fibre bone associated with metastatic cancer are distributed in many of the remaining areas of the skeleton. There is minimal overlap in the areas of the skeleton involved in the two pathological processes.     

Two cases of leprosy from Žatec (Bohemia), dated to the turn of the 12th century and confirmed by DNA analysis for Mycobacterium leprae

The leprosy known today primarily from tropical areas was a relatively common disease in European Middle Ages. This article describes two skeletons bearing palaeopathological indications of leprosy from a cemetery at ?atec in North-West Bohemia (Czech Republic). The archaeological context clearly shows that these individuals were buried prior to the second decade of the 12th century, and most probably in the second half of 11th century. This rules out the possibility that these individuals might have contracted the disease in connection with the Crusades, in which a Bohemian contingent under Prince Vladislav II participated from 1141 to 1142. Molecular genetic methods were applied to detect specific DNA fragments of the causative agent of leprosy, Mycobacterium leprae. The nasal concha of one individual yielded DNA that could be directly sequenced after isolation and amplification. The vertebral body of the second individual, on the other hand, did not provide DNA of sufficient quality for direct sequencing and only weak amplification was detectable. The morphological and genetic analyses both indicate that leprosy existed prior to the Crusades in medieval Bohemia, albeit that its prevalence was probably not as great as in northern or western Europe.     

The First Evidence for Leprosy in Early Mediaeval Scotland: Two Individuals from Cemeteries in St. Andrews,Fife, Scotland,with Evidence for Normal Burial Treatment

The study of skeletal material recovered from excavations at two distinct early mediaeval cemeteries in St. Andrews, Scotland, resulted in the diagnosis of one individual from each cemetery as having had facies leprosa (leprosy). Radiocarbon dating gave a likely date in the 8th century ad for the Hallow Hill skeleton, and the Kirkhill skull was probably from the same period. Both skulls displayed the full range of classic signs of facies leprosa. The bone changes were slightly different in the two, the maxillary alveolus having been more severely affected in the Hallow Hill skull, whereas the posterior palatal area showed greater damage in the skull from Kirkhill. The skeletons were not segregated but buried in the middle of cemeteries used for the general population, thus supporting previous research in both the history of medicine and human bioarchaeology that suggests that people with leprosy were not necessarily stigmatised in the past. Copyright © 2011 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.     

Multiple Cases with Probable Treponemal Infection from 16th to 19th Centuries Romania

In this paper, we describe pathological lesions identified in seven skeletons discovered in the Saint Sava necropolis in Bucharest, Romania, dating to the Late Medieval/Early Modern period. The pathological changes observed in the skeletons were analysed using macroscopic examination. Additionally, computed tomography scanning was performed on two individuals displaying advanced lesions on the cranial surface. For the differential diagnosis, we took into consideration treponemal infection, tuberculosis, osteomyelitis, leprosy, fluorosis, melorheostosis, hypertrophic pulmonary osteoarthropathy, Paget's disease and mycotic infection, along with the possibility of multiple afflictions occurring simultaneously. The morphology and distribution of the lesions are suggestive of treponematosis, which, to our knowledge, makes this the first case of this disease on the Romanian territory in archaeological populations. Copyright © 2015 John Wiley & Sons, Ltd.     

Reconstruction of Socioeconomic Status in the Medieval (14th–15th Century) Population of Grevenmacher (Luxembourg) Based on Growth,Development and Diet

Numerous historical sources describe many aspects of the estate‐based society in medieval times; the detection of socioeconomic status within populations through skeletal remains is a topic of growing interest in anthropological studies. In medieval times, it was common for members of high social rank to be buried within or next to a church. This was certainly the case in Grevenmacher (Luxembourg), where remains of a church building and an adjacent cemetery from the 13th until the beginning of the 15th century were subjected to archaeological and anthropological analysis. By integrating archaeological and anthropological elements, as well as stable isotope analysis, we documented osteological manifestations as indicators of diet differentials in two subsamples (first group consists out of 56 individuals, second one out of 184 individuals) from the medieval cemetery of Grevenmacher. We could distinguish two subsamples that we assumed as different in their socioeconomic status with regards to the burials' position in the cemetery and burial characteristics. Differences in osteological traits such as bone length, stature and body mass indicated differences in diet between sample groups. To substantiate these outcomes, stable isotopic analysis (δ¹³C, δ¹⁵N) were made; the results displayed a clear separation between the sample groups on the basis of their diet. Therefore, we were able to confirm certain individuals in the medieval population of Grevenmacher in relationship to their socioeconomic status. Copyright © 2017 John Wiley & Sons, Ltd.     

Leprosy at the Lazaretto on St Eustatius,Netherlands Antilles

Leprosaria established in the Americas during the Colonial period bear many similarities with those found in medieval Europe. They are comparable in terms of isolation, the objectification of leprosy sufferers and their association with religious charities. The Lazaretto on St Eustatius was operated from 1866 to 1923. The site was investigated to recover palaeopathological evidence of leprosy at a leprosarium in the Americas. Five burials were excavated; three individuals showed evidence of bone modifications consistent with those caused by leprosy, including aspects of ‘rhinomaxillary syndrome’ and the bilaterally symmetrical post‐cranial changes that have been described in leprosy examples from medieval Europe. An exceptional find was the presence of potentially leprous bone changes to the hyoid, thyroid and 3^rd–6^th cervical vertebrae. Copyright © 2007 John Wiley & Sons, Ltd.     

Pre‐Columbian Tuberculosis in Northwest Argentina: Skeletal Evidence from Rincón Chico 21 Cemetery

Systematic excavation of collective burial sites makes possible the recovery of skeletal series which may show bony evidence of infectious pathological conditions. This paper presents the first evidence of the existence of tuberculosis in prehistoric populations of NW Argentina with a subsistence economy based on agriculture and pastoralism. The study was carried out on individuals from Rincón Chico 21 cemetery, a burial site located in the Santa María Valley, Catamarca, used between the Late Ceramic Period and the onset of the Inca empire expansion (AD 1000–1400). Six individuals out of the 70 so far excavated showed destructive lesions in the vertebral bodies and periosteal reactions in other bones. The morphology and distribution of bone lesions led us to rule out several diseases from a broad spectrum of possible diseases that could have affected the skeletal system. Thus, the lesions were interpreted as caused by mycobacterial infections (Mycobacterium tuberculosis Complex). Considering previous studies on the dynamics of biocultural interactions which take into account information related from contextual associations and chronology, we can conclude that a tuberculosis‐like disease was present in prehistoric populations from NW Argentina. Copyright © 2011 John Wiley & Sons, Ltd.     

Signs of sinusitis in times of urbanization in Viking Age-Early Medieval Sweden

The influence and possible negative impact on sinus health of living conditions in rural and urban environments in Viking Age (AD 800–1050) and Early Medieval Sweden (AD 1050–1200) is investigated. Skeletal samples from 32 rural settlements in the Mälaren Valley (AD 750–1200) and burials in the nearby proto-urban port of trade Birka (AD 750–960) are examined. Based on the diagnostic criteria for maxillary sinusitis used in earlier studies, the results show that there is no significant difference in the prevalence of signs of sinusitis between the two materials (i.e. the Mälaren Valley versus Birka). Consequently, this provides no evidence that living in a proto-urban environment had a negative impact on sinus health. However, when compared with previously studied samples from the early medieval town Sigtuna, dated to AD 970–1100, the populations of the Mälaren Valley and Birka show significantly lower frequencies of bone changes interpreted as chronic maxillary sinusitis (95%, 70% and 82% respectively). This implies that the urban environment of Sigtuna could have led to impaired sinus health. There is also a significant difference between males and females in the Birka material, in which more females (100%) than males (68%) were affected. A gender based differentiation in work tasks is suggested by this, or exposure to environmental risk factors that affect sinus health. No difference between males and females could be detected in the samples from the Mälaren Valley and Sigtuna.     

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.     

Periostitis and osteolysis in a medieval skeleton from South‐West Hungary: (Leprosy,treponematosis, tuberculosis or hypertrophic osteoarthropathy) A diagnostic challenge!

This paper uses macroscopic and radiological examinations to provide differential diagnoses of pathological lesions in the well‐preserved skeleton of a young male from the medieval site of Zalavár in South‐West Hungary. Macroscopic inspection of the skeleton revealed conspicuous thickening of the tibiae and fibulae with ‘tree bark’ appearance of the cortex. Periosteal proliferations are also found on the calcanea and on the posterior part of the femora. The metatarsals showed bony proliferation and bone dissolution. No alteration of the axial skeleton or the skull was noted. Radiographs showed thickening of the cortex of tubular bones due to a multilayered type of periosteal apposition. The likelihood of these symptoms being the result of melorheostosis, hypervitaminosis A, fluorosis, thyroid acropachy, endosteal hyperostosis, tuberculosis (TB), hypertrophic osteoarthropathy (HOA), treponematosis and leprosy is reviewed. None completely explains the entire spectrum of pathological lesions in the current individual, but the individual may have suffered from two co‐existent diseases. As a clinical entity, the changes in the metatarsals are compatible with leprosy, whereas the periosteal proliferations of the lower limbs point to a diagnosis of HOA as a secondary syndrome. Thus, a combination of leprosy and TB is suggested as a potential diagnosis. Although not definitive, our differential diagnosis was able to exclude a number of conditions producing periosteal apposition. Copyright © 2011 John Wiley & Sons, Ltd.     

New regression equations for stature estimation for medieval Scandinavians

Estimating stature from skeletal remains in an archaeological context requires appropriate methods that take into account possible temporal and spatial changes in body proportions. New regression equations—both least squares (LSQ) and reduced major axis (RMA) equations—were thus developed for estimating living stature from the long bone lengths of medieval inhabitants (N = 60) of Westerhus, Sweden. The living stature of these skeletal specimens was determined by using the anatomical method. Findings in this study reveal that LSQ regression equations systematically overestimate statures of short individuals and underestimate those of tall individuals, whereas the RMA equations—both combined sexes and sex‐specific equation—provide more accurate stature estimations for individuals of very different statures. The combined sexes RMA‐equations should be used for cases in which the sex is unknown because they provide more accurate stature estimations than sex‐specific equation with a wrong sex determination. These new equations are more appropriate than generally used regression equations for estimating statures of the medieval period Scandinavians. Copyright © 2009 John Wiley & Sons, Ltd.