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.     

A case of treponematosis from pre‐Columbian Chaco Canyon,New Mexico

Although numerous cases of treponemal infection have been identified in prehispanic New World skeletal remains, none has been reported from Chaco Canyon, New Mexico. Chaco Canyon was the epicentre of a broad culture system that spanned the Four Corners region of the pre‐Columbian Southwestern United States. A burial recovered from the central Great House of Chaco Canyon, Pueblo Bonito, exhibits lesions indicative of treponematosis. However, the pathological condition of this individual has heretofore been only tentatively diagnosed because the skeleton was collected from a commingled context and distributed across four separate catalogue numbers. Now reassociated, these remains exhibit a pattern of pathological changes strongly indicative of treponemal disease. This case not only adds to the growing body of literature on the clinical expression and geographic distribution of pre‐Columbian treponematosis, but also demonstrates the utility of painstaking reassociation of commingled human remains. Copyright © 2009 John Wiley & Sons, Ltd.     

A case study of possible differential diagnoses of a medieval skeleton from Denmark: leprosy,ergotism, treponematosis,sarcoidosis or smallpox?

This paper uses macroscopic and radiological examinations to provide differential diagnoses of pathological lesions in the skeleton of a young woman, 20–25 years of age, which triggered the Danish palaeopathologist Vilhelm Møller‐Christensen's interest in leprosy. The skeleton was incomplete, but the majority of bones of the upper body, as well as the skull, were present. The pathological changes consisted of medullary and cortical lytic foci, periosteal reaction and enhanced cortical density. The lesions were most extensive on the left side, especially around the elbow, wrist and scapula. Treponematosis, leprosy, smallpox, ergotism, rheumatoid arthritis, tuberculosis and sarcoidosis are all reviewed with regard to bone and joint pathology and their likelihood of being the correct diagnosis. We concluded that the most plausible diagnosis is treponematosis, but neither sarcoidosis nor smallpox can be completely excluded. Copyright © 2007 John Wiley & Sons, Ltd.     

Ossified haematomas and infectious bone changes on the anterior tibia: histomorphological features as an aid for accurate diagnosis

Examination of the histological structure of bone not only helps investigators to estimate age at death but can also aid in the diagnosis of palaeopathological lesions. The purpose of this paper is to assess whether histological features as described in the literature can confirm the macroscopic diagnoses of ossified subperiosteal haematomas associated with healed scurvy and syphilitic bone changes observed on the anterior tibiae of individuals from a 19th century mining community from Kimberley South Africa. The frequent occurrence of these two diseases amongst the deceased was well established in related hospital documents and governmental documents. A section of bone was removed from lesions on the tibiae of 14 individuals. These bone changes were macroscopically diagnosed as being indicative of either treponematosis ossified subperiosteal haematomas or non‐specific periostitis. Cross‐sections were prepared for microscopic investigation using a manual ground section technique. Ossified haematomas were histologically identified in seven individuals. These sections were characterised by normal cortical bone an intact original periosteal surface and newly formed radiating trabecular bone apposing it. Three phases of ossified subperiosteal haematoma formation and remodelling could be distinguished. Infectious bone changes most likely associated with treponematosis were observed in one individual. These were characterised by lysis and numerous resorption holes/channels. No clear distinction could be made between the internal spongy cortical or newly formed bone. Histological features described by some authors as characteristic of this condition could not be identified. In addition three individuals presented with microscopic features indicative of both the aforementioned bone affections and three did not show any pathological changes on microscopic level. It was concluded that although specific pathological conditions can most likely not be diagnosed purely on the basis of histomorphological observations broad distinctions could be made between lesions caused by the ossification of subperiosteal haematomas and bone changes due to infectious diseases. Copyright © 2009 John Wiley & Sons Ltd.     

A pre‐Columbian case of congenital syphilis from Anatolia (Nicaea, 13th century AD)

In this study, the skeleton of an approximately 15‐year‐old child, dating back to the Late Byzantine period (13th century AD) is examined with the aim of determining where this specimen fits in the continuing arguments on the origins of syphilis. It was unearthed during an excavation at an amphitheatre in Nicaea dating to the Roman period. The Nicaea specimen displays common symptoms found in the majority of people with congenital syphilis such as Hutchinson's incisor, mulberry molar, darkened enamel, radial scar on frontal bone, sabre tibia, syphilitic dactylitis, and gummatous and non‐gummatous osteomyelitis on almost every post‐cranial bone. Because of the sub‐periosteal new bone formation, the medullary spaces in some long bones are narrowed or completely obliterated. These lesions, which were observed via macroscopic and radiological examination, reflect the late stages of congenital syphilis. The specimen, when examined together with increasing numbers of other finds from the Old World, contributes to the argument that venereal syphilis did exist in the Old World before 1493, and brings forward the need to revise the Columbian hypothesis, which maintains that syphilis is a new disease carried to the Old World from the New World by Columbus' crew. Copyright © 2005 John Wiley & Sons, Ltd.     

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

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

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.     

Pre-Columbian congenital syphilis from the late antiquity in France

Today, exactly 500 years after the discovery of America, there is still a lot of controversy about the history of syphilis in Europe, especially about the Columbian and pre-Columbian hypotheses. This paper presents evidence for the presence of venereal treponematosis in the late Antiquity in France. The case that we examined comes from the necropolis of Costebelle (3rd-5th centuries AD; Hyères, Var, France). Grave no. 1 contained the well-preserved skeleton of a relatively old woman with the skeletal remains of an approximately 7-month-old fetus in her pelvic cavity. The osseous lesions of the fetal remains can be described in four groups: periosteal appositions on the skull vault (frontal and parietal); signs of periostitis on the long bones (bilateral cortical irregularities, predominantly on the left side, which affect first of all tibiae, femora, fibulae, radii and humeri, particularly in the metaphyseal region); some infraperiosteal detachment reminiscent of an infraperiosteal haematoma surrounding the distal extremity of the left forearm and the left hand; and finally, the irregular lesions of the humeral distal and proximal tibial metaphyses reminded us radiologically of Wimberger's signs. The most probable diagnosis of all the lesions mentioned above is that of a precocious congenital syphilis. This case consists of an argument against the epidemiological theories about the migration of Treponema pallidum from the New World back to the Old World starting at the end of the 15th century.     

A palaeopathological case of a right maxilla's cemento‐ossifying fibroma

Cemento‐ossifying fibromas (COFs) are rare benign tumours affecting the maxilla and the mandible. The COF, of nonodontogenic origin, consists of a heterogeneous mixture of bone tissues and cementum. The skeleton of burial 154 excavated from the site of Magnicourt‐ en‐Comté (Pas‐de‐Calais) has been studied palaeopathologically. The cemetery is dated from the Merovingian period (6^th–7th century AD) and included 262 burials. In this study, we focus on the differential diagnosis of cemento‐ossifying fibroma and other dyplastic and cystic lesions. Various macroscopic, radiological and histological aspects enable us to make a positive diagnosis of COF. Copyright © 2007 John Wiley & Sons, Ltd.     

Skeletal pathology of a high‐ranking official from Thrace (Turkey,last quarter of the 4th century BC)

A male human skeleton from Thrace dated at around 320 BC was found in a wealthy tomb 12 km from what is now Tekirdağ, Turkey. The occupant of the tomb died at the age of 40–45 years and has a pathologic left humerus caused most probably by traumatic injury. It is 9 cm shorter than the right humerus. A drainage fistula penetrating into the medullary cavity occurs at its proximal end. Due to severe arthritic destruction, the left humeral head has completely lost normal articulation, with the glenoid cavity of the left scapula displaying, in turn, severe erosive lesions and important reduction in its articular surface. A marked abscess is discernible bilaterally on the chondro‐costal sternal end. The individual also has a hip with a total sacroiliac joint fusion and shows slight or moderately developed exostoses on different parts of his skeleton. These joint destructions most likely indicate that he suffered from chronic osteomyelitis and septic arthritis. Copyright © 2005 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.     

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.     

Porotic hyperostosis in a Late Upper Palaeolithic skeleton (Villabruna 1, Italy)

Porotic hyperostosis (PH) is a well‐recognised skeletal indicator of physiological stress occurring during the early years of childhood growth. Although frequently found starting from the Neolithic, PH is poorly documented among earlier Palaeolithic hunter–gatherers. This study reports a case of PH in a Late Upper Palaeolithic skeleton (Villabruna 1) from northern Italy. Macroscopic and radiographic examinations of the skeleton show symmetric porotic lesions of the cranial vault, hair‐on‐end appearance, thinning of the cortical bone, diploic expansion and very slight cribra orbitalia (CO). All lesions are highly remodelled and suggest a condition suffered long before death. A differential diagnosis, carried out in order to discriminate between infectious and acquired conditions, points to anaemia as likely aetiology for the changes observed. Absence of postcranial involvement, lesion healing and survival to adulthood suggest a diagnosis of acquired anaemia. Among acquired anaemias, both dietary and infectious models are discussed in light of the individual's skeletal characteristics, as well as geographic location, paleoenvironmental data, subsistence modality and dietary information. The combined analysis of these data suggests that parasitic infestation resulted in megaloblastic anaemia in this individual. Copyright © 2009 John Wiley & Sons, Ltd.     

Secondary cancer in an Anglo-Saxon female

A mature/elderly female skeleton from the Anglo-Saxon cemetery at Eccles, Kent, is described. A diagnosis of Paget's disease of the left tibia is made. The macroscopic radiological features of perforating and non-perforating osteolytic lesions in the cranium and femora are described. The differential diagnosis is discussed. The lesions are considered to be due to metastatic carcinoma, possibly from a primary carcinoma of the breast. There is a brief resumé of other recorded examples of metastatic carcinoma in early skeletons.     

Bone remodelling following a lower leg fracture in the 11,000‐year‐old hunter‐gatherer from Vado all' Arancio (Italy)

The Upper Palaeolithic skeleton from Vado all'Arancio (Italy), dated to about 11,330 BP, exhibits a severe ankle fracture healed with residual deformation. Following recovery, this young hunter‐gatherer continued to walk for an extended period of time, albeit in a mechanically altered manner. While right‐left differences in external lower limb bone measurements are relatively low, biomechanical analysis of femur and tibia indicates unusually pronounced asymmetry in all cross‐sectional measures of diaphyseal strength. Asymmetry results primarily from normal side endosteal hypertrophy, and not from hypotrophy of the injured limb, suggesting that this individual resumed active life following recovery. This pattern of asymmetry underscores the role of physical activity in maintaining bone mass. Copyright © 2002 John Wiley & Sons, Ltd.     

Pathological Evidence in Newborn Children from the Sixteenth Century in Huelva (Spain)

Archaeological infant remains rarely appear in the palaeopathological literature; above all there are few references to neonatal individuals. This work presents four infant pathological specimens from the crypt of the Ermita de la Soledad (sixteenth to nineteenth century, Huelva, Spain). The bones analysed—one right hemifrontal, two humeri and a femur—belong to at least two individuals of between 0 and 6 months of age. The differential diagnosis of the lesions—mainly detachments of the outer layer of cortical bone, areas of juxtametaphysial osteolysis and epiphysial destructuralization—supports the hypothesis of an infectious aetiology, such as congenital treponematosis and haematogenous osteomyelitis, although illness caused by a deficiency, such as scurvy or rickets, cannot be ruled out.     

Fractures of the lower limbs and their secondary skeletal adaptations: a 20th century example of pre‐modern healing

This study focuses on an old male skeleton, which shows severe fractures of the right femur and of the left tibia and fibula. The skeleton, complete and in a good condition of preservation, comes from a Sardinian osteological collection (from the beginning of 1900 AD) with known age, sex and life‐activity. The features of the fractures and pattern of joint disease, enthesis development and enthesopathies have been studied in order to ascertain a possible cause for these traumatic events, the functional implications for postural and locomotory behavior and, finally, the eventual evidence of medical treatment. Copyright © 2004 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.     

Retracted: A Possible Case of Hypopituitarism in Neolithic China

A human skeleton with a possible case of hypopituitarism is reported. The individual (burial M53) is from the site of Guanjia, a Neolithic settlement in northern China, dated to the Late Yangshao period (6000–5500 bp ). On the basis of the fully erupted third permanent molars and moderate occlusal dental wear resulting in substantial exposure of dentine, the initially estimated age‐at‐death was placed between 26 and 33 years. However, dimensions of the postcranial skeleton fall significantly below and outside the range from contemporaneous adult populations, and along with delayed epiphyseal fusion present throughout the skeleton, the postcranial age is concordant to that of an 11‐ to 13‐year‐old child. Most long bone epiphyses display incomplete fusion or are entirely unfused, but a lack of microporosity in the metaphyseal areas near growth plates indicates a cessation of longitudinal bone growth. Because no signs of porotic hyperostosis, cribra orbitalia, periosteal lesions or linear enamel hypoplasia are observed, the restricted growth of this individual is likely caused by a growth hormone disorder and is unrelated to nutritional deficiencies or systemic infection. Copyright © 2011 John Wiley & Sons, Ltd.     

Intracranial Arteriovenous Malformations as a Possible Cause of Endocranial Bone Lesions and Associated Neurological Disorder

Endocranial bone lesions have attracted intensive scientific debate on their aetiology. In recent literature, the lesions were almost exclusively interpreted as of infectious origin. In this paper, we give new insight into the aetiology of endocranial lesions, distinguishing the lesions of vascular origin from those caused by tuberculosis or other conditions. The analysis is based on a rare case of a young female individual who displayed multiple endocranial lesions with ‘serpens endocrania symmetrica’ morphology. The lesions were associated with an uncommon branching pattern of the middle meningeal artery and marked side differences in teeth pathology. Postcranial skeleton showed signs of the left upper limb weakness. The macroscopic finding of the endocranial lesions along with the skeletal evidence of neurological damage, together with characteristic radiological and histological features, can lead to diagnosis of arteriovenous malformations. This study aims to improve understanding of the aetiology of endocranial bone lesions. Copyright © 2012 John Wiley & Sons, Ltd.