Differential diagnosis of cartilaginous dysplasia and probable Osgood–Schlatter's disease in a Mississippian individual from East Tennessee

This paper details the differential diagnosis of an adult female skeleton displaying features consistent with a cartilaginous dysplasia and Osgood–Schlatter's disease. This burial was excavated in 1940 from a Mississippian platform mound at the DeArmond site (40RE12) in Roane County, Tennessee as part of the Works Progress Administration (WPA) and Tennessee Valley Authority (TVA) archaeological investigations. The right humerus and left femur of this individual display traits consistent with achondroplasia, such as shortened length and normal width. However, the rest of the long bones display typical morphology. The affected humerus and femur are 82 mm and 58 mm shorter than their counterparts, respectively. This makes for obvious asymmetry. A review of the various cartilaginous dysplasias was undertaken to identify those conditions concordant with the differential manifestation of the long bone asymmetry. Morphological and radiographic analyses were used to rule out possible diagnoses. The most likely candidate is enchondromatosis out of the presented conditions, as it most commonly affects the long bones, does not affect every bone in the skeleton, and is asymmetrical in its manifestation. In addition to the cartilaginous dysplasia, both anterior proximal tibial metaphyses of this individual display defects that are roughly triangular with pitted, irregular floors. Osgood–Schlatter's disease is caused by repeated trauma to the tibial tuberosity during childhood. This individual would have walked with an obvious limp, and perhaps the added biomechanical stress on both quadriceps muscles as a result caused the injuries and resultant defects to its attachment points. Evidence of these conditions in an adult indicates that the Mississippian people in this community offered some sort of social support to differently‐abled individuals. Copyright © 2009 John Wiley & Sons, Ltd.     

A Roman Skeleton with Possible Treponematosis in the North‐East of the Iberian Peninsula: A Morphological and Radiological Study

The main goal of this paper is to describe and discuss pathological lesions observed in a Roman skeleton (between 2^nd and 3^rd century AD) from the north‐east region of the Iberian Peninsula (St Nicasi 18–24 site. Gavà, Barcelona), which may be compatible with treponematosis. Most of the skeleton, with the exception of the neurocranium, was recovered. Only the left tibia was affected, whereas the rest of the recovered skeletal remains were unaffected. Macroscopic examination revealed a male individual between 25 and 30 years of age at death with a sabre‐shaped left tibia. The proximal half of the diaphysis was pitted and the bone overall enlarged. The surface of the tibia showed occasional vascular impressions where, in some instances, small raised plaques of new bone appeared to bridge over them, specifically in the most affected area of the proximal half of the tibia. No destructive lesions were observed. Radiographic examination and gross inspection at the cross section of the tibia showed encroachment into the medullary cavity of coarse cancellous bone and cancellization of the cortex. The observed lesions indicate that the tibia was affected by a chronic infectious disease. Differential diagnoses were considered, and these included other infectious diseases, fibrous dysplasia, Paget's disease, chronic varicose ulcers affecting bone and trauma, with the conclusion that the disease affecting the tibia could have been treponematosis. This could be significant in the history of the treponematoses being one of the oldest examples of treponematosis in pre‐Columbian Europe. Copyright © 2011 John Wiley & Sons, Ltd.     

Residual rickets or osteomalacia: a case dating from the 16–18th centuries from Krosno Odrzańskie,Poland

A skeleton from a 16–18^th century burial site in Krosno Odrzańskie, Poland, was examined using classical morphological, metric and macroscopic palaeopathological observations, as well as radiography and tomography of the skull and long bones. A wide variety of the observed bone deformations probably occurred as a consequence of past rickets and/or osteomalacia, whose primary cause may also have been chronic renal failure. Preservation of the bones enables a discussion of the cause of such pathological changes. The subject under study appears to be a very interesting example of an individual whose skeleton shows advanced pathological alterations associated with the subject's vitamin D deficiency, overall health conditions and relatively long lifespan. Copyright © 2008 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.     

A scientific analysis of cranial trepanation from an Early Iron Age cemetery on the ancient Silk Road in Xinjiang,China

This study uses multiple scientific methods to analyse a case of trepanation from a cemetery located at the westernmost point along the ancient Silk Road in China dating back to the Early Iron Age. The skull of interest belonged to a middle-aged male; the opening is located on the left posterior side of the skull in the occipital bone. Computer tomography (CT) and microscopic observation show that the incision was unhealed, indicating an immediate death either during or after the operation. The procedure of trepanation might have been used to treat a depressed fracture from inflicted trauma on the individual’s right parietal bone, suggesting the presence of surgical trepanation in early Western China.     

A nineteenth-century case of carcinoma of the prostate,with a note on the early history of the disease

A case of prostatic carcinoma is described in the skeleton of a named individual who died in 1834. The tumour was recognized from widespread periosteal new bone throughout the skeleton and by the presence of sclerosing metastases in many bones, including the pelvis and all the vertebrae. A number of features of the disease present here are said to be uncommon in modern patients, including spiculated periosteal new bone and some degree of spinal stenosis. In two previous cases of prostatic carcinoma described in the literature, periosteal new bone was a prominent feature and was probably responsible for the disease being recognized. It is likely that if skeletons from mature males were routinely X-rayed, considerably more cases would be noted and a more accurate estimate of the prevalence of this disease in the past would thus be ascertained. © 1997 John Wiley & Sons, Ltd.     

Multicentric osteosarcoma associated with DISH,in a 19th century burial from England

Osteosarcoma is a rare type of malignant neoplasm that is most frequent in adolescents and young adults although it can develop at any age. It can metastasize from a primary site in bone to other bones and soft tissues. Usually the disorder causes a single bone‐forming lesion (unicentric) but some cases have multicentric, bone‐forming lesions. Some of these lesions develop at different sites at different times. In a second variant of multicentric osteosarcoma, synchronous bone‐forming lesions develop at multiple sites. Distinguishing between these two types of multicentric osteosarcoma is challenging in a clinical context and the criteria for doing so are unlikely to be met in an archaeological burial. Wolverhampton burial HB 39 was excavated from an early‐nineteenth century cemetery site in England. It consists of the incomplete skeleton of an adult male of at least 45 years of age with multicentric osteosarcoma. The individual represented by this burial also had diffuse idiopathic skeletal hyperostosis (DISH). Three of the bone‐forming lesions associated with osteosarcoma developed on the bony outgrowths related to DISH. Copyright © 2010 John Wiley & Sons, Ltd.     

A Fisk patent metallic burial case from Western Missouri: an interdisciplinary and comprehensive effort to reconstruct the history of an early settler of Lexington,Missouri

In 2006 a cast-iron coffin was discovered in an unmarked burial plot in Lexington, Missouri. A multifaceted investigation was conducted to provide historical documentation and possible identification of the individual. The coffin is an early Fisk Patent Metallic Burial Case. Osteological analyses indicate that the skeletal remains belong to a 20 to 30 year old white female who consistently ate an omnivorous diet with significant amounts of C4 plants or seafood. Rib morphology and her burial garments suggest she frequently wore restrictive clothing. No gross skeletal pathological lesions or trauma were observed except for a patch of reactive bone and an atypical pattern of bone remodeling on the visceral surface of the sixth rib. Subsequent bacterial DNA analysis of the ribs and sternum indicate the presence of tuberculosis infection. Although not conclusive, multiple lines of evidence are consistent with the skeletal remains representing Elizabeth (Triplett) Stewart who died in 1854 of pulmonary tuberculosis. This multidisciplinary research significantly contributes to the local history of Lexington, Missouri and provides a likely identification of the deceased individual for the Stewart Family.     

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.     

Sclerosing Bone Dysplasia from 16th Century Sardinia (Italy): A Possible Case of Camurati–Engelmann Disease

The skeletal remains of a male aged 45–55 years displaying several bone anomalies were unearthed from the Alghero (Sardinia) plague cemetery ‘lo Quarter’, a burial site dating back to the 1582–1583 AD outbreak. The skeleton, whose stature is about 165 cm, presents a bilateral hyperostosis with increased diameter of the diaphyses of all the long bones of the upper and lower limbs; the metaphyses appear to be involved, while the epiphyses are spared. Marked thickening of the cranial vault is also evident. Radiological study showed irregular cortical thickening and massive endoperiosteal bone apposition; sclerotic changes are observed in the diaphysis of some metacarpals. Computed tomography (CT) cross sections of the long bones displayed a thickening of the cortical portion and endoperiosteal bone apposition. The individual was affected by a sclerosing bone dysplasia, a genetic disease characterized by increased bone density. In differential diagnosis, several sclerosing bone dysplasia, such as hyperostosis corticalis generalisata, craniodiaphyseal dysplasia, craniometadiaphyseal dysplasia, pachydermoperiostosis and Camurati–Engelmann disease, as well as other disorders characterized by sclerosing manifestations, such as Erdheim–Chester disease, mehloreostosis and skeletal fluorosis, need to be considered. The anomalies observed in skeleton 2179 fit with the features of Camurati–Engelmann disease, which is the most likely candidate for final diagnosis. It is highly challenging to evaluate how such a condition may have influenced the individual's lifestyle in terms of development, mobility and quality of life. This individual was probably symptomatic and must have experienced common clinical symptoms, such as pain in the limbs and fatigability. However, the strong development of the muscular insertions and the degenerative changes in the upper limbs suggest that the mobility problems should not have prevented him from reaching a mature age and from performing essential daily activities. The presented case is the unique paleopathological evidence of Camurati–Engelmann disease so far diagnosed. Copyright © 2015 John Wiley & Sons, Ltd.     

Fracture patterns among the Nubians of Semna South,Sudanese Nubia

A collection of 592 individuals from the site of Semna South in Sudanese Nubia was studied for evidence of healed fractures of the skull and appendicular skeleton. The sample included 241 males, 239 females, 109 subadults and three adults for whom a sex could not be determined. Potential analytical and interpretive bias due to vagaries of preservation was quantified and examined. Almost 21% of the adults exhibited at least one healed fracture, while only two subadults showed such trauma. Rates of fractures, calculated for each bone, varied from a high of 17.9% for the cranium to a low of 0% for the right femur. Some fractures were likely caused by the physical environment, for example, falls along the rocky shores of the Nile. Other trauma, such as craniofacial fractures, found in both males and females, may have been due to interpersonal violence. The high rate of craniofacial trauma may indicate that this group experienced social stress which could have precipitated or intensified interpersonal violence. Copyright © 1999 John Wiley & Sons, Ltd.     

A multiple myeloma of the late middle ages from unterregenbach,southwestern Germany

In the early 1960s the grave of a probable donor was discovered in the St Veit church in Unterregenbach, Stadt Langenburg, Kreis Crailsheim, southwestern Germany. After a re-examination, the skeleton may be regarded as clearly corresponding to the typical clinical picture of a multiple myeloma/plasma cell myeloma. The 45–55-year-old female individual shows all the characteristics of a malignant plasma cell tumour, with specific osteolytic lesions of the skull, vertebrae, ribs, pelvis, scapulae and long bones, and even-sized single defects without reactive zones on the edges. Several pathological fractures of the ribs and a vertebral compression fracture can be observed. The gnawing-mark-like features on the inner surface of the compact bone and the ‘punched-out’ lesions on the outer are distinguishing marks of a multiple myeloma.     

Possible evidence for intraspecific aggression in a Pliocene crocodile from north Queensland

A large, fossilised crocodilian metatarsal has been recovered from the Pliocene Bluff Downs Local Fauna exhibiting proliferative bone growth consistent with an episode of osteoperiostitis, possibly resulting from trauma. The nature and location of this trauma suggests that it may have occurred as a result of intraspecific aggression between rival animals. Three crocodilian genera have been recovered from the Bluff Downs Fauna, Crocodylus, Quinkana and Pallimnarchus. The metatarsal does not conform to Crocodylus porosus and therefore most probably represents one of the other two known crocodilian taxa. The nature of the injury suggests that it occurred in water and it may belong to the now extinct Plio-Pleistocene Pallimnarchus rather than Quinkana babarra which is interpreted as being predominantly terrestrial.     

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.     

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.     

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.     

Osteological evidence for the draught exploitation of cattle: first applications of a new methodology

Although the aetiology of bone pathologies in cattle is poorly documented, various deformations in the skeleton have been attributed to draught exploitation in the archaeozoological literature. This paper summarizes the results of an osteological study that was undertaken on the feet of modern draught oxen. This led to the definition of a series of draught‐related anomalies. In an attempt to describe the pathologies in a more consistent and quantitative way, a scoring scale for each individual bone pathology was established. The developed method is applied to cattle remains from four Roman and one late medieval site. The distribution of the observed pathological indices (PIs) on the first phalanges is interpreted in terms of the age structure of the cattle populations, and the possible modes of cattle exploitation and meat consumption in various settlement types. Copyright © 2000 John Wiley & Sons, Ltd.     

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.     

Analysis of ante mortem trauma in three modern skeletal populations

When archaeological skeletons are assessed, the prevalence (and patterns of bone involvement) of trauma is important. The number and pattern of fractures can be used to gain insight into the occurrence of interpersonal violence, workload and living conditions. However, the question remains as to how these results should be interpreted—such as what constitutes high or low levels of trauma? The aim of this study was to investigate the occurrence of trauma in a population of modern Greeks living in Crete, as well as South African (SA) whites and blacks in the Pretoria Bone and Raymond Dart collections. The sample comprised mostly of older individuals (n = 90–100 within a sex‐population group). Each skeleton was studied for healed trauma. For the vertebrae, only spondylolysis was assessed. In the Greek sample, it was found that 42% of the males and 46% of females had at least one fracture, with corresponding figures of 63 and 44% for SA whites and 83 and 69% for SA blacks. Radius, rib and femur fractures were most common in Greeks, with skull, radius and ribs most common in SA whites and skull, ulna and ribs in SA blacks. These prevalences of trauma are high, but the composition of the samples (mostly of lower socio‐economic origin) should be kept in mind. It may also be questioned whether these individuals reflect the society as a whole. It seems that the fractures in Greeks are mostly related to old age due to falls and accidents (radius and hip fractures), while the SA black sample reflects high prevalences of interpersonal violence (such as cranial vault and ulna fractures). The SA white sample follows a comparatively moderate pattern of trauma. These comparative figures may be useful when assessing trauma in other skeletal populations. Copyright © 2009 John Wiley & Sons, Ltd.     

Skeletal manifestations of vitamin D deficiency osteomalacia in documented historical collections

The frequency with which changes related to vitamin D deficiency are recorded in juvenile bone from archaeological contexts makes it clear that conditions conducive to such deficiency were fairly widespread at a number of points in the past. Although changes will take longer to be manifest in the adult skeleton than in juveniles, and may not be as obvious, the scarcity of reported cases suggests that it is likely that cases of osteomalacia are being overlooked in archaeological human bone. Vitamin D is probably better described as a hormone, rather than a vitamin, and the production of vitamin D within the body following exposure to sunlight allows adequate mineralisation of bone to take place. Lack of exposure to sunlight, which can be caused by a range of factors, is probably one of the main causes of vitamin D deficiency. The result of such a deficiency is a general weakening of the skeleton. The range of skeletal changes recorded across different bones of the skeleton in two documented historical pathology collections (the Galler collection, Basel, and the collection of the Federal Museum for Pathological Anatomy, Vienna), are discussed for scapulae, vertebrae, ribs, sterna, pelves and femora. The likelihood of each feature being preserved in archaeological skeletal material is considered. Although the changes associated with osteomalacia may lead to fragmentation of the skeleton, the presence of characteristic changes on bones from across the skeleton should make the condition identifiable using macroscopic examination, even where the skeleton is not well preserved. The identification of cases of osteomalacia in archaeological skeletal material is potentially significant because of the socio‐cultural information that can be implied from diagnosis of the condition. Copyright © 2005 John Wiley & Sons, Ltd.