Evidence of Stress Fracture in a Homo antecessor Metatarsal from Gran Dolina Site (Atapuerca,Spain)

We present the palaeopathological analysis of a right fourth metatarsal (ATD6‐124) recovered from the Atapuerca–Gran Dolina site (Spain). This fossil, ca. 1 Ma, belongs to Homo antecessor, the earliest known European hominin species. The metatarsal exhibits a proliferative lesion on its medial periosteal surface. Periosteal reaction can be the bone response to a wide number of injurious processes. We describe a lesion on the basis of macroscopic and microscopic analyses, including microtomography and scanning electron microscopy. Externally, the osteoblastic lesion presents a highly porotic and disorganised morphology. Internally, we observe a series of micro‐fractures on the compact bone that do not affect the medullary canal. We provide a differential diagnosis and suggest that the ATD6‐124 lesion could correspond to a pedal stress fracture, also known as fatigue or march fracture. Stress fractures have been related to a load increase and muscular fatigue. This type of fracture has been widely reported in the foot of soldiers and athletes, which are usually engaged in strenuous, excessive or prolonged locomotive activities. Despite its high frequency in these groups, stress fractures have not been reported as such in fossil collections, with the exception of a metatarsal belonging to the Sima de los Huesos site (Atapuerca). Copyright © 2013 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.     

Benign mandibular tumours: Two case studies from the Maya lowland site of Tikal,Guatemala

This study presents a differential diagnosis of benign mandibular tumours identified in two adult burials from the precontact Maya city of Tikal, Guatemala. Both individuals were recovered from domestic structures that date to the Late Classic Period (AD 550–850). The osseous growths were interpreted as probable benign tumours based on evidence of localised growth, a circumscribed border, a dense texture and a lack of osteolytic activity or spiculate bone formation. Burial PTP‐026A is a middle adult (35–50 years) of indeterminate sex with evidence of a small dense, circular mass extending laterally from the right mandibular corpus. Macroscopic and radiographic assessment of this lesion provided a diagnosis of osteoma, a true neoplasm, or alternately, hyperplasia (e.g. exostosis) or hamartoma, which are not true neoplasms. Burial PTP‐017 is a probable young adult female (20–35 years) with a large osteoblastic lesion on the right anterior mandibular corpus. This dense, bony mass extends from the anterior margin of the mental canal, and shows a distinct boundary from the adjacent trabecular and cortical bone. The growth of the osseous mass displaced the right first premolar anteriorly. Radiographic assessment showed the presence of dense, radiopaque material, indicating significant calcification. This suggested a likely fibro‐osseous origin for this lesion, with a probable diagnosis of ossifying fibroma, or possibly osseous dysplasia. Although not definitive, our differential diagnosis was able to exclude a number of neoplastic and non‐neoplastic conditions that affect the jaws. This study provides the first reported cases of possible benign mandibular tumours in the ancient Maya. Copyright © 2009 John Wiley & Sons, Ltd.     

Differential diagnosis and discussion of a large nasal neoplasm from a late Bronze Age Athenian male

An adult male from the late Bronze Age of Athens, Greece, was found to have a large neoplasm in the nasal cavity. The characteristics of the lesion suggest that it was an osteoma of the ethmoid. Secondary infections of the paranasal sinuses are present as a result of the tumour blocking the sinus drainage. Copyright © 2009 John Wiley & Sons, Ltd.     

Osseous talocalcaneal coalition in a medieval skeleton (ca. 1050 AD)

Tarsal coalition (TC) is defined as an abnormal fusion of two or more tarsal bones. The fusion may be fibrous, cartilaginous or osseous and can be congenital or acquired in response to infection, articular disorders, trauma, neoplasm or surgery. We report a case of a talocalcaneal (TCC) type of tarsal coalition in a medieval skeleton from Northwest Germany dating to ca. 1050 AD. The fusion is of osseous type. Plain AP radiographs and computed tomography confirmed the macroscopic diagnosis. Copyright © 2009 John Wiley & Sons, Ltd.     

Congenital Syphilis in the Archaeological Record: Diagnostic Insensitivity of Osseous Lesions

The paucity of convincing evidence for congenital bone lesions of syphilis in the archaeological record led to study of the human remains from the Buffalo site in West Virginia, dated at 550—650 years BP. The diagnosis of syphilis (venereal) in adults was based on previously validated population criteria for the recognition of syphilis and its distinction from among the other treponemal diseases. Among the 151 juveniles (23.3 per cent of the total series), only one had macroscopic evidence of periosteal disease. The low frequency of recognizable osseous stigmata characteristic of congenital syphilis, combined with the conspicuous absence of pathognomonic dental lesions, make such periosteal lesions insufficiently sensitive criteria for the identification of syphilis in the archaeological record. © 1997 by John Wiley & Sons, Ltd.     

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.     

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.     

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.     

Trace elements in palaeopathology: Quantitative analysis of a case of hypertrophic osteoarthropathy by instrumental neutron activation analysis

Instrumental neutron activation analysis (INAA) of the bones of a 6th century case (AD ) of hypertrophic osteoarthropathy (HOA) showed high levels of Zn, Mn and K in the periosteal new bone. The concentration of Zn in the periosteal new bone appeared to be biogenetic in origin and connected with active mineralization processes in the abnormal bone tissue. Manganese and potassium concentrations were, at least partly, related to diagenetic processes.     

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.     

Like You Need a Hole in the Head: Tool Innovation a Possible Cause of Trephination. A Case from Kerma,Nubia

This paper presents one case from Kerma (ind‐14.1.595 or K317) which was initially reported to have a ‘fatal traumatic wound’ in the front of the skull. The individual has a dime sized, circular hole with no radiating or concentric fracture lines associated with it. It also shows clear evidence of healing along the inside edges of the pathology. This was according to the preliminary, and only, analysis performed when excavated at Kerma (1913–1916), which was most likely performed by a crew member not formerly trained in anthropology, or medical science. Differential diagnosis will be discussed with respect to this lesion actually being a form of traumatic injury, possible remnants of a bony tumour, and trephination, among other diagnoses. Trephination has been identified in ancient Egypt and Nubian studies, though it is a rarity. Although trephination is a possible cause for the present lesion, this example does not fit the morphology of any other examples of the practise from this region or time period. Given that there have been similar borings witnessed on architecture from the Egyptian Old Kingdom, this lesion may suggest implementation of an already present architectural tool for medical purposes among the Kerma Nubians. Copyright © 2011 John Wiley & Sons, Ltd.     

Subadult Age at Death and Health Status at Niah Cave,Borneo (1500–200 bc)

Southeast Asia's transition to rice agriculture is often used as an exception to the general pattern of health decline at the agricultural transition. Niah Cave is the largest known Southeast Asian Neolithic cemetery, providing valuable information about subadult health during the agricultural transition in this region. This study examines the health status and mortuary treatment of subadult skeletal remains (Minimum Number of Individuals (MNI) = 49) from the Neolithic cemetery of Niah Cave, Sarawak, Malaysia (1500–200 bc ). This study found that few cases of cribra orbitalia (4.6%) and porotic hyperostosis (14%). However, nonspecific infections may have been a risk factor for subadults as over half (65%) died with active cases of periosteal reactions on their long bones. Differential diagnosis determined that possible factors for this include parasite load, rickets and scurvy. Mortuary practices indicate that subadults may have been treated differently in phases 1 and 2 but were grated similar mortuary treatment in phases 3 and 4. This study suggests that changes in mobility patterns may have placed subadults at risk for increased parasite load and vitamin deficiency, while the role of subadults within the community may have changed over time. Copyright © 2017 John Wiley & Sons, Ltd.     

Rickets in a High Social Class of Renaissance Italy: The Medici Children

Exploration of the Medici Chapels in the Basilica of San Lorenzo in Florence revealed the burials of nine juvenile members of the Medici family (16th–17th centuries). The estimated children's skeletal ages ranged from newborns to 5‐year‐olds, showing a series of bone abnormalities, in particular diffuse periosteal new bone and bowing of long bones. The comparable pathological lesions, including porosity evident on the skull, orbital roofs, costocondral ribs and growth plates between metaphyses and epiphyses, enlargement of metaphyses and sternal rib ends, and long bone bending, are interpreted as the skeletal manifestation of rickets. The diagnosis of a metabolic disease linked to vitamin D deficiency would appear to be unexpected for children brought up at the court of a Renaissance elite class family like the Medici of Florence. Analysis of the historical and social background is particularly helpful to understand the causes of the onset of the disease in this aristocratic group. Documentary sources, supported by ¹³C and ¹⁵N bone collagen analysis, attest that weaning of these children took place when they were around 2 years old. With a prolonged breast‐feeding and a delay in introducing solid food in the diet, vitamin D deficiency is expected to rise considerably, in particular if the other main risk factor, namely inadequate sunlight exposition, is associated with this human milk‐based diet. Copyright © 2013 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.     

Tuberculosis on the north coast of Peru: skeletal and molecular paleopathology of late pre-Hispanic and postcontact mycobacterial disease

This paper examines skeletal and ancient DNA evidence in the study of suspected tuberculosis infection in the late pre-Hispanic and Colonial-era Lambayeque Valley Complex, north coast Peru (A.D. 900–1750). We integrate information on macroscopic lesion characteristics and distribution, radiographic and CT scan imagery, and analysis of Mycobacterium tuberculosis complex rpoB and IS6110 ancient DNA (aDNA) sequences. Destructive lesions were observed in the vertebral bodies of three precontact indigenous adult males, one colonial adolescent female, and in the cranium of a Colonial-period subadult. Assessment of lesion morphology and distribution led us to consider multiple diseases, but tuberculosis represents the most likely diagnostic option in all individuals. DNA was poorly preserved in all samples, but an IS6110 sequence was amplified in one precontact individual consistent with macroscopic diagnosis. These findings expand the geographic and temporal extent of tuberculosis to the late pre-Hispanic and Colonial north coast of Peru to highlight potential synergisms between diet, settlement patterns, and the evolution of Andean tuberculosis before and after European conquest. Moreover, this study helps focus several key questions in Andean tuberculosis research, including possible reassessment of the presence of the IS6110 sequence in the pre-Columbian Americas. Methodological considerations include differential diagnosis – especially with incomplete skeletons – and limitations of aDNA studies underscoring an approach integrating macroscopic, radiographic, and molecular lines of evidence in the paleopathological investigation of one of humankind’s most devastating and destabilizing diseases.     

Quantification of dental caries by osteologists and odontologists—a validity and reliability study

As in modern populations, dental caries in early populations is linked to diet and general health. In order to record not only advanced disease states with frank cavitation of teeth but also early lesions, indicating the presence of the disease in a population, it is important that the archaeologist can correctly detect and classify lesions of varying severity. The present study compares and contrasts quantification of dental caries by osteologists and odontologists. Four osteologists and four odontologists undertook visual and radiographic inspection of 61 teeth from three different sources: medieval, 19th century and modern. Separate sets of criteria were applied to disclose observer confidence in detecting a lesion and in estimating lesion extent. For validation of visual assessments, the teeth were sectioned. Radiographic assessments were validated by a specialist in dental radiography. The results disclosed that the odontologists in general showed greater sensitivity than the osteologists, correctly identifying carious lesions, but the osteologists had higher specificity, correctly identifying healthy teeth. Thus, the osteologists tend to overlook carious lesions (under‐diagnosis), while the odontologists tend to incorrectly record lesions in healthy teeth (over‐diagnosis). For both osteologists and odontologists, correct assessment was poorer for radiographs than for visual inspection. Copyright © 2009 John Wiley & Sons, Ltd.     

Better a Broader Diagnosis Than a Misdiagnosis: The Study of a Neoplastic Condition in a Male Individual who Died in Early 20th Century (Coimbra,Portugal)

The paleopathological record of neoplastic conditions in the past is considered scarce. The detection of tumours in ancient populations is hindered by the quality and quantity of signs visible on the skeleton, the methodological approach, the preservation of remains, and by difficulties of differential diagnosis. The aims of this paper are to report the extensive and multiple osteolytic lesions observed in an adult male and to discuss the possible etiology of these lesions. The individual, a 71‐year‐old male who died in 1932, is part of the Coimbra Identified Skeletal Collection. Records indicate that he died of a ‘heart lesion’. The present study used macroscopic, radiological, and computerized tomography examinations to analyse the skeletal remains of the individual number 439. The type and pattern of the lesions detected, which were most prominent on the skull, were compared with both clinical and paleopathological diagnostic criteria for different nosologic groups. The differential diagnosis addresses problems expressed both in clinical and in paleopathological literature with regard to the difficulties in distinguishing metastatic tumours from multiple myeloma. The nature of the lesions represented by this individual precludes an exact diagnosis. Therefore, we employed a broader category, neoplastic condition, instead of choosing a more specific diagnosis that would likely have resulted in a misdiagnosis due to overlapping features on this individual's condition. Further investigations are necessary to establish more replicable indicators and to improve confidence in retrospective diagnosis of these types of conditions. Copyright © 2011 John Wiley & Sons, Ltd.