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.     

Warriors from the East. Skeletal evidence of warfare from a Lombard-Avar cemetery in Central Italy (Campochiaro,Molise, 6th–8th Century AD)

The early mediaeval cemetery of Campochiaro is located in Molise (Central Italy) and dates to the 6th–8th centuries AD. It consists of two inhumation areas: one at Morrione and the other at Vicenne. This site is important because of the contemporary presence of locals, Lombards and Avars of the steppes. Campochiaro was probably an outpost against the Byzantine army settled in southern Italy. Since no signs of a stable settlement or built-up area have been found, it seems the cemetery can be attributed to a semi-nomadic group. Many graves contained a man and his horse with the harness complex and typical Avar stirrups. The military nature of this settlement is shown by ostearchaeological evidence of warfare and violence on three skeletal individuals: n. 20, n. 102 and n. 108. Two of them exhibit lesions of the cranial vault probably produced by shock weapons in the fashion of the Byzantine armies: a spiked mace and a battle-axe. The cicatrisation of the wounds and the bony neo-formation suggest that the individuals survived these injuries for a long time. The third individual suffered from leprosy. He shows a long perpendicular cut in the left section of the frontal bone. The wound is clean and, because it is without traces of bony neo-formation, was probably a peri-mortem blow landed with a sharp weapon. The wound was not mortal, because it was very slight and probably produced only a slash. As ritual or magical practises and/or damage produced during the excavation or by the action of roots in the earth can be excluded, this individual was perhaps really a leper warrior who died in combat.     

Evidence of amputation as medical treatment in ancient Egypt

The use of surgical techniques in ancient Egyptian medicine has only been suggested indirectly through ancient medical texts and iconography, and there is no evidence of amputation as a means of therapeutic medical treatment. This paper presents four cases of amputation from the archaeological site of Dayr al‐Barshā, Egypt. Two of the cases (dated to the First Intermediate and Middle Kingdom periods, respectively) are from individuals that display bilateral amputations of the feet, one through the metatarso‐phalangeal joints, the other a transmetatarsal amputation. The exact reason for the amputation, perhaps from trauma or disease, is unknown. The particular healing patterns of the distal ends of the amputations suggest these individuals used foot binding or prosthetic devices. Another case represents a healed amputation of the left ulna near the elbow, dated to the Old Kingdom. The final case represents a perimortem amputation of the distal end of the right humerus. The exact date of this individual is unknown, but most likely pertains to the Old Kingdom or First Intermediate period. This individual seems to have suffered a traumatic incident shortly before death, sustaining many fractures, including a butterfly fracture on the right humerus. Several cut marks were identified on top of the butterfly fracture, indicating amputation of the arm at this point. All four cases support the hypothesis that the ancient Egyptians did use amputation as a therapeutic medical treatment for particular diseases or trauma. Copyright © 2009 John Wiley & Sons, Ltd.     

Lepromatous leprosy in an early mediaeval cemetery in Central Italy (Morrione, Campochiaro, Molise, 6th–8th century AD)

The aim of this study is to investigate and discuss the cases of leprosy diagnosed on two skeletal individuals from an early mediaeval necropolis at Morrione (Campochiaro, Molise, Central Italy), dated to the 6th–8th century AD. At present only two inhumation areas have been found in Campochiaro: one at Morrione and the other at Vicenne. Since no signs of a stable settlement or built-up area have been found, it seems the cemeteries can be attributed to a semi-nomadic Lombard-Avar group. This site may have represented a military outpost to control the area against Byzantine invasions. The skeletons of a female (40–46 years) and a male (50–55 years), from tombs 68 and 108, revealed several bony changes indicative of leprosy with clear rhino-maxillary syndrome in both specimens. There is a scarcity of information in the osteoarchaeological literature of leprosy in ancient Italy. The significance of these cases is that they add to an understanding of the history of the disease in Italy and to the data set necessary to understand the epidemiological dynamics in the Mediterranean basin during the ancient period.     

On the antiquity of leprosy in western Micronesia

The presence of leprosy in China is documented to 190 BC , and possibly earlier.; It is believed to have spread from China to Japan. Its presence in Oceania has heretofore been documented only since the eighteenth and nineteenth centuries AD, and has been attributed to migration of people from China into the Pacific subsequent to western contact and trans-Pacific trade. In the osteological analysis of 700 skeletons from pre-Spanish archaeological contexts on the islands of Guam and Saipan in western Micronesia, at least six cases of leprosy have been discovered. Radiocarbon dating places two of these in the thirteenth to fifteenth centuries AD, one in the eleventh to thirteenth centuries, and one in the seventh to eleventh centuries. This clearly indicates that the introduction of leprosy pre-dates western contact and suggests possible contact with, or immigration from, China or Japan.     

Possible cases of leprosy and tuberculosis in medieval Sigtuna,Sweden

In Sigtuna, Sweden, a medieval cemetery, including 227 skeletons, was analysed in 2006. On the outskirts of the churchyard, six skeletons with bone changes indicating systemic inflammatory disease were observed. Two out of three individuals with well‐preserved facial bone regions displayed signs of rhinomaxillary remodelling. Four of the afflicted exhibit severe bilateral alterations of the lower legs and phalanges of the feet and concentric atrophy of the metatarsals. In addition, one of the individuals exhibited a kyphosis in the lumbar vertebrae. In a discussion about alternative diagnoses, lepromatous leprosy and tuberculosis were identified as the causes of the destructive lesions in two individuals. Though the skeletal changes of the lower legs and feet in four cases demonstrate a close resemblance to secondary lesions of leprosy, the disease could not be confirmed. The skeletal changes of the last individual were unspecific and the possible causes several, rendering diagnosis difficult. The burial locations imply that the afflicted persons belonged to a lower social stratum. Due to the significantly higher frequency of pathological changes in the cemetery compared to other cemeteries in the town, the individuals could be regarded as fellow sufferers among others with various medical conditions. The bioarchaeological identification of systemic infectious diseases of a group of individuals of this size is unique to north of Scania in Sweden, where only a few cases of leprosy and tuberculosis have previously been diagnosed. The significance of the present study is emphasised by the interconnection between the afflicted, the archaeological context and the knowledge of the medieval society in Sigtuna. Copyright © 2010 John Wiley & Sons, Ltd.