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.     

Using microscopy to improve a diagnosis: an isolated case of tuberculosis‐induced hypertrophic osteopathy in archaeological dog remains

The use of histology to estimate age, understand taphonomic history and diagnose disease in human skeletal and mummified remains is a well‐known method. Even though non‐human animals experience stress and disease similar to humans, microscopy is rarely applied to faunal remains to obtain a diagnosis. Histological results from a 16^th‐century Iroquoian dog which had previously been diagnosed by macroscopic and molecular methods with tuberculosis‐induced hypertrophic osteopathy (HPO) are presented here. Comparisons indicate that canid microscopic skeletal manifestations of HPO are reminiscent of human alterations caused by this condition. In addition, the microscopy reveals an aggressive form of HPO that was chronic in nature which could not be identified by either macroscopic or molecular methods. By providing an extension to the original diagnosis, the impact of a chronic case of tuberculosis is discussed. This study helps to emphasise the utility of palaeohistopathology in both biological anthropology and zooarchaeology, as it allows for a deeper discussion of the manifestation of HPO and the impact of tuberculosis on both dogs and humans. Copyright © 2008 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.     

Essentials in the use of mycolic acid biomarkers for tuberculosis detection: response to “High-throughput mass spectrometric analysis of 1400-year-old mycolic acids as biomarkers for ancient tuberculosis infection” by

High molecular weight long-chain mycolic acids are key structural components of the cell envelope of Mycobacterium tuberculosis and they are established as biomarkers for the identification of both ancient and modern tuberculosis. Mycolic acids from M. tuberculosis have a characteristic profile, reflecting contributions from five major distinct homologous series of mycolate structural types. Diagnosis of tuberculosis in archaeological material, using mycolic acid biomarkers, depends on objective recognition of the key characteristic mycolic acid components. A recent article in this journal claimed that tuberculosis could be confirmed in ancient bones by high throughput mass spectrometric analysis of mycolic acids. Scrutiny of the data presented reveals no convincing evidence for the presence of mycolic acids, characteristic of the M. tuberculosis complex, in the skeletal remains examined. This communication reviews the essential criteria necessary for positive tuberculosis diagnosis, using mycolic acids.     

A FAREWELL TO ‘RURAL BLISS’

The article discusses health policies towards school children in Norway from 1900 until the Second World War. It is concerned with dominant definitions of health threats against children and the variables used in defining the groups conceived as most vulnerable to poor health. A distinct change took place in the period. Whereas in the early 1900s poor and working‐class children in urban surroundings were considered to be under severe threats, in the 1920s a less specific category of ‘children’ were conceived as threatened. Eventually rural children were singled out as the important target group for health measures. The shifts had medical as well as political motivations. Another prominent feature in the period was that poverty took on a new meaning in the dominant medical discourse on children: from having been conceived as a material reality impinging upon health, it came to be considered mainly a cultural problem. Especially medical officers within the social democratic camp contested this argument although they did not rule out education and cultural transformation as a means to promote children's health. Despite the conceptual shift, however, social benefits and equal access to health services – measures that lay at the heart of the post‐war welfare state – remained in the 1930s an essential part of promoting children's health.     

Paleopathology of The Population of Krasnoyarsk,Central Siberia (Pokrovskiy and Voskresensko-Preobrazhenskiy Cemeteries of the 17th– Early 20th Centuries)

Published data on the paleopathology of Siberian populations are scarce. However, two samples of adult and non- adult skeletons taken from excavations at the Pokrovskiy (17th–18th centuries) and Voskresensko-Preobrazhenskiy (17th–early 20th century) cemeteries in Krasnoyarsk (123 and 204; 101 and 81, respectively) revealed cases of rickets, tuberculosis, and congenital syphilis in children, and vertebral tuberculosis and tertiary syphilis in adults. Trauma areas included ribs, hands, forearms, and tibiae. These two samples provide evidence on which to base an assessment of the health of the Krasnoyarsk population from 1628 to the early 1900s.     

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.