International Journal of Paleopathology最新文献

Objective

To evaluate the presence of a trauma that results in pelvic ring disruption and its clinical implications in two individuals from ancient Egypt.

Materials

Two complete skeletons of adult women, dated to the Middle Kingdom (c. 1980–1760 BCE), from two tombs in the necropolis of Qubbet el-Hawa (Aswan, Egypt).

Methods

The anatomical elements were examined macroscopically in Egypt.

Results

Unilateral sacroiliac luxation with disruption of the pubic symphysis was detected in both individuals. The presence of an overlapped symphysis was evident in female QH34aa. A healed fracture of the iliopubic ramus are present in female QH122. Antemortem bone alterations in the pelvis demonstrate that they survived the trauma.

Conclusions

Pelvic trauma due to a lateral compression was detected in the os coxae. Both women survived but probably had severe sequelae that impaired their quality of life. At least one of them might have received some type of medical treatment.

Significance

Both cases shed light on pelvic fractures, their mechanisms of production, and their effects on bone and its functionality, as well as revealing possible associated lesions of soft tissues and vital organs.

Limitations

The pelvis, or at least the pubic symphysis, must be well preserved to allow the correct diagnosis of this type of lesion.

Suggestions for further research

Studies are warranted on the detection of this type of fracture, focusing on the subtle bone changes that indicate its presence. There is also a need to develop methodologies that combine the study of bone and soft tissue alterations.

Objective

This case study evaluates an individual with skeletal changes consistent with DISH and ankylosing spondylitis. We present here an evaluation of the individual’s pathological skeletal changes and a review of the potential diagnoses. Finally, we offer a differential diagnosis of co-morbidity infrequently found in the paleopathological record.

Materials

The skeletal remains of a male, aged 50 + years from the early modern Polish (17th-18th century CE) site of Drawsko 1.

Methods

Skeletal remains were examined for the presence of spondyloarthropathies.

Results

The individual presented with anterolateral fusion of the vertebral bodies of T6-T10 with a “dripping candle wax” appearance, fusion of the right costovertebral joint at rib 8, fusion of the left apophyseal joints of T8-T10, and the calcification of the supraspinous ligament at T3-T4. The left sacroiliac joint shows intra-articular and para-articular fusion; the right has bony changes consistent with ongoing fusion. Entheseal reactions were noted on the left clavicle, scapulae, first metacarpals, ulnae, and humerii. Diffuse idiopathic skeletal hyperostosis (DISH), ankylosing spondylitis (AS), reactive arthritis (RA), psoriatic arthritis (PA), and enteropathic arthritis (EA) are considered as differential diagnoses.

Conclusions

Based on the skeletal pattern of involvement, the individual suffered from both DISH and AS, which has previously been reported once in the paleopathological literature since 1950. The clinical literature indicates that co-occurrence of these two conditions is possible, with approximately 40 individuals affected.

Significance

This case study is significant for demonstrating the co-occurrence of DISH and AS in the paleopathological record. Additionally, this case contributes to the understanding of heterogenous frailty and syndemics.

Limitations

No radiographs were taken to confirm the differential diagnosis. No aDNA analysis was conducted.

Suggestions for further research

The remains have been reburied; no further analysis is possible.

Objective

To combine paleopathological and biomechanical analysis to reconstruct the impact that a severe skeletal injury had on an individual’s ability to function and participate in medieval society.

Materials

Three medieval individuals from Cambridge, England with ante-mortem fractures to the lower limb were analyzed.

Methods

Plain X-rays were used to determine the degree of malunion, rotation and overlap of each fracture. Cortical bone architecture of the injured individuals and 28 uninjured controls were analyzed using micro-computed tomography (µCT). Clinical and functional consequences were examined using the Bioarcheology of Care framework.

Results

The mechanism of injury, the secondary complications, and the extent of the care received was reconstructed for each individual. Bilateral asymmetry in the cortical bone architecture revealed the long-term alterations to each individual’s gait.

Conclusion

Each of these individuals survived a severe injury resulting in chronic physical impairment, though not all would have been considered ‘disabled’.

Significance

This research contributes to the discussion about medieval care provision and social constructions of disability by illustrating how an interdisciplinary approach provides insight into the experiences of those with physical impairments. The integration of µCT imaging within the Bioarcheology of Care model is a novel approach with great potential for application across the field.

Limitations

Biomechanical analysis was restricted to cortical geometry.

Suggestions for future research

Further study of bilateral asymmetry in trabecular architecture could complement our understanding of altered loading modalities in past societies.

Objective

This paper provides some conceptual guidelines for interpreting the phenomenon of impairment-disability between Antiquity and the Middle Ages from an historical-medical perspective. The paper illustrates application of these guidelines in an historical-medical reassessment of a published paleopathological case-study.

Materials and methods

The skeletal remains of a woman who experienced bone fusion and osteoarthritis (Rome, VIII century AD) were selected. We first contextualize her impairments through a paleopathological approach, then locate her experience of disability and care within the cultural and social background to which she belongs.

Results

This study illustrates the difficulty of reconstructing one consistent single model of disability.

Conclusions

The traditional idea of disability as a parameter of exclusion is not appropriate for every historical context.

Significance

The paper attempts an integrated and transdisciplinary approach to historical reconstruction of lifestyle in the presence of impairments between late Antiquity and the Early Middle Ages.

Limitations

The main research obstacle is the difficulty of going beyond documented Christian interpretation of disability and provision of welfare to identify detail of lived experience for individuals with impairments.

Suggestions for further research

The transdisciplinary historical-medical approach can be adapted for inclusion in any bioarchaeological study of impairment in historic times; future applications of this model will lead to its refinement.

Objective

To contribute to differential diagnosis of multiple epiphyseal dysplasia (MED) in archeological and clinical contexts.

Materials

A skeleton of a 30- to 45-year-old male (grave no. 806) from the Late Migration Period graveyard in Drnholec-Pod sýpkou (Czech Republic), radio-carbon dated to AD 492–530.

Methods

Morphological and metric analyses.

Results

Significant pathological changes were noted on ossa coxae and proximal ends of the femora, which appear similar to changes associated with Legg-Calvé-Perthes disease. X-ray examination made it possible to rule out pseudoachondroplasia, rickets and metabolic bone diseases.

Conclusions

The finding was evaluated as a probable case of congenital multiple epiphyseal dysplasia.

Significance

This case will contribute to the construction of estimates of the occurrence of this disease in historical populations and can be instructive for diagnostics in current medical practice.

Limitations

The final diagnosis is limited by the lack of genetic analysis.

Suggestion for the future research

Further clarification leading to diagnosis will benefit from genetic analysis and evaluation of skeletal remains throughout Europe.

Objective

This project evaluates a cranial lesion from a Hellenistic-era individual excavated by the Muğla Archaeological Museum in Gülağzı, Turkey.

Materials

An osseous tumor measuring 3.02 × 3.54 × 2.98 cm originating from the occipital bone of a probable young adult male.

Methods

The tumor was examined using gross morphological inspection, plain radiography (x-ray), and computed tomography (CT) imaging to identify potential differential diagnoses for the osseous cranial tumor.

Results

The lesion in question displays features highly consistent with both osteoid osteoma and osteoblastoma. The tumor had a non-sclerotic, sharply demarcated border, a radiolucent nidus measuring less than 2 centimeters in diameter, and homogeneous sclerotic bone surrounding the nidus.

Conclusions

Differential diagnosis determined the osseous tumor to be a benign neoplasm, and in this case the features of the tumor are highly consistent with a diagnosis of either osteoblastoma or osteoid osteoma.

Significance

The identification of novel neoplastic cases in paleopathology represents an important contribution to ongoing discussions regarding the temporality and regional variability of neoplastic conditions in the past. Additionally, a rigorous diagnostic study augmented by x-ray, CT scans, and 3D modeling provides data that can be utilized in future paleopathological studies.

Limitations

Diagnostic interpretation would be aided by histological examination of the tumor, which was impossible in this case. Histological examination would provide a definitive diagnosis.

Suggestions for further research

Given the high incidence of benign tumors in the clinical literature but a paucity of reports in the paleopathological record, further research is indicated to better understand the implications of benign neoplasms in antiquity.

Objective

This study assessed the sensitivity and specificity of skeletal lesions to accurately diagnose TB in a pre-antibiotic South African skeletal sample.

Materials

A total of 435 skeletons of individuals who died before 1950 from the Raymond A. Dart Collection of Human Skeletons. 176 died of TB, 109 died of other pulmonary diseases, and 150 died of other causes.

Methods

The presence / absence of 23 skeletal lesions were assessed for differences in frequency between groups. Sensitivities and specificities were calculated and compared to Dangvard Pedersen et al. (2019).

Results

Lesions on the ventral surface of thoracic and lumbar vertebral bodies were observed significantly more often in TB and pulmonary cases than in other cause of death group and yielded a 55% probability of a true TB diagnosis, if observed. An association between skeletal lesions and TB was found for rib and vertebral lesions.

Conclusions

The results suggest that even when not documented to have died of TB, TB-related changes are observed in many individuals in a South African skeletal sample, indicating that they may have been infected with the disease.

Significance

The study provides information that can assist palaeopathologists in making inferences about the prevalence of TB in past populations.

Limitations

Sample sizes were small, and the inclusion of a pulmonary disease group may have confounded the results.

Suggestions for further research

The selection of a control group without any possible contact with TB may improve the results and should be investigated.

Objective

This project aims to provide an objective approach to suggesting cases of adolescent rickets using the presence of anterior sacral angulation and interglobular dentine.

Materials

Sacra from 49 individuals from Hattem and 150 individuals from Middenbeemster, and second and third molars from five individuals from Hattem were analyzed. Both sites date to the 17th to 19th centuries.

Methods

The sacra were visually assessed for sacral angulation and measured to quantify anterior sacral angulation. The sampled molars were thin sectioned to look for the presence of interglobular dentine.

Results

Metric analysis determined that seven individuals had significantly anteriorly angled sacra. Three of the five individuals with sampled molars had interglobular dentine formed during adolescence.

Conclusions

Adolescent rickets may be associated with anterior sacral angulation.

Significance

Anterior sacral angulation may help identify possible cases of adolescent rickets in archaeological human remains.

Limitations

The small sample size for the molars prevented the identification of more individuals with interglobular dentine present during adolescence. Several individuals with visibly angled sacra were unmeasurable due to post-mortem damage and lacked molars.

Suggestions for further research

Research on a larger sample would allow us to understand better the association between anterior sacral angulation and adolescent rickets.

Objective

To evaluate pathological lesions suggesting the presence of rickets and to place the diagnosis into bioarchaeological and historical context.

Materials

The remains of a 3-year ± 12-month-old child discovered during a rescue excavation in Heuvelton, New York.

Methods

We examined the individual macroscopically and conducted a differential diagnosis following established protocols in the palaeopathological literature.

Results

Bony change on the orbits, mandible, ribs, clavicles, left scapula, humerii, radii, ulnae, femora, tibiae, fibulae (e.g., porosity, diaphyseal thickening, flaring, bowing), and dental lesions were recorded.

Conclusions

We demonstrate that the child likely presented with vitamin D deficiency rickets during crawling and as they learned to walk.

Significance

This example offers an important contribution to the bioarchaeological literature, as few cases of rickets have been recorded in rural North America using updated diagnostic criteria and little is known of the health and lifeways of early settlers in 19th-century upstate New York.

Limitations

It is not possible to ascertain the precise aetiology of this child’s rachitic state and to compare this individual with others in the population.

Suggestions for further research

Examination (and re-assessment) of other North and South American skeletal assemblages for signs of vitamin D deficiency rickets following current bioarchaeological standards.

Since the publication of the Christ Church Spitalfields crypt, London, in 1993, archaeologists and paleopathologists have increasingly recognized the importance of post-medieval burial assemblages. Increasingly paleopathologists have explored the impact industrialization and urbanization had on disease. This virtual special issue focuses upon a global examination of the transition to industry commencing in the mid-18th century. The objectives are to identify commonalities and disparities in general health during the development of industry within a global context, and to examine, and in some cases challenge, long-held assumptions about health during this period of dramatic social change. It gathers together papers from international scholars in order to examine patterns in health experience throughout the transition to industry. The individual papers address this transition in terms of the unique chronological, political, economic, and social parameters of their specific region. This introduction identifies long held assumptions about the impact the industrial revolution had on health and outlines the specific environmental and social conditions of industry that influenced human disease.