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The utility of Bayes' theorem in paleopathological diagnoses is explored. Since this theorem has been used heavily by modern clinical medicine, its usefulness in that field is described first. Next, the mechanics of the theorem are discussed, along with methods for deriving the prior probabilities needed for its application. Following this, the sources of these prior probabilities and their accompanying problems in paleopathology are considered. Finally, an application using prehistoric rib lesions is presented to demonstrate the utility of this method to paleopathology.
The aim of this paper was to demonstrate the application of computerized tomographic (CT)-guided biopsy in a paleopathological examination. Researchers dealing with such special tasks should be aware of this method. We performed a CT-guided percutaneous biopsy of an ancient Egyptian child mummy, which allowed us to revise its initial diagnosis. Based on this experience, extended preinterventional planning and the choice of equipment (needle type) preferred by performing radiologists are strongly recommended, since they will influence diagnostic outcome. Easy documentation, suitable approaches according to the object's condition, and a reliable anatomical orientation without superposition effects during the procedure are some of the advantages of this method. It its already widely established in clinical practice. This technique is recommended for future tissue-sampling of human paleopathologic remains like mummies that are still wrapped within their original bandages, or any small bone lesion of unclear etiology.
PURPOSE: To correlate presence and size of the third intercondylar tubercle of Parsons (TITP) with occurrence and severity of osteoarthritis of the knee. MATERIALS AND METHODS: In 100 paleopathologic tibial specimens and on 160 clinical knee radiographs, size of the TITP was correlated with osteoarthritis of medical and lateral femorotibial joints (FTJ) and with prominence of tibial spines. RESULTS: TITP size correlated significantly with osteoarthritis of the tibial plateau in the paleopathologic specimens (P<.0001). TITP size correlated significantly with osteoarthritis of medial FTJ and tibial spines on radiographs (P<.0001). Of 85 patients without osteoarthritis of the medial FTJ, 49 (58%) had no TITP, 33 (39%) had small TITPs, and three (4%) had medium or large TITPs. TITPs were found in 15 (88%) of 17 patients with pronounced osteoarthritis. CONCLUSION: Frequency and prominence of TITPs are increased in patients with osteoarthritis of the medial FTJ and prominent tibial spines. Prominent TITP is a secondary sign of osteoarthritis. At histologic examination, increasing size of TITPs represents osteophytosis or enthesopathy of the TITP.
Spinal tuberculosis (TB) infrequently involves more than one to three vertebrae, and kyphotic angulation of greater than 30 degrees is rare in paleopathological specimens and clinical studies. The authors describe findings obtained in two spines (dating from the Early and Late Middle Ages). Spinal TB was present in both as well as sharply angulated kyphosis (approximately 180 degrees) resulting from complete destruction of five and seven vertebral bodies, respectively. In these two specimens obtained in individuals older than 12 years of age at the time of death we observed no involvement of the disease in posterior vertebral elements, and the laminae showed osseous fusion without signs of infection. The osseous diameter of the spinal canal was not narrowed in either case. These findings are discussed in the context of modern medical knowledge and paleopathological and genetic examinations.
The occurrence and frequency of neoplastic lesions in ancient populations has been a subject of debate for both paleopathologists and medical historians. The available sources of information are both direct, i.e., deriving from the study of ancient skeletal or mummified samples, and indirect, i.e., deriving from the analysis of ancient works of art, and of written records. Often, however, indirect sources do not allow a precise nosographic identification of the disease. Therefore, paleopathology is critical for the study of tumors in antiquity. The paleopathological record is itself difficult to interpret, because of the relative scarcity and poor state of preservation of the samples generally available for analysis. The study of the antiquity of tumors can be conveniently approached following a geographic criterion. Tumors are already documented in fossil specimens referred to an early ancestor of modern humans, Homo erectus. However, neoplastic lesions become relatively abundant only from the Neolithic period. Altogether, in ancient populations from Africa, Eurasia and the Americas, some benign tumors and most malignant soft tissue tumors may have had a frequency comparable to that documented for modern populations. In contrast, carcinomas and hemopoietic tumors which occur frequently in modern populations appear to have been generally rare in antiquity. To a large extent, this was probably related to the demographic structure of ancient populations. However, some malignant tumors, including nasopharyngeal carcinoma in ancient Egypt, and multiple myeloma in Africa, Eurasia, and the Americas, may have occurred more frequently in the past.
Mirko Drazen Grmek died on 6 March 2000, defeated by an implacable enemy (amyotrophic lateral sclerosis, which had been diagnosed just 18 months earlier). He has now found peace in his final resting place, the Montparnasse cemetery in Paris. His immense body of work reveals an omniscient man of great wisdom, a cosmopolitan polyglot who devoted his life to the history of science, with particular emphasis on medicine and disease. He looked at paleopathology for what that discipline could bring to the study of populations in antiquity, and succeeded in anchoring it in history with his definitive concept of "pathocenose", created in 1969. Several years later, his most important work, "Les Maladies à l'aube de la civilisation occidentale", (1983) set forth with definitive and convincing illustrations the importance of paleopathology, which will therefore be forever associated with one of the most outstanding medical history books of the XXth. century.
Paleopathology is useful for our knowledge of the natural history of cancer. However, the interpretation of neoplasms (retrospective diagnosis and past epidemiology) is one of the more interesting and difficult aspects of paleopathology. The occurrence and frequency of neoplastic lesions in ancient populations which seem lower in human antiquity than they are now, are still a subject of debate for both paleopathologist and medical historians. However, all forms of benign and malignant tumors of bones have been documented in ancient human specimens from the Neolithic period.
OBJECTIVE: Identification and paleopathological analysis of the remains of the first members of the Nassau dynasty in the Netherlands. DESIGN: Descriptive. SETTING: Centre for Physical Anthropology 'Barge's Anthropologica', Leiden University. METHODS: In 1996, seven interments were discovered in situ in a tomb under the Nassau monument of the so-called 'Grote' or 'Onze Lieve Vrouwe' Church of the city of Breda. The interments were excavated and examined by osteological analysis, X-ray analysis, accelerator mass spectrometry (AMS) 14C dating of bone and dendrochronological dating. RESULTS: Evaluation of archaeological, osteological, dendrochronological and AMS 14C-dating data resulted in identification. in order of death, of: Engelbrecht I van Nassau (ca. 1370-1442 AD), Johanna van Polanen (1392-1445 AD), Jan IV van Nassau (1410-1475 AD), Cimburga van Baden (1450-1501 AD), Maria van Loon (1425-1502 AD), Engelbrecht II van Nassau (1451-1504 AD) and Françoise van Savoye ((1480-1486)-1511 AD). Remarkable medical findings were: embalming procedures employed (skull cap detachment, removal of viscera), treponematosis (Engelbrecht II), tumour metastases (Jan IV) and scoliosis (Françoise van Savoye). CONCLUSION: The methods employed resulted in positive identification of the first members of the Nassau dynasty in the Netherlands and diagnoses of their paleopathological changes.
An Iron Age (megalithic) skull recovered from a cist burial complex at Agripalle, Andhra Pradesh, India, exhibits extensive erosion of the calvarium, areas of sclerotic diploe, irregular osteitic and periosteitic lesions, and deep ulcerations with a granulomatous appearance of nodular foci due to bone remodeling. These lesions are found over the entire surface, but are less severe in the temporal region and in the occipital region below lambda. There is extensive ulceration and destruction of the orbital roof and the nasopalatine region. A thick bony mass representing a healed lesion is present on the nasal margin. Comparison with the pathologic skeletal series of Ortner and Putschar ([1981] Smithson. Contrib. Anthropol. 28:180-218), Steinbock ([1976] Paleopathology: Diagnosis and Interpretation, pp.86-169), and Calvin ([1964] Bones and Disease: Evidence of Disease and Abnormality in Early Man) indicates that these findings warrant a diagnosis of an advanced stage of treponematosis. The material from Agripalle, together with similar specimens recovered from the sites of Bhimbetka (Iron Age) and Inamgaon (Chalcolithic), furnish additional evidence supporting the hypothesis of the prehistoric antiquity of treponemal disease in both the New and Old Worlds.
Nine human skeletons of medieval date from a rural English burial site show signs of skeletal tuberculosis. They were subject to polymerase chain reaction (PCR) assays aimed at detecting traces of DNA from infecting mycobacteria, with the purpose both of confirming the paleopathological diagnosis of tuberculosis and determining in individual cases whether disease was due to M. tuberculosis or M. bovis. In all nine cases, evidence for M. tuberculosis complex DNA was found, and in all instances it appeared that disease was due to M. tuberculosis rather than M. bovis. The significance of the findings for understanding tuberculous infection in rural agrarian communities in medieval England is discussed.
In the nineteenth century, accurate descriptive studies, often dealing with pre-Columbian "syphilis," were made by Virchow, J. Jones, and Putnam. Hrdlicka, Moodie, Ruffer, and others in the early twentieth century carried out research on subjects ranging from trephination to schistosomiasis. However, it was not until Hooton, Williams, Stewart, Wells, and others (1930 to 1965) that paleopathology was combined with paleodemography to get a population perspective on health as an equilibrium with disease. Not until recently, with the creative summaries of Jarcho and Brothwell, have we had bone pathologists (Lent Johnson and especially Putschar) and others (Moseley in blood, Cockburn and Allison in epidemiology and mummies) working actively with physical anthropologists and historians. This cooperation has triggered a major revival in the study of bone physiology and responses to disease (Ortner), disease ecology, demography and health, and paleonutrition (Goldstein, Laughlin, Cook and Buikstra, Ubelaker, Angel). New techniques range from histology to immunochemistry and now involve a host of young investigators.
Paleopathological analyses of skeletal remains have provided significant information about diet and health in prehistoric populations. A number of individuals have been recovered whose remains show evidence of impairments that would have precluded "normal" functioning, resulting in a disability. The most famous example is Shanidar I; more recent discoveries include the Romito 2 dwarf from Italy and a boy with spina bifida from the Windover site in Florida. These finds have been interpreted by some writers as evidence for compassion and "moral decency" among the other members of the community, who would have had to support these nonproductive individuals. However, these interpretations are based on a number of implicit assumptions: about the number of nonproductive members normally present in any population, about the abilities of disabled individuals to contribute to society, about the treatment of disabled individuals by other members of the group, and about the "moral rightness" of facilitating the survival of a disabled individual under all circumstances. These assumptions are not justified by the evidence from the archeological record or by reference to ethnographic analogy. A tendency to focus on physical traits as the sole measure of productive ability, images of Rousseau's "noble savage" transported to the past, and unexamined beliefs about the disabled in modern societies have influenced these archeological interpretations. We are not justified in drawing conclusions either about the quality of life for disabled individuals in the past or about the motives or attitudes of the rest of the community from skeletal evidence of physical impairment.
Hallux valgus is the abnormal lateral deviation of the great toe. The principal cause is biomechanical, specifically the habitual use of footwear which constricts the toes. In this study, descriptions of the anatomical changes of hallux valgus from published cadaveric and clinical studies were used to generate criteria for identifying the condition in ancient skeletal remains. The value of systematic scoring of hallux valgus in paleopathology is illustrated using two British skeletal series, one dating from the earlier and one from the later Medieval period. It was found that hallux valgus was restricted to later Medieval burials. This appears consistent with archaeological and historical evidence for a rise in popularity, during the late Medieval period (at least among the richer social classes), of narrow, pointed shoes which would have constricted the toes.