Reconstructing the history of helminth prevalence in the UK.

Intestinal helminth parasites (worms) have afflicted humans throughout history and their eggs are readily detected in archaeological deposits including at locations where intestinal parasites are no longer considered endemic (e.g. the UK). Parasites provide valuable archaeological insights into historical health, sanitation, hygiene, dietary and culinary practices, as well as other factors. Differences in the prevalence of helminths over time may help us understand factors that affected the rate of infection of these parasites in past populations. While communal deposits often contain relatively high numbers of parasite eggs, these cannot be used to calculate prevalence rates, which are a key epidemiological measure of infection. The prevalence of intestinal helminths was investigated through time in England, based on analysis of 464 human burials from 17 sites, dating from the Prehistoric to Industrial periods. Eggs from two faecal-oral transmitted nematodes (Ascaris sp. and Trichuris sp.) and the food-derived cestodes (Taenia spp. and Diphyllobothrium latum syn Dibothriocephalus latus) were identified, although only Ascaris was detected at a high frequency. The changing prevalence of nematode infections can be attributed to changes in effective sanitation or other factors that affect these faecal-oral transmitted parasites and the presence of cestode infections reflect dietary and culinary preferences. These results indicate that the impact of helminth infections on past populations varied over time, and that some locations witnessed a dramatic reduction in parasite prevalence during the industrial era (18th-19th century), whereas other locations continued to experience high prevalence levels. The factors underlying these reductions and the variation in prevalence provide a key historical context for modern anthelmintic programs.

ERA Merewether - And asbestos.

After a succession of posts and studying for the Bar, Edward Merewether joined the Medical Inspectorate of Factories in 1927. Not long thereafter he was asked to undertake a study of the effects of asbestos exposure on the lungs. His results showed that asbestos workers had a significant risk of developing pulmonary fibrosis and this resulted in the promulgation of regulations to limit exposure. Some years later, Merewether showed that asbestos workers also had a higher than expected risk of developing lung cancer, but on this occasion there was no further protective legislation, and the association was not generally accepted until some years later. Merewether's name is inextricably linked with the risks of asbestos exposure but after his death the importance of his efforts was often played down by those who wished to show that the government had not acted quickly enough, or vigorously enough to control the hazard. The contention of this paper is that these criticisms are not justified and that Merewether acted to the best of his ability, given the conditions and knowledge current at the time he was working.

Epidemiological insights from a large-scale investigation of intestinal helminths in Medieval Europe.

Helminth infections are among the World Health Organization's top neglected diseases with significant impact in many Less Economically Developed Countries. Despite no longer being endemic in Europe, the widespread presence of helminth eggs in archaeological deposits indicates that helminths represented a considerable burden in past European populations. Prevalence of infection is a key epidemiological feature that would influence the elimination of endemic intestinal helminths, for example, low prevalence rates may have made it easier to eliminate these infections in Europe without the use of modern anthelminthic drugs. To determine historical prevalence rates we analysed 589 grave samples from 7 European sites dated between 680 and 1700 CE, identifying two soil transmitted nematodes (Ascaris spp. and Trichuris trichiura) at all locations, and two food derived cestodes (Diphyllobothrium latum and Taenia spp.) at 4 sites. The rates of nematode infection in the medieval populations (1.5 to 25.6% for T. trichiura; 9.3-42.9% for Ascaris spp.) were comparable to those reported within modern endemically infected populations. There was some evidence of higher levels of nematode infection in younger individuals but not at all sites. The genetic diversity of T. trichiura ITS-1 in single graves was variable but much lower than with communal medieval latrine deposits. The prevalence of food derived cestodes was much lower (1.0-9.9%) than the prevalence of nematodes. Interestingly, sites that contained Taenia spp. eggs also contained D. latum which may reflect local culinary practices. These data demonstrate the importance of helminth infections in Medieval Europe and provide a baseline for studies on the epidemiology of infection in historical and modern contexts. Since the prevalence of medieval STH infections mirror those in modern endemic countries the factors affecting STH decline in Europe may also inform modern intervention campaigns.

Sibyl Horner, Sydney Alexander Henry, and occupational skin disease.

Occupational skin disease was, and remains, a major cause of morbidity, accounting for many thousands of hours lost from work each year. Investigating the causes, and seeking preventive measures, occupied much of the time of the early Medical Inspectors of Factories. Two of the inspectors, Sydney Henry and Sibyl Horner, became specialists in certain types of skin disease.

Edgar Leigh Collis: Industrial lung disease and ergonomics.

Edgar Collis was appointed as the second Medical Inspector of Factories in 1908, holding the post until the outbreak of the First World War when he became Medical Director of the Ministry of Munitions. After the war, he was appointed to the chair in public health in the University of Wales. He held this post while living in Lossiemouth in Scotland, some 570 miles distant. His research interests were in industrial lung disease, industrial hygiene, and the health of coal miners. He made important contributions to the first and third subjects, but was a less significant figure in the field of industrial hygiene. Among his achievements were the recognition of the relationship between silicosis and tuberculosis, the harmful effects of non-silicaceous coal dust, and the need to fit the worker to the job, and the job to the worker.

Hypertrophic osteoarthropathy in an adult macaque.

OBJECTIVE: To evaluate through differential diagnosis whether hypertrophic osteoarthropathy was present on an adult macaque skeleton. MATERIALS: Skeletal remains of a well-preserved adult macaque (Macaca) of unknown species curated by the archaeology department at University College London. METHODS: Macroscopic and radiographic evaluation of pathological lesions. RESULTS: Widespread bilateral and symmetrical periosteal new bone growth primarily affecting the limbs was observed. CONCLUSION: A careful differential diagnosis of the lesions and comparison with previously published cases of hypertrophic osteoarthropathy among humans and non-humans suggests this animal displays a case of Hypertrophic osteoarthropathy. SIGNIFICANCE: Only been three reported cases of HOA in non-human primates have been reported, and all were apes. This study serves as the first reported case of HOA among non-hominoid simians, providing a detailed description of the skeletal lesions to aid future with paleopathological analyses. LIMITATIONS: Small sample sizes for comparison and lack of context for this specimen limits discussion of the scope of this disease among non-human primates. SUGGESTIONS FOR FURTHER RESEARCH: Re-evaluate skeletal collections which have not been subject to recent osteological and pathological analysis.

SCJ osteoarthritis: The significance of joint surface location for diagnosis.

An evaluation of the method used to diagnose sternoclavicular joint (SCJ) osteoarthritis (OA) in skeletal remains is presented, with particular attention given to the anatomy of the joint. The current palaeopathological diagnostic criteria used to identify SCJ OA were found to be appropriate for both the sternal and clavicular surfaces of the SCJ, with eburnation indicating perforation of the intra-articular disc and advanced disease. Eburnation was found to occur rarely in the SCJ, and if used as the sole diagnostic criterion would result in an underestimation of SCJ OA prevalence in archaeological assemblages. A key finding was the identification of changes characteristic of OA but confined to the attachment zone of the intra-articular disc on the clavicular surface of the SCJ. As this area of the joint is non-articular, and not normally covered with articular cartilage, a diagnosis of OA would be inaccurate and instead it should be considered as an enthesopathy. It is likely that SCJ OA has been incorrectly identified and over-diagnosed in the archaeological record in the past. More histological research into the disc attachment and its degeneration is required before this can be confirmed.

Extensive periosteal new bone formation in a skeleton from post-Medieval Chichester, England: A probable case of metastatic prostatic carcinoma.

An elderly male skeleton from a site in Chichester, UK, was found with a widespread periosteal reaction, principally affecting the axial skeleton and the pelvis. Radiography showed the presence of sclerosing infiltrates, mainly involving the lumbar vertebrae and pelvis. The differential diagnosis is discussed, reaching the conclusion that hypertrophic osteo-arthopathy (HOA) is the only reasonable alternative condition likely to produce such a widespread periosteal reaction as found here. HOA does not produce secondary deposits in the skeleton, however, and we conclude that his is most likely a case of prostatic carcinoma.

On the importance of considering disease subtypes: Earliest detection of a parosteal osteosarcoma? Differential diagnosis of an osteosarcoma in an Anglo-Saxon female.

A case of potentially dedifferentiated parosteal osteosarcoma was found in the proximal humerus of an adult female buried in the late Anglo-Saxon cemetery of Cherry Hinton, Cambridgeshire, UK. Key features include a large, dense, lobulated mass attached to the medial metaphysis of the proximal humerus by a broad-based attachment, accompanied by cortical destruction and widespread spiculated periosteal reaction. Radiographic images confirm medullary involvement, lack of continuity between the cortex and external mass, a radiolucent cleavage plane and possible radiolucent zones within the bony masses. Differential diagnoses considered include osteochondroma, myositis ossificans, fracture callus, as well as the primary malignancies of osteosarcoma and chondrosarcoma, and their various subtypes. The macroscopic and radiographic analysis of the tumor is described and discussed within clinical and paleopathological contexts. One of only 19 uncontested examples of osteosarcoma from past human populations, most of which remain unconfirmed, this case represents what we believe to be the earliest, and probably singular, bioarcheological example of parosteal osteosarcoma in human history.

Case report: A giant calcified uterus, likely due to benign leiomyoma.

During the 2011 excavation of the site of St. Michael's Litten, in Chichester, England, a female skeleton, dating to the post-Medieval period (1550-1850), with a large, unidentified pelvic mass was uncovered. The mass measured 16.4H×19.0W×24.3L and was 66cm in its greatest circumference; it weighed 3.32kg. The skeleton presented with established osteoporosis and was estimated to be of an advanced age. The analytic methodology used to evaluate the mass was based on that of Kramar et al. (1983). Considering the results of these analyses, and through an extensive search of the relevant medical, historical and archaeological literature, it was determined that this mass was likely a neoplasm of reproductive origin, and was further defined as a calcified uterus containing a number of leiomyomas. To date, this is the largest of its kind ever found archaeologically.

Roy Lee Moodie (1880-1934) and the beginnings of palaeopathology.

Roy Lee Moodie was a geologist whose interest in ancient disease was stimulated by his finding of pathological change in some of the fossils that he studied, including many from the Rancho La Brea site in California. He occupied teaching positions in Chicago, Dallas and Santa Monica and in 1928 began an acquaintance and a correspondence with Henry Wellcome who was then in the United States and appearing before the Senate Committee on Foreign Affairs. Moodie persuaded Wellcome to sponsor his palaeopathological work and the following year he was appointed palaeopathologist to the Wellcome Historical Medical Museum (WHMM) at a salary of six thousand dollars a year, the first person to hold such a title and the first and only occupant of the title at the WHMM or its successor organisations. He published extensively from 1915 until his death in 1934, including his great compendium Paleopathology; an Introduction to the Study of Ancient Evidences of Disease, and the collected papers of Sir Marc Armand Ruffer. He is perhaps best remembered or, at least, most widely quoted for attributing the beginnings of palaeopathology to a publication of Esper in 1774 although the passage in which he did so contained two major errors that have been perpetuated in the literature ever since, the authorship of the publication and the diagnosis of the lesion that he supposed began the study of disease in antiquity.

Henry Moon and his molars.

Henry Moon qualified in London in medicine and dentistry, emigrated to New Zealand, eventually returning to London. He is known for his observations of the malformation of tooth cusps in children with congenital syphilis.

Crooked Timber: The life of Calvin Wells (1908-1978).

Calvin Wells was the leading palaeopathologist in the UK between the later 1950s and the early 1970s. He studied medicine at University College London but failed in anatomy and qualified in 1933 with the Conjoint Diploma (MRCS, LRCP). After qualification he began to study obstetrics and after war service in the RAMC he settled in Norfolk (UK), established a small general practice and took up palaeopathology. Although he was usually conservative in diagnosis he tended to over-interpret signs in the skeleton, often publishing descriptions that were more fiction than science. He held firm views on the way in which palaeopathology should be undertaken and in particular he resented the entry into the field of anthropologists without medical training. His major contributions to palaeopathology were related to the study of cremations and the introduction of the notion of pseudopathology, and his writings on these subjects have scarcely been improved upon since. He was extremely well read, warm and encouraging to those with archaeological or medical qualifications, but vituperative about those he disliked. His bone reports, which are a major proportion of his published output, generally were highly regarded but his writing is often marred by sexual innuendo and vulgarity which does his memory little credit.

TMJ osteoarthritis: a new approach to diagnosis.

Disorders of the temporomandibular joint (TMJ), including TMJ osteoarthritis (TMJ OA), are the topic of intensive clinical research; however, this is not the case in the archaeological literature, with the majority of work on the subject ceasing with the early 1990s. The methods employed in the diagnosis of TMJ OA within the archaeological work appear nonrepresentative of the disease and may have led to erroneous assumptions about the pattern and prevalence of OA. This current work presents a new method for evaluating OA specifically for the TMJ, considering both the biomechanics of the joint and the mechanisms of the disease. Totally, 496 specimens (including a group of modern documented specimens) were analyzed for the presence of TMJ OA using the following criteria: eburnation, osteophytes (marginal and new bone on joint surface), porosity, and alteration to joint contour. The results suggest that eburnation occurs rarely in the TMJ, so should not be used as an exclusive criterion. Rather a combination of at least two of the other criteria should be used, with osteophytes and porosity occurring the most frequently on both the mandibular condyle and articular eminence. Additionally, the prevalence of TMJ OA in the modern assemblage was similar to that observed in current clinical research, suggesting that the method employed here was able to produce a reasonable approximation of what is found in contemporary living populations.

Apple Down 152: a putative case of syphilis from sixth century AD Anglo-Saxon England.

This report describes a putative case of a treponemal infection observed on a skeleton of a young male adult from the Apple Down Anglo-Saxon cemetery dating to the sixth century AD, accompanied by grave goods indicative of a high status burial. The skeleton is well preserved and almost complete. The pathological evidence includes an extensive area of lytic destruction to the frontal bone of the skull, widespread profuse bilateral symmetrical periosteal reaction affecting scapulae, clavicles, arms, legs, hands, feet and ribs. There is also evidence of gummatous destruction on some of the long bones. Application of a differential diagnosis of all probable diseases exhibiting the individual symptoms leads to a clear conclusion that the person was infected with a treponemal pathogen. The skeleton shows none of the stigmata associated with the congenital form of treponemal disease. We propose that the evidence suggests a possible case of venereal syphilis rather than one of the endemic forms of treponemal disease. This diagnosis is based on the geographical pathogen range, the apparent low prevalence of the disease, significant social upheaval at the time, the high social status and early age of death of the individual.

Thomas Morison Legge (1863-1932): the first medical factory inspector.

After a brief career in public health, Thomas Morison Legge was appointed to become the first medical factory inspector, in 1898, and remained in post until his resignation in 1927. During his tenure in office he became the leading authority on lead poisoning and anthrax; he resigned when the government refused to ratify the White Lead Convention. Subsequently he became the first medical adviser to the Trades Union Congress.