A depiction of poliomyelitis in a 17th -century Piedmontese fresco?

INTRODUCTION: A potential representation of poliomyelitis is investigated in an Italian artwork. MATERIALS AND METHODS: A 17th century Piedmontese fresco is analyzed by combining historico-medical, palaeopathological and clinical approaches. Alternative diagnoses are considered. RESULTS, DISCUSSION AND CONCLUSIONS: The man appearing in the fresco holding a crutch is characterized by an atrophic left leg reminiscent of poliomyelitic atrophic. Other congenital anomalies or cerebrovascular causes appear less likely. A reflection on the difficulty of retrospectively diagnosis poliomyelitis is offered.

The first probable case with tuberculous meningitis from the Hun period of the Carpathian Basin - How diagnostics development can contribute to increase knowledge and understanding of the spatio-temporal distribution of tuberculosis in the past.

The aim of our paper is to demonstrate and discuss in detail the endocranial bony changes suggestive of tuberculous meningitis (TBM) that were recorded in an adult female's (SPF15) skeleton. The bone remains were uncovered from a solitary grave from the Hun period (5th-century-CE) archaeological site of Solt-Polya-fok (Bács-Kiskun county, Hungary). During the macromorphological examination of the very incomplete and poorly preserved skeleton of SPF15, the inner surface of the skull displayed abnormally pronounced digital impressions (APDIs) and granular impressions (GIs). Recently, it was confirmed that endocranial GIs can be considered as specific signs of TBM; and thus, they are sufficient enough on their own to make a definitive diagnosis of the disease in the palaeopathological practice. On the other hand, APDIs are not specific to TBM but can be tuberculous in origin; their concomitant presence with GIs in SPF15 makes their tuberculous origin very likely. Based on the above, it seems that the adult female from the 5th-century-CE archaeological site of Solt-Polya-fok suffered from TBM. SPF15 is the first reported probable case with tuberculosis (TB) from the Hun period of the present-day territory of Hungary, who gives us invaluable information about the spatio-temporal distribution of the disease in the past. Furthermore, it highlights the paramount importance of diagnostics development, especially the identification and refinement of diagnostic criteria, as without the application of APDIs and GIs, the diagnosis of TB could not have been established in SPF15.

Leprosy: The age-old companion of humans - Re-evaluation and comparative analysis of Avar-period cases with Hansen's disease from the Danube-Tisza Interfluve, Hungary.

In recent years, our knowledge of leprosy in the past has substantially been enriched. Nonetheless, much still remains to be discovered, especially in regions and periods from where no written sources are available. To fill in some research gaps, we provide the comparative analysis of eight Avar-period leprosy cases from the Danube-Tisza Interfluve (Hungary). In every case, to reconstruct the biological consequences of leprosy, the detected bony changes were linked with palaeopathological and modern medical information. To reconstruct the social consequences of being affected by leprosy, conceptualisation of the examined individuals' treatment in death was conducted. In every case, the disease resulted in deformation and disfigurement of the involved anatomical areas (rhinomaxillary region, feet, and/or hands) with difficulties in conducting certain physical activities. These would have been disadvantageous for the examined individuals and limited or changed their possibilities to participate in social situations. The most severe cases would have required continuous support from others to survive. Our findings indicate that, despite their very visible disease and associated debility, the examined communities did not segregate leprosy sufferers but provided and cared for them, and maintained a strong enough social network that made their survival possible even after becoming incapable of self-sufficiency.

Survival in Mudejar Spain in the Middle Ages (thirteenth-fourteenth centuries): Ancient Rare Diseases-an uncommon diagnosis in archaeological human remains.

PURPOSE: The finding of severe skeletal alterations in ancient remains could give us useful information not only about the pathologies of the individual per se, as it could infer the state of health of a population. METHODS: From the findings of the Mudéjar Cemetery of Uceda (Guadalajara, Central Spain) where a total of 116 burials with almost complete skeleton were recovered, an interesting individual is presented (palaeopathological perspective). The individual 114UC corresponds to a male of 20-25 years old and its age goes back to the thirteenth-fourteenth centuries. RESULTS: The first inspection showed the presence of serious alterations especially in the lumbar spine and pelvic girdle. Seven vertebrae (from T11 to L5) showed an unusual posterior fusion only in the postzygapophyseal joints. The pelvis, after being accurately assembled and congruence verified by X-ray and CT scan, showed a noticeable asymmetry of both iliac wings together with a coxa magna protusa (Otto's pelvis), severe anteversion of both cup hips and osteochondritis of the right femoral head. The posterior-slope of both tibias reached about 10°. CONCLUSIONS: The differential diagnoses lead us to think of Arthrogryposis Multiplex Congenita as the most probable diagnosis. We analyzed the same biomechanical aspects after taking into account some patterns that give us information about a possible mobility in the first stage of life. We discuss the very few other cases described both from artworks and in the palaeopathological record. To our knowledge, this case could be the oldest published case of AMC worldwide.

Toxicological Analysis of Drugs in Human Mummified Bodies and Proposed Guidelines.

From palaeopathology to forensic taphonomy, mummified human bodies constitute biological archives of paramount importance. Toxicology analysis of endobiotics and xenobiotics has already shown value to archaeological mummies research with detecting heavy metals, sedative-hypnotic drugs, and stimulants. Thanks to the large window of drug detection in hair and nails, the information from such studies has increased the scientific community's knowledge regarding past populations' lifestyles. Still, few bibliographic references exist regarding toxicology reports in mummified bodies from forensic settings. Here, the authors aim to draw attention to the valuable contribution of toxicology analysis, taking into account previously conducted studies and their findings. Given that sample collection on mummified bodies from forensic scenarios may not always happen in laboratories or autopsy rooms, the authors also suggest guidelines for in situ sampling of forensic mummies. It is expected that the present technical note will encourage experts to perform toxicology analysis in mummified bodies and publish their case reports more often.

Insights into the aetiologies of hypercementosis: A systematic review and a scoring system.

OBJECTIVES: This paper aims to better define hypercementosis, investigate its described potential aetiologies, and determine whether there are different patterns of cementum apposition and if they are a function of their supposed aetiology. DESIGN: A literature review was undertaken using the Medline, DOSS, Scopus and Cochrane Library electronic databases. Two co-authors selected the published works independently, extracted the data in accordance with the PRISMA statement. RESULTS: Among 546 articles, 75 articles were finally selected. Eight different supposed aetiologies were identified: (1) intensive masticatory effort, (2) systemic disease, (3) carious lesion and apical periodontitis, (4) impaction, (5) periodontal disease, (6) concrescence, (7) super-eruption, and (8) drugs. Some of these aetiologies can be combined in the same tooth. Hypercementosis manifestations are various in nature and extent with different patterns that may be aetiology-specific. To improve the description and associated consistency in the characterisation of hypercementosis, in this review but also in future studies, we propose a new qualitative scoring system to quickly characterise hypercementosis and determine its most relevant aetiology. CONCLUSIONS: This systematic review demonstrates that hypercementosis is a complex and not yet well-defined condition. Some forms of apposition are specific to a given aetiology. The hypercementosis characterisation may contribute to document the oral condition and/or the individuals masticatory activity.

The history of pertussis: from an ancient scourge to a contemporary health burden.

The present article offers a historical overview on pertussis (whooping cough) by analysing the ancient epidemic manifestations of the disease and the path towards the discovery of an effective vaccine against it. The original mentions of pertussis are examined with reference to Mediaeval Afghanistan and the famous AD 1578 Paris epidemic described by the French physician Guillaume de Baillou. The historical data are then matched with information derived from analyses of phylogenetic trees of B. pertussis. Finally, this article also highlights some recent challenges posed to public health by this infectious disease.

Adipositas and metabolic bone disorder in a 16th century Upper Austrian infant crypt mummy-An interdisciplinary palaeopathological insight into historical aristocratic life.

We describe here the results of a multidisciplinary study on an infant mummy from 16th century Upper Austria buried in the crypt of the family of the Counts of Starhemberg. The macroscopic-anthropological, radiological (whole-body CT scan), histological (skin tissue), and radiocarbon isotope investigations suggested a male infant of 10-18 months' age, most likely dying between 1550 and 1635 CE (probably Reichard Wilhelm, 1625-1626 CE), that presented with evidence of metabolic bone disease with significant bilateral flaring of costochondral joints resembling "rachitic rosary" of the ribs, along with straight long bones and lack of fractures or subperiosteal bleeding residues. Although incompletely developed, the osteopathology points toward rickets, without upper or lower extremities long bone deformation. The differential diagnosis is vitamin C deficiency (scurvy) (also with an incomplete presentation, although overlap between both disorders may be present). As additional pathology, there was significantly enlarged subcutaneous fat tissue (thickness more than 1 cm at the navel and thighs and longitudinal creases of the skin) along with a histologically enlarged subcutaneous fat layer consistent with infantile adipositas as a coincident disorder. Finally, remnants of lung tissue with pleural adhesion of the right lung indicate possibly lethal pneumonia, a disease with an increased prevalence in vitamin D deficient infants. Ultimately, the skull presented with extensive destruction of the bones of the base and dislocation of the bones of the skull squama. These changes, however, are most likely post-mortal pseudopathology, the result of a burial in a flat, narrow coffin because there were no bone fractures or residues of bleeding/tissue reaction that would have occurred whilst the patient was alive.

Bioarchaeological Notes on the Commingled Human Remains Held in the Church of Saint Francis of Paola, Sant'Angelo di Brolo, Sicily, Italy.

In this study, we examine human skeletal remains from the church of Saint Francis of Paola located in the small town of Sant'Angelo di Brolo, in the Italian region of Sicily. The preserved skeletal remains were temporarily transferred from their permanent resting place in the crypt for a macroscopic examination and evaluation. Various established methods were used to estimate age at death, sex, stature, any evidence of disease(s) as well as the fact that there was a minimum of 15 individuals. The findings were then subdivided into different groups of pathologies and recorded as individual cases. Amongst which, dental issues and cases of trauma were most prevalent. Additional conditions such as joint disease, congenital, metabolic and multifactorial disorders were also identified. The prevalence of dental decay indicates that the group's diet consisted largely of carbohydrates, and that their oral hygiene was poor. Furthermore, evidence of trauma and poor healing suggested that the town was isolated from the main medical centres of the island. Severe complications of traumas linked with a loss of movement and overall independence, as well as physical pain, must have had a significant impact on the lives of those affected.

A growth area: A review of the value of clinical studies of child growth for palaeopathology.

Studies of living children demonstrate that early life stress impacts linear growth outcomes. Stresses affecting linear growth may also impact later life health outcomes, including increased cardiometabolic disease risk. Palaeopathologists also assess the growth of children recovered from bioarchaeological contexts. Early life stresses are inferred to affect linear growth outcomes, and measurements of skeletal linear dimensions alongside other bioarchaeological information may indicate the types of challenges faced by past groups. In clinical settings, the impacts of stress on growing children are typically measured by examining height. Palaeopathologists are limited to examining bone dimensions directly and must grapple with incomplete pictures of childhood experiences that may affect growth. Palaeopathologists may use clinical growth studies to inform observations among past children; however, there may be issues with this approach. Here, we review the relationship between contemporary and palaeopathological studies of child and adolescent growth. We identify approaches to help bridge the gap between palaeopathological and biomedical growth studies. We advocate for: the creation of bone-specific growth reference information using medical imaging and greater examination of limb proportions; the inclusion of children from different global regions and life circumstances in contemporary bone growth studies; and greater collaboration and dialogue between palaeopathologists and clinicians as new studies are designed to assess linear growth past and present. We advocate for building stronger bridges between these fields to improve interpretations of growth patterns across human history and to potentially improve interventions for children living and growing today.

Transmission of Zoonotic Diseases in the Daily Life of Ancient Pompeii and Herculaneum (79 CE, Italy): A Review of Animal-Human-Environment Interactions through Biological, Historical and Archaeological Sources.

There is no doubt that the cultural and urban environments contributed to the animal-human interaction in the daily life of the ancient Roman world. The singularity of the circumstances of the burial of Pompeii and Herculaneum, together with literary sources and the extraordinary state of preservation of the archaeological and biological material found, has provided researchers with an opportunity, unique in its kind, to reconstruct the life and ways of living of its inhabitants. This study illustrates the main drivers and mechanisms for the distribution and transmission of zoonotic diseases in these ancient Roman populations, such as (i) the large number and role that different animal species played in the ancient Roman world; (ii) the environmental conditions for the survival of parasites, pathogens and vectors; (iii) the great variety and intensity of commercial activities and occupations that presented certain risks of infections; (iv) the absence of adequate safety controls during processing, distribution and preservation of foodstuffs in unsuitable environments and some culinary habits; (v) the inadequate mechanisms of the disposal of human waste and the biotic contamination of watercourses and reservoirs; and finally (vi) the use of animals related to religious and cultural practices.

The Blessed Antonio (Patrizi) from Monticiano, Sienna (Italy): Bioanthropological and Palaeohistological Considerations.

Background: A medieval mummy known as the Blessed Antonio (Patrizi) is held in the church of Saints Peter and Paul at Monticiano, Sienna, central Italy. Objectives: The aim of our investigation was to complete a biological profile of the subject, as well as to assess the impact of deterioration to the concerned remains. Methods: As a follow-up of our bioanthropological, macroscopic approach, two of the samples taken underwent rehydration, fixation, desiccation, paraffin-embedding, and staining according to standard histological techniques applied to mummified remains. Results: The body was determined to be that of an adult male, who showed some pathological changes such as dental calculus and what is suspected to be hallux valgus. The overall preservation of a skin sample revealed damage caused by a post-mortem infestation of insects, while a second, inner sample was identified as lung tissue, and revealed a case of anthracosis. Conclusions: The Blessed Antonio was an adult male, who had poor dental hygiene and was likely exposed to smoke during his lifetime. Damage observed on the remains indicated that a conservation treatment was desirable for the future preservation of the body.

Zoonotic diseases: New directions in human-animal pathology.

Zoonotic diseases-human diseases of animal origin-represent one of the world's greatest health challenges, both today and in the past. Since the Neolithic, zoonotic diseases have been one of the major factors shaping and influencing human adaptation. Archaeology is ideally situated to provide the long view on human-animal-pathogen relationships through combining cultural, environmental and biological datasets, yet long-term studies of linked human and animal records have often been overlooked and undertheorized. The seven papers in this special issue "Zoonotic diseases: New directions in human-animal pathology" cover a range of diseases caused by bacterial, viral, and parasitic pathogens, from case studies drawn from across Europe, Asia, Africa and the Americas. They speak to the diversity of human-animal-environment interactions that shaped disease emergence and transmission. They also review methodological advancements relating to disease identification and interpretation and discuss interdisciplinary approaches to effectively investigate these complex processes in the past. This introduction highlights their key themes and outcomes and identifies research priorities moving forward.

One Health Approaches to Trace Mycobacterium leprae's Zoonotic Potential Through Time.

Hansen's disease (leprosy), mainly caused by infection with Mycobacterium leprae, has accompanied humanity for thousands of years. Although currently rare in Europe, there are over 200,000 new infections annually in South East Asia, Africa, and South America. Over the years many disciplines - palaeopathology, ancient DNA and other ancient biomolecules, and history - have contributed to a better understanding of leprosy's past, in particular its history in medieval Europe. We discuss their contributions and potential, especially in relation to the role of inter-species transmission, an unexplored phenomenon in the disease's history. Here, we explore the potential of interdisciplinary approaches that understand disease as a biosocial phenomenon, which is a product of both infection with M. leprae and social behaviours that facilitate transmission and spread. Genetic evidence of M. leprae isolated from archaeological remains combined with systematic zooarchaeological and historical analysis would not only identify when and in what direction transmission occurred, but also key social behaviours and motivations that brought species together. In our opinion, this combination is crucial to understand the disease's zoonotic past and current potential.

The elusive parasite: comparing macroscopic, immunological, and genomic approaches to identifying malaria in human skeletal remains from Sayala, Egypt (third to sixth centuries AD).

Although malaria is one of the oldest and most widely distributed diseases affecting humans, identifying and characterizing its presence in ancient human remains continue to challenge researchers. We attempted to establish a reliable approach to detecting malaria in human skeletons using multiple avenues of analysis: macroscopic observations, rapid diagnostic tests, and shotgun-capture sequencing techniques, to identify pathological changes, Plasmodium antigens, and Plasmodium DNA, respectively. Bone and tooth samples from ten individuals who displayed skeletal lesions associated with anaemia, from a site in southern Egypt (third to sixth centuries AD), were selected. Plasmodium antigens were detected in five of the ten bone samples, and traces of Plasmodium aDNA were detected in six of the twenty bone and tooth samples. There was relatively good synchronicity between the biomolecular findings, despite not being able to authenticate the results. This study highlights the complexity and limitations in the conclusive identification of the Plasmodium parasite in ancient human skeletons. Limitations regarding antigen and aDNA preservation and the importance of sample selection are at the forefront of the search for malaria in the past. We confirm that, currently, palaeopathological changes such as cribra orbitalia are not enough to be certain of the presence of malaria. While biomolecular methods are likely the best chance for conclusive identification, we were unable to obtain results which correspond to the current authentication criteria of biomolecules. This study represents an important contribution in the refinement of biomolecular techniques used; also, it raises new insight regarding the consistency of combining several approaches in the identification of malaria in past populations. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12520-021-01350-z.

Lesions in sheep elbows: Insights from a large-scale study.

OBJECTIVES: Enthesophytes on sheep elbow joints are commonly reported in archaeological material. Although these lesions are often described as 'penning elbow', little is known of their aetiology. In this study, a new method for recording these lesions is presented, and the effect of age, sex and body size is explored to understand their potential for informing upon past human-animal interactions. MATERIALS: 1133 distal humerii and proximal radii from 16 archaeological sites. METHODS: The presence and severity of enthesophytes were recorded and findings compared with modern data from a group of 17 complete Soay sheep skeletons. RESULTS: Significant, positive correlations between age and body size and the presence of enthesophytes were demonstrated. Environmental factors and trauma may also play a role in their formation. CONCLUSION: The aetiology of enthesophytes on sheep elbows is complex and varied, affected by age, body size and environment. SIGNIFICANCE: This is the first study of enthesophytes on sheep elbows to combine archaeological data with modern animals of known age and sex. Blanket explanations of husbandry methods for the cause of these lesions are dispelled, and use of the term 'penning elbow' is redundant. LIMITATIONS: The sample of modern specimens is relatively small and would benefit from the inclusion of older individuals and those raised in different environments. FUTURE RESEARCH: The method developed here can be adopted in future studies. Interpretations should take age, size and environmental factors into consideration, and only when these variables are established can the role of husbandry be evaluated.