Razi and his Concepts on Bone and Joint Disorders.

This brief review presents Razi's concepts of bone and joint disorders. Razi differentiated between ligaments, tendons, and nerves and recognized the role of the brain, spinal cord, and peripheral nervous system in the perception of senses and voluntary movements. He described paralysis and loss of sensation following brain, spinal cord, and peripheral nervous system injuries. Razi presented an early concept of compartment syndrome. Razi's approach to fracture management is very similar to the current concept of functional bracing for some fractures. Razi mentioned suturing the wounds and ligation of bleeding large vessels. He cautioned about phlebotomy in the antecubital fossa as it may become complicated by the adjacent arterial and nerve injuries. Razi treated osteomyelitis by removing the infected and necrotic bone by sawing, cutting, and rasping. He also documented arthralgia, painful hip, and sciatic pain and made a sharp distinction between arthralgia and gout. He indicated the gout origin as the production of a waste substance that the body fails to expel. Razi's basic concepts on the bone and joint disorders established a foundation for modern orthopedic science.

Bioarchaeological reconstruction of physiological stress during social transition in Albania.

OBJECTIVE: We test the hypothesis that physiological stress increased in response to increasing social turmoil following waves of colonization and social transition. The ways local conditions, including variation in geography, environment, and levels of urbanization impact physiological stress are also explored. MATERIALS: In Albania, the historic period is a sequence of different waves of colonization. Skeletal data come from three Albanian archaeological sites: Apollonia (n = 231), Durrës (n = 246), and Lofkënd (n = 129). METHODS: Prevalence of cribra orbitalia, porotic hyperostosis, linear enamel hypoplasia, and periosteal new bone formation are analyzed using chi-square and logistic regression tests. RESULTS: We observe increased skeletal manifestations of physiological stress between prehistoric and historic groups, but physiological stress is generally consistent through time. CONCLUSIONS: General increase in skeletal pathology between prehistoric and historic periods corresponds to broad increases in political unrest associated with colonization spanning the entire historic period. However, little difference in physiological stress across colonization episodes (Greek, Roman, Byzantine, Bulgarian, Ottoman) suggests skeletal health is affected similarly by colonization, regardless of particularities in method and type of colonial control. SIGNIFICANCE: Examining human response to social change across broad time scales is useful in identifying broad patterns in the human experience. LIMITATIONS: Exploring variation across broad time scales and multiple sites is potentially problematic because confounding factors could impact results and interpretations. SUGGESTIONS FOR FURTHER RESEARCH: Environmental, social, and geographic differences, likely impacted the lives and lifestyles of individuals living in the past and should be explored further to understand the nuances in local response to colonization.

Syphilis in an Italian medieval jewish community: A bioarchaeological and cultural perspective.

OBJECTIVES: We aim to discuss the presence of treponemal infections in three individuals belonging to a large (∼400 individuals) Late Medieval cemetery (14th -16th century) that archaeological and documentary sources place within a Jewish context, and to discuss the role of these diseases in a biocultural perspective. MATERIALS AND METHODS: An anthropological and paleopathological study was conducted on skeletal remains of three individuals, though macroscopic and tomographic examination. RESULTS: Cranial lesions in which simultaneous destructive and proliferative processes (caries sicca) are noted. Long bones also present osseous alterations with increased bone density and non-uniform thickening. CONCLUSIONS: Skeletal lesions are consistent with treponemal infections (possibly either endemic or acquired syphilis). Historical documentation could help the interpretation of our cases, recording a syphilis outbreak in Bologna in 1496, possibly coeval to the Late Medieval Jewish cemetery. SIGNIFICANCE: These cases of treponematosis are unique, documenting the presence of the disease within the Jewish Medieval community in Italy, as they frame the effects and consequence of the infection in shaping social and cultural contexts of the medieval Italian and European communities. They offer material evidence to elaborate on the historical documents on the hostility Jewish community suffered. LIMITATIONS: Radiocarbon dating have not been performed directly on skeletal remains of the three pathological individuals. δ13C and δ15N isotope ratios should also be acquired to estimate the marine diet component, to account for possible marine reservoir effect on radiocarbon age calibration.

Evidence of Skeletal Fluorosis at the Ray Site, Illinois, USA: a pathological assessment and discussion of environmental factors.

OBJECTIVE: To carefully assess skeletal lesions in close environment context in order to evaluate whether skeletal fluorosis was present in individuals living in the prehistoric Midwest, USA. MATERIALS: Skeletal remains from minimally 117 individuals recovered from the Ray Site, located in western Illinois (USA) and dated to the Middle/early Late Woodland periods (50 BC-AD 400). METHODS: Macroscopic evaluation of all recovered skeletal elements. RESULTS: Eight individuals display a constellation of abnormal bony changes, including osteosclerosis, a high frequency of fractures, and dental abnormalities. CONCLUSIONS: The osteosclerotic changes along with the naturally high fluoride content of west central Illinois soil and water suggests the presence of skeletal fluorosis. SIGNIFICANCE: This is the first report of skeletal fluorosis from archaeologically recovered human remains from North America. LIMITATIONS: The ambiguous nature of the skeletal changes associated with fluorosis, especially in the less severe stages of the disease, renders determination of the etiology difficult. SUGGESTIONS FOR FURTHER RESEARCH: The continuation of paleopathological investigations of fluoride toxicity within archaeological communities recovered from this region with emphasis on the incorporation of biomedical and environmental data. Furthermore, complementary analyses of the chemical composition and the histological presentation of the skeletons could provide support for this diagnosis.

Palaeopathological analysis of a Chilean gomphothere (Proboscidea: Gomphotheriidae).

OBJECTIVE: Re-evaluate the pathological lesions found on a gomphothere recovered from Quebrada Quereo (Late Pleistocene), Coquimbo region, Chile (31º55'41" S, 71º34'43" W, 20 masl). MATERIALS: 227 axial and appendicular specimens from a young adult male individual (SGO.PV.267). METHODS: Macroscopic and radiographic analysis. RESULTS: Pathological conditions identified included asymmetries of a cervical vertebra and of thoracic vertebra 16, degenerative joint disease in thoracic and lumbar vertebrae, possible evidence of neoplastic lesions within the bodies of three thoracic vertebrae (possibly hemangiomas), and fusion at thoracic vertebrae 15 and 16, suggesting the presence of spondyloarthropathy. CONCLUSIONS: The original diagnosis of traumatic lesions on this specimen is unsupported. The re-evaluation identified the presence of developmental defects, degenerative joint disease, possible neoplastic lesions, and spondyloartropathy. SIGNIFICANCE: The present analysis adds data to the sparse paleopathological record of South American gomphotheres. LIMITATIONS: Taphonomic alteration of some skeletal elements, as well as the presence of an incomplete individual, limits the ability to determine the etiology of some of the lesions identified. SUGGESTIONS FOR FURTHER RESEARCH: Researchers are encouraged to re-examine specimens curated in museums in order to identify pathological conditions that might have been overlooked or might benefit from re-evaluation.

Osteoarchaeology and the History of Medicine in our experience.

The encounter between archaeology and medicine is no longer the result of sporadic or intermittent research. Stemming from different areas of expertise and training, as well as historical sciences, archaeology, biology and medicine, common investigative objectives must come together in a coordinated manner. However, defining the boundaries of different areas of work, collaboration, interferences and interconnections is not an easy task.

The ice age with little effect? Exploring stress in the Danish Black Friars cemetery before and after the turn of the 14th century.

The Little Ice Age, beginning in Europe in the 14th century, saw a period of climatic cooling and increased precipitation where food sources dwindled and famine became rampant, particularly in urban city centers. This study focuses on the Black Friars population (13th-17th centuries) to explore changes in stress in Denmark at the onset of the Little Ice Age. This study specifically explores the periods before and after the turn of the 14th century. Forty-five adult individuals were analyzed for cribra orbitalia, porotic hyperostosis, and enamel hypoplastic lesions. Results showed no statistically significant differences between the prevalence of these stress indicators between either time period; however, reduced age at death and increased lesion frequency was more prevalent post-1300. It was expected that increased stress would be evident in those buried after the turn of the 14th century due to the many challenges associated with wide spread climatic cooling; however, the reliance on nutrient rich marine resources and alms provisions may have helped lessen the burden of these stressors during this period of climatic hardship. Additionally, while famine characterized the beginning of the 14th century, agricultural rebound shortly after this period may have also influenced the stress levels observed.

Examining the osteological paradox: Skeletal stress in mass graves versus civilians at the Greek colony of Himera (Sicily).

OBJECTIVES: Bioarchaeologists interpret skeletal stress as evidence of resilience or frailty, where absence of lesions might result from lack of exposure to pathogens (i.e., good health) or extreme vulnerability (i.e., selection). We examine physiological stress in two skeletal series from Greek Himera: (1) nine mass graves from the battles of Himera (480 and 409 BCE) and (2) Himeran civilians (648-409 BCE). Civilians are assumed to have died from multiple causes, including ill health leading to their deaths. Individuals from the battles presumably died while in relatively good health, in battle. More skeletal stress among civilians than battle casualties would support the idea that skeletal stress is a sign of frailty at Himera. We compare variation in skeletal stress between and among civilians and battle casualties. MATERIALS AND METHODS: Cribra orbitalia, porotic hyperostosis, linear enamel hypoplasia (LEH), and sub-periosteal new bone formation, were examined in 474 individuals (mass graves n = 64; civilians n = 410). RESULTS: Chi-square tests showed significantly higher prevalence of LEH (p = 0.04) and sub-periosteal new bone formation (p = 0.05) among young and mid-aged adult male civilians than mass grave casualties. Skeletal stress was also lower in the earlier battle, and varied among civilians with burial style. DISCUSSION: Our findings generally support the hypothesis that skeletal stress is evidence of frailty (i.e., leading to greater risk of mortality). However, the relationship between stress and frailty is complicated by social factors, when considering historical context. In particular, a possible "soldier-class" may have experienced less stress than the overall civilian population.

Life and death at the "The Land of Three Lakes": Revisiting the non-adults from Roman Aventicum, Switzerland (1st-3rd century CE).

The study of Roman childhood has been the focus of research primarily using documentary and archaeological evidence, while relatively few non-adult skeletal assemblages have been analyzed. This paper presents the study of 93 non-adult individuals from four cemeteries in the Roman (1st-3rd c. CE) civitas capital of Aventicum (Avenches), Switzerland. The results of the analysis offer a new bioarchaeological perspective on mortality and disease patterns during childhood in Roman Switzerland, adding to the discussion regarding living conditions in the urban centers at the periphery of the Roman Empire. This study also highlights the importance of studying perinates in archaeological populations, since the current research inform us about the experiences of mothers and their offspring in Aventicum. The mortality and disease patterns of the perinates, representing 71% of the total non-adult sample (66/93), suggest that pregnancy and the time around birth were extremely challenging at Aventicum. It is argued that environmental constraints, e.g. the risk of infectious diseases such as malaria and natural phenomena such as recurring floods resulting in resources scarcity, could have considerably affected the mother-fetus pair in this urban settlement.

Elongated odontoid process in late Holocene skeletal remains from B6 archaeological site, Mendoza, Argentina.

The odontoid process of the axis can be affected by congenital or acquired pathologies. While abnormalities such as os odontoideum, agenesis, and fractures are reported in archaeological remains, the abnormality of an elongated length of the odontoid process has not been described in the paleopathological literature. The aim of this paper is to evaluate two individuals with elongated odontoid processes from a skeletal assemblage from the B6 archaeological site (Mendoza, Argentina), and to discuss the possible etiologies of the condition, with particular attention given to the relation to trauma and Crowned Dens Syndrome (CDS), a condition characterized by the ossification of ligaments of the odontoid process of the second cervical vertebra.

Neoplasm or not? General principles of morphologic analysis of dry bone specimens.

Unlike modern diagnosticians, a paleopathologist will likely have only skeletonized human remains without medical records, radiologic studies over time, microbiologic culture results, etc. Macroscopic and radiologic analyses are usually the most accessible diagnostic methods for the study of ancient skeletal remains. This paper recommends an organized approach to the study of dry bone specimens with reference to specimen radiographs. For circumscribed lesions, the distribution (solitary vs. multifocal), character of margins, details of periosteal reactions, and remnants of mineralized matrix should point to the mechanism(s) producing the bony changes. In turn, this allows selecting a likely category of disease (e.g. neoplastic) within which a differential diagnosis can be elaborated and from which a favored specific diagnosis can be chosen.

How should we diagnose disease in palaeopathology? Some epistemological considerations.

This paper analyses some of the epistemological frameworks that underpin diagnosis in palaeopathology. Currently, the dominant approach is comparative: relationships between skeletal lesions and disease in a reference group in which there is independent evidence of the diseases present in individuals are used to identify disease in unknown archaeological skeletons on the basis of the lesions present. This is essentially a reference sample - target sample approach, analogous to that used to develop methodology in other areas of biological anthropology (e.g. age estimation in palaeodemography). As well as considerable strengths, this approach also has significant weaknesses. Many of these arise from the nature of the reference material (mainly pathology museum and other skeletal collections, and published collations of medical imaging data) used to develop diagnostic criteria. There may also be a tendency toward over-emphasis on pattern-matching between reference and target material, and an under-emphasis on developing our understanding of the biology of bone lesions. Despite its shortcomings, the comparative approach is likely to remain the foundation of most palaeopathological work, but we should increasingly augment it with other diagnostic approaches, especially those grounded in the pathophysiology of bony responses to disease.

Middle and late holocene micromammal pathologies from Cueva Tixi (Tandilia Range, Buenos Aires Province, Argentina).

Paleopathology in bones of very small mammals has rarely been studied. Different types of osseous lesions of mammals weighing under 0.2kg, recovered from the Holocene strata of Cueva Tixi archaeological and paleontological site (Tandilia range, province of Buenos Aires, Argentina), are described and discussed in this report. Several types of trauma, entheseal changes, degenerative joint diseases, and probable osteomyelitis were identified. The lesions were chronic, indicating that the animals were able to survive a period of convalescence, although in many cases the decreased capacity for locomotion likely was significant. These pathological findings open research avenues for very small mammals that usually are not considered in archaeological disease studies.

Chronic diseases in cats from the medieval site of Qalhât (Oman).

Paleopathological information observed in cats (Felis catus, L. 1758) is rarely described in zooarcheological assemblages. This article is intended to present different bone diseases (infections, degenerative and traumatic lesions) affecting several bones (i.e. femur, hip bone, skull, etc.) of at least two cats from the medieval harbor site of Qalhât (Oman) and to inform us about the health status of these felines.

In sickness and in death: Assessing frailty in human skeletal remains.

Stress plays an important role in the etiology of multiple morbid and mortal outcomes among the living. Drawing on health paradigms constructed among the living augments our evolving knowledge of relationships between stress and health. Therefore, elucidating relationships between stress and both chronic and acute skeletal lesions may help clarify our understanding of long-term health trends in the past. In this study, we propose an index of "skeletal frailty," based on models of frailty used to evaluate the life-long effects of stress on health among living populations. Here, we assess the possible applicability of frailty to archaeological populations. The skeletal frailty index (SFI) is proposed as a methodological liaison between advances made by biological anthropologists studying relationships between stress and health among the living and bioarchaeologists studying stress and health among the dead. In a case study examining skeletal stress in Medieval London, the SFI is applied to nonmonastic (N = 60) and monastic (N = 74) samples. We used analysis of variance/analysis of covariance to compare SFI values between nonmonastic-monastic groups, sexes, and age cohorts. Results indicate higher lifetime morbidity among monastic groups. These results complement previous bioarchaeological findings on the same London populations, wherein lower risks of mortality and longer lifespans were observed for monastic populations. SFI data reflect the morbidity-mortality paradox observed in modern populations and accompany recent findings in bioarchaeology of variation in Medieval monastic and nonmonastic "health." Ultimately, this study demonstrates the SFI's utility in bioarchaeology, through its application of commonly assessed skeletal biomarkers, its ease of applicability, and its potential usefulness for assessing changes in skeletal health over time and across specific geographies.

Osteoporosis Associated with Epilepsy and the Use of Anti-Epileptics-a Review.

The increased rate of fractures associated with epilepsy has been long recognised but remains incompletely understood. Study quality and study results have varied, with some but not all studies showing bone diseases including osteoporosis and/or osteomalacia, and a high prevalence of vitamin D insufficiency and deficiency are also noted. Falls risk can also be higher in patients with epilepsy taking anti-epileptic medications, potentially leading to fracture. Larger research collaborations are recommended to further advance understanding in this field, particularly to examine underlying genetic and pharmacogenomic associations of epilepsy and anti-epileptic medication usage and its association with bone diseases and fractures, as well as further investigation into optimal management of bone health in epilepsy.

A possible case of acquired syphilis at the former Royal Hospital of All-Saints (RHAS) in Lisbon, Portugal (18th century): a comparative methodological approach to differential diagnosis.

Between the years of 1999 and 2001, during the excavation of the Praça da Figueira (Lisbon, Portugal), several human osteological remains from various chronological periods were discovered. Amongst them several skeletons are known to be related with the Hospital Real de Todos-os-Santos (Royal Hospital of All Saints - RHAS), which had an important role. The hospital history begun in 1492 and ended in 1755 largely as a consequence of the Lisbon earthquake. Of the skeletons exhumed, one in particular, the adult female Sk. 1310 showed significant pathological changes. The bone lesions characterized by new bone deposition, with a symmetric and disseminate pattern, were found in the upper limbs, distal end of femurs and in tibia and fibula diaphyses. A bowing deformity with "sabre shape" morphology was also observed in the tibiae. The most striking lesions, characterized by healed nodular cavitations and similar to those of caries sicca, were recorded on the frontal bone. Considering the value of a complete description, as well as the application of multiple lines of enquiry for a reliable differential diagnosis, three distinct techniques were applied and compared: visual examination, imagiology and histology. The results showed that the macroscopic analysis coupled with conventional X-ray analysis were fundamental to obtain a possible diagnosis of acquired syphilis. In contrast, the CT-scan and the histological analyses were less informative. The application of a new scoring system also supports a diagnosis of acquired syphilis. This case-study constitutes the first evidence of syphilis associated with the RHAS, supporting historical data on the pivotal role that this hospital had on the treatment of several conditions, namely, syphilis.