A bioarcheological study of maxillary sinusitis

Which types of bony changes in the maxillary sinus indicate chronic sinusitis?

OBJECTIVES

To determine which types of bone lesion (spicules, lobules, porous bone) in the maxillary sinus indicate sinusitis METHODS: Subadjacent dental disease is a cause of maxillary sinusitis; if a lesion type indicates sinusitis it should be more common above diseased posterior maxillary teeth than a lesion type that is not indicative of sinusitis. The study sample is a British Mediaeval human skeletal collection.

RESULTS

Porous bone lesions (chiefly new bone deposits) in maxillary sinuses are associated with subadjacent dental disease; spicules/lobules of bone in the sinus are not.

CONCLUSIONS

The results support the idea that porous lesions indicate sinusitis but the spicules/lobules may not. Spicules, lobules and porous lesions within the maxillary sinus should be analysed separately in biocultural studies; it would be prudent to regard only the porous lesions as indicative of sinusitis.

SIGNIFICANCE

Maxillary sinusitis is commonly used as a health indicator in palaeopathology, and spicular deposits are generally the most common type of alterations. By assuming that they are indicative of sinusitis we may have been greatly overestimating the prevalence of bony sinusitis in the past.

LIMITATIONS

These conclusions are provisional. Further work on larger, more diverse samples, together with more detailed anatomical studies on lesion location and structure is ongoing.

Chronic Maxillary Sinusitis: A comparison of osteological and CT methods of diagnosis

OBJECTIVE

To assess the differences between endoscopic and radiological methods of analysis for diagnosing chronic maxillary sinusitis (CMS) in archaeological skeletal remains.

MATERIALS

32 crania from a Dutch post-medieval rural population.

METHODS

We assessed the presence of bone changes indicative of CMS (i.e., bone growth and bone resorption) both endoscopically and through computed tomography (CT), and then compared results.

RESULTS

We observed moderate agreement between bone growth scores obtained through endoscopy and CT, and fair agreement when assessing bone resorption.

CONCLUSIONS

CMS prevalence rates observed through CT may be comparable to rates assessed endoscopically, although caution is needed when making direct comparisons.

SIGNIFICANCE

This is the first study comparing data obtained through endoscopy and radiological methods in the study of CMS, informing paleopathologists about potential biases in data comparison.

LIMITATIONS

Our small sample size likely impacted results.

SUGGESTIONS FOR FURTHER RESEARCH

Further research is advised to fully explore the comparability of endoscopic and radiological method of analysis in the study of sinusitis.

DATA AVAILABILITY

The datasets generated and analyzed during the current study are available upon request.

Chronic maxillary sinusitis in palaeopathology: A review of methods

OBJECTIVE

This study reviews the palaeopathological literature discussing maxillary sinusitis to examine current trends and issues within the study of this condition, and to make recommendations for future research in this area.

MATERIALS

Seventy-five studies were identified through a literature search of digital and physical sources.

METHODS

Information regarding study metadata, the populations investigated, sinusitis diagnostic criteria, and sinusitis prevalence was examined.

RESULTS

Populations from the UK and Europe were the most studied, reflecting both palaeopathology's systemic colonialism and academic legacies. Most studies used diagnostic criteria published in the mid-1990s, with some subsequent studies modifying these criteria.

CONCLUSIONS

The diagnostic criteria from 1995 are widely used but do not include all possible bone changes seen within sinusitis. There is also a need for researchers to engage in issues of data reductionism when using descriptive categories for archaeological sites and populations.

SIGNIFICANCE

This paper provides considerations as to how the 1995 diagnostic criteria may be revised by future researchers and synthesises much of the published sinusitis prevalence data to assist researchers interested in the palaeopathology of respiratory disease.

LIMITATIONS

More general osteological research, which includes palaeopathological information, was likely missed from this review due to the choice of key terms and languages used in the literature search.

SUGGESTIONS FOR FURTHER RESEARCH

Additional research into sinusitis in archaeological populations outside of Western Europe is required. Further work examining the ability to compare pathological data from macroscopic observation and medical imaging would be advantageous to palaeopathology as a whole.

Is the promontory a promising site to diagnose otitis media in paleopathology? A search for evidence

OBJECTIVE

The promontory of the middle ear was recently suggested to be an appropriate site for diagnosing otitis media (OM) in archaeological bones by endoscopic inspection. The present study scrutinized the underlying assumption that a bulgy, irregular promontorial surface represents a pathological condition.

MATERIALS

We compared an allegedly healthy individual and an allegedly diseased individual in skeletal remains of two human individuals from the early Medieval period in Germany.

METHODS

The specimens were studied using microscopic analyses of thin ground sections.

RESULTS

The osseous architecture of the three-layered promontorial wall was the same in both specimens. Both the contour of the resorption front of the middle layer and the thickness of the overlying outer periosteal layer showed some variation, resulting in an either smooth or a bulgy promontorial surface, while signs of resorptive or proliferative changes at the periosteal surface were missing in both cases.

CONCLUSIONS

Our results suggest that an irregular promontorial surface represents normal variation in the development of the otic capsule rather than a pathological condition. We therefore conclude that the promontory is not an appropriate site for diagnosing OM in archaeological bone.

SIGNIFICANCE

The study contributes to evidence-based diagnoses in paleo-otological studies. Our assumption is in line with clinical and experimental findings indicating that the otic capsule is protected against bone remodeling.

LIMITATIONS

Only two specimens were studied.

SUGGESTIONS FOR FURTHER RESEARCH

SEM-studies to detect more subtle changes to the promontorial surface.

Beyond dirty teeth: Integrating dental calculus studies with osteoarchaeological parameters

The study of ancient human dental calculus (mineralized dental plaque, also known as tartar) is becoming increasingly important in osteoarchaeology, human palaeoecology and environmental archaeology. Microremains of different origin (e.g. starch granules, pollen, phytoliths, feather barbules) as well as biomolecules and chemical compounds retrieved from its mineral matrix may represent an important link between past humans and their physical, biological and social environment, but they are rarely fully linked to the evidence from skeletal remains. This paper critically reviews the lines of evidence retrieved from dental calculus in relation to osteoarchaeological parameters, employing macroscopic, microscopic and biomolecular approaches, assessing synergy potential and limitations. The scope of this paper is also to contribute to the building of a much needed theoretical framework in this emerging subfield.

Dental calculus in the industrial age: Human dental calculus in the Post-Medieval period, a case study from industrial Manchester

The analysis of dental calculus (mineralised dental plaque) has become an increasingly important facet of bioarchaeological research. Although microscopic analysis of microdebris entrapped within dental calculus has revealed important insights into the diet, health, and environment of multiple prehistoric populations, relatively few studies have examined the contributions of this approach to more recent historical periods. In this study, we analyze dental calculus from an English Post-Medieval, middle-class urban skeletal assemblage from Manchester, England using light microscopy. We characterize all types of microremains, observing heavily damaged starch and plant material, high quantities of fungal and yeast spores, the presence of wood particles, plant (cotton) and animal (wool) fibres, as well as limited quantities of microcharcoal and burnt debris. We observe the presence of non-native, imported plant products, including New World maize and potentially tapioca starch. We compare our results to similar studies from earlier time periods to reveal the impacts of the significant economic, social and environmental changes occurring during the Industrial period in England, including changes in food processing, food access, food storage, and air quality. We conclude by outlining important methodological considerations for the future study of Post-Medieval dental calculus and propose potential areas of future research.

The dark satanic mills: Evaluating patterns of health in England during the industrial revolution

OBJECTIVE

this research seeks to investigate the impact the industrial revolution had on the population of England.

MATERIALS

Pre-existing skeletal data from 1154 pre-Industrial (1066-1700 CE) and 4157 industrial (1700-1905) skeletons from 21 cemeteries (N = 5411).

METHODS

Context number, sex, age-at-death, stature and presence/absence of selected pathological conditions were collated. The data were compared using chi square, Kolmogorov-Smirnov, t-tests and logistic regression (α = 0.01).

RESULTS

There was a statistically significant increase in cribra orbitalia, periosteal reactions, rib lesions, fractures, rickets, osteoporosis, osteoarthritis, enamel hypoplasia, dental caries and periapical lesions in the industrial period. Osteomyelitis decreased from the pre-industrial to industrial period.

CONCLUSION

Our results confirm the industrial revolution had a significant negative impact on human health, however the prevalence of TB, treponemal disease, maxillary sinusitis, osteomalacia, scurvy, gout and DISH did not change, suggesting these diseases were not impacted by the change in environmental conditions.

SIGNIFICANCE

This is the largest study of health in the industrial revolution that includes non-adults and adults and considers age-at-death alongside disease status to date. This data supports the hypothesis that the rise of industry was associated with a significant decline in general health, but not an increase in all pathological conditions.

A Case of Chronic Maxillary Sinusitis in a Late Neanderthal Population of the Altai Mountains

We describe a likely case of chronic maxillary sinusitis (CMS) in a Neanderthal skeletal sample from Chagyrskaya Cave, in the Altai Mountains. Signs of CMS were recorded in the Chagyrskaya 57 specimen, which is a fragment of a left maxilla. Alveoli of the upper fi rst molar are partially preserved, and so are the second and third upper molars, with adjacent parts of the walls, and the fl oor of the maxillary sinus. The fragment was found in layer 6b, dating to 53,100–51,100 BP. We analyze the factors that had caused the development of the disease, and assess its etiology. In the 3D-model, generated by computed microtomography, and in the original specimen, porotic changes were registered, situated at the fracture line of the alveoli of M1, lost post-mortem, and near the vestibular roots of both preserved molars. Also, there were isolated bone spicules, 1.0–2.6 mm in size. These signs indicate incipient CMS, evidently caused by chronic periodontal disease combined with a deep alveolar recess of the maxillary sinus. As the periodontal gap expanded, several small nutrient foramina, piercing the bottom of the sinus, merged. As a result, several oro-antral channels formed, whereupon the infection spread into the maxillary sinus. Since the deep alveolar recess is observed in the vast majority of Neanderthal crania with published images or reconstructed maxillary cavities, it can be assumed that Neanderthals were predisposed to odontogenic CMS.

Analysis of fine particulates from fuel burning in a reconstructed building at Çatalhöyük World Heritage Site, Turkey: assessing air pollution in prehistoric settled communities

The use of wood, dung and other biomass fuels can be traced back to early prehistory. While the study of prehistoric fuel use and its environmental impacts is well established, there has been little investigation of the health impacts this would have had, particularly in the Neolithic period, when people went from living in relatively small groups, to living in dense settlements. The UNESCO World Heritage Site of Çatalhöyük, Turkey, is one of the earliest large 'pre-urban' settlements in the world. In 2017, a series of experiments were conducted to measure fine particulate (PM_2.5) concentrations during typical fuel burning activities, using wood and dung fuel. The results indicate that emissions from both fuels surpassed the WHO and EU standard limits for indoor air quality, with dung fuel being the highest contributor for PM_2.5 pollution inside the house, producing maximum values > 150,000 µg m^-3. Maximum levels from wood burning were 36,000 µg m^-3. Average values over a 2-3 h period were 13-60,000 µg m^-3 for dung and 10-45,000 µg m^-3 for wood. The structure of the house, lack of ventilation and design of the oven and hearth influenced the air quality inside the house. These observations have implications for understanding the relationship between health and the built environment in the past.

Maxillary sinusitis as a respiratory health indicator: a bioarchaeological investigation into medieval central Italy

OBJECTIVE

This study aims to assess chronic maxillary sinusitis in an osteoarchaeological sample from the medieval rural site of Pieve di Pava (central Italy), to investigate triggers responsible for sinus inflammation, and to compare prevalence rates with coeval European rural sites.

MATERIALS

The analysis focused on 145 10^th-12^th-century adults with at least one preserved maxillary sinus.

METHODS

Sinusitis-related lesions were observed macroscopically and microscopically. Alveolar pathologies of the maxillary posterior dentition were recorded to investigate the impact of odontogenic sinusitis.

RESULTS

Maxillary sinusitis was observed in 23.4% of the individuals (n = 34), with similar frequencies in both sexes and bilateral sinusitis appearing more frequently than unilateral sinusitis. An association of alveolar lesions with sinusitis was found in 38.2% of cases.

CONCLUSIONS

Compared to coeval rural sites in Northern Europe, Pieve di Pava shows the lowest prevalence of maxillary sinusitis, likely reflecting a greater amount of time spent outdoors. Despite the small size of the sample, odontogenic sinusitis cannot be ruled out.

SIGNIFICANCE

This is the first Italian study to investigate maxillary sinusitis and to focus on the Mediterranean area, contributing to the understanding of this condition as a health indicator in ancient populations.

LIMITATIONS

Research limitations include preservation issues affecting the number of observable sinuses, the non-homogenous age distribution of the sample, and the impact of inclusion and methodological criteria on the comparability of results.

SUGGESTIONS FOR FURTHER RESEARCH

Further investigations into odontogenic sinusitis and the microscopic examination of dental calculus may provide new data on the pathogenesis of sinusitis.

Time to be nosy: Evaluating the impact of environmental and sociocultural changes on maxillary sinusitis in the Middle Nile Valley (Neolithic to Medieval periods)

OBJECTIVE

To investigate the prevalence of maxillary sinusitis in people who lived in the Middle Nile Valley across different periods, cultures, and environmental conditions.

MATERIALS

481 skeletons from 13 sites, curated at the British Museum, London, were analysed. The sites ranged in date from the Neolithic to Medieval periods (c. 4900 BCE-CE 1500).

METHODS

Bony changes within the maxillary sinuses, associated with sinusitis and oroantral fistulae were systematically recorded according to pre-established criteria.

RESULTS

There were significant differences in the prevalence of maxillary sinusitis between time period/subsistence economy groups. The Neolithic hunter-gatherer/early agricultural group had the lowest prevalence, whilst the urban group demonstrated the highest frequency of the disease.

CONCLUSIONS

Factors involved in the development of maxillary sinusitis are manifold and complex. However, the results indicate that increased aridity in Sudan in later periods and intensification of agricultural practices may have played a role in increasing prevalence of the disease. Urban environments, including crowding, poor sanitation, and industrial air pollution, could also have influenced susceptibility to maxillary sinusitis.

SIGNIFICANCE

Prior to this paper, the impact of arid environments on respiratory health in the past had received little attention despite growing clinical research on the topic. Both arid and urban environments are predicted to expand in the future. This paper provides a deep-time perspective on an issue of increasing concern today.

LIMITATIONS

Poor preservation of skeletons and a lack of archaeological settlement data for some sites.

FUTURE RESEARCH

Investigation of a greater range of populations from different environments/climates.

Paleopathology of the Ychsma: Evidence of respiratory disease during the Late Intermediate Period (AD 1000-1476) at the Central Coastal site of Pachacamac, Peru

OBJECTIVE

To investigate evidence for maxillary sinusitis and pulmonary inflammation in archaeological skeletons dating to the Late Intermediate Period (AD 1000-1476) at the site of Pachacamac, Peru.

MATERIALS

Thirty-nine individuals (male, female, and unknown sex; 16+ years age-at-death) were analyzed for inflammatory periosteal reaction (IPR) on the visceral (inner) surfaces of the ribs, and 16 individuals were analyzed for evidence of maxillary sinusitis.

METHODS

All individuals were macroscopically examined for bony changes in the maxillary sinuses and new bone formation on the ribs according to pre-established criteria.

RESULTS

Some 33.3% (13/39) of individuals had IPR on the ribs and 93.8% (15/16) had bony changes in the maxillary sinuses.

CONCLUSIONS

Respiratory disease was likely prevalent in people buried at Pachacamac during the Late Intermediate Period. A number of factors may have increased the risk of developing respiratory disease, including exposure to poor air quality and increased crowding and social mixing, resulting from pilgrimage to this important ritual center.

SIGNIFICANCE

This paper represents one of the first systematic analyses of evidence for respiratory disease in Peruvian and South American human skeletal remains, demonstrating the suitability of the region for further study.

LIMITATIONS

A limited sample was available for analysis. Additionally, the site's skeletal preservation was excellent, meaning the sample available for assessment of maxillary sinusitis was smaller, being limited to individuals with post-mortem breakage.

FURTHER RESEARCH

The results of this study should stimulate further much needed systematic investigation of evidence for respiratory disease in other Peruvian and South American populations.

Cancers as rare diseases: Terminological, theoretical, and methodological biases

OBJECTIVE

Was cancer a rare disease in the past? Our objective is to consider the various terminological, theoretical, and methodological biases that may affect perceptions of the rarity of cancer in the past.

MATERIALS AND METHODS

We discuss relevant malignant neoplastic biomedical and paleopathological literature and evaluate skeletal data. We selected 108 archaeological sites (n = 151 cancer cases) with published malignant neoplasms and that were amenable to calculating cancer crude prevalence. Furthermore, datasets from four medieval/postmedieval Portuguese and 12 postmedieval UK sites were used to compare age-adjusted rates for metastatic bone disease and tuberculosis.

RESULTS

In the literature review, mean cancer crude prevalence (1.2 %; 95 % CI = 0.96-1.4) exceeded the threshold for a rare disease (RD). Age-standardized rates of MBD and TB were not markedly different in the sites surveyed.

CONCLUSIONS

Methodological, theoretical and historical factors contribute to assumptions that cancers were rare diseases. The assumption that cancers are extremely rare in the paleopathological literature was not fully supported. Cancer is a heterogeneous concept, and it is important to view it as such. If a disease is considered rare, we may fail to recognize it or dismiss it as unimportant in the past.

SIGNIFICANCE

We present a re-evaluation of the idea that cancer is a rare disease. We present a more nuanced way of comparing rates of pathological conditions in archaeological contexts.

LIMITATIONS

Variation in the amount of useable information in published literature on malignant neoplasms.

SUGGESTIONS FOR FURTHER RESEARCH

More large-scale studies of cancer in the past alongside comparative studies of cancer prevalence with other assumed rare diseases.

Toward a bioarchaeology of urbanization: Demography, health, and behavior in cities in the past

Urbanization is one of the most important settlement shifts in human history and has been the focus of research within bioarchaeology for decades. However, there have been limited attempts to synthesize the results of these studies in order to gain a broader perspective on whether or how urbanization affects the biology, demography, and behavior of humans, and how these potential effects are embodied in the human skeleton. This paper outlines how bioarchaeology is well-suited to examine urbanization in the past, and we provide an overview and examples of three main ways in which urbanization is studied in bioarchaeological research: comparison of (often contemporaneous) urban and rural sites, synchronic studies of the variation that exists within and between urban sites, and investigations of changes that occur within urban sites over time. Studies of urbanization, both within bioarchaeology and in other fields of study, face a number of limitations, including a lack of a consensus regarding what urban and urbanization mean, the assumed dichotomous nature of urban versus rural settlements, the supposition that urbanization is universally bad for people, and the assumption (at least in practice) of homogeneity within urban and rural populations. Bioarchaeologists can address these limitations by utilizing a wide array of data and methods, and the studies described here collectively demonstrate the complex, nuanced, and highly variable effects of urbanization.

An innovative method to visualise mastoiditis using a hand-held X-ray system

OBJECTIVE

We explore the utility of using a hand-held X-ray system to diagnose mastoiditis in archaeological populations.

MATERIALS

A sample (n = 56) of hunter-fisher-gatherers from the Early Neolithic (8,000-7,000/6,800 cal. BP) Cis-Baikal cemetery of Shamanka II (Russia) were examined.

METHODS

Images were taken medio-laterally, approximately 90° to a sensor temporarily affixed to the lateral surface of the mastoid process. Digital radiographs were analysed for signs of mastoiditis occurring pre- and/or post-puberty.

RESULTS

Two thirds of individuals (39/56) exhibited evidence of mastoiditis. Chronic mastoiditis and chronic sinusitis co-occurred in 61.5% (24/39) of observable individuals.

CONCLUSIONS

This method was found to be an effective, convenient, and versatile non-destructive alternative to sectioning and traditional radiographic imaging.

SIGNIFICANCE

This is the first project to adapt a hand-held X-ray system for imaging and diagnosis of mastoiditis and this approach encourages future analyses of this infection.

LIMITATIONS

The cost of the imaging system is limiting and there are few comparative images taken in the same plane.

SUGGESTIONS FOR FURTHER RESEARCH

Further research should create a larger catalogue of comparative radiographs and assess the diagnostic potential of imaging the mastoid process to rather than imaging the entire pneumatized portion of the temporal bone.

New case of concha bullosa from Bronze Age Iberia (Granada, Spain)

OBJECTIVE

This study aims to expand knowledge of Concha bullosa in a prehistoric population.

MATERIALS

The skull of an adult female from the Bronze Age archeological site ofCastellón Alto (Granada, Spain), dated between 1900 and 1600 BCE.

METHODS

The diagnosis of middle turbinateconcha bullosa was based on macroscopic, radiographic, and computed tomography studies.

RESULTS

This is one of the oldest findings ofconcha bullosa in Europe. Despite the possible obstruction of the osteomeatal complex by the concha bullosa in this individual, no signs of sinusitis were observed in maxillary sinuses.

CONCLUSIONS

The maxillary sinuses of this female showed no signs of sinusitis related to theconcha bullosa.

SIGNIFICANCE

This study provides new evidence on the chronological limits of this condition. The particular funeral rites of these populations have preserved the majority of skeletons at this site in an excellent condition.

LIMITATIONS

The identification ofconcha bullosa continues to be rare in ancient populations, in part due to the poor preservation of nasal bones in archeological collections. Suggestions for further research: Detailed study of the nasal cavity of adequately preserved individuals can be expected to identify further cases of concha bullosa in ancient populations.

Inflammatory periosteal reaction on ribs associated with lower respiratory tract disease: A method for recording prevalence from sites with differing preservation

Objectives

Inflammatory periosteal reaction (IPR) on the visceral surfaces of the ribs has been used in bioarchaeology as an indicator of lower respiratory tract disease. This article presents a detailed method for recording IPR on the ribs, even those in severely fragmented states, with the objectives of increasing the consistency of recording and producing true prevalence rates for skeletons so as to improve data comparability between future bioarchaeological studies of lower respiratory tract disease.

Materials and methods

The presence and prevalence of respiratory‐related IPR were recorded from three different Sudanese cemetery sites using a detailed method for identifying and recording IPR. Sites with variable preservation were chosen to test the applicability of the method. A flowchart to aid in identification of bony changes is presented. The method requires the recording of IPR on three separate sections of the rib (neck, angle, and shaft) and the allocation of ribs into rib cage regions of upper, upper‐middle, middle, lower‐middle, and lower.

Results

Results demonstrate differences in the distribution of IPR between sites and verify the method's applicability to archeological sites with various levels of skeletal preservation.

Discussion

While crude prevalence rates can indicate the number of individuals experiencing lower respiratory tract disease within a site, this method can provide information about the distribution of IPR within the rib cage. This should lead to new ways of distinguishing respiratory diseases within archeological populations. This method also allows for comparability between well‐preserved and lesser‐preserved sites by accommodating for rib fragmentation.

Anatomical Variation in Maxillary Sinus Ostium Positioning: Implications for Nasal-Sinus Disease

Among humans, superiorly located maxillary sinus ostia (MSO) result in drainage complications and maxillary sinus (MS) disease. While previous studies investigate maxillary sinusitis frequency or MSO-position relative to specific nasal landmarks, few explore MSO-position to overall MS dimensions. This study investigates whether MSO-position relates to MS size/shape and if sex-based differences exist. Twenty-nine landmarks, placed on magnetic resonance images (MRIs) of 109 individuals (males = 57; females = 52), captured maximum dimensions of the cranium, MS, nasal cavity, and MSO-position relative to the MS floor (MSO_MSF) and nasal floor (MSO_NCF). Landmark coordinates were used to calculate centroid sizes and 13 linear distances; distances were size standardized by cranial centroid-size. Principal components analysis (PCA) on 3D-coordinates indicates that variation in MSO-position relates to superior-inferior MS positioning within the face (PC1 22% variance) and MS height (PC2 12% variance). Regression analyses indicate that MS size (r² = 0.502; P < 0.001) and height (r² = 0.589; P < 0.0001) strongly contribute to MSO_MSF: larger, taller MSs exhibit greater MSO_MSFs. Sex-based differences were not evident in PC shape-analyses nor among size-standardized dimensions. However, Mann-Whitney U-tests indicate females have absolutely smaller MSs (P = 0.001) and MSO_MSF distances (P = 0.001). Further, regressions indicate females exhibit lower MSO_MSFs for a similar MS height. Overall, MSOs superiorly placed relative to the MS floor correlate with larger, taller MSs and/or sinuses positioned inferiorly within the face. While craniofacial surgeons/clinicians should be aware of potential sex-based differences in MS size and MSO position, this study does not suggest that higher incidences of female-reported sinusitis relate to sex-based differences in MS anatomy. Anat Rec, 302:917-930, 2019. © 2018 Wiley Periodicals, Inc.

Life on a Napoleonic battlefield: A bioarchaeological analysis of soldiers from the Battle of Aspern, Austria

On the 21st-22nd of May 1809, French and Austrian soldiers engaged in battle near the village of Aspern on the outskirts of Vienna. This battle, the first defeat of Napoleon's army on land, was one of the largest and deadliest encounters during the Napoleonic Wars (1798-1815). Salvage excavations between 2009 and 2016 have revealed several battlefield burial sites in Aspern. The remains of 30 individuals were evaluated for a series of pathological conditions which develop during childhood and adulthood to elucidate the impact of Napoleonic military conditions on health. Statistical comparisons were conducted of stature estimates and frequencies of pathological conditions between the Aspern soldiers, several contemporaneous military, and two civilian samples of differing socioeconomic status. These data were compared to test the hypothesis that military conscripts had 'healthy' childhoods, but then experienced deteriorating health as a result of military conditions. The analysis revealed comparatively high mean stature, but also a high prevalence of enamel hypoplastic defects, indicating that the childhood health of the military recruits was more varied than was initially expected. High frequencies of carious lesions, dental calculus, active maxillary sinusitis and pleuritis and osteoarthritis were recorded, demonstrating the deleterious effects of military life on health.

Concha Bullosa in Paleoanthropological Material

Concha bullosa is a variant of the sinonasal anatomy in which the middle nasal turbinate contains pneumatized cells, which leads to turbinate enlargement. The reason for concha bullosa formation is unclear, but the variant is seen in up to half the modern population and it may predispose to paranasal sinusitis. The variant has hitherto featured little in paleopathology. Therefore, in the present study we seek to determine the presence of concha bullosa, with the coexisting hypertrophy of the middle turbinate and signs of sinusitis or other pathology of the paranasal complex, in a population living in Tomersdorf-Toporow in the Upper Lausatia, a historical region in Germany and Poland, presently Zgorzelec County in the Lower Silesian voivodeship, at the turn of the nineteenth and twentieth century. The material consisted of 32 skeletons (24 males, 8 females). The gender, age, and stress indicators and the presence of pathological signs were assessed, followed by CT of the skulls. We found 2 skulls (6.3 %) with concha bullosa. In one case septal nasal deviation was present. We conclude that the incidence of concha bullosa could be lower in the past times than at present. Wider research is necessary to settle whether concha bullosa is indeed a rare respiratory paleopathology or a missed, and thus underreported observation.

Differentiating between rhinosinusitis and mastoiditis surgery from postmortem medical training: A study of two identified skulls and hospital records from early 20th century Coimbra, Portugal

Differentiating between medical procedures performed antemortem, perimortem or postmortem in skeletal remains can be a major challenge. This work aims to present evidence of procedures to treat rhinosinusitis (RS) and mastoiditis, suggest criteria for the diagnosis of frontal sinus disease, and frame the individuals described in their medical historical context. In the International Exchange collection, the skull (878) of a 24-year-old male, who died in 1933 due to frontal sinusitis and meningitis, presents evidence of a trepanation above the right frontonasal suture, and micro/macroporosity on the superciliary arches. The available Coimbra University Hospitals archives (1913-1939) reported that 46 females and 59 males (aged 15 months-84 y.o., x̄=35.33) underwent surgery to treat RS, primarily by trepanation (94.3%). In a search for similar evidence in the collection, the skull of a 42-year-old female (85), who died in 1927 due to sarcoma in the abdomen, shows four quadrangular holes located above the right supraorbital notch, right and left maxilla, and left mastoid process. The number/location of the holes and cut marks point to postmortem medical training (possible dissection). This paper discusses the value of information from historical contexts to differentiate between surgery and medical training in the paleopathological record.

Growth and health status of children and adolescents in medieval Central Europe

Subadult growth and health have been analyzed in three cemetery samples from medieval Poland, including two early-urban sites: Cedynia dated to the 10t-14th centuries AD, and Ostrów Lednicki dated to the 13th-15th centuries AD, and a rural site Słaboszewo dated to the 14th-17th centuries AD. The nutritional status was not expected to have substantially differed among the settlements, due to the culturally induced undiversified diet of children, and predominant share of medium-to-low status individuals. However, city life and village life were supposed to differ in factors correlated with the spread of infections, and as such it was expected to find significant differences in respiratory health among early-urban and rural dwellers.The prevalences of diet-dependent diseases, scurvy and rickets, were found to be statistically indistinguishable among the three studied populations, while higher frequency of skeletal signs of poor respiratory health was observed in early-urban Cedynia than rural Słaboszewo. Slightly lower prevalences of skeletal stress indicators were found for the rural than the early-urban site. Skeletal growth profiles and the dynamics of long bone growth were found to be remarkably similar for the early-urban samples (Cedynia and Ostrów Lednicki), with the rural subadults having the shortest diaphyseal lengths, and lower growth dynamics.It can be concluded that adverse factors associated with the urban settlement were more detrimental to respiratory health than those in the village. A variety of factors are potentially responsible for this pattern, including population density, building structure, quality of air and water, sanitation, and occupation. Perhaps, the key factor in response to environmental and socio-cultural constraints was the stability of living conditions in the village, which allowed the inhabitants to develop sufficient adaptive mechanisms. In contrast, the history of strongholds such as Cedynia was changeable due to political situation, military threats and migrations of people.

Concha Bullosa in Paleoanthropological Material

Concha bullosa is a variant of the sinonasal anatomy in which the middle nasal turbinate contains pneumatized cells, which leads to turbinate enlargement. The reason for concha bullosa formation is unclear, but the variant is seen in up to half the modern population and it may predispose to paranasal sinusitis. The variant has hitherto featured little in paleopathology. Therefore, in the present study we seek to determine the presence of concha bullosa, with the coexisting hypertrophy of the middle turbinate and signs of sinusitis or other pathology of the paranasal complex, in a population living in Tomersdorf-Toporow in the Upper Lausatia, a historical region in Germany and Poland, presently Zgorzelec County in the Lower Silesian voivodeship, at the turn of the nineteenth and twentieth century. The material consisted of 32 skeletons (24 males, 8 females). The gender, age, and stress indicators and the presence of pathological signs were assessed, followed by CT of the skulls. We found 2 skulls (6.3 %) with concha bullosa. In one case septal nasal deviation was present. We conclude that the incidence of concha bullosa could be lower in the past times than at present. Wider research is necessary to settle whether concha bullosa is indeed a rare respiratory paleopathology or a missed, and thus underreported observation.

Palaeopathology and its relevance to understanding health and disease today: the impact of the environment on health, past and present

This paper considers the discipline of palaeopathology, how it has developed, how it is studied, and what limitations present challenges to analysis. The study of disease has a long history and has probably most rapidly developed over the last 40-50 years with the development of methods, and particularly ancient pathogen DNA analysis. While emphasizing that palaeopathology has close synergies to evolutionary medicine, it focuses then on three ‘case studies’ that illustrate the close interaction people have had with their environments and how that has impacted their health. Upper and lower respiratory tract disease has affected sinuses and ribs, particularly in urban contexts, and tuberculosis in particular has been an ever present disease throughout thousands of years of our existence. Ancient DNA methods are now allowing us to explore how strains of the bacteria causing TB have changed through time. Vitamin D deficiency and ‘phossy jaw’ are also described, both potentially related to polluted environments, and possibly to working conditions in the industrial period. Access to UV light is emphasized as a preventative factor for rickets and where a person lives is important (latitude). The painful stigmatizing ‘phossy jaw’ appears to be a condition related to the match making industries. Finally, thoughts for the future are outlined, and two key concerns: a close consideration of ethical issues and human remains, especially with destructive analyses, and thinking more about how palaeopathological research can impact people beyond academia.

An unusual exostotic lesion of the maxillary sinus from Roman Lincoln

This report provides a differential diagnosis of an exostotic bony lesion within the left maxillary sinus of a Romano-British (3rd to 4th century AD) adult male from Newport, Lincoln. Macroscopic, radiographic, and cone beam computed tomography (CBCT) analyses suggest that the lesion is likely of odontogenic origin. The overall size of the lesion and areas of sclerosis and radiolucency, together with its hypothesised odontogenic origin, suggest that the lesion represents a chronic exostotic osteomyelitic reaction to the presence of odontogenic bacteria. While modern case studies of odontogenic maxillary sinus osteomyelitis are noteworthy, published cases of this condition are extremely rare in an archaeological context and may be underreported due to the enclosed nature of the sinuses. Such infections may have serious implications for individual and population health, and non-destructive investigation should be considered in cases where significant maxillary caries are present.

Household air pollution from wood burning in two reconstructed houses from the Danish Viking Age

During 13 winter weeks, an experimental archeology project was undertaken in two Danish reconstructed Viking Age houses with indoor open fireplaces. Volunteers inhabited the houses under living conditions similar to those of the Viking Age, including cooking and heating by wood fire. Carbon monoxide (CO) and particulate matter (PM2.5 ) were measured at varying distances to the fireplace. Near the fireplaces CO (mean) was 16 ppm. PM2.5 (mean) was 3.40 mg/m(3) , however, measured in one house only. The CO:PM mass ratio was found to increase from 6.4 to 22 when increasing the distance to the fire. Two persons carried CO sensors. Average personal exposure was 6.9 ppm, and from this, a personal PM2.5 exposure of 0.41 mg/m(3) was estimated. The levels found here were higher than reported from modern studies conducted in dwellings using biomass for cooking and heating. While this may be due to the Viking house design, the volunteer's lack of training in attending a fire maybe also played a role. Even so, when comparing to today's issues arising from the use of open fires, it must be assumed that also during the Viking Age, the exposure to woodsmoke was a contributing factor to health problems.

Consequences of evolution: is rhinosinusitis, like otitis media, a unique disease of humans?

We hypothesize that if otitis media is most likely primarily a human disease due to consequences of evolution, rhinosinusitis may also be limited to humans for similar reasons. If otitis media, with its associated hearing loss, occurred in animals in the wild, they probably would have been culled out by predation. Similarly, if rhinosinusitis occurred regularly in animals, they likely would have suffered from severely decreased olfactory abilities, crucial for predator avoidance, and presumably would likewise have been selected against evolutionarily. Thus, both otitis media and rhinosinusitis-common conditions particularly in infants and young children-appear to be essentially human conditions. Their manifestation in our species is likely due to our unique evolutionary trajectory and may be a consequence of adaptations, including adaptations to bipedalism and speech, loss of prognathism, and immunologic and environmental factors.

Nasal septal deviation in a mediaeval population

In modern populations, there is evidence that nasal septal deviation (NSD) may be associated with maxillary sinusitis, and that those with NSD may differ in craniofacial morphology from those without or with less severe NSD. Whether these associations hold true for earlier populations has yet to be investigated. The current work is a step toward remedying this. The study group comes from a mediaeval English archaeological site. NSD was quantified using image analysis. Maxillary sinusitis was identified from new bone formation in the antrum. Cranial morphology was assessed using standard craniometric measurements. The results provided no evidence for a relationship between NSD and maxillary sinus disease. NSD was associated with reduced measures of upper facial height, suggesting decoupling of growth in vertical height of the nasal septum and the bony structures surrounding it.

Sex differentials in frailty in medieval England

In most modern populations, there are sex differentials in morbidity and mortality that favor women. This study addresses whether such female advantages existed to any appreciable degree in medieval Europe. The analyses presented here examine whether men and women with osteological stress markers faced the same risks of death in medieval London. The sample used for this study comes from the East Smithfield Black Death cemetery in London. The benefit of using this cemetery is that most, if not all, individuals interred in East Smithfield died from the same cause within a very short period of time. This allows for the analysis of the differences between men and women in the risks of mortality associated with osteological stress markers without the potential confounding effects of different causes of death. A sample of 299 adults (173 males, 126 females) from the East Smithfield cemetery was analyzed. The results indicate that the excess mortality associated with several osteological stress markers was higher for men than for women. This suggests that in this medieval population, previous physiological stress increased the risk of death for men during the Black Death to a greater extent than was true for women. Alternatively, the results might indicate that the Black Death discriminated less strongly between women with and without pre-existing health conditions than was true for men. These results are examined in light of previous analyses of East Smithfield and what is known about diet and sexually mediated access to resources in medieval England.

Differential diagnosis of mastoid hypocellularity in human skeletal remains

Mastoid hypocellularity is frequently used as an indicator of chronic otits media in paleopathological investigations. The condition can be caused by a poor development of air cells during infancy and early childhood (primary hypocellularity) or by obliteration of air cells with bone during later life (secondary hypocellularity). We performed a macroscopic, radiographic, and microscopic study of pneumatization patterns in 151 mastoid processes of individuals from an early-medieval cemetery in Germany, with emphasis on the architecture of the nonpneumatized portion of hypocellular mastoid processes. Two types of primary mastoid hypocellularity were distinguished. The first was characterized by a poorly defined boundary between the pneumatized portion and the nonpneumatized portion and a trabecular thickening in the spongy bone of the latter. The second showed a well-defined boundary between the pneumatized portion and the nonpneumatized portion and normal spongy bone architecture in the latter. The key feature for the diagnosis of secondary hypocellularity was the recognition of the walls of former air cells. Our observations closely match the histopathological findings by Wittmaack (Wittmaack: Uber die normale und die pathologische Pneumatisation des Schläfenbeins. Jena: Gustav Fischer [1918]), who developed a concept of the normal pneumatization process of the temporal bone and the pathogenesis of aberrant pneumatization. We agree with Wittmaack's view that two types of primary mastoid hypocellularity can be distinguished morphologically. Regarding the pathogenesis of these types, we, however, conclude that Wittmaack's concept needs to be revised and updated. Further studies are required to establish the relationship between morphological findings in cases of mastoid hypocellularity and the health status of individuals.

Diet, tuberculosis, and the paleopathological record

Osseous manifestation of infectious disease is of paramount importance to paleopathologists seeking to interpret ancient health, but the relationships among infectious agent exposure, development of disease, and skeletal involvement are complex. The outcome of an exposure strongly depends on multiple factors, including ecology, diet, nutrition, immune function, and the genetics of pathogen and host. Mycobacterial diseases are often studied in ancient remains but also are especially influenced by these factors; individual and population differences in severity and course are apparent following onset of active disease. The osteological record for these diseases represents the complex interplay of host and pathogen characteristics influencing within- and among-individual skeletal lesion prevalence and distribution. However, many of these characteristics may be assessed independently through the archaeological record. Here, we explore the contributions of dietary protein and iron to immune function, particularly the course and outcome of infection with Mycobacterium tuberculosis. We emphasize how nutrition may influence the dissemination of bacilli to the skeleton and subsequent formation of diagnostic lesions. We then generate models and hypotheses informed by this interplay and apply them to four prehistoric New World areas. Finally, discrepancies between our expectations and the observed record are explored as a basis for new hypotheses.

Ancient skeletal evidence for leprosy in India (2000 B.C.)

Background

Leprosy is a chronic infectious disease caused by Mycobacterium leprae that affects almost 250,000 people worldwide. The timing of first infection, geographic origin, and pattern of transmission of the disease are still under investigation. Comparative genomics research has suggested M. leprae evolved either in East Africa or South Asia during the Late Pleistocene before spreading to Europe and the rest of the World. The earliest widely accepted evidence for leprosy is in Asian texts dated to 600 B.C.

Methodology/Principal Findings

We report an analysis of pathological conditions in skeletal remains from the second millennium B.C. in India. A middle aged adult male skeleton demonstrates pathological changes in the rhinomaxillary region, degenerative joint disease, infectious involvement of the tibia (periostitis), and injury to the peripheral skeleton. The presence and patterning of lesions was subject to a process of differential diagnosis for leprosy including treponemal disease, leishmaniasis, tuberculosis, osteomyelitis, and non-specific infection.

Conclusions/Significance

Results indicate that lepromatous leprosy was present in India by 2000 B.C. This evidence represents the oldest documented skeletal evidence for the disease. Our results indicate that Vedic burial traditions in cases of leprosy were present in northwest India prior to the first millennium B.C. Our results also support translations of early Vedic scriptures as the first textual reference to leprosy. The presence of leprosy in skeletal material dated to the post-urban phase of the Indus Age suggests that if M. leprae evolved in Africa, the disease migrated to India before the Late Holocene, possibly during the third millennium B.C. at a time when there was substantial interaction among the Indus Civilization, Mesopotamia, and Egypt. This evidence should be impetus to look for additional skeletal and molecular evidence of leprosy in India and Africa to confirm the African origin of the disease.