Palaeopathology: Current challenges and medical impact

Did Suetonius really call gout morbus dominorum? A philological and historico-medical reconstruction

Current scientific literature often defines gout as morbus dominorum, in agreement with the Greek-Roman representation of podagra (ποδάγρα, literally "foot-trap") as a consequence of gluttony and libertinage. Several authors place the origins of this expression with the Roman writer Suetonius, without however quoting any specific primary source. We have investigated this problem again and scrutinized primary sources ranging from the Roman World to the early Middle Ages. A search on the database of Latin texts for the expression morb* domin* failed to identify any positive correspondence, not only in Suetonius' works but also in those of other Latin authors. As a matter of fact, the expression morbus dominorum appeared for the first time in the literature on podagra in 1661 in Jakob Balde's book Solatium Podagricorum. Since then, this definition has been endlessly repeated in seventeenth- to eighteenth-century literature on gout. In 1866, while lecturing on the diseases of the elderly, the French neurologist Jean-Martin Charcot first ascribed the expression morbus dominorum to Suetonius. However, this attribution is unsupported by primary sources. In conclusion, Suetonius never used the wording morbus dominorum, which was probably coined by Jakob Balde in 1661. The origin of this erroneous ascription dates to Jean-Martin Charcot's lectures in 1866. Key Points • Albeit a much-quoted sentence in rheumatology,the Roman author Suetonius never called gout morbusdominorum. • When referencing historical point in rheumatology, a careful perusal of the primary sources should beimplemented to avoid misquoting and false myths.

Sacral Spina Bifida Occulta: A Frequency Analysis of Secular Change

Substantial relaxation of natural selection beginning around 1900 changed the mutation/selec­tion balance of modern genetic material, producing an increase in variable anatomical structures. While multiple structures have been affected, the temporal increase in variations of the sacrum, specifically, ‘Sa­cral Spina Bifida Occulta,’ have been reliably demonstrated on a localised scale. Calculation of largescale frequency has been hindered by the localised nature of these publications, the morphological variability of this variation, and potential pathological associations, which have produced divergent classifications, and conflicting reported rates of occurrence. A systematic review of the reported literature was conducted to provide an objective analysis of Sacral Spina Bifida Occulta frequency from 2500 BCE to the present. This review was designed to compensate for observed inconsistencies in reporting and to ascertain, for the first time, the temporal trajectory of this secular trend. A systematic review of Sacral Spina Bifida Occulta lit­erature was conducted through the strict use of clinical meta-analysis criteria. Publications were retrieved from four databases: PubMed, Embase, the Adelaide University Library database, and Google Scholar. Data were separated into three historical groups, (1 = <1900, 2 = 1900 to 1980 and 3 = >1980), and frequency outcomes compared, to determine temporal rates of occurrence. A total of 39/409 publications were included in the final analysis, representing data for 16,167 sacra, spanning a period of 4,500 years. Statistically significant results were obtained, with total open S1 frequen­cy increasing from 2.34%, (79 to 1900CE), to 4.80%, (1900 to 1980CE) and to 5.43% (>1980CE). These increases were significant at p<0.0001, with Chi-squared analysis. A clear secular increase in the global frequency of Sacral Spina Bifida Occulta has been demonstrated from 1900 to the present. This research provides a novel and adaptable framework for the future assessment of variation distribution, with impor­tant implications for the fields of biological anthropology and bioarchaeology.

A content analysis by bibliometry of the first ten years of the International Journal of Paleopathology

OBJECTIVES

The aim is to provide an overview of the nature of the content of palaeopathology articles in the International Journal of Paleopathology during the first ten years of publication (2011-2020), and to compare these results with those from other similar journals.

METHODS

The method used is bibliometry of International Journal of Paleopathology plus nine other periodicals publishing in the field of osteoarchaeology / palaeopathology. In these ten journals, 2513 publications in human osteology are reviewed of which 1032 are devoted specifically or substantially to palaeopathology.

RESULTS

International Journal of Paleopathology has attracted a large number of palaeopathology publications, but this has not been at the expense of extant journals. Its appearance appears to have coincided with an expansion of the discipline, and it may also act as a focus for publication for articles that would not previously have found a venue. Its output is distinctive from other journals assessed, with greater emphasis on review articles (including those focusing on method and theory in palaeopathology) and, especially, on case reports.

SIGNIFICANCE

International Journal of Paleopathology acts as a focal point for publications from diverse areas of the field. The connection with the Paleopathology Association provides a conduit by which outcomes of debates within the profession concerning future priorities for the field (e.g. development of method and theory; the status of the case report within the discipline) can be reflected in journal policy.

LIMITATIONS

Palaeopathology and other osteoarchaeology articles are published in venues other than those analysed in the current work.

Differential diagnosis of a calcified cyst found in an 18th century female burial site at St. Nicholas Church cemetery (Libkovice, Czechia)

During archaeological excavations in burial sites, sometimes stoned organic objects are found, in addition to human remains. Those objects might be of a different origin, depending on various factors influencing members of a community (i.e. diseases, trauma), which provides information about their living conditions. The St. Nicholas Church archaeological site (Libkovice, Czechia) in the 18^th century horizon of the cemetery, yielded a maturus-senilis female skeleton with a stone object in the left iliac fossa. This object was an oviform cyst-like rough structure, measuring 54 mm in length, 35 mm in maximum diameter and 0.2–0.7 mm shell thickness. Within the object there were small fetal bones (long bones, i.e. femur and two tibias, two scapulas, three ribs, vertebrae and other tiny bone fragments). Methods utilized to analyze the outer and inner surface morphology of the cyst and its inside, included: X-ray, CT imaging, SEM, histological staining and EDS. The EDS analysis revealed the presence of primarily oxygen, calcium and phosphorus in bone samples, and oxygen and silicon, in stone shell. Based on the length of the femur (20.2 mm) and tibia (16 mm) shafts, the fetal age was determined as being in the 15–18 week of pregnancy. The differential diagnosis was conducted, including for the three most probable cases: fetiform teratoma (FT), fetus-in-fetu (FIF) and lithopedion. The possibility of fetiform teratoma was discounted due to the presence of an anatomically correct spine, long bones and the proportions of the find. Although the low calcium content in the shell (2.3% atom mass), the lack of skull bones and the better developed lower limbs indicate fetus-in-fetu rather than lithopedion, the analyses results are unable to conclusively identify the object under one of these two categories since there are insufficient such cases in excavation material with which to draw comparison.

Human major infections: Tuberculosis, treponematoses, leprosy-A paleopathological perspective of their evolution

The key to evolution is reproduction. Pathogens can either kill the human host or can invade the host without causing death, thus ensuring their own survival, reproduction and spread. Tuberculosis, treponematoses and leprosy are widespread chronic infectious diseases whereby the host is not immediately killed. These diseases are examples of the co-evolution of host and pathogen. They can be well studied as the paleopathological record is extensive, spanning over 200 human generations. The paleopathology of each disease has been well documented in the form of published synthetic analyses recording each known case and case frequencies in the samples they were derived from. Here the data from these synthetic analyses were re-analysed to show changes in the prevalence of each disease over time. A total of 69,379 skeletons are included in this study. There was ultimately a decline in the prevalence of each disease over time, this decline was statistically significant (Chi-squared, p<0.001). A trend may start with the increase in the disease’s prevalence before the prevalence declines, in tuberculosis the decline is monotonic. Increase in skeletal changes resulting from the respective diseases appears in the initial period of host-disease contact, followed by a decline resulting from co-adaptation that is mutually beneficial for the disease (spread and maintenance of pathogen) and host (less pathological reactions to the infection). Eventually either the host may become immune or tolerant, or the pathogen tends to be commensalic rather than parasitic.

Five millennia of Bartonella quintana bacteraemia

During the two World Wars, Bartonella quintana was responsible for trench fever and is now recognised as an agent of re-emerging infection. Many reports have indicated widespread B. quintana exposure since the 1990s. In order to evaluate its prevalence in ancient populations, we used real-time PCR to detect B. quintana DNA in 400 teeth collected from 145 individuals dating from the 1^st to 19^th centuries in nine archaeological sites, with the presence of negative controls. Fisher’s exact test was used to compare the prevalence of B. quintana in civil and military populations. B. quintana DNA was confirmed in a total of 28/145 (19.3%) individuals, comprising 78 citizens and 67 soldiers, 20.1% and 17.9% of which were positive for B. quintana bacteraemia, respectively. This study analysed previous studies on these ancient samples and showed that the presence of B. quintana infection followed the course of time in human history; a total of 14/15 sites from five European countries had a positive prevalence. The positive rate in soldiers was higher than those of civilians, with 20% and 18.8%, respectively, in the 18^th and 19^th centuries, but the difference in frequency was not significant. These results confirmed the role of dental pulp in diagnosing B. quintana bacteraemia in ancient populations and showed the incidence of B. quintana in both civilians and soldiers.

The infant mummy's face-Paleoradiological investigation and comparison between facial reconstruction and mummy portrait of a Roman-period Egyptian child

In Graeco-Roman times in the Lower-Egyptian Fayoum region, a painted portrait was traditionally placed over the face of a deceased individual. These mummy portraits show considerable inter-individual diversity. This suggests that those portraits were created separately for each individual. In the present study, we investigated a completely wrapped young infant mummy with a typical mummy portrait by whole body CT analysis. This was used to obtain physical information on the infant and provided the basis for a virtual face reconstruction in order to compare it to the mummy portrait. We identified the mummy as a 3-4 years old male infant that had been prepared according to the typical ancient Egyptian mummification rites. It most probably suffered from a right-sided pulmonary infection which may also be the cause of death. The reconstructed face showed considerable similarities to the portrait, confirming the portrait's specificity to this individual. However, there are some differences between portrait and face. The portrait seems to show a slightly older individual which may be due to artistic conventions of that period.

Why paleomedicine is useful for medical education

What is the place of medico-historical cases in the professional practice of the disciplinary field of medicine and biology? How can these patients from the past be used for teaching and continuing medical education? How to justify their place in biomedical publications? In this article, we explain all the legitimacy of paleomedicine, and the need to intensify such research in the form of a well-individualised branch of paleopathology and the history of medicine.

The earliest known case of frontal sinus osteoma in man

Frontal sinus osteoma is a relatively common finding in the modern clinical setting. Although, its paleopathological record is not in dispute, its presence in Ancient Egypt has never been clarified. The aim of this article is to contribute to the debate. An Egyptian mummy head from the Musée d'Éthnographie de Neuchâtel (Switzerland) was studied radiologically and the obtained evidence was contextualized in the wider frame of multidisciplinary paleopathology. A 128-slice CT scanner was used for further investigation; datasets were processed with OsiriX-64 bit (version 5.8.5), and multiplanar (MPR) and volumetric reconstructions were performed. A small hyperdense and well-defined structure, most likely an osteoma, was identified in the right frontal sinus. Frontal sinus osteoma definitely existed in Ancient Egypt. Finally, this represents the oldest case in anatomically modern humans so far reported. Clin. Anat.32:105-109, 2019. © 2018 Wiley Periodicals, Inc.

Autopsing history: The mummy of Charlemagne (c. 747 - 814 AD), father of Europe

In this article, a complete history of Charlemagne's mortal remains is outlined, including the first publication reporting on the most recent tomb opening in 1988. Besides exclusive bioarchaeological details - namely that his body was indeed mummified - a full clinical interpretation of the Emperor's final illnesses and death is given: a likely combination of osteoarthritis, gout and a recurrent fever caused by an infectious disease.

Lumbosacral Defects in a 16th-18th-Century Joseon Dynasty Skeletal Series from Korea

Paleopathological evidence for congenital and degenerative disorders of the lumbosacral vertebrae is informative about ancient individual lifeways and physical conditions. However, very few studies have focused on the paleopathology of the lumbosacral vertebrae in ancient skeletal series from East Asia. One reason for the lack of studies is that skeletal samples from East Asia are typically insufficient in size to represent populations for comparative studies within the continent. Here, we present the first comprehensive analysis of lumbosacral defects in an East Asian human skeletal sample, examining occurrences of spina bifida occulta (SBO), lumbosacral transitional vertebrae (LSTV), and spondylolysis in remains from Joseon tombs dating to the 16–18th centuries in Korea. In this study, we present an alternative methodology for understanding activities of daily life among ancient Koreans through paleopathological analysis.

Radiological findings in ancient Egyptian canopic jars: comparing three standard clinical imaging modalities (x-rays, CT and MRI)

Background

The aim of our study was to evaluate the potential and the limitations of standard clinical imaging modalities for the examination of ancient Egyptian canopic jars and the mummified visceral organs (putatively) contained within them.

Methods

A series of four ancient Egyptian canopic jars was imaged comparing the three standard clinical imaging modalities: x-rays, computed tomography (CT) and magnetic resonance imaging (MRI). Additionally, imaging-data-based volumetric calculations were performed for quantitative assessment of the jar contents.

Results

The image contrast of the x-ray images was limited by the thickness and high density of the calcite mineral constituting the examined jars. CT scans showed few artefacts and revealed hyperdense structures of organ-specific morphology, surrounded by a hypodense homogeneous material. The image quality of MRI scans was limited by the low amount of water present in the desiccated jar contents. Nevertheless, areas of pronounced signal intensity coincided well with hyperdense structures previously identified on CT scans. CT-based volumetric calculations revealed holding capacities of the jars of 626–1319 cm³ and content volumes of 206–1035 cm³.

Conclusions

CT is the modality of choice for non-invasive examination of ancient Egyptian canopic jars. However, despite its limitations, x-ray imaging will often remain the only practicable method for on-site investigations. Overall, the presented radiological findings are more compatible with contained small organ fragments rather than entire mummified organs, as originally expected, with consequent implications for envisioned future sampling for chemical and genetic analysis.

Dry bone histology of bone tumours

This article focuses on the application of dry bone histology in the diagnosis of a series of different bone tumours. It provides a short introduction on bone tumour classification and how tumours may affect the skeleton. To illustrate the value of dry bone histology in the diagnostic process we studied the 'fresh' and 'dry' bone histology of a series of well-documented, recent clinical cases of various benign and malignant bone tumours. We show that histology is a valuable instrument to assess bone tissue architecture, which provides information on the biological behaviour of a tumour. Though histology may reveal the specific 'tumorous' bone deposition of high-grade conventional osteosarcomas, all other bone tumours display common, unspecific features. This holds for the following tumours: osteochondroma, hyperostotic meningioma, high-grade angiosarcoma, grade 2 chondrosarcoma, myoepithelial carcinoma, high-grade osteosarcoma and four carcinoma metastases. We conclude that histology is useful in cases where the biological behaviour of a tumour is to be defined, and is particularly an aide in the diagnosis of high-grade conventional osteosarcomas. Nevertheless, the differential diagnosis on the bone tumours in our series should primarily be based on a combination of physical anthropological patient data (age, sex), gross anatomy (e.g. tumour morphology and location), and radiography.

Medical and neuropsychiatric phenomena depicted in two Spanish medieval texts of Marian miracles

In the history of Christianity, veneration of the Virgin Mary reached its greatest intensity in the XIII century. Her perceived impact on daily life was tremendous and not surprisingly this extended to the spheres of disease and healing. The purpose of this study is to compare the medical and neuropsychiatric findings in two XIII century Spanish texts of Marian miracles, both examples of the popular Catholicism (vs. official catholic doctrine). We analyzed the medical and neuropsychiatric events in the Cantigas de Santa Maria (Canticles of St. Mary, CSM), composed at the court of Alfonso X and the Milagros de Nuestra Señora (The Miracles of Our Lady, MNS), written by Gonzalo de Berceo. Among the 25 miracles reported in the MNS, medically relevant facts were addressed in 19 miracles with a total of 23 recorded events (including resurrection or escape from death in five) and demonic possession in three (one with witchcraft/deicide). The most common medical subjects were ergotism, obstetric-gynecological, sudden death, intellectual disability/illiteracy, encephalopathy/alcohol intoxication, suicide (with self-mutilation/castration), infanticide, infections, and absence of body decomposition after death. The 427 canticles in the CSM contain 270 medically relevant facts. Neuropsychiatric conditions were alluded to in 98 songs. Blindness and dystonia/weakness/deformities were the most common phenomena. Illuminations detailed many of the medical facts in the CSM, but not in the MNS. Medically relevant facts were described in both texts, but with more details in the CSM. Neurological conditions were more often described in the CSM, psychiatric conditions in the MNS.

Paleogenetic study on the 17th century Korean mummy with atherosclerotic cardiovascular disease

While atherosclerotic cardiovascular disease (ASCVD) is known to be common among modern people exposed to various risk factors, recent paleopathological studies have shown that it affected ancient populations much more frequently than expected. In 2010, we investigated a 17^th century Korean female mummy with presumptive ASCVD signs. Although the resulting report was a rare and invaluable conjecture on the disease status of an ancient East Asian population, the diagnosis had been based only on anatomical and radiological techniques, and so could not confirm the existence of ASCVD in the mummy. In the present study, we thus performed a paleogenetic analysis to supplement the previous conventional diagnosis of ASCVD. In aDNA extracted from the same Korean mummy, we identified the risk alleles of seven different SNPs (rs5351, rs10757274, rs2383206, rs2383207, rs10757278, rs4380028 and rs1333049) that had already been revealed to be the major risk loci of ASCVD in East Asian populations. The reliability of this study could be enhanced by cross-validation using two different analyses: Sanger and SNaPshot techniques. We were able to establish that the 17^th century Korean female had a strong genetic predisposition to increased risk of ASCVD. The current paleogenetic diagnosis, the first of its kind outside Europe, re-confirms its utility as an adjunct modality for confirmatory diagnosis of ancient ASCVD.

Giovanni Boccaccio's (1313-1375) disease and demise: The final untold tale of liver and heart failure

Giovanni Boccaccio's fatal disease(s) and cause of death have long remained a mystery. Now, for the first time, a thorough multidisciplinary reassessment has finally been carried out. By combining philological and clinical approaches, it is at last possible to suggest a solid retrospective diagnosis based upon a study of his correspondence, poetry and iconography, as well as references to his physical decay in coeval and later sources. It would appear that he suffered over the last three years of his life from hepatic and cardiac failure, conditions that resulted in edema and potentially even hepatic carcinoma. Focusing on an unusually well-documented case from the Middle Ages, this analysis of exceptionally high informative value reconstructs the symptoms of his medical conditions and finally permits us to clarify and explain the historical feaures, presentations and evolutionary history of the case at hand.

Palaeopathology of the earlobe crease (Frank's sign): New insights from Renaissance art

Several studies have associated the earlobe crease sign, discovered by Sanders T. Frank in 1973, with cardiovascular pathology, yet very few studies have focused on the antiquity of this trait, with the most ancient one thought to date back to the Roman Emperor Hadrian (76-138CE). This article presents two more cases from the Italian Renaissance in the works of the artist Andrea Mantegna (1431-1506) and examines them in a multidisciplinary fashion.