Testing the Digital Atlas of Ancient Rare Diseases (DAARD) using a new case of Legg-Calvé-Perthes disease from Early Byzantine (500-700 CE) Olympia, Greece

OBJECTIVE

The first case of Legg-Calvé-Perthes disease (LCPD) in Greece is presented. LCPD, a rare disease, is discussed using the Digital Atlas of Ancient Rare Diseases (DAARD), which tests the benefits of the database for diagnosing and contextualizing the new case with 42 archaeological cases of LCPD recorded in the DAARD.

MATERIALS

A 30-40-year-old, probable male individual was found at the archaeological site of Olympia, Greece, dating to 500-700 CE.

METHODS

Biological sex, age-at-death and pathological changes were investigated using macroscopic and osteometric methods. The DAARD provided the typical characteristics of LCPD.

RESULTS

Pathological changes in both hip joints without any other related changes in the skeleton corresponded to the skeletal features of LCPD. The DAARD produced 42 cases of LCPD, most of which from Europe, with a preference for male sex and unilateral involvement of the hip joint.

CONCLUSIONS

The DAARD aids in diagnosing rare diseases and interpreting new cases in the context of already known studies.

SIGNIFICANCE

This study shows that the DAARD has the potential to help researchers move beyond the level of single case studies and create a broader picture of the history of rare diseases.

LIMITATIONS

This paper focuses on the benefits of the DAARD in relation to LCPD but not all rare diseases have been included in the database.

SUGGESTIONS FOR FURTHER RESEARCH

More rare diseases from archaeological contexts should be added to the DAARD to create a base for the interpretation of their history and expand our understanding of rare diseases in the past.

14th century Yersinia pestis genomes support emergence of pestis secunda within Europe

Pestis secunda (1356-1366 CE) is the first of a series of plague outbreaks in Europe that followed the Black Death (1346-1353 CE). Collectively this period is called the Second Pandemic. From a genomic perspective, the majority of post-Black Death strains of Yersinia pestis thus far identified in Europe display diversity accumulated over a period of centuries that form a terminal sub-branch of the Y. pestis phylogeny. It has been debated if these strains arose from local evolution of Y. pestis or if the disease was repeatedly reintroduced from an external source. Plague lineages descended from the pestis secunda, however, are thought to have persisted in non-human reservoirs outside Europe, where they eventually gave rise to the Third Pandemic (19th and 20th centuries). Resolution of competing hypotheses on the origins of the many post-Black Death outbreaks has been hindered in part by the low representation of Y. pestis genomes in archaeological specimens, especially for the pestis secunda. Here we report on five individuals from Germany that were infected with lineages of plague associated with the pestis secunda. For the two genomes of high coverage, one groups within the known diversity of genotypes associated with the pestis secunda, while the second carries an ancestral genotype that places it earlier. Through consideration of historical sources that explore first documentation of the pandemic in today's Central Germany, we argue that these data provide robust evidence to support a post-Black Death evolution of the pathogen within Europe rather than a re-introduction from outside. Additionally, we demonstrate retrievability of Y. pestis DNA in post-cranial remains and highlight the importance of hypothesis-free pathogen screening approaches in evaluations of archaeological samples.

GDP effects of pandemics: a historical perspective

The paper estimates dynamic effects of pandemics on GDP per capita with local projections, controlling for the effects of wars and weather conditions, using a novel dataset that covers 33 countries and stretches back to the thirteenth century. On average, pandemics are found to have prolonged and highly statistically significant effects on GDP per capita-a pandemic killing 1% of the population tends to increase GDP per capita by approx. 0.3% after about 20 years. The study of a more detailed dataset available for the UK reveals that this results mainly from an increase in per capita land and a disproportionate impact of pandemics on low-productivity workers, while monetary expansion, institutional change and innovation could also play some role. At the same time, the effects of pandemics are found to vary with scale and across time and countries, with positive effects present following the Black Death and the Spanish flu pandemics, especially in Northern Europe. This suggests that only the largest and most unexpected pandemics have a positive impact on income.

Misunderstandings of the transmission of the Black Death to Western Europe : a critical review of De Mussis's account

This article aims to critically review de Mussis's report of the events at Caffa. De Mussi says in his account that Tartars catapulted their dead compatriots infected by the plague into the besieged city of Caffa in order to contaminate the Genoese defending the city and that some Genoese galleys fleeing from the city transported the disease to Western Europe. Some historians interpret his report of Tartars catapulting plague-infected bodies as an act of biological warfare, and others do not trust his account as a reliable historical record, while some works rely on his account, even though they do not interpret it as evidence of biological warfare. This article tries to determine whether his account is true or not, and explain historical contexts in which it was made. De Mussi was not an eye-witness of the war between the Tartars and the Genoese in the years of 1343 to 1437 in Caffa, contrary to some historians' arguments that he was present there during the war. In addition, he understands and explains the disease from a religious perspective as does most of his contemporary Christians, believing that the disease was God's punishment for the sins of human beings. His account of the Tartars catapulting their compatriot's bodies may derive from his fear and hostility against the Tartars, thinking that they were devils from hell and pagans to be annihilated. For de Mussi, the Genoese may have been greedy merchants who were providing Muslims with slaves and enforcing their military forces. Therefore, he thought that the Tartars and the Genoese were sinners that spread the disease, and that God punished their arrogance. His pathological knowledge of the disease was not accurate and very limited. His medical explanation was based on humoral theory and Miasma theory that Christians and Muslims in the Mediterranean World shared. De Mussi's account that Caffa was a principal starting point for the disease to spread to Western Europe is not sufficiently supported by other contemporary documents. Byzantine chronicles and Villani's chronicle consider not Caffa but Tana as a starting point. In conclusion, most of his account of the disease are not true. However, we can not say that he did not intentionally lie, and we may draw a conclusion that his explanation was made under scientific limits and religious prejudice or intolerance of the medieval Christian world.

Genetic Evidence of the Black Death in the Abbey of San Leonardo (Apulia Region, Italy): Tracing the Cause of Death in Two Individuals Buried with Coins

The Abbey of San Leonardo in Siponto (Apulia, Southern Italy) was an important religious and medical center during the Middle Ages. It was a crossroads for pilgrims heading along the Via Francigena to the Sanctuary of Monte Sant’Angelo and for merchants passing through the harbor of Manfredonia. A recent excavation of Soprintendenza Archeologica della Puglia investigated a portion of the related cemetery, confirming its chronology to be between the end of the 13th and beginning of the 14th century. Two single graves preserved individuals accompanied by numerous coins dating back to the 14th century, hidden in clothes and in a bag tied to the waist. The human remains of the individuals were analyzed in the Laboratorio di Antropologia Fisica of Soprintendenza ABAP della città metropolitana di Bari. Three teeth from each individual were collected and sent to the Istituto Zooprofilattico Sperimentale di Puglia e Basilicata to study infectious diseases such as malaria, plague, tuberculosis, epidemic typhus and Maltese fever (Brucellosis), potentially related to the lack of inspection of the bodies during burial procedures. DNA extracted from six collected teeth and two additional unrelated human teeth (negative controls) were analyzed using PCR to verify the presence of human DNA (β-globulin) and of pathogens such as Plasmodium spp., Yersinia pestis, Mycobacterium spp., Rickettsia spp. and Brucella spp. The nucleotide sequence of the amplicon was determined to confirm the results. Human DNA was successfully amplified from all eight dental extracts and two different genes of Y. pestis were amplified and sequenced in 4 out of the 6 teeth. Molecular analyses ascertained that the individuals buried in San Leonardo were victims of the Black Death (1347–1353) and the data confirmed the lack of inspection of the corpses despite the presence of numerous coins. This study represents molecular evidence, for the first time, of Southern Italy’s involvement in the second wave of the plague pandemic.

Doctrinal and Physical Marginality in Christian Death: The Burial of Unbaptized Infants in Medieval Italy

The burial of unbaptized fetuses and infants, as seen through texts and archaeology, exposes friction between the institutional Church and medieval Italy’s laity. The Church’s theology of Original Sin, baptism, and salvation left the youngest children especially vulnerable to dying unbaptized and subsequently being denied a Christian burial in consecrated grounds. We here present textual and archaeological evidence from medieval Italy regarding the tensions between canon law and parental concern for the eternal salvation of their infants’ souls. We begin with an analysis of medieval texts from Italy. These reveal that, in addition to utilizing orthodox measures of appealing for divine help through the saints, laypeople of the Middle Ages turned to folk religion and midwifery practices such as “life testing” of unresponsive infants using water or other liquids. Although emergency baptism was promoted by the Church, the laity may have occasionally violated canon law by performing emergency baptism on stillborn infants. Textual documents also record medieval people struggling with where to bury their deceased infants, as per their ambiguous baptismal status within the Church community. We then present archaeological evidence from medieval sites in central and northern Italy, confirming that familial concern for the inclusion of infants in Christian cemeteries sometimes clashed with ecclesiastical burial regulations. As a result, the remains of unbaptized fetuses and infants have been discovered in consecrated ground. The textual and archaeological records of fetal and infant burial in medieval Italy serve as a material legacy of how laypeople interpreted and sometimes contravened the Church’s marginalizing theology and efforts to regulate the baptism and burial of the very young.

Epidemiology of Plague: Problems with the Use of Mathematical Epidemiological Models in Plague Research and the Question of Transmission by Human Fleas and Lice

This article addresses the recent use of mathematical epidemiological SIR or SEIR models in plague research. This use of S(E)IR models is highly problematic, but the problems are not presented and considered. Serious problems show in that such models are used to "prove" that historical plague was a (1) Filoviridae disease and (2) a bacterial disease caused by Yersinia pestis which was transmitted by human fleas and lice. (3) They also support early-phase transmission (by fleas). They purportedly consistently disprove (4) the conventional view that plague is/was a rat-and-rat-flea-borne disease. For these reasons, the focus is on methodological problems and on empirical testing by modern medical, entomological, and historical epidemiological data. An important or predominant vectorial role in plague epidemics for human fleas and lice requires that several necessary conditions are satisfied, which are generally not considered by advocates of the human ectoparasite hypothesis of plague transmission: (1) the prevalence and levels of human plague bacteraemia (human plague cases as sources of infection of feeding human ectoparasites); (2) the general size of blood meals ingested by human fleas and lice; (3) the consequent number of ingested plague bacteria; (4) the lethal dose of bacteria for 50% of a normal sample of infected human beings, LD50; and (5) efficient mechanism of transmission by lice and by fleas. The factual answers to these crucial questions can be ascertained and shown to invalidate the human ectoparasite hypothesis. The view of the standard works on plague has been corroborated, that bubonic plague, historical and modern, is/was a rat-and-rat-flea-borne disease caused by Yersinia pestis. These conclusions are concordant with and corroborate recent studies which, by laboratory experiments, invalidated the early-transmission hypothesis as a mechanism of transmission of LDs to humans in plague epidemics and removed this solution to the problem of transmission by human fleas.