"Tuberculosis on the spot" - Discussion of a probable sternal tuberculosis from a late medieval cemetery from Hungary

Investigations of non-adult remains are particularly suitable for finding epidemic periods in past populations. This study presents a probable unique example of osseous manifestation of tuberculosis on a child's skeletal remains from medieval Hungary. Between 2009 and 2011 the Field Service for Cultural Heritage excavated the exceptional cemetery of Perkáta - Nyúli-dűlő in Hungary, with around 5000+ graves. The analysed skeleton (SNR 948) was located in the medieval (10-16th century) part of the cemetery. Besides the standard macroscopic pathological observation, we also performed radiographic analysis. The remains of the child (13-14 year-old) showed numerous skeletal lesions: the ribs have proliferative lesions (dense nodules) on the visceral surface of the shaft, lytic lesions with rounded edges occurred on the thoracic and lumbar vertebral bodies, and on the facies auricularis of the left ilium we can see pitting and new bone formation. What makes this pathological case exceptional is the significant change in the manubrium. It shows extensive osteolytic lesions, probably due to tuberculous osteomyelitis, which is a unique phenomenon in an archaeological context. This rare type of extra-spinal tuberculous osteomyelitis appears in less than 1% of cases with skeletal TB, and even less in case of children, according to modern medical literature. Although some cases of slight lesions on the manubrium have been described from an archaeological context, no such cases showing advanced lesions have been published so far. In the future, biomolecular analyses should be conducted as well, in order to confirm the presence of TB in this individual.

Generalized dermatitis in the natural mummy of the Roman Catholic nun Marie-Léonie Martin (France, 1863-1941)

OBJECTIVE

To document skin lesions on a mummified individual from the XIX century and to diagnose the pathology based historical documentation and physical examination.

MATERIALS

Marie Leonie Martin (1863-1941) was a Roman Catholic nun. Her naturally mummified body is currently preserved in the Monastery of the Visitation in Caen (France). On the occasion of her beatification, the body was exhumed, studied and restored for conservation purposes.

METHODS

The mummy was analyzed histologically and with CT imaging.

RESULTS

The examination of the body noted areas of skin discoloration of reddish color; the paleopathological investigations revealed the presence of skin lesions (pustules) distributed throughout the body, with the exception of the face, abdomen and palms. The histological analyses of the pustules showed the presence of a central duct for the leakage of exudate, hyperkeratosis of the stratum corneum and a proliferation of cells in the spinous layer (acanthosis) of the epidermis.

CONCLUSIONS

The red discoloration of the skin is typical of extensive erythema.

SIGNIFICANCE

Our understanding of skin conditions in the past is extremely limited. This study provides the first paleopathological case of diagnosed unclassified endogenous eczema and provides insight into the antiquity and effects of the disease.

LIMITATIONS

It was not possible to carry out a genetic analysis due to DNA contamination of the mummy.

Sir Marc Armand Ruffer, MD: The early years, 1878-1896

A founder of paleopathology, the study of disease in ancient human remains, Sir Marc Armand Ruffer, MD (1859-1917) served in Egypt, from 1896 to 1917, as a public-health administrator, epidemiologist, and pathologist. He was professor of Bacteriology at the Cairo Medical School, President of the Sanitary, Maritime, and Quarantine Council, member of the Indian Plague Commission, and author or co-author of 40 papers in palaeopathology. However, little is known of his early professional life, which encompassed his education, medical training, and research in England and France. The pre-Egyptian period, 1878 to 1896, was a time of extraordinary activity. Acquiring four academic Degrees at Oxford University and clinical experience at the University College Hospital, London (1878-1889), he was the clinical assistant of Louis Pasteur during the anti-rabies campaign (autumn 1889), interim President of the British Institute of Preventive Medicine (1893-1896), and immunology researcher (1890-1895), in London and Paris, under the guidance of Élie Metchnikoff (1845-1916). Ruffer developed the diphtheria antitoxin in Britain. In addition to a dissertation on hydrocephalus, he composed or co-authored 34 papers. A prolific writer, linguist, clinician, and administrator, he explored several medical sub-disciplines before concentrating on palaeopathology.

Archaeobotanical evidence of the use of medicinal cannabis in a secular context unearthed from south China

ETHNOPHARMACOLOGICAL RELEVANCE

As one of the first plants used by ancient people, cannabis has been used for medicinal purposes for thousands of years. The long history of medicinal cannabis use contrasts with the paucity of archaeobotanical records. Moreover, physical evidence of medicinal cannabis use in a secular context is much rarer than evidence of medicinal cannabis use in religious or ritual activities, which impedes our understanding of the history of medicinal cannabis use.

AIM OF THE STUDY

This study aims to provide archaeobotanical evidence of medicinal cannabis use and analyse the specific medicinal usage of cannabis in a secular context in ancient times.

MATERIALS AND METHODS

Plant remains were collected from the Laoguanshan Cemetery of the Han Dynasty in Chengdu, South China, with the archaeological flotation process and were identified based on morphological and anatomical characteristics. The examination of the medicinal significance of the remains relied on the investigation of the documentation on unearthed medical bamboo slips, the diseases of the tomb occupants, the cemetery's cultural background and Chinese historical records.

RESULTS

The botanical remains were accurately identified as cannabis. More than 120 thousand fruits were found, which represents the largest amount of cannabis fruit remains that have been statistically analysed from any cemetery in the world thus far. The cannabis fruits are suspected to have been used for medical purposes in a secular context and were most likely used to stop severe bleeding of the uterus and treat lumbago and/or arthralgia.

CONCLUSIONS

The cannabis fruit remains reported here likely represent the first physical evidence of medicinal cannabis use for the treatment of metrorrhagia, severe lumbago, and/or arthralgia. This study emphasizes the importance of the evidence of the diseases suffered by the occupants of the tomb in determining the medicinal use of cannabis in a secular context and contributes to a comprehensive understanding of the ancient history of medicinal cannabis.

Differential diagnosis of metabolic disease in a commingled sample from 19th century Hisban, Jordan

OBJECTIVE

This research attempts a differential diagnosis of skeletal lesions in a commingled sample from Hisban, Jordan, focusing on non-adults in the assemblage.

MATERIALS

2,883 well-preserved skeletal elements and 9 relatively complete skulls representing an MNI of 32 non-adults (<18 years old).

METHODS

All skeletal elements were observed macroscopically and pathophysiological processes underlying any lesions or other anomalies were assessed, followed by a comparative approach to rule out potential diagnoses.

RESULTS

The skeletal lesions observed were caused by inflammation due to chronic hemorrhaging, marrow hyperplasia due to an increase in hemopoiesis, rapid bone growth, and the impact of biomechanical strain on poorly mineralized elements. Rickets, scurvy, and acquired anemias best fit this pattern of lesions, although inflammation from other sources such as trauma or infection could not be definitively ruled out.

CONCLUSIONS

The in utero and postnatal environments at Hisban were conducive to the development of vitamin C and D deficiencies from birth until 2 years of age. The analysis of commingled remains requires an ontological shift in the importance of the individual to the population in paleopathology.

SIGNIFICANCE

This investigation demonstrates the efficacy of a combined biological and comparative approach in differential diagnosis in complicated commingled collections. In addition, it emphasizes the importance of the mother-infant dyad in understanding metabolic disease.

LIMITATIONS

Histological and radiographic analyses were not included in this diagnostic study due to COVID-19 travel restrictions.

SUGGESTIONS FOR FURTHER RESEARCH

Isotopic analysis to investigate childhood diet and histological and radiographic analyses to assess survival of deficiencies.

Verification of tuberculosis infection among Vác mummies (18th century CE, Hungary) based on lipid biomarker profiling with a new HPLC-HESI-MS approach

Tuberculosis (TB) was a large burden of infections that peaked during the 19th century in Europe. Mummies from the 18th century CE, discovered in the crypt of a church at Vác, Hungary, had high TB prevalence, as revealed by amplification of key fragments of TB DNA and genome-wide TB analysis. Complementary methods are needed to confirm these diagnoses and one approach uses the identification of specific lipid biomarkers, such as TB mycocerosic acids (MCs). Previously, MC derivatives were profiled by specialised gas chromatography-mass spectrometry (GC-MS), so an alternative more direct approach has been developed. Underivatized MCs are extracted and analysed by high-performance liquid chromatography linked to a mass spectrometer, in heated electrospray ionisation mode (HPLC-HESI-MS). The method was validated using representatives of the Mycobacterium tuberculosis complex and other mycobacteria and tested on six Vác mummy cases, previously considered positive for TB infection. Analysing both rib and soft tissue samples, four out of six cases gave profiles of main C32 and major C29 and C39 mycocerosates correlating well with those of M. tuberculosis. Multidisciplinary methods are needed in the diagnosis of ancient tuberculosis; this new protocol accesses important confirmatory evidence, as demonstrated by the confirmation of TB in the Vác mummies.

Advances in paleopathology in context: A focus on soft tissue paleopathology

Skeletal and mummified remains from South America have had a significant impact on the progress of paleopathological research. In 1997, John Verano synthesized the state of paleopathological research, identifying trends and highlighting future potentials. The goal of this contribution is to consider Verano's observations on advances in soft tissue paleopathology within the context of the development of the field of mummy studies. As his article was published near the midpoint between the present and the early 1970s, when the modern form of mummy studies began to form, considering his observations in this context allows researchers the opportunity to consider how the field has progressed since the late 1990s.

Looking back, looking forward: Paleopathology in Andean South America

Over the past twenty years, the field of Andean paleopathology has advanced significantly thanks to a new generation of scholars who have been attracted to this region and whose innovative research has expanded our knowledge substantially. The papers in this special issue demonstrate how the field of Andean paleopathology has diversified and grown to become what is today a truly interdisciplinary enterprise involving archaeology, ethnohistory, biological anthropology, geochemistry, medical imaging, and genetics. These studies apply theoretical approaches to research questions that are increasingly innovative and nuanced as well as analytical methods that were in their infancy when I wrote my 1997 survey of the field.

A male adult skeleton from the Han Dynasty in Shaanxi, China (202 BC-220 AD) with bone changes that possibly represent spinal tuberculosis

Bioarchaeological data for tuberculosis (TB) have been published very sporadically in China or the rest of East Asia. To explore the history of TB in this area, 85 skeletons excavated from the Liuwei Cemetery in Shaanxi, China (202 BC-220 AD) were macroscopically examined to record TB related bone changes. These skeletons represented inhabitants of Maolingyi, an urban area that had a high population density during the Han Dynasty (202 BC-220 CE). Seventeen of the 85 skeletons had spines that were well enough preserved to observe evidence of spinal disease. Among them, a male skeleton aged around 30 years (M34-E) manifested multiple lytic lesions in the eleventh thoracic to second lumbar vertebral bodies (T11 to L2). TB was considered a possible diagnosis for the spinal lesions observed, with differential diagnoses of brucellosis and typhoid. The dense population and overcrowding in urban Maolingyi were considered the potential social risk factors for TB found at this site. The findings of this study contribute to limited knowledge about the history of TB in East Asia and suggest a relationship between population density and the spread of TB in Maolingyi at that time. However, the lack of published bioarchaeological data of TB in East Asia hinders understanding the transmission of TB within Asia and its link to the rest of the world. Further intensive review of archaeological skeletons in Asia is urgently needed. 。, 。85, 17, 。, 30、、。, 。, 。、, , 。, 。, 。.

A Possible case of Facio-Auriculo-Vertebral sequence (FAVs) in an adult female from medieval Iceland (13th-16th Century)

OBJECTIVE

This paper presents a possible case of Facio-Auriculo-Vertebral sequence (FAVs) in an adult female from Haffjarðarey, Western Iceland (1200-1563 CE) and a brief review of associated terminology.

MATERIALS

The skeletal remains of a single adult female (HFE-A-34, 18-24 years old), excavated in 1945 by the National Museum of Iceland.

METHODS

We carried out macroscopic examination of the cranium and mandible in 2017.

RESULTS

Right side unilateral asymmetric craniofacial dysplasia was identified on the cranium and mandible of HFE-A-34.

CONCLUSIONS

This individual presents with anomalous craniofacial asymmetry consistent with a clinical diagnosis of FAVs.

SIGNIFICANCE

This paper offers a visually distinct case of an under-represented and under-documented congenital condition for future identification within paleopathology.

LIMITATIONS

Infra-cranial skeletal manifestations of FAVs would strengthen this possible diagnosis, but at this time it is not possible to definitively link the cranium and mandible of HFE-A-34 to any of the infra-cranial remains excavated from Haffjarðarey.

SUGGESTIONS FOR FURTHER RESEARCH

In addition to further clarifying the variable nature of FAVs in archaeological remains, a detailed discussion of disability and the perception of disabled individuals within the medieval North Atlantic is necessary in order to understand the lived experiences of affected individuals.

Vertebral infection in a male individual buried in the monastic cemetery (Cemetery 2) at Ghazali (ca. 670-1270 CE), northern Sudan

PURPOSE/RESEARCH QUESTION

This article examines pronounced osteoblastic-osteolytic vertebral lesions in a middle adult male (Ghz-2-033), from the Christian Nubian monastic settlement of Ghazali (ca. 670-1270 CE), Sudan, to explore their potential etiology.

METHODS

Morphological assessments of sex and age were undertaken in conjunction with macroscopic and radiological methods of assessment for the skeletal lesions documented.

RESULTS

Macroscopic assessment of Ghz-2-033 identified mixed osteoblastic-osteolytic lesions in L2-L3 with minor foci in T12-L1, while radiological assessment identified no further lesions. This paleopathological analysis considers tuberculosis, brucellosis, pyogenic intervertebral disc infection, neoplastic conditions, and mycotic infections as potential etiologies.

CONCLUSIONS

Tuberculosis is the most probable etiology for the lesions observed. This assessment is based on the morphology of the lesions in conjunction with the known confined living quarters at Ghazali and the presence of tuberculosis vectors (i.e. cattle) in the region.

CONTRIBUTIONS TO KNOWLEDGE/ORIGINALITY/VALUE

This brief communication contributes original data documenting the presence of tubercular lesions in a monk buried at the Christian Nubian monastery of Ghazali. On a broader level this study contributes to regional and temporal paleopathological dialogues regarding interactions with pathogens in Christian Nubian monastic contexts.

LIMITATIONS FOR THIS STUDY

The potentiality of co-infection with other pathogens (e.g. brucellosis, Staphylococcus) with similar macromorphological traits in skeletal remains cannot be entirely discounted.

SUGGESTIONS FOR FURTHER RESEARCH

The use of biomolecular analyses may help to clarify the potential presence of tuberculosis in individual Ghz-2-033.

A tale of two cities: A comparison of urban and rural trauma in Medieval Denmark

OBJECTIVE

This study explores the differences in frequency and type of trauma found in two Medieval cemeteries in Denmark, as well as the cultural and community implications of those differences.

MATERIALS

We examined 235 skeletons from the cemetery at Tjærby (rural) and 170 skeletons from the cemetery at Randers (urban) for trauma from the Medieval period in Denmark, 1050 to 1536 CE.

METHODS

Trauma was assessed through macroscopic examination and odds ratio and relative risk assessments were run to assess the difference in trauma.

RESULTS

There was no significant difference in the presence of trauma between the rural and urban cemeteries or between males and females. There were some significant differences in relative risk for trauma between the two cemeteries.

CONCLUSIONS

The division and variation in trauma between the two cemeteries is most likely related to differences in economy and occupation.

SIGNIFICANCE

There are relatively few studies that examine the difference in inherent risk of trauma between rural and urban Medieval communities, especially in Denmark. This research also adds to the growing body of literature in paleopathology that uses epidemiology to explore the parallels between patterns of trauma and community lifeways.

LIMITATIONS

The cemeteries are approximately 5 km distance from each other so similarities in the sample could be a result of location.

SUGGESTIONS FOR FURTHER RESEARCH

A wider sample of Medieval cemeteries in Denmark needs be added to this analysis to provide a more complete picture of trauma patterns during this time period.

Healed impact trauma to a Neolithic cattle frontal bone: A posthuman perspective

Trauma associated with slaughter is identified occasionally archaeologically in the cranial remains of domesticated animals, with evidence for pole-axing occurring in Europe, especially from the Roman period onwards. The injury typically extends through the frontal bone and sinuses to penetrate the braincase, causing haemorrhage, loss of consciousness, brain damage, and death. Evidence for slaughter methods in the British Neolithic, however, is lacking. We report such evidence from a healed blunt-force impact trauma to the frontal bone of a domestic cattle skull from Beckhampton Road Neolithic long barrow, Wiltshire. The injury suggests a failed attempt at slaughter. To our knowledge, this is the first such report for domestic cattle from the British Neolithic. We contextualise this discovery, drawing on research into the role and meaning of faunal remains from Neolithic long barrows in Wiltshire. This work has been undertaken from a posthuman perspective. Thus, we demonstrate the opportunities for paleopathologists to inform and engage within posthumanist interpretative frameworks.

Horse-riding accidents and injuries in historical records of Joseon Dynasty, Korea

Only a few osteological reports describe bone injuries thought to have been caused by falls from horses. Nevertheless, anthropological study alone is insufficient for establishing the correlates of such equestrian accidents. We therefore reviewed the records in Seungjeongwon ilgi (Diaries of the Royal Secretariat) and Joseon wangjo silrok (Annals of the Joseon Dynasty) of the Korea's Joseon period (1392-1910 CE). Although the mechanisms of trauma were diverse, the Joseon documents recorded many injuries caused by horse-riding accidents. During 1625-1872 CE, equestrian-related accidents occurred almost every year, overwhelming other causes of trauma. In all horse-riding accidents (n=142), 37.77% of the records offer detailed data about the traumatic mechanism. Injuries occurred most frequently to the extremities (79.58%), which were followed by the trunk (34.5%) and head (4.92%). Although we do not think that this attempt can explain every paleopathological case, our historical review shows that equestrian-related injuries could be considered as one of the major causes for the bone trauma observed among ancient equestrian people.

Paleopathology of cardiovascular diseases in South American mummies

BACKGROUND

Cardiovascular disease has emerged as the world's leading cause of death in the last century. An epidemiological focus of this disease that extends not only beyond the developed world but also far back into antiquity asks new questions about associated risk factors. Ancient mummies found in the Atacama desert are well preserved and show signs of cardiovascular disease as early as 1000B.C. in Peru and Chile.

METHOD AND RESULTS

Gross and histopathological examination of specimens shows atherosclerosis, cardiomegaly, endocarditis, and myocardial fibrosis.

CONCLUSION

In comparison to other ancient populations, less atherosclerosis has been noted in South American mummies. The chewing of coca leaves, a habitual cultural practice unique to the region, supports evidence of reduced cardiovascular risk among ancient people living in South America.

[Not Available]

Although its title is not vey clear, René Larger's book, Théorie de la Contre-évolution, published in 1917, is a major contribution to paleopathology, and pathocoenosis, a concept coined by M. D. Grmek in 1969 ; it offers a good occasion to have a new look on Lamarck's and Darwin's theories.

Ancient pathogens in museal dry bone specimens: analysis of paleocytology and aDNA

Bone samples investigated in this study derive from the pathologic-anatomical collection of the Natural History Museum of Vienna. In order to explore the survival of treponemes and treponemal ancient DNA in museal dry bone specimens, we analyzed three individuals known to have been infected with Treponema pallidum pallidum. No reproducible evidence of surviving pathogen's ancient DNA (aDNA) was obtained, despite the highly sensitive extraction and amplification techniques (TPP15 and arp). Additionally, decalcification fluid of bone sections was smear stained with May-Gruenwald-Giemsa. The slides were examined using direct light microscope and dark field illumination. Remnants of spirochetal structures were detectable in every smear. Our results demonstrate that aDNA is unlikely to survive, but spirochetal remains are stainable and thus detectable.

[Archaeology and criminology--Strengths and weaknesses of interdisciplinary cooperation]

Interdisciplinary cooperation of archaeology and criminology is often focussed on the scientific methods applied in both fields of knowledge. In combination with the humanistic methods traditionally used in archaeology, the finding of facts can be enormously increased and the subsequent hermeneutic deduction of human behaviour in the past can take place on a more solid basis. Thus, interdisciplinary cooperation offers direct and indirect advantages. But it can also cause epistemological problems, if the weaknesses and limits of one method are to be corrected by applying methods used in other disciplines. This may result in the application of methods unsuitable for the problem to be investigated so that, in a way, the methodological and epistemological weaknesses of two disciplines potentiate each other. An example of this effect is the quantification of qualia. These epistemological reflections are compared with the interdisciplinary approach using the concrete case of the "Eulau Crime Scene".

[Mycobacterium infection in prehistoric humans: co-evolution in remote ages]

The introduction of agriculture and animal husbandry at the end of the Mesolithic era, despite enabling a significant demographic growth through an increase in food storage and availability, caused new infectious noxae to enter the pathocoenosis. However in the Palaeolithic era, hunter-gatherers were already in contact with infectious diseases of animal origin, albeit episodically. Modern biomedical technologies allow us to estimate, with better approximation, how long mankind has been in contact with Mycobacterium tuberculosis. Archaeological finds, including human and animal remains (especially the aurochs), are particularly studied by palaeopathologists, as mycobacteria frequently cause bone involvement and this characteristic is of particular interest for palaeopathological (even macroscopic) studies; the interest is to detect the ancient DNA of MT, which is the cause of bone tuberculosis in skeletal remains as well as in mummies. According to our present knowledge, palaeopathological findings, confirmed by molecular techniques, suggest that tuberculosis in human skeletons goes back at most to 9000 years ago, while, in a veterinary environment, the most ancient DNA of MTBC to be detected in an American bison dates back about 17,000 years. The possibility of discovering archaeological finds making even more ancient human remains available leaves opens up the possibility of dating back to previous eras the transmission of MTBC infection to mankind. Phylogenetic works examining the available materials (DNAa) suggest that Mycobacterium tuberculosis, the cause of tuberculosis infection in humans and cattle (Aurochs), would have had a co-evolutionary process. On the basis of recent phylogenetic studies, the MTBC genome would have had a wide span of time to reach a suitable adjustment, co-evolving in geographical environments both at high and low host density. It is likely that the strains that did not show this strong "flexibility" underwent extinction, in favour of more versatile, adaptable strains, that are able to infect susceptible hosts "always" and in any environmental condition.

Roy Lee Moodie (1880-1934) and the beginnings of palaeopathology

Roy Lee Moodie was a geologist whose interest in ancient disease was stimulated by his finding of pathological change in some of the fossils that he studied, including many from the Rancho La Brea site in California. He occupied teaching positions in Chicago, Dallas and Santa Monica and in 1928 began an acquaintance and a correspondence with Henry Wellcome who was then in the United States and appearing before the Senate Committee on Foreign Affairs. Moodie persuaded Wellcome to sponsor his palaeopathological work and the following year he was appointed palaeopathologist to the Wellcome Historical Medical Museum (WHMM) at a salary of six thousand dollars a year, the first person to hold such a title and the first and only occupant of the title at the WHMM or its successor organisations. He published extensively from 1915 until his death in 1934, including his great compendium Paleopathology; an Introduction to the Study of Ancient Evidences of Disease, and the collected papers of Sir Marc Armand Ruffer. He is perhaps best remembered or, at least, most widely quoted for attributing the beginnings of palaeopathology to a publication of Esper in 1774 although the passage in which he did so contained two major errors that have been perpetuated in the literature ever since, the authorship of the publication and the diagnosis of the lesion that he supposed began the study of disease in antiquity.

Crooked Timber: The life of Calvin Wells (1908-1978)

Calvin Wells was the leading palaeopathologist in the UK between the later 1950s and the early 1970s. He studied medicine at University College London but failed in anatomy and qualified in 1933 with the Conjoint Diploma (MRCS, LRCP). After qualification he began to study obstetrics and after war service in the RAMC he settled in Norfolk (UK), established a small general practice and took up palaeopathology. Although he was usually conservative in diagnosis he tended to over-interpret signs in the skeleton, often publishing descriptions that were more fiction than science. He held firm views on the way in which palaeopathology should be undertaken and in particular he resented the entry into the field of anthropologists without medical training. His major contributions to palaeopathology were related to the study of cremations and the introduction of the notion of pseudopathology, and his writings on these subjects have scarcely been improved upon since. He was extremely well read, warm and encouraging to those with archaeological or medical qualifications, but vituperative about those he disliked. His bone reports, which are a major proportion of his published output, generally were highly regarded but his writing is often marred by sexual innuendo and vulgarity which does his memory little credit.

[Lead poisoning: towards a paleo-epidemiologic re-interpretation?]

Lead is a major public health issue. Its use has been increasing since Neolithic times, climaxing in the Ancient Rome and the nineteenth century. Defining the frequency of plumbism before modern times proves to be a difficult matter because of its various and delayed symptoms, and of diagenetic processes affecting bones. After reviewing various methods of lead measurement in bone and tooth, we will expose ways to ascertain lead measurement interpretation in order to estimate the epidemiology of plumbism in ancient times.

[Brief history of paleopathology in Italy]

In the last decades, paleopathologists have developed a growing interest in archaeological, anthropological, and medical disciplines. However, although there have been satisfactory results, which are reflected in numerous publications at the international level and in academic credits that,for example, have led to the establishment of an autonomous Division of Paleopathology (unique in an Italian University) at the Faculty of Medicine in Pisa, the future seems not so bright. Indeed, the lack of general interest that Italian institutions have shown toward research and the reduction of ministerial financial support, will result not only in a lack of a generational turnover among researchers, but also in the suspension or closure of the few paleopathology courses that are now running, and in the layoff of the small but excellent study groups currently working in the field.

The privileged burial of the Pava Pieve (Siena, 8th Century AD)

RATIONALE

The 6(th) archaeological excavation campaign performed at the 'Pieve di Pava' (San Giovanni d'Asso, Siena, Italy) unearthed a privileged stone burial of a single individual (US 2378), covered by a monolithic slab and placed in front of an altar. The skeletal remains of a young male (18-20 years old), not in anatomical connection, were found at the bottom floor of a tomb (160 cm long, 40 cm large and over 70 cm deep).

METHODS

A multidisciplinary study has been carried out concerning that privileged bone burial. The study combines paleopathology studies, stable isotope palaeodietary reconstruction, radiocarbon dating and archaeological analyses.

RESULTS

(14)  C dating of the skeleton revealed a date between 650 and 688 AD. Stable isotope analysis (δ(18) O, δ(13) C, δ(15) N) attested that he was probably a member of the local population, whose diet was rather rich in animal proteins. The paleopathological study diagnosed a case of acromesomelic dysplasia, a congenital anomaly with disproportion of the limbs. Archaeological evidence regarding the circular delimitation of the bones suggested that the skeleton was a secondary deposition, transported to the church in a sack.

CONCLUSIONS

We argue that the relic was used for the re-consecration of the church, following the restoration work in the 8(th) century. We conclude that the skeleton belonged to an eminent personage (e.g., either the member of a local elite family or a saint).

[The collection of medical works attributed to Cleopatra in the M.D. Grmek fund deposited at the IMEC]

After describing the dossier of the medical works attributed to Cleopatra in the MD. Grmek fund deposited at IMEC (Institut Mémoires de l'Edition Contemporaine, Abbaye d'Ardenne, Saint-Germain-la-Blanche-Herbe, near Caen), this paper reports some recent papyrological discoveries (P. Oxy. 71.4809, third century AD, and P. Berol. inv. 25239, BC 33), as well as some new studies in the field over the past ten years, and presents the project of the Centre de Documentation de Papyrologie Littiraire (CEDOPAL, University of Liège) for an edition of the fragments of Cleopatra's Kosmetikon.

Paleopathological and paleodemographical analysis of Sarmatian osteological series originating from southern Hungary

The Sarmatian are one of the most characteristic people of the Great Hungarian Plain between the 1st and 5th centuries AD. The main purpose of our study was paleodemographical and paleopathological analysis of Sarmatian osteological samples originating from the southern part of the Great Hungarian Plain. During the analysis classical anthropological methods were used. However, we have to note that the fragmentary state of preservation of skeletons caused some incertainty during the examinations. The examined Caucasoid osteological series (skeletal remains of 97 individuals) contains mixed male and female skeletons, the distribution of which is nearly the same. Among pathological lesions, beside the bony symptoms of joint alterations and non-specific infections, traumatic and hematological lesions and developmental alterations can also be seen.

[Centenary of the publication of the monograph by Jenô Hillebrand entitled "New data on the morphology of human teeth"]

The dental morphological monograph by the anthropologist Jenô Hillebrand was published one hundred years ago. The book gave statistical data on 89 pages in eight chapters from the tooth collection of 4000 skulls and 2000 mandibles, as well as of 60 skulls of children. The chapters are about: onto- and phylogenesis of teeth, the size of teeth, crown-morphology, the roots of teeth, supernumerary teeth, absence of teeth, gaps (diasthema, trema), enamel hypoplasy and caries. Hillebrand described some new characteristics, too. The main representatives of Hungarian dental paleopathology and their works are also presented in this publication, including Hillebrand and his mentioned work.

[Contribution of paleopathology to defining the pathocoenosis of infectious diseases (Part one)]

Studying the remains of mummies obtained by archaeological research may provide key information concerning historical pathocoenosis. Paleopathology makes it possible to recognise, characterise and connect different features involved in human pathocoenosis, such as epidemiology, in a historical perspective, and cultural development, via the introduction of new livestock farming techniques and agriculture in general. Several distinct pathologies may produce direct and indirect changes in the skeleton of affected individuals. Therefore bone remains represent very important sources of information to study such diseases. Changes related to trauma and nutrition deficiency as well as secondary signs, induced by tuberculosis, brucellosis, leprosy, syphilis, malaria, periostitis and aspecific osteomyelitis, persist in bones. In addition, other diseases may cause indirect alterations and subsequent secondary bone in the skeleton via different mechanisms. A secondary bone dimorphism may be induced by poliomyelitis. Aspecific lesions may arise in a skeletal bone and then cause secondary alterations in near-bone segments. Reviewing studies of paleopathologic research found in the literature, we emphasize the relationship between the appearance of major infectious diseases and the development of human activities; whereas it is clear that the introduction of livestock farming had a key role in the pathocoenosis of distinct infections such as tuberculosis, brucellosis and leprosy, some doubts and uncertainty remain in relation to the origin of others with epidemiologically important pathologies, such as syphilis.

[A new approach to the identification and the interpretation of the various forms of cribra orbitalia]

The so-called cribra orbitalia lesion was described for the first time in 1885 by H. Welcker. Since then the cribriform tectum of the orbit has provoked the most varied pathogenic interpretations. However for 40 years the whole paleopathologist community agreed to recognize that anaemia and generally deficiency in iron, food or infections were the causes of medullary hyperplasia which would be the alone responsible for the damage. Through new macroscopic explorations and new understanding of the genesis of the lesion, the author does not admit the principle of an universal hyperplasia but he suggests to distinguish three causes ofcribra orbitalia: the anatomic variations, the osteoperiostitis, the cortical erosion.

Blind ambition: Geoffroy St-Hilaire's theory of everything

When Napoléon Bonaparte invaded Egypt in 1798, he took with him a group of savants to study the natural history, architecture, ancient history and society of Egypt. One young naturalist, Etienne Geoffroy Saint-Hilaire, went along and made his mark in the study of living and mummified animals, setting the course for his future successes and fame when he returned to Paris in 1801. But during his time in Egypt, when he was free to roam physically and intellectually, he formulated a radical, all-encompassing theory, which he claimed could explain all natural forces and processes in the world.

[Trephined skulls in Hungary]

Trephination of the cranial vault is the oldest known surgical procedure and has often been reported in literature. Residuals of ancient trephinations have been found all over Europe. In present study both the recorded and unpublished trephined cases found in Hungary are reviewed. Four Neolithic, two Copper Age, eight Bronze Age, seven Covering Age (4th-6th century AD), twelve Awar Age (7th-9th century AD) seventy one Conquest Age (10th century AD) and eleven Arpadian Age (11th-13th century) cases are found. On the base of archeological, historical and paleopathologic aspects trephination is mainly (67%) connected with the Hungarians of the 10th century. The finds in our study are from whole territories of country (North-East Hungary, the zone of Great Plain, Northern Highlands, Danube-Tisza Mid-Region, the broader geographical vicinity of Budapest, Transdanubia and Transylvania). The surgical trepanation was practiced on both males (75.6%), females (15.7%), from the second period of infancy (2.6%) until the beginning senility, and persons. with undetermined age and gender. Considering the presumed time of the trephination and the time of death, trephinations were employed for every age, while the majority of investigations were performed on persons between 21 and 50 years of age. The majority of trephinations (84.4%) were performed in the parietal and/or frontoparietal regions. The long time surviving rate is 63% among the pre-Hungarians, while 84% among the 10th century Hungarian cases. The records of trephined cases excavated in Hungary are published in Hungarian, mostly in the annals of museums, but no cases were published in international periodicals. Consequently, the giant great trephined material (115 cases) of Hungary is unknown in the international scientific literature, although, in their detailed study Piek et al. (1999) counted altogether 450 trephined skulls found in Europe.

[Cripples at the medieval hospital of Bátmonostor, Hungary--archeological findings]

Cripples from the medieval hospital of Bátmonostor, Hungary. People with disabilities were generally burdened with a painful fate in ancient times, however in the hospitals was no effective therapy. The hospital of Batmonostor was founded at late 13th century, The authors examine by morphological, radiological and histological methods 426 complete skeletons excavated from medieval (14th-15th century) cemetery of Bátmonostor (Hungary). Among them 30 cases (7.1%) of bony ankylosis, (24 cases on lower limb and 6 cases on upper limb) was found. Sacroiliac ankylosis 3 cases, Bechterew's spondylitis ankylopoetica 1 case was seen. Spondylitis tuberculosa and malum Potti 4 cases, and hunchback with other aetiology 2 cases was detected. Beside the cases with ankylosis severe posttraumatic osteomyelitis (7 cases), primary malignant bone tumors (2 cases) and an osteoplastic metastatic tumors (probably prostata carcinoma) was diagnosed. Paleopathologic study of the physically disabled may yield information and insight on the prevalence of crippling disorders. The authors hypothetize, that crippled persons lived in the hospital until their deaths.

[Paleopathology of cancer: continuity or interruption?]

Paleopathology is useful for our knowledge of the natural history of cancer. However, the interpretation of neoplasms (retrospective diagnosis and past epidemiology) is one of the more interesting and difficult aspects of paleopathology. The occurrence and frequency of neoplastic lesions in ancient populations which seem lower in human antiquity than they are now, are still a subject of debate for both paleopathologist and medical historians. However, all forms of benign and malignant tumors of bones have been documented in ancient human specimens from the Neolithic period.

[Evolution of embalming methodology in Medieval and modern France (Agnès Sorel, the Duc de Berry, Louis the XIth, Charlotte de Savoie)]

The development of paleopathology and the use of techniques inspired by forensic medicine authorise new observations about embalming methodology. We will discuss in this article five different examples taken from personal recent analysis dealing with aristocratic bodies from French Middle Ages to modern times. Botanical, mineralogical and toxicological studies were performed in order to better understand anatomic discoveries and technical facts.

[The School of Palaeopathology of Turin: from the histology of mummified tissues to the monitoring and programmed conservation of the mummies of the Egyptian Museum and the Anthropology Museum]

Scientific analyses, frequent revisions of historical collections and unsuitable preservation conditions in storage and display environments can cause damage to the anthropological patrimony. Therefore, there is an urgent need to establish criteria for the correct conservation of anthropological material according to a "standard of quality". Within the context of a broad and complex view of the protection of anthropological materials, the methodology followed by the research group is aimed at identifying a series of primary (diagnostic) and supportive (therapeutic) interactive processes. The final purpose of these processes is the programmed management of each specimen which is able to identify and control the activities necessary for conservation of the material.

Genetic analysis of modern and historical burned human remains

Burning of corpses is a well-known funeral procedure that has been performed for a long time in many cultures. Nowadays more and more corpses are burned in crematories and buried in urns, often for practical and financial reasons. In some scientific, criminal or civil cases even after cremation there is the need of genetic investigations for identification or paternity testing. Furthermore, burned remains are the only remains left in North Europe from 1200 BC to 500 AD. This makes genetic investigation of those materials interesting for anthropological reasons. We present on one hand a systematic investigation of 10 corpses before and after the cremation and on the other hand the analysis of seven historical remains representing the bronze age. We chose the ground bone powder and the less destroyed bone parts respectively and employed a slightly modified commercially available DNA extraction method. The presence of human nuclear and mitochondrial DNA was tested by a simple but highly sensitive Duplex-PCR. DNA quantification was done using real time PCR, and genetic typing was tried out using the AmpFISTR Identifiler Multiplex Kit, followed by an automatic analysis on an AbiPrism310.

[Molecular paleopathology: a novel perspective for biomedical history]

Molecular paleopathology is an emerging field that is devoted to the detection, indentification and characterization of the molecular signatures in past diseases. When studied with modern molecular techniques, ancient human remains may yield direct informations on the diseases of ancient populations as well as the history of human diseases. Data concerning specific diseases of infectious, neoplastic and genetic origin can be obtained by molecular investigations of skeletal and mummified human remains. In particular, ancient DNA extracted from bone tissue, teeth and mummified soft tissue can be deeply analyzed by using PCR-based molecular techniques. Additionally, DNA of ancient pathogens, including bacteria, viruses and parasites, can be isolated from human remains and molecular diagnosis of infectious diseases can be made. Thus, molecular data, complemented by morphological and biochemical analyses, could help to reconstruct the epidemiology of past diseases and epidemics.

Did Ramesses II really have ankylosing spondylitis? A reappraisal

OBJECTIVE

To challenge the diagnosis of ankylosing spondylitis in the mummy of Ramesses II that was suggested about 30 years ago and to propose a differential diagnosis for the changes that were detected in the mummy's spine and pelvis.

METHODS

We read and interpreted both the published and unpublished radiographs of the mummy.

RESULTS

Changes in the mummy's spine and pelvis included ossification of the anterior longitudinal ligament at the cervical spine level, ossified enthesopathy of both the right and left rectus femoris tendons as well as the right ischial tuberosity, a large osteophyte at both acetabula margins, no ankylosis of the cervical apophyseal joints and no ankylosis of the right sacroiliac joint.

CONCLUSION

The radiologic evidence does not support the claim that Ramesses II had ankylosing spondylitis. Our radiologic reappraisal suggests instead the diagnosis of diffuse idiopathic skeletal hyperostosis. This new diagnosis needs to be validated by a computed tomographic scan of the mummy.

[Mysteries of the Bourges mummy, an paleopathologic survey]

Discovered in 1908 in a lead coffin conserved in a stone sarcophagus, the mummy of the "fin Renard" (Bourges, France), was immediately identified as that of a gallo-roman child. The circumstances of his death as the extraordinary conservation of this body were the object of many conclusions related to contemporeanous medico-historical knowledge and limited by partial investigation potentiality. The application of the most actual paleopathological methods and techniques permitted a more precise observation of this unique but surprising French specimen. However, after many radiographic, scannographic, fibroscopic and microscopic studies, the little mummy conserves many of its mysteries...

[The archeology of human aggressiveness: violence from a paleo-epidemiological perspective]

Acute traumatic injuries provide direct evidence that is used in studies of violence in the past. When analyzed from a paleo-epidemiological perspective and in conjunction with data from the material culture, these injuries are an important tool in the interpretation of human aggressive behavior. The latter, which seems to underlie human nature itself, has been recorded as far back as the remote time of man's ancestral hominids and in any type of social organization. By studying the pattern and distribution of blow marks and other signs of physical aggression, we contribute to our understanding not only of the emergence, use, motives, and impact of violence down through time but also of its continuance today.

[When the Egyptian mummies are speaking about the infections that have made them ill]

The microbiological study of mummies has started in 1910 when Sir M.A. Ruffer first applied the histologic methods to the study of mummified tissues and found Schistosoma haematobium ovas dated from the XXth dynasty. Up to the 1990 years, morphological methods including radiology, computed tomography, endoscopy, history, electron microscopy, and serology have been the main tools used in Paleopathology. They led to identify schistosomiasis, dracunculiasis, trichinosis, ascariasis and bone tuberculosis as the most prevalent diseases of the ancient residents of Egypt. The recent introduction of molecular methods (PCR) allowed t confirm the high prevalence of helminth diseases and tuberculosis among these populations, but also added new data exemplified by the widespread distribution of Plasmodium falciparum malaria. In addition, cases of bacterial septicemias and diphteria possibily occurred. Thousands of human and animal mummies remain to be studied with the hope to discover another pathogens responsible for viral or zoonotic infections prevalent during the pharaons' times.

[Buried Pleistocene human remains of Weissenthurm, Mayen-Koblenz district: new and old information]]

The landscape at central Rhine and Mosel is one of the most famous archaeological sites in middle Europe. A layer of pumicetufa from the eruption of the lake Laacher volcano 13,000 years B.P. is an important mark which approximately divides the Palaeolithic and Mesolithic period. Although numerous excavations in this area have been carried out, quaternary hominid remains are quite rare. A few short notes from the early 1920s reports of human bones "below the pumice, in Weissenthurm, District Mayen-Koblenz, Rhineland-Palatinate". However, these remains were probably destroyed in the Second World War in Munich on April 25, 1944. Recently, some new information has appeared on the discovery and the whereabouts of these fragments. The chronological classification of the Weissenthurm-hominid into the Pleistocene based on this information remains uncertain.

[Arthur Keith and the first settlement of human being in Malta. Two subversive teeth]

The paper aims to give historical example of errors to which the examination of two fragmentary - and probably pathological - fossil remains can lead in the field of human palaeontology. In 1917, two very special human molars with a wide extension of their pulp cavity and fused fang were found in Neolothic excavations in Malta. As he had observed such a dental morphology of Neanderthal man in Jersey Arthur Keith (1866-1955) called that taurodontism and claimed it was a characteristic between Malta and the Italian coast he asserted that Neanderthat Man had lived in Malta. The theory has never been corroborated and taurodontism is not so characteristic as supposed by Keith. Furthermore it might be an individual pathological feature. Up to now there is no proof of human beings in Malta before about 5,000 BC.