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Palaeopathology This page intentionally left blank Palaeopathology Paleopathology is designed to help bone specialists with diagnosis of diseases in skeletal assemblages. It suggests an innovative method of arriving at a diagnosis in the skeleton by applying ‘operational definitions’. The aim is to ensure that all those who study bones will use the same criteria for diagnosing disease, which will enable valid comparisons to be made between studies. This book is based on modern clinical knowledge and provides background information so that readers understand the natural history of bone diseases, which will enable them to draw reliable conclusions from their observations. Details of bone metabolism and the fundamentals of basic pathology are also provided, as well as a comprehensive and up- to-date bibliography. A short chapter on epidemiology provides information on how best to analyze and present the results of a study of human remains. Professor Tony Waldron teaches paleopathology at the Institute of Archaeology, University College London. The author of about 300 peer-reviewed papers in medical, scientific and archaeology journals, as well as books on occupational medicine and paleoepidemiology, Waldron is co-founder of the International Journal of Osteoarchaeology and served as co- editor for its first decade. He is a Fellow of the Royal College of Physicians of London, the Royal Society of Medicine, the Institute of Biology and the Royal Anthropological Institute. Cambridge Manuals in Archaeology General Editor Graeme Barker, University of Cambridge Advisory Editors Elizabeth Slater, University of Liverpool Peter Bogucki, Princeton University Cambridge Manuals in Archaeology is a series of reference handbooks designed for an inter- national audience of upper-level undergraduate and graduate students and professional archaeologists and archaeological scientists in universities, museums, research laboratories and field units. Each book includes a survey of current archaeological practice alongside essential reference material on contemporary techniques and methodology. Books in the Series Pottery in Archaeology, CLIVE ORTON, PAUL TYRES and ALAN VINCE Vertebrate Taphonomy, R LEE LYMAN Photography in Archaeology and Conservation, 2nd edition, PETER G DORRELL Alluvial Geoarchaeology, A G BROWN Shells, CHERYL CLAASEN Sampling in Archaeology, CLIVE ORTON Excavation, STEVE ROSKAMS Teeth, 2nd edition, SIMON HILLSON Lithics, 2nd edition, WILLIAM ANDREFFSKY JR Geographical Information System in Archaeology, JAMES CONOLLY and MARK LAKE Demography in Archaeology, ANDREW CHAMBERLAIN Analytical Chemistry in Archaeology, A M POLLARD, C M BATT, B STERN and S M M YOUNG Zooarchaeology, 2nd edition, ELIZABETH J REITZ and ELIZABETH S WING Quantitative Paleozoology, R LEE LYMAN Palaeopathology Tony Waldron Institute of Archaeology, University College London CAMBRIDGE UNIVERSITY PRESS Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo Cambridge University Press The Edinburgh Building, Cambridge CB2 8RU, UK Published in the United States of America by Cambridge University Press, New York www.cambridge.org Information on this title: www.cambridge.org/9780521861373 © Tony Waldron 2009 This publication is in copyright. Subject to statutory exception and to the provision of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press. First published in print format 2008 ISBN-13 978-0-511-43711-3 eBook (EBL) ISBN-13 978-0-521-86137-3 hardback Cambridge University Press has no responsibility for the persistence or accuracy of urls for external or third-party internet websites referred to in this publication, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. CONTENTS List of Figures page xiii Preface xv 1. Introduction and Diagnosis 1 Diagnosis in Palaeopathology 2 Other Comparisons 7 A Note on Health . 9 . and Mummies 10 2. Bone Metabolism and Pathology 12 Types of Bone 12 The Bone Matrix 14 Bone Cells and Cytokines 14 Bone Mass 17 Remodelling 17 Bone Pathology 19 Pathology, Pseudopathology and Normal Variation 21 3. Diseases of Joints, Part 1 24 Osteoarthritis 26 Precipitants of Osteoarthritis 28 The Natural History of Osteoarthritis 30 Diagnosis of Osteoarthritis 33 Osteoarthritis at Individual Sites 34 The Association Between Osteoarthritis and Other Conditions 39 Rotator Cuff Disease and Intervertebral Disc Disease 40 Schmorl’s Nodes 45 viii contents 4. Diseases of Joints, Part 2 46 Rheumatoid Arthritis 46 The Natural History of Rheumatoid Arthritis 49 Sero-Negative Arthropathies 53 Erosive Osteoarthritis 53 The Spondyloarthritides 56 Ankylosing Spondylitis 57 Reiter’s Syndrome (Reactive Spondyloarthropathy) 60 Psoriatic Arthropathy 62 Enteropathic Arthropathy 65 Undifferentiated Spondyloarthritides 66 Juvenile Arthritis 66 Gout 67 Bunions 70 5. Bone forming and DISH 72 Bone Forming and Bone Formers 72 Diffuse Idiopathic Skeletal Hyperostosis (DISH) 73 Ossification in the Posterior Longitudinal Ligament 77 Hyperostosis Frontalis Interna 78 Heterotopic Ossification 79 Osteopetrosis 82 6. Infectious Diseases 83 Osteomyelitis 84 Special Forms of Osteomyelitis 87 Tuberculosis 90 Leprosy 97 Venereal Syphilis 102 The Origins of Syphilis 104 Changes in the Skeleton 105 Poliomyelitis 109 Smallpox 110 Fungal Infections of Bone 111 Parasitic Disease 111 Non-Specific Infections 113 7. Metabolic Diseases 118 Osteoporosis 118 Paget’s Disease of Bone (PDB) 122 contents ix Rickets and Osteomalacia 127 Osteomalacia 130 Scurvy 130 Other Metabolic Diseases 133 Thyroid Disease 134 Hyperparathyroidism 134 Diabetes 136 Anaemia 136 8. Trauma 138 Fractures and Dislocations 138 Fractures 141 Treatment of Fractures 142 Complications of Fractures 143 Healing of fractures 146 The Epidemiology of Fractures 148 Comments of the Aetiology of Some Fractures 151 Osteochondritis Dissecans (OCD) 153 Dislocations and Subluxations 155 Dislocation of the Shoulder 155 Wounding 156 Gunshot Wounds 157 Amputation 158 Trephination 161 The Autopsy 162 Legalised Trauma 165 Beheading 165 Hanging 165 9. Tumours 168 Epidemiology of Bone Tumours 168 The Diagnosis of Tumours in Human Remains 170 Benign Tumours 170 Tumours Arising from Bone 171 Tumours Arising from Cartilage 174 Malignant Tumours 177 Primary Malignant Bone Tumours 178 The Periosteal Response to Malignant Bone Tumours 178 Ewing’s Sarcoma 181 Metastatic Bone Tumours 184 Diagnosing Secondary Tumours 189 x contents 10. Disorders of Growth and Development 191 Normal Growth 191 Abnormal Growth and Development 195 Dwarfism 195 Pituitary Dwarfism 196 Turner’s Syndrome 197 Achondroplasia 197 Other Forms of Dwarfism 206 Gigantism 207 Disorders of Skull Growth 208 Cleft Palate 209 Developmental Disorders of the Hips 210 Fibrous Dysplasia 213 Kyphosis and Scoliosis 215 Klippel-Feil Syndrome 218 Other Spinal Anomalies 218 11. Soft Tissue Diseases 221 Cardio-Vascular Lesions 224 Neurological Lesions 227 Stones and Cysts 233 12. Dental Disease 236 Caries 236 Ante-Mortem Tooth Loss 238 Periodontal Disease 239 Dental Calculus 240 Periapical Cavities 241 Developmental Defects of Enamel 243 Ectopic Teeth and Morphological Variation 245 Dental Tumours 246 Dental Cysts 247 13. An Introduction to Epidemiology 249 Disease Frequency 249 Incidence 250 Prevalence 252 Outcome Variables 255 Missing Data 256 Overall Prevalence 257 contents xi Denominator-Free Methods 258 Ranking 258 Proportional Morbidity or Mortality Ratio 259 Analytical Epidemiology 261 Case-Control Studies in Palaeopathology 263 Planning a Study 264 ANoteaboutTeeth 265 Select Bibliography 267 Index 269 LIST OF FIGURES 2.1. Diagram to show different phases of bone remodelling. page 18 2.2. Diagram of remodelling unit. 19 3.1. Diagram of normal synovial joint. 26 3.2. Model of aetiology of osteoarthritis. 29 3.3. Secondary osteoarthritis of the hip. 30 3.4. Osteoarthritis of the patello-femoral compartment of the knee. 32 3.5. Osteoarthritis of the hip. 32 3.6. Cervical vertebrae (C3–C5) with disc disease. 44 4.1. Diagram to show relationship of the different joint diseases. 47 4.2. Model of aetiology of rheumatoid arthritis. 50 4.3. Rheumatoid arthritis of the elbow. 52 4.4. Radiograph of erosive osteoarthritis. 55 4.5. Ankylosing spondylitis. 57 4.6. Model to show aetiology of reactive arthritis. 62 4.7.Radiographofankle. 69 4.8. Simplified diagram to show the differentiation between the various forms of erosive arthropathy. 70 5.1. Thoracic spine of Giso. 74 5.2. Two large plaques of heterotopic bone. 80 6.1. Posterior view of left femur with osteomyelitis. 86 6.2. Thoracic spine with tuberculosis. 93 6.3. Frontal bone of skull affected with syphilis. 106 6.4. Left and right tibia and femur from a presumptive case of polio. 110 7.1. Model of aetiology of Paget’s disease of bone. 125 8.1. Healedfractureoftherightankle. 144 8.2. Fourth lumbar vertebra with spondylolysis. 152 xiv list of figures 8.3. Skull from Anglo-Saxon male showing healed wound. 156 8.4. Distal end of amputated femur from an eighteenth-century context. 160 8.5. Skeleton from late eighteenth or early nineteenth century. 164 9.1. Frontal bone showing the presence of a small button osteoma. 173 9.2. Skull of elderly female from eighteenth century context showing the presence of several holes. 186 10.1. Diagram to show four hypothetical cohorts of children. 194 10.2. Scheme for differentiating between the more common forms of dwarfism. 206 10.3. Diagram of a cross-section of the spine in scoliosis.
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