U UNIVERSITY OF CINCINNATI Date: May 26, 2009 I, Elizabeth Grace Wehri , hereby submit this original work as part of the requirements for the degree of: Master of Arts in Anthropology It is entitled: A Classification System of Osteomyelitis for Historic Skeletal Remains: An Assessment of Civil War Soldier Amputees Student Signature: Elizabeth Wehri This work and its defense approved by: Committee Chair: Alan P. Sullivan Anthony J. Perzigian MariaTeresa A. Tersigni-Tarant Approval of the electronic document: I have reviewed the Thesis/Dissertation in its final electronic format and certify that it is an accurate copy of the document reviewed and approved by the committee. Committee Chair signature: Alan P. Sullivan A Classification System of Osteomyelitis for Historic Skeletal Remains: An Assessment of Civil War Soldier Amputees A thesis submitted to the Division of Graduate Studies and Advanced Research of the University of Cincinnati in partial fulfillment of the requirements for the degree of MASTER OF ARTS in the Department of Anthropology of the McMicken College of Arts and Sciences 2009 by Elizabeth G. Wehri B.A., Purdue University, 2007 Committee: Alan P. Sullivan III (Chair) Anthony J. Perzigian MariaTeresa A. Tersigni- Tarrant (ex-officio) ABSTRACT Osteomyelitis is a pus-producing infection caused by the presence of bacteria, such as Staphylococcus aureus, that specifically affects the endosteal surface of bone. Although this disease can be found in prehistoric and historic populations, one ubiquitous system for descriptive classification has not been developed for use on skeletal remains. This research utilizes the long bones from Civil War soldier amputees with evidence of osteomyelitis, housed at the National Museum of Health and Medicine in Washington D.C., to develop a classification method for use on skeletal collections to assess the characteristics of osteomyelitis. In total, 77 long bone specimens (including humeri, radii, ulnae, femora, tibiae and fibulae) were examined. Three categories, Etiology, Severity and Duration, were used to both classify and describe the osteomyelitis presented in each case. The first category, Etiology, describes the origin of the infection by determining whether the osteomyelitis is “Exogenous” or “Hematogenous”. The second category, Severity, is divided into “Minor”, “Moderate,” and “Severe” Hyperostosis. The final descriptive category, Duration, determines whether the infection is “Acute” or “Chronic” based upon information gathered from medical records. The Wehri classification system of osteomyelitis can be readily applied to collections of skeletal remains, unlike most other methods of classifying osteomyelitis, because it provides specific morphological traits for each category, thereby removing the vague nature of other systems. i ii Acknowledgements I would like to thank the Department of Anthropology and University of Cincinnati for giving me the opportunity to continue my education in Physical Anthropology. My experience at UC has been enlightening. Thank you to my committee members, Dr. Alan Sullivan, Dr.Anthony Perzigian and Dr. MariaTeresa Tersigni-Tarrant, for their input and diligent editing of this thesis. I would also like to thank Dr. Alan Sullivan, Dr. Jeffrey Jacobson and Dr. MariaTeresa Tersigni, for their donation of tools used during this research project. Thank you for understanding that it is difficult for a poor grad student to subsidize all the materials needed to undertake proper research. I would also like to thank the Taft Research Center for granting me the Graduate Student Enrichment Award. These funds were essential to reaching my research destination and my daily living expenses during my data collection period. Thank you to the National Museum of Health and Medicine (and the Armed Forces Institute of Pathology) for allowing me access to the skeletal collection used for this research, as well as, a work area in which I was able to perform daily data collection. There are many special people in my life which require recognition as well. All of these individuals require credit for final product of this thesis. The many tasks provided by these individuals range from editing to moral support. Dr. Tersigni aka Dr. Tersigni-Tarrant, Dr. MT, Mrs. Tarrant, my rightful committee chair, I can’t even begin to express how much I appreciate all that you have done for me the past two years. You have truly gone above and beyond what is expected of most professors. I could not have imagined a better mentor or friend than you. I value your intelligence in all areas, specifically physical anthropology, and appreciate all that you have taught me while being at UC iii and after. I learned more from you about this field in the past two years, than I think I learned in the entirety of my undergraduate career. Thank you for always being there when I was over stressed or freaking out about my thesis or everyday issues (although I think the freaking out was mostly done by Jess!). Thank you for lighting a fire under my tail when I slacked on both my thesis and class work. If you hadn’t been such a slave driver, I would not have finished this project in such a timely manner. Finally, thank you for dedicating yourself to your students (specifically Jessica and Myself). You could have very easily passed our theses to someone else and made your life much less stressful. On that note, don’t relax just yet. I will need you for my dissertation. Thank you again and again! Dr. Sullivan, thank you so much for taking me in as your student when I was a little grad student orphan. I appreciate all the work you have put into this thesis. I know it was trying at times, especially when discussing statistics with me. This research project is better because you were on my committee and were a touch critic. You can now officially add one more individual to your very short list of people you have not made cry! Jessica-Fireman-Juarez, I don’t think I could have made it to this point with out you. Things have really been a rollercoaster for us through this program (as you well know) and I am glad that you were the one with whom it was shared. I value your friendship and scholarly abilities more than you could know! Thanks for patiently reading and editing my chapters, when I know you had your own to work on as well. I know those times were not really breaks from your own thesis. I will miss you greatly after we leave, but look forward to our many years of friendship (may we be far or near). Try not to be a spazz at your new program. I know you won’t find a better cubby buddy there!! iv Franklin Damann and Brian Spatola: Gentlemen, it was truly a pleasure working with the both of you. Your expertise on this collection was essential to my data collection. I know I could not have survived the process of research with out your intelligent conversation and sarcastic wit to entertain me. I do hope that there is a chance for me to work with the both of you in the future. Erin Gill aka Er-Bear: I didn’t imagine that I would find such a friend as you during my time at UC! You have made these years amazingly fun and entertaining. Thanks for always being there to distract me from my work and forcing me to get off my butt to go to the gym. I am sure that the Anthropology Dept. will not be the same without the “Blondes” to confuse people. I truly consider you one of my best friends and will miss you immensely once we move away from Cincinnasty. I would also like to thank Kevin, Marianne and Angie for their amazing friendship and continued support of my project. I don’t think I could have survived grad school without any of you. I know we will all be lifelong friends and I am truly thankful for that. Last, but not least, I would like to thank my family for their moral and financial support throughout the whole process of grad school and the writing of this thesis. I am very lucky to have a family that continuously supports my passion. There is never a doubt that you all are proud of my accomplishments and that means the world to me. Thank you, Thank you Thank you! I love you all! v Table of Contents Abstract…………………………………………………………………………………………..i Acknowledgements……………………………………………………………………………..iii List of Appendices……………………………………………………………………….……………..viii List of Figures…………………………………………………………………….…………………….ix List of Tables……………………………………………………………………….…………….x Chapter 1: Introduction……………………………………………………………………………1 Chapter 2: Medical History of the Civil War…………………………………………….………..3 Union and Confederate Medical Departments…………………………………………..…..……3 The Doctors…………………………………………………………………………........………6 Disease and Illness………..………………………………………………..………….…….……8 Surgery ………………………………………………………………………………… .………..9 Amputations……………………..………………………………………..…………… ….……12 Social Ramifications of Amputation ……………………………………..……………… ….…14 Chapter 3: BonBiology…………………………………………………………………………..15 Bone Maintenance Cells and Composition…………………………………………………… .15 Anatomy of Bone………………………………………………………………………………....17 Skeletal Development……………………………………………………………………………19 Modeling and Remodeling…………………………………………………………..…. ………20 Chapter 4: Osteomyelitis……………………………………………………………………..…..25 Hematogenous Osteomyelitis………………………………………………………...………….25 Clinical Development…………………………………………………………………...……….27 Exogenous Osteomyelitis………………………………………………………..………………30 Chronic vs. Acute ……………………………………………………………….………………31 vi Historic Treatment of Osteomyelitis………………………………………………….…………32 Clinical Classification of Osteomyelitis…………………………………………………………32 Chapter 5: Materials and