A COMPARATIVE STUDY OF VERTEBRAL PATHOLOGIES AND ANOMALIES IN TWO MEDIEVAL BRITISH POPULATIONS A thesis submitted in partial fulfilment of the requirements of Liverpool John Moores University for the degree of Master of Philosophy Clair Richardson February 2018 I would like to dedicate this work to my grandfather Roy 1938 – 2015 “Do you not know that a man is not dead while his name is still spoken?” – Terry Pratchett, Going Postal 1 Disclaimer: All of the photographic images used within this study were taken by and are owned by the author of this thesis. 2 Abstract A holistic approach to palaeopathological studies using historical documentation and clinical, archaeological and epidemiological literature can provide important information as to the health, lifestyles, socioeconomic and occupational status of individuals from the past. Applying this approach, the study provides an overview and comparative analysis of the spinal health of two contemporaneous British skeletal samples from the medieval period; St Owen’s Cemetery, an urban based population from Gloucester (n=68) and Poulton a rural, agrarian community from Cheshire (n=70). Sex and age at death were estimated using a variety of osteological techniques and descriptive statistics and Chi-square statistical tests were computed to identify and assess inter- and intra-population differences. Although some significant differences were observed, both skeletal samples had similar types and anatomical locations of the pathological conditions observed. St Owen’s Cemetery exhibits higher frequencies of degenerative conditions and vertebral fractures, whereas Poulton displays higher frequencies of congenital conditions such as lumbosacral anomalies and cervical vertebral synostosis (possible Klippel-Feil Syndrome). Age of onset of degenerative conditions is markedly earlier in Poulton indicating occupational status from a younger age than their contemporaries in St Owen’s. Females are more affected by degenerative conditions and vertebral fractures than the males in both samples. The frequency of the aforementioned conditions increases dramatically with age suggesting the fractures could be related to osteoporosis. Significant differences were observed between population samples in the frequency of osteoarthritis in the thoracic segment of middle adult males and females in which St Owen’s exhibit double the amount. This indicates that biomechanical stresses were more likely to have been placed on the thoracic segment such as carrying heavier loads and repetitive bending and twisting in a singular occupational role in an urban setting such as a craft (cordwainer) or working for a merchant guild. Frequency of infectious lesions is comparable in both samples, indicating similar exposure to pathogens albeit there may be differences in the type of infections present. Males are more affected than the females in the rural sample suggesting that pathogens in the soil and livestock may be the cause of the lesions observed. The findings of this study are generally consistent with other published data, although frequency of vertebral 3 trauma in the urban sample far exceeds other contemporary sites. The study presented here provides a glimpse into medieval life in both the large town and the rural farming community in the British Isles. Further studies include comparing data from more contemporary urban and rural populations to produce a more holistic study on medieval health and lifestyle in the British Isles including further analysis of larger skeletal samples from Poulton and St Owen’s. Additional observation of complete skeletons including body mass and stature and radiographic analyses will give further supportive evidence for some diagnoses. 4 Table of Contents List of Figures ................................................................................................... 8 Abbreviations .................................................................................................. 12 Acknowledgments .......................................................................................... 13 Chapter 1: Introduction................................................................................... 14 Chapter 2: Literature Review .......................................................................... 19 2.1 Anatomy of the Spine ........................................................................... 19 2.2 Significance of the Spine in Palaeopathology.................................... 21 2.3 Sex and Gender in Palaeopathology ................................................... 21 2.4 The Osteological Paradox .................................................................... 22 2.5 Joint Conditions .................................................................................... 22 2.5.1 Osteoarthritis (OA) / Degenerative Joint Disease (DJD) ......................... 22 2.5.2 Intervertebral (IDD) / Degenerative Disc Disease (DDD) ......................... 25 2.5.3 Schmӧrl’s Nodes (SN) ............................................................................... 26 2.5.4 Diffuse Idiopathic Skeletal Hyperostosis (DISH) ..................................... 27 2.5.5 Vertebral Osteophytosis (VO) ................................................................... 28 2.6 Infectious Diseases .............................................................................. 29 2.6.1 Tuberculosis (TB) ...................................................................................... 30 2.6.2 Brucellosis ................................................................................................. 30 2.6.3 Spinal Osteomyelitis (SO) ......................................................................... 31 2.7 Metabolic Diseases ............................................................................... 31 2.7.1 Osteoporosis ............................................................................................. 32 2.7.2 Paget’s Disease of Bone (PDB) ................................................................ 33 2.8 Congenital Conditions and Vertebral Anomalies ............................... 33 2.8.1 Transitional Vertebrae, Sacralisation and Lumbarisation ...................... 33 2.8.2 Spina bifida ................................................................................................ 34 2.8.3 Scoliosis .................................................................................................... 34 2.8.4 Kyphosis .................................................................................................... 35 2.8.5 Klippel-Feil Syndrome (KFS)/ Cervical Vertebral Synostosis ................ 35 2.9 Trauma ................................................................................................... 36 2.9.1 Spondylolysis and Spondylolisthesis ...................................................... 36 2.9.2 Stress, Crush and Burst Fractures .......................................................... 37 2.10 Summary ............................................................................................. 37 Chapter 3: Site Information and Hypotheses ................................................ 39 5 3.1 Poulton, Cheshire ................................................................................. 39 3.2 St Owen’s Cemetery, Gloucester ......................................................... 42 3.3 Medieval Burial Practices ..................................................................... 48 Chapter 4: Materials and Methods ................................................................. 50 4.1 Skeletal Samples ................................................................................... 50 4.2 Biological Profiling ............................................................................... 51 4.2.1 Sex Estimation ........................................................................................... 51 4.2.2 Age Estimation .......................................................................................... 53 4.3 Observation of Pathological Lesions .................................................. 55 4.3.1 Joint Conditions ........................................................................................ 55 4.3.2 Infectious Diseases ................................................................................... 61 4.3.3 Congenital Conditions and Vertebral Anomalies .................................... 62 4.3.4 Trauma ....................................................................................................... 68 4.3.5 Data Analysis ............................................................................................. 70 Chapter 5: Results .......................................................................................... 71 5.1 Skeletal Samples ................................................................................... 71 5.2 Joint Conditions .................................................................................... 72 5.2.1 Osteoarthritis (OA) .................................................................................... 72 5.2.2 Intervertebral Disc Disease (IDD) ............................................................. 81 5.2.3 Schmörl’s Nodes (SN) ............................................................................... 84 5.2.4 Diffuse Idiopathic Skeletal Hyperostosis (DISH) ..................................... 90 5.2.5 Vertebral Osteophytes .............................................................................