Human Osteological Methods - ADBOU

Copyright ADBOU August 2015

HUMAN OSTEOLOGICAL

METHODS

Human Osteological Methods – ADBOU 1

Contents

HEAD OF THE FORM..................................................................................................................................... 2 THE FORM ........................................................................................................................................................ 4 PRESERVATION.............................................................................................................................................. 4 SEX ESTIMATION .......................................................................................................................................... 5 AGE ESTIMATION.......................................................................................................................................... 8 EPIPHYSEAL FUSION ................................................................................................................................. 12 DENTITION .................................................................................................................................................... 13 CRANIAL MEASUREMENTS ...................................................................................................................... 19 POSTCRANIAL MEASUREMENTS............................................................................................................ 21 JOINT CHANGES .......................................................................................................................................... 22 TRAUMATIC CHANGES .............................................................................................................................. 24 LOG .................................................................................................................................................................. 26 OTHER DESCRIPTIONS AND COMMENTS .......................................................................................... 27 LEPROSY ......................................................................................................................................................... 27 TUBERCULOSIS ........................................................................................................................................... 34 SYFILIS/TREPONEMATOSIS .................................................................................................................... 47 FOCAL OSTEOLYTIC DISEASE ................................................................................................................ 57 REFERENCES................................................................................................................................................. 58 REPORT REGISTRATION FORM .............................................................................................................. 61 CHRONIC INFECTIOUS DISEASE REGISTRATION FORMS .......................................................... 62

Human Osteological Methods – ADBOU 2

HEAD OF THE FORM

Location/site number

It is crucial that the identification of the skeleton is unambiguous and correct. It is

therefore important that both the ’location/site number’ and ’grave number’ are en-

tered carefully and readable in their respective textboxes on the form. Several excava-

tions/sites have been given different names over the course of time (for instance Tirup

is the same location as Bygholm). As long as the site designation is unambiguous it is

acceptable to use all synonyms, but it is most practical to use the same name on all

registration forms from the same site. The ‘site number’ is the excavating authority’s

registration of the actual excavation. The ‘site number’ is relevant to use where sever-

al excavations, dispersed in time, have taken place on the same site.

Grave number

The numbering of the graves and the skeletons in them is often not consistent. Many

cemeteries were excavated during the course of several independent digs and thus

have different systems of numbering for each dig. As a main rule, a skeleton found in

a grave must get a number starting with ’G’ followed by a number (1, 2,… etc.). Both

in the field and in the anthropological lab, it is not uncommon to find remains from

additional skeletons intermixed with the bones of the primary skeleton of the grave. If

the additional bones can be assigned to the skeleton of a neighboring grave, they are

transferred. If this is not the case, an independent registration of the additional bones

is made.

Context

The grave numbers of additional skeletons are entered in the textbox ’context’. These

skeletons are given the same ‘G-numbers’ as the primary skeleton in the grave they

were found in. The only difference is that the number is followed by a letter. The let-

ters ‘A, B,..’ are used for the skeletal parts that were identified as being different do-

ing excavation and the letters ’X, Y, ..’ are used for the skeletal parts that were recog-

nized as being from another person during examination in the lab. Such additional

skeletons must always get their own skeletal registration form so at least one form

exists for each recognized individual of a cemetery excavation.

If it is logical and possible, other numbering systems should be converted to the ‘G’

numbering system mentioned above. To be able to relate to the archaeological regis-

trations, the original number is written on the registration form in brackets on the

form.

Human Osteological Methods - ADBOU

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Coordinates

In order to keep track of the position of finds doing an archaeological excavation a

system of coordinates is put down in the excavation field. The space termed ’coordi-

nates’ in the registration form refers to the points of the position of the grave in the

system of coordinates. The two coordinates of the position of the cranium are entered

on the form. The information about coordinates is found in the archaeological field

form.

Arm position

’Arm position’ is entered for the right and the left side respectively. The information

about arm position is found in the archaeological field form.

Grave type

Six possible scores are used to describe the grave types. The information about grave

type is found in the archaeological field form.

/: No information about grave type

1: Grave without coffin

2: Wooden coffin grave - seen as traces of wood in situ, nails in situ or handles and

mountings in situ in the grave.

3: A stone cist – made of either natural stones or bricks.

4: A stone grave – the grave is framed with either headstones, foot-stones or both.

5: Other grave types – for instance ship burials.

Height

The length of the skeleton is measured in the grave (using definitions presented in

Boldsen, 1984). The measurements are taken on skeletons found undisturbed in situ

in the graves and the length of the skeleton is measured from the top of the skull to

the distal point of the os talus. It is important that all sources (the box, excavation

forms, notes from the field osteologist, previous journals and field reports) are all ex-

amined both to maximize the sample size and to check for validity. The method of

measuring the height as described above was not used on all excavations. If another

method was used or if there are uncertainties about which method was used the

measurement is given in brackets in the registration form. The height is given in cen-

timeters. The information about height measured in the grave is found in the archaeo-

logical field form.

Age

In the textbox ’age’ in the head of the registration form the final subjective estimation

of the age at death is given. Together with the space ‘sex’ this is the last to be filled


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out in the form.

Age is entered as an interval in years. Concerning children, it is possible to estimate

the age within a narrow interval using the dentition and measurements of the long

bones. The age is given as a decimal fraction of a year (for instance a child with an

age at death of one and a half to two is written as ‘1.5 – 2’). Concerning adults, an

appropriate interval of years is given. The age is put down as the closest whole year

and not to the next birthday (the interval 30 – 35 years is a span of 6 years from

30.00 – 35.99 years).

Sex

In the textbox ’sex’ in the head of the registration form the final subjective estimation

of the sex of the individual is given. This is a score given according to a 7-point scale

(see table 3) and is a joined assessment of the sex estimation scores of the cranium,

pelvis and postcranial skeleton. Together with the textbox ‘age’ this is the last to be

filled out in the form.

THE FORM

Questionable features

If a given trait cannot be registered a ‘/’ is entered in the textbox on the form. This

will usually occur if the bone is not preserved at all or if the bone is insufficiently pre-

served to make relevant observations. At least 25 % of a bone has to be preserved in

order to score a given trait.

PRESERVATION

The preservation of the skeleton is given as a quantitative and a qualitative assess-

ment (see table 1 and 2).

Quantitative preservation

The quantitative preservation describes how much of the skeleton is preserved. The

scores 1, 2 and 3 are used. If less than 1/3 of the bones of the skeleton are preserved

the score 1 is given. If approximately half of the bones are preserved the score 2 is

given. If more than 2/3 of the bones are preserved the score 3 is given.


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Table 1 Quantitative preservation

Score Description

1 Maximum 1/3 of the bones is preserved

2 Between 1/3 and 2/3 of the bones are preserved

3 Minimum 2/3 of the bones are preserved

Qualitative preservation

The qualitative preservation describes how well the bones of the skeleton are pre-

served. The erosion of the bone surface and the degree of fragmentation are consid-

ered. If the skeleton is poor preserved and more than 2/3 of the bones of the skele-

tons have a pronounced degree of erosion and fragmentation the score 1 is given. If

the skeleton is intermediately preserved and 1/3 - 2/3 of the bones have a pro-

nounced degree of erosion of surfaces and fragmentation the score 2 is given. If the

skeleton is well preserved and less than 1/3 of the bones have a pronounced degree of

erosion of surfaces and fragmentation the score 3 is given.

Table 2 Qualitative preservation

Score Description

1 Poor

2 Intermediate

3 Well

SEX ESTIMATION

Sex is estimated according to the 7-point scale seen in table 3. In children the sexual

characteristics have not developed and an estimation of sex is not possible to make.

The sex is estimated only when os ilium, os ischii and os pubis are fused in

acetabulum or when the synchondrosis spheno-occipitalis (S.S.O.) is fused (table 4)

both features are fused by the age of approximately 16 years. When neither the pelvic

nor the cranial bones are preserved the degree of epiphyseal fusion of the long bones

is assessed - the degree of fusion then has to correspond to an age older than 16

years in order to estimate the sex.

Note: Only one sex estimation score is given for the cranium, pelvis and postcranial

skeleton separately.


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Table 3 Sex estimation scores

Score Description

/ Sex cannot be estimated - the relevant

skeletal parts are not preserved

1 Clear male morphology

2 Predominatly male morphology

3 Slight male morphology

4 The sex is indeterminable/children

5 Slight female morphology

6 Predominantly female morphology

7 Clear female morphology

Cranium

When estimating sex the following components of the cranium are assessed: the

shape of arcus superciliaris, the morphology of margo supraorbitalis, the size of

processus mastoideus, the relief of linea nuchalis superior, angulus mandibula and the

shape of protuberantia mentalis. The features are compared with the illustrations in

figure 1 and an overall sex estimation score for the cranium is given.

Pelvis

When estimating sex the following two components of the pelvis are assessed:

incisura ischiadica major and angulus subpubicus. The features are compared with the

illustrations in figure 2 and an overall sex estimation score for the pelvis is given.

Postcranial skeleton

An overall sex estimation score is given based upon the robusticity and length of the

postcranial skeleton.


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MALE FEMALE

Figure 1. Differences in cranial features of males and females.


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MALE FEMALE

Figure 2. Differences in pelvic features of males and females.


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AGE ESTIMATION

The estimation of age at death has been one of the main topics within biological

anthropological research for the past 150 years. The first systematic studies of cranial

sutures took place in the 1860s and age estimation based upon dental attrition

originates back to the late 19th century.

A general development in society, where focus has been on expanding the

implementation of technological features in all aspects of human life, has taken place

throughout the past decades. This development is also reflected in the efforts of

generating new knowledge about age at death estimated in skeletal material within

the field of anthropology. Statistical based computer software has been developed

(e.g. transition analysis) and other methods that use X-ray technology, microscopic

analysis and chemical analysis have been introduced to improve the methods. In this

way new methods of analyzing the age of death in skeletal material using scientific

methods will be applied in the future.

A new method named CEI (Calibrated Expert Inference) has been developed within

the last couple of years. The method was introduced by a collaboration of researchers

from the University of Southern Denmark, the Max Planck Institute of Demographic

research in Rostock and Pennsylvania State University. The use of the method

requires basic training in osteology and is based upon both observations made of

skeletons from reference samples (skeletal material where age at death and sex is

known) and statistical methods (logistic regression analysis and Bayes’ theorem).

The following anatomical components can be used to estimate the age at death of

individuals in European medieval and post-medieval periods. The indicated age marks

the midpoint of the transition from a young to an old stage and the 95% confidence

intervals.


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Limbus acetabula

Female : 30 [-11; 73]

Male: 28 [-7;60]

Figure 3.A-B: Skeletal aging of limbus acetabula of the hip joint. A. Rounded edge (young feature). B. Sharp edge (old feature).

Proximal Tibia

Female: 42 [-13;92]

Male: 24 [-19;66]

Figure 4.A-B: Skeletal aging of proximal tibia. A. Round edges of the intercon-dylar area (young feature). B. Sharp edges of the intercondylar area.

Femur linea aspera

Female: 30 [15;38]

Male: 21 [-19;61]

Figure 5.A-B: Skeletal aging of linea aspera of the femur. A. Rounded linea aspera (young feature). B. Sharp and irregular linea aspera (old feature).

A B

A B

A B


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Femur fossa trochanteria

Female: 54 [8;102]

Male: 42 [2;82]

Figure 6.A-B: Skeletal aging of fossa trochanteria on the femur. A. the area is

smooth (young feature). B. The area has one or more exostosis (old feature).

Femur caput fovea

Female: 35 [8;63]

Male: 33 [21;45]

Figure 7.A-B: Skeletal aging of fovea on the femur. A. The area is smooth (young feature). B. The area is pointed and irregular (old feature).

A B

A B


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EPIPHYSEAL FUSION

The degree of epiphyseal fusion is scored according to the descriptions seen in tables

4 and 5.

Epiphyseal fusion is registered for the proximal ends of the right and left hu-

meri, claviculae and radii. Furthermore the fusion of the epiphyses of the right and left

crista iliaca are registered. The ages of epiphyseal fusion of the bones in the skeleton

are given in figure 8.

Table 3 Epiphyseal fusion

Score Description

/ No information - the relevant bone is not preserved

0 The epiphysis is loose

1 The epiphysis is partly fused

2 The epiphysis is fused but the epiphysis line is visible

3 The line of the epiphysis is erased

Table 4 Spheno-occipitalis Synchondrosis (S.O.S. / S.S.O.)

Score Description

/ No information - the relevant bone is not preserved

0 The synchondrosis is open

1 The synchondrosis is partly fused

2 The synchondrosis is fused


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Figure 8. Epiphyseal fusion of the skeleton


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DENTITION

Dental developmental age

In the textbox ’age’ the age that corresponds closest to the dental developmental

stage is entered using the drawings in figure 9 and 10. It is the degree of

mineralization that is important not the degree of dental eruption. The age is given as

a decimal fraction of a year. A 6 months old child will get a scoring of 0.5 years.

Likewise, a 4 months old child would give a score of 0.3 years. Only one decimal is

used. For a fully developed set of teeth – when the third molar has erupted and is in

occlusion - the score 25+ (years) is given.

In the textbox ’information’ the number of dental groups, used for age estimation

is entered. A full set of deciduous teeth contributes six dental groups: Three groups in

both the maxilla and the mandibular. The four incisors form one group, the two

canines form one group and the four deciduous molars form one group. One group

only has to be represented by a single tooth in order to get a positive score. The

deciduous dental formula is given as follows:

Deciduous dental formula: i 2/2 c 1/1 m 2/2 = 10 x 2 = 20

A full set of permanent teeth contributes eight dental groups: Four groups in both the

maxilla and the mandibular. The four incisors form one group, the two canines form

one group, the four premolars form one group and the six molars form one group. The

dental formula for the permanent teeth dentition is given as follows:

Permanent dental formula: i 2/2 c 1/1 pm 2/2 m 3/3 = 16 x 2 = 32

In cases where a child is in an age where both deciduous and permanent teeth are

present the number of remaining deciduous groups and permanent erupted groups are

counted separately. Afterwards the number of groups of the two types of teeth are

added to get the final result to be entered in the ’information’ textbox.


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ill. 1 Figure 9. Formation of decidious and permanent teeth. (Massler, Schour & Poncer 1941.


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Figure 10. Stages of dental development.

Enamel Hypoplasia

Enamel hypoplasia is irregularities in the dental enamel seen as an impressed band on

the tooth. Hypoplasia is coursed by physiological disturbances and is formed while the

tooth is developing. Enamel hypoplasia is only scored on permanent canines (see table

6). The upper left canine is preferred, but if it is missing the right canine is scored

instead. Only hypoplasia visible to the naked eye is scored.

Table 5 Enamel hypoplasia on +3

Score Description

/ No information - the tooth is not preserved

0 Normal tooth without enamel hypoplasia

1 One or more enamel hypoplasia


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We use the dental table of Haderup – but others exist, see for instance Lynnerup et al.

(2008) or Hillson (1996).

right MAXILLA left

Permanent 8 7 6 5 4 3 2 1 + 1 2 3 4 5 6 7 8

Deciduous 05 04 03 02 01 + 01 02 03 04 05

MANDIBULA

Permanent 8 7 6 5 4 3 2 1 - 1 2 3 4 5 6 7 8

Deciduous 05 04 03 02 01 - 01 02 03 04 05

Figure 11. Haderups dental table (Lynnerup et al 2008).

Dental conditions

In all categories only the 12 permanent teeth are scored. The tooth has to be in

occlusion in order to be scored. Only teeth that with certainty can be identified are

scored.

Table 6 The presence of the tooth

Score Description

/ No information - neither the tooth nor the relevant piece of jaw

are preserved.

0 Tooth found in the jaw

1 Tooth has fallen out after death

2 Tooth has fallen out before death

3 Loose tooth – tooth without the matching piece of jaw.

4 Third molar not formed

5 The tooth is formed but not in occlusion


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Table 7 Dental attrition

Score Description

/ No information – the tooth is insufficiently preserved

0 Unworn tooth

1 Attrition only in enamel

2 Attrition has exposed the dentine in one cusp

3 Attrition has exposed the dentine in two cusp

4 Attrition has exposed the dentine in three cusp

5 Attrition has exposed the dentine in four cusp

6 Attrition has exposed the dentine so the dentine is visible

interconnected in two or more cusps

7 Attrition has removed the enamel of the mastical surface

8 Attrition has removed the entire crown of the tooth

Table 8 Caries

Score Description

/ No information – the tooth is insufficiently preserved

0 Normal tooth without caries

1 Caries in the enamel

2 Caries in the dentine but the pulp is not open

3 The pulp is open due to caries

4 Caries has destroyed the crown of the tooth


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Fistula/abscess is scored in the bone of the jaw. The tooth does not have to be present

in order to score a fistle.

Table 9 Fistula/abscess

score Description

/ No information – the relevant piece of jaw is not preserved

0 Normal jaw, no fistulae

1 One or more fistulae by the root of the tooth

CRANIAL MEASUREMENTS

The frontal bone (os frontalis) is a very robust bone this is the reason why this bone is

used for morphometric analysis. When working with skeletons excavated from soil the

state of preservation is an important factor. The frontal bone is frequently preserved

even though the rest of the skull is destroyed by external factors such as pressure

from the soil.

Seven measurements are used that reflect the form, size and general appearance of

the frontal bone: Six chords (measured with a sliding caliper) and one arch. Five of

the measurements were described by Martin and Saller (1957) and the names of the

measurements presented in that publication are given in brackets after the title of the

measurements. The last two measurements – 6 and 7 - were created to be able to

describe the maximal curvature of the frontal bone and the size of arcus supraciliaris.

1. Outer biorbital width (M431)

This measurement reflects the width of the upper face. It is measured between the

most anterior points on the suture between os zygomaticum and os frontalis in both

sides. This point is called the frontomalare temp. It is marked as number 1 on figure

12.

2. Minimal frontal width (M9)

This measurement reflects the minimum width of the frontal bone behind arcus

superciliaris. It is marked as number 2 on figure 12.

1 Anthropometric parameters such as M43 refer to the measurements defined by R. Martin in Martin and

Saller (1957).


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3. Maximal frontal width (M10)

This measurement reflects the maximum width of the frontal bone on sutura coronalis.

It is marked as number 3 on figure 12.

4. Frontal chord (M29)

This measurement reflects the length of the frontal bone from nasion to bregma. It is

marked as number 4 on figure 13.

5. Frontal arch (M26)

This measurement also reflects the length of the frontal bone but as an arch from na-

sion to bregma. The midpoint between nasion and bregma is marked with a pen. This

dot defines the measurement point called mesomethopion. It is marked as number 5

on figure 13.

6. Lower frontal chord

The nasion – mesomethopion chord. This measurement reflects the distance between

nasion and mesomethopion. It is marked as number 6 on figure 13.

7. Upper frontal chord

The bregma – mesomethopion chord. This measurement reflects the distance between

mesomethopion and bregma. It is marked as number 7 on figure 13.

3

2

1

Figure 12. Cranial measurements 1-3.

5

7 4 6

Figure 13. Cranial measurements 4-7.


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POSTCRANIAL MEASUREMENTS

Femur length

The maximal length of both the right and left femora are measured on the measuring

table. Length is entered millimeters with one decimal. In the case of children with un-

fused epiphyses the femur is measured without epiphyses. Where one epiphysis is

fused, the other is held in place and measured thus with both epiphyses. If the un-

fused epiphysis is missing the score “/” is given as is the case if the entire bone is

missing. See figure 14.

Femur caput

The maximal width across both the right and the left proximal caput femur measured

in vertical direction with a sliding caliper in millimeters with one decimal.

Humerus length (M1)

The maximal length of both the right and the left humeri are measured on the meas-

uring table. Length is entered in millimeters with one decimal. In the case of children

with unfused epiphyses the humerus is measured without epiphyses. Where one

epiphysis is fused, the other is held in place and measured thus with both epiphyses.

If the unfused epiphysis is missing the score “/” is given as is the case if the entire

bone is missing. See figure 14.

Humerus caput

The maximal width across both the right and the left proximal caput humerus meas-

ured in vertical direction with a sliding caliper in millimeters with one decimal.

Humerus epicondyl width

The maximal width across both the right and the left humeri epicondyles measured

with a sliding caliper in millimeters with one decimal. In children the loose epiphyses

are measured. See figure 14.


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Figure 14. Postcranial measurements.

JOINT CHANGES

In these textboxes the changes to the largest joints of the skeleton are entered. The

joint rims of all bones of the joint of interest are scored as one entry. In the shoulder

the humerus, scapula and clavicula are scored. In the ankle the tibia, fibula and talus

are scored. In the knee the femur, tibia and patella are scored. In the pelvis the femur

and acetabula are scored. At least half of the relevant bone has to be preserved in

order to score it. Examples of joint changes are seen on figure 15 and 16.

Table 10 Joint changes

Score Description

/ The joint rim is not sufficiently preserved for it to be registered.

0 Normal joint rim.

1 Lipping (osteophytosis): at least 10 mm long and 1 mm tall.


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Figure 15. Lipping on vertebral bodies.

Figure 16. Joint changes on proximal tibia in the knee joint.

Diffuse idiopathic skeletal hyperostosis (DISH)

DISH is a joint disease without known etiology but genetic heredity and diabetes are

considered as possible causative agents. The paleopathological diagnosis requires an

anterolateral fusion of at least four vertebrae. That is a fusion of the part of the verte-

bral column that is turned towards the inside of the body and towards the right. This is

also known as dripping candle wax. The disease must not be mistaken for the condi-

tion pelvospondylite (Morbus Becterew) which is seen as symmetric and complete cal-

cification of the longitudinal ligaments of the vertebral column. DISH does in most

cases not cause any severe symptoms other than stiffness and unspecific pain to the

back. Modern epidemiological studies show that DISH is found most frequently among

Caucasoid in Europe and North America, that it is found primarily among persons in

ages between 50 and 75 years and that it is more frequently found among males

(65%) than females (35%). (Leden 2008; Verlaan et al. 2007)

http://emedicine.medscape.com/article/388973-overview.

Historical studies have tried to show a connection between DISH and monastic life

as they assume a higher frequency of well nutriment and thus diabetes among monks

than others in the surrounding society (see ex. Verlaan et al. 2007).

Table 11 DISH

Score Description

/ The vertebrae are not sufficiently preserved to be scored

0 Normal vertebrae

1 Minimum four vertebrae are fused

http://emedicine.medscape.com/article/388973-overview


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Figure 17. Pathological changes on the spine related to DISH.

TRAUMATIC CHANGES

The presence of trauma in four regions of the skeleton is scored: The cranium, the

upper extremities, the lower extremities and a collective group of the rest of the

skeleton (ribs and vertebral column).

Trauma can be divided into two different types of fractures – high impact and low

impact fractures.

The high impact fractures occur from sudden arising traumatic situations such as

violent acts and accidents. The person is exposed to a trauma with such a high impact

that the bone will get an immediate fracture. High impact fractures are seen on figure

18.A – 18.G.

Low impact fractures are caused by continued pressure or pull on a bone throughout a

long period of time with low energy. In time (up to years) the pressure will create

small fractures to the bone for instance caused by an unfortunate working position.

The low impact fractures are most often seen in the vertebral column and the pelvic

bones but most other larger bones can be affected. Low impact fractures are seen on

figure 18.H.

Open and unhealed fractures relate to trauma received around the time of death.

However, it can be difficult to differentiate it from postmortem damage either arising

in the soil or during excavation. When a sharp object strikes the fresh bone it leaves a

shiny mark with sharp edges. When a blunt object strikes a cranium it leaves an

impression on it often with secondary star-shaped fractures seen as beams away from

the primary fracture site. When both unhealed and healed fractures are found in the

same area the score 3 is given.


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Figure 18.A, 18.B and 18.C show examples of trauma caused by sharp edged violence.

Figure 18.D shows trauma caused by a strike by a blunt object. In figure 18.E, 18.F

and 18.G trauma presumably caused by accidents is shown.

Table 12 Traumatic changes

Score Description

/ No information - the bones are not preserved

0 Normal bones

1 Open, unhealed fracture

2 Healed fracture

3 Both open, unhealed fracture and healed fracture


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Figure 18. A-H. Examples of traumatic bone changes.

LOG

Here the dates, who registered what etc. is entered. Initials on the person doing the

registration are entered in the textbox termed ‘signature’.

G H

F E

C D

A B


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OTHER DESCRIPTIONS AND COMMENTS

On the back of the form or on a separate form miscellaneous observations from the

examination of the skeleton are noted. Both conditions related to human biology and

other aspects should be noted. It is important to write down and describe findings of

archaeological artifacts on or inside the skeleton. The finding of such objects is

reported to the relevant archaeological authority and is turned in or discarded as soon

as possible after an agreement has been made.

LEPROSY

The infectious disease leprosy is caused by the infectious agent Mycobacterium leprae.

The disease was present in Denmark and Sweden in early roman iron age around 1st

century AD (Boldsen 2007). Analyses of Scandinavian skeletal material dated to ap-

proximately AD 400 (Arcini og Artelius 1993) have shown that the disease was present

but not as prevalent as in the medieval period where leprosy had a very high preva-

lence. From around AD 1250 Sct. Jørgensgårde (leprosaria) was established in South-

ern Scandinavia and in these the lepers were isolated. The isolation was very efficient

and in the beginning of the 13th century - at a time where 31 leprosaria was found in

Denmark - the disease was almost eradicated in the towns but still present in rural

areas.

Leprosy is transmitted by bacteria through airborn droplets, skin contact and mucous

infiltration. The bacteria are multiplied in the coldest areas of the body – distal ex-

tremities and facial area. The nerve threads are affected and thus the motoric control

and sense of feeling is lost.

The skeletal changes are found primarily in the facial skeleton, the bones of the hands

and feet and on the fibula. Further secondary infections can be found on lateral tibia.

Registration

Seven leprosy related lesions are registered in the skeleton and form the basis of the

likelihood based diagnostic system developed by Boldsen (2011). The location and

scoring guidelines for the seven lesions are described. It is important to stress that

none of the lesions described on their own are sufficient to make a valid diagnosis.


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Edge of the nasal aperture

Location: The vertical part of the edges of the nasal aperture in both sides from

the most inferior point on the nasal-maxillary suture to approximately 1 cm lateral of

the anterior nasal spine.

Scores: /: No information due to poor preservation of the of the

relevant bone

0: Unaffected: Normal (sharp) edge of the bone lateral to the nasal

aperture as seen in figure 19.A.

1: Affected: Remodeled edge of the nasal aperture (i.e. at least ½

cm of this edge is rounded)

The figures below show three faces with changes of the edge of the nasal aperture

ranging from none to severe. It is unlikely that the individual illustrated in figure 19.A

suffered from leprosy and it is unlikely that the individual in figure 19.C, did not suffer

from leprosy, but this is not only due to the changes illustrated here. The ½ cm crite-

rion for rounding of the edge of the nasal aperture might appear scanty. It was on

purpose chosen to be inclusive in the positive state because it will permit scoring of a

number of skeletons where the maxilla has been separated from the calvarium.

Figure 19.A-C. The edge of the nasal aperture. A. Normal bone without changes related to leprosy.

B. Slight rounding of the edge of the nasal aperture. C. Severe rounding of the edge of the nasal aperture.

A B C


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Anterior nasal spine

Location: The most anterior point of the medial-sagittal plane of the nasal aper-

ture where the two lateral edges meet.


relevant bone

0: Unaffected: The nasal spine is pointed as seen in figure 20.A.

1: Affected: Nasal spine is missing or well rounded and this is clearly

a condition acquired during life. If it is even a remote

possibility that the rounding of the nasal spine could be

post mortem then ‘No information’ (-) is scored

The figures below show three faces with changes to the anterior nasal spine ranging

from none (a clearly pointed spine) over a mild affection (a just rounded spine) to se-

vere (a spine which is completely gone). It is unlikely that the individual illustrated in

figure 20.A suffered from leprosy and it is unlikely that the individual in figure 20.C did

not suffer from leprosy, but this is not due to the changes illustrated here, alone.

Figure 20.A-C. The anterior nasal spine. A. normal bone without changes related to leprosy. B. Rounding

of the nasal spine. C. The nasal spine is missing.

A B C


30

Alveolar process of the pre-maxilla

Location: The anterior part of the upper jaw; basically the bone around the roots of

the upper incisors.


relevant bone

0: Unaffected: Normal alveolar process as seen in figure 21.A.

1: Affected: Intra vitam destruction of the alveolar process (i.e. Pros-

thion has retreated above a straight line connecting the

most prominent point of the alveolar process between

the lateral incisor and the canine in both sides of the up-

per jaw)

The figures below show three faces with changes of the alveolar process of the pre-

maxilla. These range from none to severe. It is unlikely that the individual illustrated

in figure 21.A. suffered from leprosy and it is unlikely that the individual in figure 21.C

did not suffer from leprosy, but this is not due only to the changes illustrated here.

Figure 21.A-C. The alveolar process. A. normal bone without changes related to leprosy. B. Slight de-struction of the alveolar process. C. Severe destruction of the alveolar process.

A B C


31

Palate

Location: The palatine process of the maxilla, i.e. the flat or arched area between the

sutura incisivum and the transverse palatine suture not including the maxillary alveo-

lar processes.


relevant bone

0: Unaffected: Normal palate with no or little porosity as seen in figure

22.A.

1: Affected: Pitted or perforated palate. Over ½ of the palate (pala-

tine process of the maxilla) is porous (i.e. covered by

densely packed small holes) and/or the palate is perfo-

rated in one or more locations by holes measuring at

least 2 x 2 mm.

The figures below show three faces with changes the palate. These range from non

porosity over clustered small wholes to a large perforation of the palate. It is unlikely

that the individual illustrated in figure 22.A suffered from leprosy and it is unlike that

the individual in figure 22.C did not suffer from leprosy, but this is not due only to the

changes illustrated here.

Figure 22.A-C. The palate. A. normal bone without changes related to leprosy. B. Pitted palate. C. Perfo-rated palate.

A B C


32

Figure 23.A-C. Fibula hypertrophy (swelling). A. normal bone without changes related to leprosy. B. Hypertrophic fibula with slight porous bone formation. C. Hypertrophic fibula

with severe porous bone formation.

Fibula hypertrophy (swelling)

Location: The medial plane and the inter-osseous crest of the middle two thirds of fib-

ula


relevant bone

0: Unaffected: Normal, smooth bone as seen in figure 23.A.

1: Affected: Hypertrophy, presence of new-formed porous bone.

There is a distinct swelling of the bone surface. The

swollen areas have a porous surface and small and even

large drainage holes are frequently seen

The figures below show three fibulae with varying degrees of hypertrophy. These

range from a fibula with no hypertrophy over one showing a limited area with a little

hypertrophy to a fibula with extensive hypertrophy. It is unlikely that the individual

illustrated in figure 23.A suffered from leprosy and it is unlikely that the individual in

figure 23.C did not suffer from leprosy, but this is not due only to the changes illus-

trated here. In other papers using this approach to study the pathology and epidemi-

ology of osteological leprosy the terms ‘porotic hyperosteosis’ or general swelling have

been used for this lesion.

A B C


33

Figure 24.A-C. 5th metatarsal. A. normal bone without changes related to leprosy. B. Periosteal changes on 5th metatarsal. C. Deformed 5th metatarsal.

5th metatarsal bone

Location: The metatarsal bone proximal to the little (5th) toe.

Scores: /: No information due to poor preservation of the of the rele-

vant bone

0: Unaffected: Normal bone as seen in figure 24.A.

1: Affected: Any changes on the bone from mild periosteal reactions on

the palmar face of the bone to grossly deformed and

shortened bone

The figures below show three 5th metatarsal bones with varying degrees of leprosy

related changes. These range from a normal, smooth 5th metatarsal bone over one

that has small irregular exostoses on the palmar surface of the bone to one that is

severely shortened and deformed. It is unlikely that the individual illustrated in figure

24.A suffered from leprosy and it is unlike that the individual in figure 24.C did not

suffer from leprosy, but this is not due only to the changes illustrated here.

A B C


34

TUBERCULOSIS

The chronic infectious disease tuberculosis is in humans caused by two types of myco-

bacteria. Mycobacteria bovis is transmitted from cattle to humans through the gastro-

intestinal system by intake of infected milk and meat products. Mycobacteria tubercu-

losis is transmitted between humans by inhalation of airborne particles and the lungs

are primarily infected. If the immune response of the infected are immature or other-

wise inhibited the disease will soon after infection progress into an active stage of dis-

ease. If the immune response is well-developed the bacteria will lie latent in the hu-

man tissue and will if the immune response is some how weakened progress into an

active stage.

In the active stage of disease the bacteria is spread to the organs and soft tissues of

the body through the bloodstream. In a rather well-developed stage the bones will be

involved as granulomas are developed within bone tissues.

Analyses of archaeological samples and modern reference samples of skeletons of in-

dividuals with diseases of known diagnosis have led to well-documented descriptions

of skeletal involvement at least in the modern cases of the tuberculosis (Aufderheide &

Rodriquez-Martin 1998, Ortner 2003). The research into the skeletal expression of

tuberculosis is however made difficult due to both low skeletal involvement rates - an

estimate of 5-7% of cases of active tuberculosis show skeletal changes - and diseases

that cause similar bone lesions. Tuberculosis can affect all bones of the skeleton and

the presence of a single lesion is not enough to make a valid diagnosis of tuberculosis.

The disease however most often affect the vertebrae, areas of the pelvis and the

weight bearing joints and the more of these lesions that are scored positive the more

likely a positive diagnosis.

Understanding the epidemiology of tuberculosis in the past can become useful for re-

searchers when analyzing and predicting the spread of the disease in modern socie-

ties. The importance of such research is great as though tuberculosis had a profound

impact as late as the 1950s in Europe and North America it has lately reemerged in

developing countries (Daniel 2009). There were 8.7 million new cases of the disease in

2011 most of them in Africa, Asia and the areas of the Pacific Ocean (WHO, 2012).

Tuberculosis alone is responsible for 5000 deaths per day in developing countries

which have significant social and economic consequences in such societies (Roberts &

Buikstra 2003).

The tuberculosis manual presented includes the most likely affected areas of the

skeleton. The location and appearance of the lesions are described in the manual in

order to make uniform registrations of tuberculosis in human skeletal material possible

for comparative studies. Furthermore the design of the manual makes it possible to

register large skeletal samples. The manual makes it possible to detect cases of tuber-

culosis in early or little progressive stages of disease process, which makes it possible


35

to get better estimates of the prevalence of the disease in skeletal samples.

Ribs

Location: The visceral surface of ribs

Scores: /: No ribs preserved or the ribs fragments measures less than 5 cm

#: The number of preserved ribs is counted

Affected: The number of affected ribs is counted.

Ribs are affected when an area covering at least 3 cm have nodules

(figure 25.B) or calcified periosteum (figure 25.D and E). Further-

more two or more transversal depressions from blood vessels (fig-

ure 25.C) and/or erosive lytic lesions measuring more than 5 mm

in diameter can be present.

Figure 25. A.-E. A. Normal ribs no pathological changes. B. Nodules. C. Transversal depressions

from blood vessels. D. Slight periosteal changes. E. Severe periosteal changes.

A

B

D

C

E


36

Vertebral body (facies intervertebralis)

Location: The superior and inferior surfaces of thoracic and lumbar vertebral bodies

are registered.

Scores: /: Less than 50 % of the superior and inferior surface of the tho-

racic and lumbar vertebral bodies is preserved.

#: The number of preserved thoracic and lumbar vertebral bodies is

counted separately.

Affected: The number of thoracic and lumbar vertebral bodies is counted

separately.

Clustered pitting is present on the anterior part of the paraver-

tebral area of the vertebral body (figure 26.A.). The area with

pitting measure more than 3 mm in diameter (figure 26.B). The

clustered pits can evolve into deep cavities (figure 26.C).

Figure 26.A-C.: A. Normal bone without tuberculosis related pathology. B. Clustered pitting. C.

Erosive cavities.

A B

C


37

Ventral part of vertebral body

Location: The ventral part of thoracic and lumbar vertebral bodies is regis-

tered.

Scores: /: Less than 50 % of the ventral part of thoracic and lumbar vertebral

bodies is preserved.

#: The number of preserved thoracic and lumbar ventral part of verte-

bral bodies is counted separately.

Affected: Hypervascularity of nutritium foraminae is present on the ventral

surface of the vertebral body. The foraminae measures more than 3

mm in diameter (figure 27.B.). Periosteal changes with either wo-

ven structure (unhealed process) or lamellar structure (healed pro-

cess) can be present on the bone surface surrounding the nutricium

foramina (figure 27.C.)

Figure 27.A.-C.: A. Ventral part of vertebral body with no pathology related to tuberculosis. B.

Enlarged nutricium foramina and slight periosteal changes with woven structure. C. Enlarged nu-tricium foramina.

A B

C


38

Corpus ossis ilii

Location: The surface of corpus ossis ilii.

Scores: /: Less than 50 % of the ventral part of thoracic and lumbar ver-

tebral bodies is preserved.

0 (unaffected: Normal bone or no pathological changes related to tuberculo-

sis (figure 28.A.).

1 (affected): Hypervascularity of nutritium foraminae is present on the ven-

tral surface of the vertebral body. The foraminae measures

more than 3 mm in diameter (figure 28.B.). Periosteal chang-

es with either woven structure (unhealed process) or lamellar

structure (healed process) can be present on the bone surface

surrounding the nutricium foramina (figure 28.C.).

Figure 28.A.-C.: A. Corpus ossis ilii with no pathology related to tuberculosis. B. Slight periosteal

changes and enlarged nutritium foraminae. C. Periostitis with lamellar bone structure and abscess

with fistula.

A B

C


39

Acetabulum

Location: Fossa acetabuli and facies lunata of acetabulum

Scores: /: Less than 50 % of the acetabulum is preserved.

0 (unaffected): Normal bone or no pathological changes related to tuber-

culosis (Figure 29.A.).

1 (affected): Clustered pitting measuring more than 3 mm in diameter

(figure 29.B.). In fossa acetabuli deep cavities measuring

at least 3 mm can be present and/or the bone tissue has a

woven structure (figure 29.C.). Larger lytic erosions and/or

abscesses with fistulae can be present in both facies lunata

and fossa acetabula in severe disease progress.

Figure 29.A.-C.: A. Acetabulum with no pathology related to tuberculosis. B. Deep cavities on fossa acetabulum. C. Shallow erosive lesions on facies lunata.

A B

C


40

Proximal end of femur

Location: Articular surface, collum, trochanter major and trochanter minor of proximal

end of femur

Scores: /: Less than 50 % of the proximal end of femur is preserved.


culosis (figure 30.A and B.)

1 (affected): Clustered pitting measuring more than 3 mm in diameter.

The clustered pits can evolve into large cavities on caput

femoris (figure 30.D.), trochanter minor and major (figure

30.C.). Periosteal changes and enlarged nutricium forami-

nae measuring more than 3 mm can be present in collum

femoris

Figure 30.A-D.: A. Trochanter major of proximal femur with no pathology related to tuberculosis. B. Caput femoris with no pathology related to tuberculosis. C. Clustered pitting on trochanter ma-

jor. D. Clustered pitting forming and erosive lesions on caput femoris.

B A

C D


41

Facies auricularis os ilium and os sacrum

Location: The facies auricularis of the ilium and of the sacrum are registered.

Scores: /: Less than 50 % of the facies auricularis of the ilium and

sacrum are preserved


culosis (figure 31.A.)


(figure 31.B). The clustered pits can evolve into large

cavities (figure 31.C and D).

Figure 31.A.-D.: A. Facies auricularis of ilium with no pathology related to tuberculosis. B. Clus-

tered pitting on facies auricularis of ilium. B. Erosive lesions on facies auricularis of ilium. C. Ero-sive lesions on the facies auricularis of sacrum.

A

D

B

C


42

Distal end of femur

Location: The articular surface and metaphyseal part of distal femur including epi- and

intercondylar areas and the articular surface

Scores: /: Less than 50 % of the distal end of femur is preserved.


culosis (figure 32.A.).


(figure 32.B.). The clustered pits can evolve into large

cavities (figre 32.C.). Periosteal changes and enlarged nu-

tricium foraminae measuring more than 3 mm can be pre-

sent in metaphyseal areas and on non-articular surfaces.

Figure 32.A.-C.: A. Distal femur with no pathology related to tuberculosis. B. Clustered pitting

on articular surface. C. Erosive lesion on articular surface.

A

C

B


43

Proximal end of tibia

Location: Tuberositas tibiae, condylar and intercondylar areas of proximal end of

tibia.

Scores: /: Less than 50 % of the proximal end of tibia is pre-

served.

0 (unaffected): Normal bone or no pathological changes related to tu-

berculosis (33.A.).

1 (affected): Clustered pitting measuring more than 3 mm in diame-

ter (figure 33.B.). The clustered pits can evolve into

large cavities (figre 33.C.). Periosteal changes and en-

larged nutricium foraminae measuring more than 3 mm

can be present in metaphyseal areas and on non-

articular surfaces.

Figure 33.A.-C.: A. Proximal tibia with no pathology related to tuberculois. B. Clustered pitting on articular surface and on intercondylar area. C. Erosive lesion on articular surface and erosive

lesions on intercondylar area.

A B

C


44

Distal end of humerus

Location: The articular surface and condylar areas of distal end of humerus




1 (affected): Clustered pitting measuring more than 3 mm in diame-

ter. The clustered pits can evolve into large cavities. Per-

iosteal changes and enlarged nutricium foraminae meas-

uring more than 3 mm can be present on non-articular

surfaces (figure 34.B.).

Figure 34.A.-B.: A. Distal humerus with no pathology. B. Erosive lesion on trochlea humeri and

periosteal changes and enlarged nutricium foramina on lateral posterior humeri.

A B


45

Proximal end of radius

Location: The articular surface and tuberositas radii of proximal radius





(figure 35.B.). The clustered pits can evolve into large

cavities (figure 35.C.). Periosteal changes and enlarged

nutricium foraminae measuring more than 3 mm can be

present on non-articular surfaces.

Figure 35.A.-C. A. Proximal end of radius with no tuberculosis related pathology. B. Clustered pitting on tuberositas radii. C. Clustered pitting and areas of erosive lesions on tuberositas radii.

A B C


46

Proximal end of ulna

Location: The articular surface and olecranon of proximal end of ulna.


0 (unaffected): Normal bone or no pathological changes related to tubercu-

losis (figure 36.A.).


(figure 36.B.). The clustered pits can evolve into large cavi-

ties (figure 36.C.). Periosteal changes and enlarged nutrici-

um foraminae measuring more than 3 mm can be present

on non-articular surfaces.

Figure 36.A.-C.: A. Olecranon process with no tuberculosis related pathology. B. Clusted pitting on olecranon process. C. Clustered pitting and areas of erosive lesions on olecranon process.

B A

C


47

SYFILIS/TREPONEMATOSIS

Treponematosis has been around for a very long time. The infection spread over most

of the world through interpersonal contact. The bacterium has been mutating and

adapting to different climates, population and levels of socio-economic development.

Treponema primarily causes skin diseases. Lesions in the soft tissue may vary a lot;

but as they are not visible in the bones they are not considered here.

By looking at the skeletons from people that suffered from Treponema we will see

what appear to be different kinds of lesions; but in fact there is only one type of bone

involving pathological process leading to lesions of different appearance but of the

same fundamental nature. The variation is caused by differences in virulence of the

infection and of the bone observed. The first step in diagnosing skeletons is to classify

the lesions. In the case of Treponema we are dealing with a bacterium that can be

transferred from one person to another in different ways. Inside the body the infection

spreads through the bloodstream. Here the bacteria cause small blood cloths in the

arterioles that supply oxygen and nutrients to the bones.

The lack of oxygen and nutrients caused by these blood cloths lead to necrotic de-

struction of bone tissue. Initially, cortical bone reacts with compensatory swelling due

to the necrosis inside. In the resorptive process following the bone necrosis porosity

often appears on the surface cortical bone. After the removal of the necrotic bone the

cavity left might become visible on the surface of the bone. In some aspects, the reac-

tion to the bone necrosis induces by blood cloths is similar to the healthy process of

bone remodeling. The formation of new living bone substance follows immediately

after the removal of the dead bone tissue. It appears that the disease manifests itself

in pulses with episodes of widespread formation of blood cloths, followed by bone ne-

crosis, removal of dead bone tissue and formation of new living bone substance. These

pulses might be separated by substantial time periods. In more virulent infections the

pulses occur with very short intervals leading to a mixture of lesions in different stages

– from new formed necroses to fully remodeled and healed lesions; in less virulent

cases where the pulses are more widely spread lesions tend to be in the same stage of

remodeling at the time of death. Due to differences in the dynamics of vascularization

in trabecular and compact bone regions two different type of lesion appearance are

generated: trabecular crumbling and compact lesions.


48

Tibia hypertrophy (swelling)

Figure 37.A-F. Hypertrophy (swelling) of tibia. A. Tibia with no pathological changes related to treponematosis. B. Close up of tibia diaphysis with no pathological changes related to trepone-

matosis. C. Medial tibia is swollen. D. Close up of medial tibia diaphysis with periosteal changes. E. Tibia with periosteal changes and open cavities. F. Close up of medial tibia diaphysis with

severe periosteal changes and open cavities (Photos by Ulla Freund).

Location: Medial tibia diaphysis.

Scores: /: Less than 50 % of the bone is preserved.

0 (unaffected): Normal bone or no pathological changes related to trepo-

nematosis (figure 37.A and B).

1 (affected): Hypertrophy and periosteal changes (figure 37.C and D)

and in severe progress open cavities can be present (figure

37.E and F).

A

E

C

B

D

F


49

Femur hypertrophy (swelling)

Figure 38.A-F. Hypertrophy (swelling) of femur. A. Femur with no pathological changes related

to treponematosis. B. Close up of posterior femur diaphysis with no pathological changes related to treponematosis. C. Distal posterior femur is swollen. D. Close up of distal posterior femur

diaphysis with periosteal changes. E. Femur with periosteal changes and necrosis. F. Close up of distal anterior diaphysis with periosteal changes and necrosis (Photos by Ulla Freund).

Location: Distal femur diaphysis.





and in severe progress necroses or open cavities can be

present (figure 38.E and F).

A B

C D

E F


50

Humerus hypertrophy (swelling)

Figure 39.A-F. Hypertrophy (swelling) of humerus. A. Humerus with no pathological changes related to treponematosis. B. Close up of posterior humerus diaphysis with no pathological

changes related to treponematosis. C. Distal posterior humerus is swollen. D. Close up of distal posterior humerus diaphysis with periosteal changes. E. Distal posterior Humerus with periosteal changes and necrosis. F. Close up of distal posterior diaphysis with periosteal changes and ne-

crosis (Photos by Ulla Freund).

Location: Distal humerus diaphysis.





and in severe progress necroses or open cavities can be

present (figure 39.E and F).

A B

C D

E F


51

Ripples – femur

Figure 40.A-B. Ripples on femur diaphysis A. Swelling and bumps on the entire diaphysis. B.

Close up of femur diaphysis with swelling and bumps (Photos by Ulla Freund).

Ripples – humerus

Figure 41.A-B. Ripples on humerus diaphysis A. Swelling and bumps on the entire diaphysis. B.

Close up of humerus diaphysis with swelling and bumps (Photos by Ulla Freund).

Location: Femur diaphysis.



nematosis.

1 (affected): Swelling and bumps of the entire diaphysis (figure 40.A and

B).

Location: Humerus diaphysis.



nematosis.

1 (affected): Swelling and bumps of the entire diaphysis (figure 41.A and

B).

A B

A B


52

Crumbling – acromion process

Figure 42.A-C. Crumbling on acromion process. A. Acromion with no pathological changes relat-ed to treponematosis. B. Acromion with clustered pitting. C. Acromion with worm eaten necros-

es (Photos by Ulla Freund).

Location: Acromion process of scapula.



nematosis (figure 42.A).

1 (affected): Acromion shows clustered pitting (pits at least 0,5 mm in

diameter)(figure 42.B). Advanced stages might include in-

flammatory changes of the latter that give the surface a

“worm eaten” look (gummatous arthritis) (figure 42.C).

A

B C


53

Crumbling – olecranon process

Figure 42.A-C. Crumbling on olecranon process. A. Olecranon with no pathological changes re-lated to treponematosis. B. Olecranon with pitting and one larger erosive area. C. Olecranon

with worm eaten necroses (Photos by Ulla Freund).

Location: Olecranon process of proximal ulna.




1 (affected): Olecranon process shows clustered pitting (pits at least 0,5

mm in diameter) or larger erosive areas (figure 42.B). Ad-

vanced stages might include inflammatory changes that

give the surface a worm eaten look (gummatous arthritis)

(figure 42.C).

A

B C


54

Crumbling - ischium

Figure 43.A-B. Crumbling on ischium. A. Ischium with no pathological changes related to trepo-nematosis. B. Ischium with pitting and an erosive area with a worm eaten look (Photos by Ulla

Freund).

Location: Ischium of the pelvic bone.




1 (affected): Ischium shows clustered pitting (pits at least 0.5 mm in

diameter). Advanced stages might include inflammatory

changes that give the surface a “worm eaten” look (gum-

matous arthritis) (figure 43.B).

A B


55

Crumbling – patella

Figure 44.A-D. Crumbling on patella A. Distal posterior patella with no pathological changes related to treponematosis. B. Proximal anterior patella with no pathological changes related to treponematosis. C. Distal posterior patella with pitting. D. Proximal anterior patella with pitting

and erosive areas with a worm eaten look (Photos by Ulla Freund).

Location: Distal posterior patella and proximal anterior patella.




1 (affected): Patella shows clustered pitting (pits at least 0,5 mm in di-

ameter) (figure 44.C). Advanced stages might include in-

flammatory changes that give the surface a “worm eaten”

look (gummatous arthritis) (figure 44.D).

A B

C D


56

Caries sicca – frontal bone, parietal bone and occipital bone

Location: External surface of frontal, parietal and occipital bones.


0(unaffected): Normal bone or no pathological changes related to trep-

onematosis (figure 45.A)

1 (affected): Necroses with sharp or rounded edges can be present

(figyre 45.B). The necroses can be remodelled where

the depressions show radiated lines (star shaped pat-

tern) (figure 45.D). Furthermore the pathology seen on

the cranial bones can have a worm eaten look (figure

45.C).

Figure 45.A-D. Caries sicca on frontal, parietal and occipital bone A. Frontal bone with no patho-logical changes related to treponematosis. B. Parietal bones with necrosis. C. Frontal bone with

worm eaten look. D. Frontal bone with remodelled necroses. (Photos by Ulla Freund).

A B

C D


57

FOCAL OSTEOLYTIC DISEASE (FOD)

This assumed pathological condition was recently recognized and so far only for certain

in Danish medieval skeletons2. The bone changes are found in all bones of the skeleton

and in both compact and trabecular tissues. The lesions are round or elongated osteo-

lytic lesions either with no new bone formation at margins or with a rim of new bone

formation at the margins. The build up of new bone at margins verifies the pathological

nature of the condition as this is an intra vitam process - the affected individuals must

have been alive when the rim at lesion margins was formed. The pathological changes

related to FOD can however easily be mistaken for post mortem changes due to the

roots of plants winded around the bones in the soil.

As the condition is not recognized and described in modern medical literaure nothing is

known about the pathogen behind or the degree and nature of soft tissue or organ

involvement. FOD is most likely as other skeletal conditions not 100 % bone involving

and conclusions about the prevalence of the disease cannot be directly deduced from

studies of skeletons. The analysis performed so far show that the frequency of lesions

is not the same in different Danish medieval skeletal samples in different geographic

areas of the country, in different time periods within the medieval period and with dif-

ferent socioeconomic background of the dead. Lesions persumed to be related to FOD

have been observed in German prehistoric skeletons, Swedish medieval skeletons and

possibly in Native Americans dated to 17th century and Jordanian skeletons dated to

approximately 3000 BP.

Registration

The flat bones of the calvarium and the diaphyses of the humerus, ulna, radius, fe-

mur, tibia and fibula are registered. More than half of the cortex has to be preserved

for the bone to be registered.

2 The pathological nature of the disease was first recognized by Dr. Jesper Boldsen and skeletal technician Ulla

Freund at ADBOU in skeletons from the early medieval cemetery Nordby. A registration of the condition in different medival

skeletal populations have afterwards been carried out which has resulted in a description of the bone changes related to

FOD (Pedersen, 2008).


58

Scores: /: Not enough is preserved for the bone to be registered.

0: Unaffected: Normal bone without ante mortem lytic lesions. If le-

sions are present they are clearly of post-mortem na-

ture as seen in figure 45.A.

1: Affected: Clear, elongated or round lytic lesion with sharp or

rounded edges and without any signs of new bone for-

mation as seen in ill. 40 and ill. 43.

2: Affected: Clear, elongated or round lytic lesion with sharp or

rounded edges. There is new bone formation present

seen as a rim around the margins and/or in the cavity of

the lesion. The surrounding bone tissue can be affected

seen as either new bone formation and/or bone resorp-

tion as seen 46

Figure 46.A-D. Bone changes related to focal osteolytic disease A. Post mortem changes on the external cranial vault. B. Sharp edged lesion on posterior femur. C. Lesion with rounded egdes on parietal bone. D. Lesion with new bone formation at rims of lesion margins on parietal and

occipital bone.

REFERENCES

Aufderheide, A.C. & C. Rodríguez-Martín 1998. The Cambridge encyclopedia of human

A B

C D


59

paleopathology. Cambridge University Press, p. 118 - 141

Boldsen, J. L., 1984. A Statistical Evaluation of the Basis for Predicting Stature from

Length of Long Bones in European Populations. American Journal of Physical An-

thropology, vol. 65: 305-311.

Boldsen J. L. 2001. An epidemiological approach to the paleopathological diagnosis of

leprosy. American Journal of Physical Anthropology 115: 380-387.

Boldsen J. L. 2005a. Leprosy and mortality in the Medieval Danish village of Tirup.

American Journal of Physical Anthropology 126: 159-168.

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REPORT REGISTRATION FORM

location site number grave no skeleton no

sex age min age max

context grave type height in mm coord. X coord. Y

L arm pos. R arm pos.

preservation cranial measurements

quantitative outer biorbital width

qualitative minimal frontal width

sex determination maximal frontal width

cranium frontal cord

pelvis frontal arch

post cranial skeleton lower frontal cord

epiphyseal fusion left right upper frontal cord

humerus proximal post cranial measurements left right

clavicle proximal femur length

iliac crest femur caput

radius proximal humerus length

sos humerus caput

dental development age humerus epicondyl width

age joint changes left right

information shoulder

hyperplasia (+3 upper left canine) ankle

dental conditions knee

present

+

hip

attrition dish

caries traumatic changes left right

abscess head

8 7 6 6 7 8 arms

present

-

legs

attrition rest of the skeleton

caries diseases n N

abscess leprosy

photo tuberculosis

signature date

treponematosis/syphilis

focal osteolytic disease

Notes


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CHRONIC INFECTIOUS DISEASE REGISTRATION FORMS

LEPROSY

left right left right

Edge of nasal aperture Palate

Nasal spine fibula hypertrophy

Alveolar process 5th metatarsal bone

Notes

TUBERCULOSIS

Hip joint left right Elbow joint left right Vertebral body # Aff.

Corpus ossis ilii Distal humerus Thoracic

Proximal femur Proximal radius Lumbar

Acetabulum Proximal ulna Ventral part of vertebral body

Sacroiliac joint Knee joint Thoracic

Ilium Distal femur Lumbar

Sacrum Proximal tibia Ribs

Notes

SYFILIS/TREPONEMATOSIS

Hypertrophy (swelling) left right Crumbling left right

Tibia Acromion process

Femur Olecranon process

Humerus Ischium

Caries sicca Patella

Frontal bone Ripples

Parietal bones Femur

Occipital bones Humerus

Notes


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FOCAL OSTEOLYTIC DISEASE

Cranium left right Post cranial skeleton left right

Parietal bones Clavicula

Frontal bone Humerus

Occipital bone Ulna

Notes Femur

Tibia

Human Osteological Methods - ADBOU

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