Living with lower limb traumas and below-knee amputation in a Jordanian Late Ottoman nomadic community.

OBJECTIVE: Paleopathological analysis is combined with ethnohistorical, ethnographic and ethnomedical reports to assess the sociocultural implications for a historical nomadic Bedouin female following her survival of a below-knee amputation and multiple injuries to the stump. MATERIALS: A middle-aged female recovered from a nomadic-style burial dated to the Late Ottoman Period (1789-1918) in Jordan's Wadi ath-Thamad region. METHODS: Macroscopic and radiographic assessment. RESULTS: A supracondylar femur (Hoffa) fracture, knee complex injury and lower leg amputation were observed on the right lower limb. Other pathological lesions that may have affected movement included bilateral os acromiale, intervertebral disc disease, osteoarthritis and right hook of hamate fracture. CONCLUSIONS: The individual survived a below-knee amputation, two injuries to the stump, and likely experienced lower back pain. Mobility may have been painful, but she likely functioned within the community performing gender-specific daily tasks within the family tent and designated community female workspaces. Ethnohistoric and ethnographic reports suggest that marital demotion by other wives or a return to her father's tent may have occurred. SIGNIFICANCE: Healed multiple injuries and amputation affecting one limb are rare in paleopathological literature. LIMITATIONS: It is uncertain whether the amputation or either of the stump injuries occurred during the same event. If they resulted from separate events, slight hip joint osteoarthritis suggests that the amputation preceded the other injuries. SUGGESTIONS FOR FURTHER RESEARCH: Full pathological assessment of individuals with amputations may provide additional insight into impairment resolution, health problems and injury arising from impairment following amputation.

Commingled crypts: Comparative health among Byzantine monastics in the Levant.

OBJECTIVES: Early Byzantine (A.D. 330-842) monastic rules stipulated that entrants relinquished familial connections, personal belongings and secular relationships to become part of the ascetic collective that continued in death, resulting in bioarchaeological marginalization, as was the case of the monastics excavated from the Chapel of Robebus at Mount Nebo, Jordan (ca. A.D. 491-640). It was hypothesized that compared to contemporary monastic groups, the Mount Nebo monastics experienced poorer health and gravitated to Mount Nebo, owing to its association with the Prophet Moses and proximity to the Dead Sea, Livias baths and Jordan River, all associated with curative benefits, especially for those suffering from leprosy. MATERIALS AND METHODS: The commingled remains of 73 adult males from Mount Nebo and the articulated skeletons (n = 27) from the Sanctuary of Agios Lot at Deir 'Ain 'Abata (Jordan) were assessed for paleopathology, then compared with a contemporary commingled group from the Monastery of Saint Euthymius at Khan-el-Ahmar (Judean Desert) (n = 117). RESULTS: No skeletal evidence of leprosy was observed among the groups. Most Mount Nebo individuals did not reach an older age, yet injuries, severe osteoarthritis, lower leg osteoperiostitis and antemortem tooth loss were common. The paleopathological profile was similar at Deir 'Ain 'Abata, but paleopathology was negligible at Khan-el-Ahmar. CONCLUSIONS: The similar paleopathological profiles of the Jordanian monastic groups suggest that the proximity to the Dead Sea may have attracted monastics to both sites, in addition to spirituality, but leprosy was not a factor based on the skeletal evidence.

A microscopic evaluation of Paget's disease of bone from a Byzantine monastic crypt in Jordan.

Paget's disease of bone (PDB) is a metabolic bone disease that has been present in human populations for over 2000 years, with the earliest cases reported in Western Europe. Now present globally, PDB is one of the most common metabolic bone diseases in modern populations. This study details possible PDB of an adult male (MNR-EN Skull 3) with abnormally thickened cranial bones (17 mm). The skull was recovered from commingled skeletal remains excavated from the Robebus crypt at the Byzantine monastery of Mount Nebo, Jordan (c. late 4-7th C). Micro-CT imaging and histological sections of the bone samples revealed an abnormal pattern of bone remodeling, with atypical osteon formation, convoluted and enlarged trabeculae, and an overall pattern of highly vascularized bone. Polarized microscopy produced a mix of woven bone and lamellar bone, the mosaic pattern of atypical bone remodeling indicative of PDB. Coupled with the dense, thickened nature of the vault bones, these data suggest that the individual had PDB. To our knowledge, this represents the earliest evidence of PDB in the Middle East supported by micro-analysis, and adds to the emerging paleopathological literature involving commingled skeletal remains and the potential for identifying unique disease processes.

Maternal environment and craniofacial growth: geometric morphometric analysis of mandibular shape changes with in utero thyroxine overexposure in mice.

An estimated 3% of US pregnancies are affected by maternal thyroid dysfunction, with between one and three of every 1000 pregnancies being complicated by overactive maternal thyroid levels. Excess thyroid hormones are linked to neurological impairment and excessive craniofacial variation, affecting both endochondral and intramembranous bone. Using a geometric morphometric approach, this study evaluates the role of in utero thyroxine overexposure on the growth of offspring mandibles in a sample of 241 mice. Canonical variate analysis utilized 16 unilateral mandibular landmarks obtained from 3D micro-computed tomography to assess shape changes between unexposed controls (n = 63) and exposed mice (n = 178). By evaluating shape changes in the mandible among three age groups (15, 20 and 25 days postnatal) and different dosage levels (low, medium and high), this study found that excess maternal thyroxine alters offspring mandibular shape in both age- and dosage-dependent manners. Group differences in overall shape were significant (P < 0.001), and showed major changes in regions of the mandible associated with muscle attachment (coronoid process, gonial angle) and regions of growth largely governed by articulation with the cranial base (condyle) and occlusion (alveolus). These results compliment recent studies demonstrating that maternal thyroxine levels can alter the cranial base and cranial vault of offspring, contributing to a better understanding of both normal and abnormal mandibular development, as well as the medical implications of craniofacial growth and development.

Life in the fast lane: Settled pastoralism in the Central Eurasian Steppe during the Middle Bronze Age.

OBJECTIVES: We tested the hypothesis that the purported unstable climate in the South Urals region during the Middle Bronze Age (MBA) resulted in health instability and social stress as evidenced by skeletal response. METHODS: The skeletal sample (n = 99) derived from Kamennyi Ambar 5 (KA-5), a MBA kurgan cemetery (2040-1730 cal. BCE, 2 sigma) associated with the Sintashta culture. Skeletal stress indicators assessed included cribra orbitalia, porotic hyperostosis, dental enamel hypoplasia, and tibia periosteal new bone growth. Dental disease (caries, abscess, calculus, and periodontitis) and trauma were scored. Results were compared to regional data from the nearby Samara Valley, spanning the Early to Late Bronze Age (EBA, LBA). RESULTS: Lesions were minimal for the KA-5 and MBA-LBA groups except for periodontitis and dental calculus. No unambiguous weapon injuries or injuries associated with violence were observed for the KA-5 group; few injuries occurred at other sites. Subadults (<18 years) formed the majority of each sample. At KA-5, subadults accounted for 75% of the sample with 10% (n = 10) estimated to be 14-18 years of age. CONCLUSIONS: Skeletal stress markers and injuries were uncommon among the KA-5 and regional groups, but a MBA-LBA high subadult mortality indicates elevated frailty levels and inability to survive acute illnesses. Following an optimal weaning program, subadults were at risk for physiological insult and many succumbed. Only a small number of individuals attained biological maturity during the MBA, suggesting that a fast life history was an adaptive regional response to a less hospitable and perhaps unstable environment.

A truncated temporal styloid process from the Jordanian Ottoman Period: Developmental variant or fracture?

Styloid process (SP) development and its role in an individual's lived experience plays a negligible role in paleopathological research, although a handful of possible Eagle's syndrome cases have been reported. Here, the development of the stylohyoid chain and the medical research of SP variants are reviewed to inform the differential diagnosis of a probable SP fracture in a young adult male associated with the Ottoman Period (13-19thC) in Jordan. The fracture surface of the right SP is smooth rather than irregular, the coloration is uniform with the surrounding cortical bone staining, and no new bone formation is visible. All features are consistent with a perimortem injury. An unossified stylohyal is a differential diagnosis, while the left elongated SP suggests a predisposition to intrinsic injury. The implications of SP fractures are considered.

Investigating health at Kerma: sacrificial versus nonsacrificial individuals.

This analysis examines heterogeneity in risks by assessing the health status of individuals in two distinct burial contexts from the Nubian site of Kerma: sacrificial (n = 100) and nonsacrificial (n = 190) burial areas dated to the classic Kerma period ( approximately 1750-1500 BC). Indicators of physiological stress that were examined include cribra orbitalia, dental enamel hypoplasia, tibial osteoperiostitis, and femur length. The analysis presented here shows that the people interred in the sacrificial and nonsacrificial burial contexts at Kerma in Upper Nubia had similar health profiles that were comparable with other contemporaneous samples from the region. If sacrificial individuals did not experience the same risk of death as nonsacrificial individuals, it was not evident in the frequencies of nonspecific stress indicators. However, this differential risk of death may be blurred by our inability to examine nonadults for childhood disease. This research demonstrates the complexities involved in understanding the multiple factors that result in heterogeneity in skeletal samples.

Continuity of interpersonal violence between Nubian communities.

Modern communities affiliated with the same culture have been shown to experience comparable levels of interpersonal violence, no matter what their size. It was hypothesized that a similar relationship would exist among ancient rural and urban people, but that accident-related trauma may be more prominent among rural dwellers due to their activity base. Through an analysis of antemortem trauma, this investigation contrasted the injury profile of Nubian adult villagers (N = 55) from the Kerma period (2500-1750 BC) to that of their urban neighbors (N = 223) at Kerma (2050-1500 BC). The injury pattern associated with interpersonal violence (cranial injury, direct-force ulna fractures, and multiple injuries) was similar between the two samples, as hypothesized. The rural group sustained significantly more nonviolence-related injuries that suggested occupational or environmental influences. The more severe cranial injuries observed among urban people are attributed to a preference for more lethal hand-wielded objects that may have accompanied increasing local tensions and incursions into Egypt during the 17th Dynasty.