Yersinia pestis: the Natural History of Plague.

The Gram-negative bacterium Yersinia pestis is responsible for deadly plague, a zoonotic disease established in stable foci in the Americas, Africa, and Eurasia. Its persistence in the environment relies on the subtle balance between Y. pestis-contaminated soils, burrowing and nonburrowing mammals exhibiting variable degrees of plague susceptibility, and their associated fleas. Transmission from one host to another relies mainly on infected flea bites, inducing typical painful, enlarged lymph nodes referred to as buboes, followed by septicemic dissemination of the pathogen. In contrast, droplet inhalation after close contact with infected mammals induces primary pneumonic plague. Finally, the rarely reported consumption of contaminated raw meat causes pharyngeal and gastrointestinal plague. Point-of-care diagnosis, early antibiotic treatment, and confinement measures contribute to outbreak control despite residual mortality. Mandatory primary prevention relies on the active surveillance of established plague foci and ectoparasite control. Plague is acknowledged to have infected human populations for at least 5,000 years in Eurasia. Y. pestis genomes recovered from affected archaeological sites have suggested clonal evolution from a common ancestor shared with the closely related enteric pathogen Yersinia pseudotuberculosis and have indicated that ymt gene acquisition during the Bronze Age conferred Y. pestis with ectoparasite transmissibility while maintaining its enteric transmissibility. Three historic pandemics, starting in 541 AD and continuing until today, have been described. At present, the third pandemic has become largely quiescent, with hundreds of human cases being reported mainly in a few impoverished African countries, where zoonotic plague is mostly transmitted to people by rodent-associated flea bites.

Forensic use of the Greulich and Pyle atlas: prediction intervals and relevance.

OBJECTIVE: The Greulich and Pyle (GP) atlas is one of the most frequently used methods of bone age (BA) estimation. Our aim is to assess its accuracy and to calculate the prediction intervals at 95% for forensic use. METHODS: The study was conducted on a multi-ethnic sample of 2614 individuals (1423 boys and 1191 girls) referred to the university hospital of Marseille (France) for simple injuries. Hand radiographs were analysed using the GP atlas. Reliability of GP atlas and agreement between BA and chronological age (CA) were assessed and prediction intervals at 95% were calculated. RESULTS: The repeatability was excellent and the reproducibility was good. Pearson's linear correlation coefficient between CA and BA was 0.983. The mean difference between BA and CA was -0.18 years (boys) and 0.06 years (girls). The prediction interval at 95% for CA was given for each GP category and ranged between 1.2 and more than 4.5 years. CONCLUSION: The GP atlas is a reproducible and repeatable method that is still accurate for the present population, with a high correlation between BA and CA. The prediction intervals at 95% are wide, reflecting individual variability, and should be known when the method is used in forensic cases. KEY POINTS: • The GP atlas is still accurate at the present time. • There is a high correlation between bone age and chronological age. • Individual variability must be known when GP is used in forensic cases. • Prediction intervals (95%) are large; around 4 years after 10 year olds.

[Study of remains and dental wastes of a First World War German rest camp]. / Etude des restes et déchets dentaires d'un camp de repos allemand de la première guerre mondiale.

INTRODUCTION: This article presents the analysis of dental remains and waste from the dental office of a German rest camp of the First World War in order to study the living conditions of the soldiers, the care policy and the prosthetic rehabilitation techniques used in this context. MATERIALS AND METHODS: The study included both dental and prosthetic remains, revealed during the excavation. The criteria to determine dental and periodontal health were the presence or absence of caries, wear, tartar and periodontal lesion. Location, severity and frequency of each of these parameters were examined. Regarding the prosthetic remains, the type of prosthesis and the materials used were determined. RESULTS: Three hundred and twenty seven (327) dental remains were analyzed. A high prevalence of large caries, especially in the molar areas, was highlighted. The incisal areas had however more wear and tartar. 183 casts of plaster dental arcade allowed to highlight a significant proportion of posterior edentulous. Prosthetic remains and laboratory waste revealed the use of vulcanite and porcelain for making dentures.

[Biometric and biomechanic analysis of lumbar posterior facets based on a CT-scan database]. / Analyse biométrique et biomécanique des articulaires lombaires postérieures au sein d'une base de données scanographique.

AIM OF THE STUDY: Our knowledge on anatomy of lumbar spine is based on few cadaver's study with old and few subjects. CT-scan is very precise for lumbar facet's morphology. We have analysed 400 subjects. The aim of this study is to measure different distances, angles and circles to better understand the mechanical function of the lumbar facets. PATIENTS AND METHODS: We have analysed 720 CT-scan. We had 217 men and 183 women with 59 years of mean age. We used native slices of 1.25 mm thick from L1 to S1. We created transversal plan and we put different mark point. We took their coordinates and we have calculated different distances, angles and mechanical circles. We have compared different axis of rotation of the facets. RESULTS: From L1 to S1, the facets goes near to the posterior wall and far from themselves. Moreover, the posterior angle between both facets increase down to the sacrum. The radius of the left side circle and the right one are very closed in 50% of the cases but the three radius are close only in 10% of cases. CONCLUSION: This study based on 400 subjects shows that there is not a unique axis of rotation for both lumbar posterior facets. We have had only 50% of symmetry between both sides whatever the level studied.

Reflections on crisis burials related to past plague epidemics.

Drawing its etymology from the Latin pestis (curse), plague, over the centuries, has been more dreaded by humankind than any other epidemic. The Apocalypse had recognized plague as the archetypal divine curse, 'the power to kill over a fourth of the earth'. Plague is thus a particular topic of study, insofar that it is one of the rare epidemics that has had recurrent major consequences on demography and human societies. Its highly transmissible nature, the brutality of its action, its high pathogenicity, marked by strong lethality and great swiftness, and the complete absence of treatment options before the 20th century conferred on it a sinister aspect. Generating a series of severe demographic crises, well known in the Western world, it has necessarily influenced the evolution of societies at both the biological and cultural levels.

[A look into the past: improves in obstetrical and neonatal outcome in maternity since the 19th century]. / Un regard dans le passé : évolution du devenir materno-fœtal en maternité depuis le xixe siècle.

OBJECTIVE: Evaluate changes in obstetrical and neonatal outcome of women who delivered in maternity hospital since the 19(th) century. MATERIALS AND METHODS: Data from a historic cohort of 1022 women who delivered between 1871 and 1874 in the hôtel Dieu hospital of Marseille were compared to those from 1159 women who delivered from 2005 to 2006 in the level 3 maternity of Nord hospital of Marseille (contemporary cohort). Deliveries that had occured before 22 weeks and/or with a foetal birth weight of less than 500 g were excluded. RESULTS: A total of 2131 pregnancies were included: 1011 and 1120 in historic and contemporary cohort, respectively. Despite comparable mean term of delivery, mean birth weight of neonates from historic cohort were significantly lower: 2971 g (550-4900 g) vs 3250 g (500-5375 g), respectively (p<0.001). Stillbirths were reported in 72 (7.1%) cases in historic cohort compared to nine (0.8%) in contemporary cohort (p<0.001). Neonatal mortality was 3.7% in historic cohort and 1.9% in contemporary cohort (p=0.012). A total of 99 (9.8%) maternal deaths were reported in historic cohort, while none in contemporary cohort (p<0.001). A wide majority of maternal deaths were caused by maternal infection (72.9%); 5.2% were caused by postpartum haemorrhage. CONCLUSION: Our results illustrate the tremendous impact on maternal and neonatal outcome of advances in obstetrical management. The significant increase in the median foetal birth weight is likely to be related to wide changes in environmental conditions and behaviour.

Limits of the Lamendin method in age determination.

This study shows that epithelial attachment level, used as age determination criterion in Lamendin's method, is not reliable for adults of either sex above the age of 49 years with periodontal diseases in any quadrant. The underestimation of calculated age increases from 7 to 19 years with chronological age. On the other hand, the present paper confirms the pertinence of dentin translucency as an age indicator in Lamendin's method.

[Epidemic recrudescence of the Great Plague in Marseille (May-July 1722): excavation of a mass grave]. / La rechute épidémique de la Grande Peste de Marseille [Mai-Juillet 1722]: le charnier de l'Observance.

The return of some infectious disease has stimulated specialists to study historical aspects of human infections. A major model for this study is Yersinia pestis which has had a great impact on human demography due to the fact that it is highly contagious and has a high mortality rate similar to that of the most lethal viral pathogenic agents. We carried out excavation of a mass grave containing the bodies of victims of an outbreak of bubonic plague that occurred in Marseille from 1720 to 1722. More than 200 skeletons were uncovered from the grave known as the Observance (second district in Marseille). In conjunction with laboratory testing, archival records were studied to determine the conditions and dates surrounding the use of this mass grave and to explain certain findings made at the site. This multidisciplinary approach revealed previously unknown facts concerning the Great Plague and provided new insight into recrudescence of the epidemic in 1722.

Detection of 400-year-old Yersinia pestis DNA in human dental pulp: an approach to the diagnosis of ancient septicemia.

Ancient septicemic plague epidemics were reported to have killed millions of people for 2 millenniums. However, confident diagnosis of ancient septicemia solely on the basis of historical clinical observations is not possible. The lack of suitable infected material has prevented direct demonstration of ancient septicemia; thus, the history of most infections such as plague remains hypothetical. The durability of dental pulp, together with its natural sterility, makes it a suitable material on which to base such research. We hypothesized that it would be a lasting refuge for Yersinia pestis, the plague agent. DNA extracts were made from the dental pulp of 12 unerupted teeth extracted from skeletons excavated from 16th and 18th century French graves of persons thought to have died of plague ("plague teeth") and from 7 ancient negative control teeth. PCRs incorporating ancient DNA extracts and primers specific for the human beta-globin gene demonstrated the absence of inhibitors in these preparations. The incorporation of primers specific for Y. pestis rpoB (the RNA polymerase beta-subunit-encoding gene) and the recognized virulence-associated pla (the plasminogen activator-encoding gene) repeatedly yielded products that had a nucleotide sequence indistinguishable from that of modern day isolates of the bacterium. The specific pla sequence was obtained from 6 of 12 plague skeleton teeth but 0 of 7 negative controls (P < 0.034, Fisher exact test). A nucleic acid-based confirmation of ancient plague was achieved for historically identified victims, and we have confirmed the presence of the disease at the end of 16th century in France. Dental pulp is an attractive target in the quest to determine the etiology of septicemic illnesses detected in ancient corpses. Molecular techniques could be applied to this material to resolve historical outbreaks.

Evidence of pin implantation as a means of verifying death during the Great Plague of Marseilles (1722).

The evidence obtained for the methods used in verification of death during the Great Plague of Marseilles in 1722 is presented here. This evidence was gathered during the excavation of a mass grave dating from this epidemic, and is based on two adjacent interments. The technique used at that time was the implantation of bronze pins into the toes. This method is precisely described in the medical treatises dating from this period, which list different death verification methods. The fear of "false death" and the burial of still living people characterized the end of the 17th and the 18th centuries. It should be noted that the main cause of apparent death is presented in the same medical treatises as the plague. This observation is the first anthropological evidence of the use of this forensic method to verify the fact of death.

[Demonstration of a cranial autopsy performed during the Great Plague of Marseille (1720-1722)]. / Mise en évidence d'une autopsie crânienne réalisée pendant la Grande Peste de Marseille (1720-1722).

The excavation of the mass grave from the Monastery of the Observance dating from the Great Plague of Marseilles revealed the first evidence of an autopsy on the skull of a 15-year-old boy, performed during the spring of 1722. The reconstruction of the skull allows us to reconstitute the anatomic technique used, which is identical to those described in a surgical book dating from 1708. This research highlights the interest in correlating the biological and historical archives, and brings new anthropological data to the debate on the contagious nature of the plague.

[Variation of sphenoidal angle of human skull in the course of aging]. / Variation de l'angle sphénoïdal du crâne humain en fonction du vieillissement.

The degree of the cranial base flexion is a major parameter in the study of the evolution of verbal communication in mankind. The variability of this area among modern humans has received little attention. In the present study, a sample of 330 modern human skulls have been used to characterize the changes in the angle of the cranial base flexion with age, and its possible relationships with gender and ethnic origin. Statistical analysis of the results show significant changes with age. Two conclusions emerged: i) the debate regarding Neanderthal speech should also consider the effect of age on the cranial base; and ii) the sphenoidal angle can be used as an ageing criterion in forensic and anthropological studies.