Childhood trauma: Methods for the identification of physeal fractures in nonadult skeletal remains.

OBJECTIVES: Today, fractures at the growth plate (or physis) are common injuries in children, but provide challenges of identification in skeletonized remains. Clinical studies provide detailed information on the mechanisms, locations, age of occurrence, and complications associated with physeal fractures, enabling the development of new criteria for identifying this injury in nonadults. To test these criteria, skeletal remains from five rural and urban medieval cemeteries were examined. METHODS: The sample consisted of 961 skeletons (0-17 years) with open epiphyses. Macroscopic observation looked for any irregularities of the metaphysis or epiphysis, which was consistent with the clinical appearance of physeal fractures or resulting complications. Radiographic examination was applied to identify fracture lines or early growth arrest. RESULTS: This study revealed 12 cases of physeal trauma (1.2%). Physeal fractures occurred predominantly at the distal end (75%), and while they were identified in all age categories, they were most frequent in those aged 12-17 years (0.2% TPR). The humerus was the most commonly affected location (3/12 or 25%). CONCLUSIONS: This study highlights the potential for recognizing physeal fractures in children of all ages, enhancing our understanding of nonadult trauma, and enabling us to assign a more precise age of the injury to build up a picture of their activities in the past.

Brief communication: a proposed method for the assessment of pubertal stage in human skeletal remains using cervical vertebrae maturation.

The assessment of age-at-death in non-adult skeletal remains is under constant review. However, in many past societies an individual's physical maturation may have been more important in social terms than their exact age, particularly during the period of adolescence. In a recent article (Shapland and Lewis: Am J Phys Anthropol 151 (2013) 302-310) highlighted a set of dental and skeletal indicators that may be useful in mapping the progress of the pubertal growth spurt. This article presents a further skeletal indicator of adolescent development commonly used by modern clinicians: cervical vertebrae maturation (CVM). This method is applied to a collection of 594 adolescents from the medieval cemetery of St. Mary Spital, London. Analysis reveals a potential delay in ages of attainment of the later CVM stages compared with modern adolescents, presumably reflecting negative environmental conditions for growth and development. The data gathered on CVM is compared to other skeletal indicators of pubertal maturity and long bone growth from this site to ascertain the usefulness of this method on archaeological collections.

Brief communication: a proposed osteological method for the estimation of pubertal stage in human skeletal remains.

Puberty forms an important threshold between childhood and adulthood, but this subject has received little attention in bioarchaeology. The new application of clinical methods to assess pubertal stage in adolescent skeletal remains is explored, concentrating on the development of the mandibular canine, hamate, hand phalanges, iliac crest and distal radius. Initial results from the medieval cemetery of St. Peter's Church, Barton-upon-Humber, England suggest that application of these methods may provide insights into aspects of adolescent development. This analysis indicates that adolescents from this medieval site were entering the pubertal growth spurt at a similar age to their modern counterparts, but that the later stages of pubertal maturation were being significantly delayed, perhaps due to environmental stress. Continued testing and refinement of these methods on living adolescents is still necessary to improve our understanding of their significance and accuracy in predicting pubertal stages.

Tuberculosis in the non-adults from Romano-British Poundbury Camp, Dorset, England.

The prevalence of tuberculosis and pulmonary disease in 165 non-adults (under 17 years) from Romano-British Poundbury Camp (1st-3rd centuries ad) is examined. Previous studies have reported eleven individuals with tuberculosis in England during the Roman period, but none are of children. Ten (6.1%) non-adults between the ages of 3 and 15 years were identified that presented lesions suggestive of a pulmonary infection, with seven (4.2%) likely to have been suffering from tuberculosis. Pathological changes included spinal lytic lesions, active new bone on the visceral aspects of the ribs, widespread periostitis on the long bones, dactylitis, and osteomyelitis of the mandible and scapula. The nature of skeletal tuberculosis in children and various differential diagnoses are discussed. The results from this study increase our knowledge of tuberculosis in the UK, and suggest that the disease was much more prevalent in Romano-British society than has been previously reported.

Life and death in a civitas capital: metabolic disease and trauma in the children from late Roman Dorchester, Dorset.

The impact that "Romanization" and the development of urban centers had on the health of the Romano-British population is little understood. A re-examination of the skeletal remains of 364 nonadults from the civitas capital at Roman Dorchester (Durnovaria) in Dorset was carried out to measure the health of the children living in this small urban area. The cemetery population was divided into two groups; the first buried their dead organized within an east-west alignment with possible Christian-style graves, and the second with more varied "pagan" graves, aligned north-south. A higher prevalence of malnutrition and trauma was evident in the children from Dorchester than in any other published Romano-British group, with levels similar to those seen in postmedieval industrial communities. Cribra orbitalia was present in 38.5% of the children, with rickets and/or scurvy at 11.2%. Twelve children displayed fractures of the ribs, with 50% of cases associated with rickets and/or scurvy, suggesting that rib fractures should be considered during the diagnosis of these conditions. The high prevalence of anemia, rickets, and scurvy in the Poundbury children, and especially the infants, indicates that this community may have adopted child-rearing practices that involved fasting the newborn, a poor quality weaning diet, and swaddling, leading to general malnutrition and inadequate exposure to sunlight. The Pagan group showed no evidence of scurvy or rib fractures, indicating difference in religious and child-rearing practices but that both burial groups were equally susceptible to rickets and anemia suggests a shared poor standard of living in this urban environment.

Brief and precarious lives: infant mortality in contrasting sites from medieval and post-medieval England (AD 850-1859).

This study compares the infant mortality profiles of 128 infants from two urban and two rural cemetery sites in medieval England. The aim of this paper is to assess the impact of urbanization and industrialization in terms of endogenous or exogenous causes of death. In order to undertake this analysis, two different methods of estimating gestational age from long bone lengths were used: a traditional regression method and a Bayesian method. The regression method tended to produce more marked peaks at 38 weeks, while the Bayesian method produced a broader range of ages and were more comparable with the expected "natural" mortality profiles.At all the sites, neonatal mortality (28-40 weeks) outweighed post-neonatal mortality (41-48 weeks) with rural Raunds Furnells in Northamptonshire, showing the highest number of neonatal deaths and post-medieval Spitalfields, London, showing a greater proportion of deaths due to exogenous or environmental factors. Of the four sites under study, Wharram Percy in Yorkshire showed the most convincing "natural" infant mortality profile, suggesting the inclusion of all births at the site (i.e., stillbirths and unbaptised infants).

Impact of industrialization: comparative study of child health in four sites from medieval and postmedieval England (A.D. 850-1859).

The morbidity and mortality profiles of 831 non-adult skeletons from four contrasting sites in medieval and postmedieval England were compared to assess whether urbanization and later industrialization, had a detrimental effect on the health of the inhabitants. Failure in the population's ability to adapt to these environments should be evident in the higher rates of mortality, retarded growth, higher levels of stress, and a greater prevalence of metabolic and infectious disease in the urban groups. Non-adult skeletons were examined from Raunds Furnells in Northamptonshire, from St. Helen-on-the-Walls and Wharram Percy in Yorkshire, and from Christ Church Spitalfields in London. Results showed that a greater number of older children were being buried at the later medieval sites and that the skeletal growth profiles of the medieval urban and rural children did not differ significantly. A comparison of the growth profiles of St. Helen-on-the-Walls (urban) and Spitalfields (industrial) showed that the Spitalfields children were up to 3 cm shorter than their later medieval counterparts. At Spitalfields, cribra orbitalia and enamel hypoplasias occurred during the first 6 months of life, and 54% of the non-adults had evidence of metabolic disease. It is argued that differences in the morbidity and mortality of non-adults from urban and rural environments did exist in the past, but that it was industrialization that had the greatest impact on child health. Environmental conditions, urban employment, socioeconomic status, and changes in weaning ages and infant feeding practices contributed to differences in health in rural, urban, and industrial environments.

Inflammatory Bone Changes in Leprous Skeletons from the Medieval Hospital of St. James and St. Mary Magdalene, Chichester, England

Resumo: The extent and location of an inflammatory bone lesion, periostitis, were examined in 50 leprous skeletons from the Chichester cemetery of the Hospital of St. James and St. Mary Magdalene in Sussex, England. Although the presence of periostitis is not pathognomonic of leprosy, it predominantly indicates dermal and neuropathic changes that the patient would have presented in life. The spread of inflammation across the knee joint and the ossification of the interosseous membrane due to inflammation are also suggested