On the trail of pulmonary tuberculosis based on rib lesions: results from the Human Identified Skeletal Collection from the Museu Bocage (Lisbon, Portugal).

In the last 20 years, studies on human identified skeletal collections have revealed a significant relationship between new bone formation on the visceral surface of ribs and pulmonary tuberculosis (TB). To improve methods of differential diagnosis of respiratory diseases in archaeological skeletons, an investigation was conducted on 197 individuals from the Human Identified Skeletal Collection of the Museu Bocage (Lisbon, Portugal). This sample included 109 males and 88 females who lived during the 19th-20th centuries, with ages at death ranging from 13-88 years. The skeletons were grouped according to cause of death: 1) pulmonary TB (N = 84); 2) pulmonary non-TB diseases (N = 49); and 3) a control group (N = 64) composed of individuals randomly selected among the extrapulmonary non-TB causes of death. The ribs, sterna, scapulae, and clavicles were macroscopically observed. New bone formation on the visceral surface of ribs was recorded in 90.5% (76/84) of individuals who died from pulmonary TB, in 36.7% (18/49) with a pulmonary non-TB disease as cause of death, and in 25.0% (16/64) of the control group. These differences were statistically significant (P < 0.001). Furthermore, in individuals with pulmonary TB, the bony lesions presented mainly as lamellar bone on the vertebral end of the upper and middle thoracic rib cage. Proliferative alterations also occurred on one sternum and in nine clavicles and eight scapulae. This work strongly supports the results of similar studies performed on other documented collections, suggesting that new bone formation on ribs, although not pathognomonic, is a useful criterion for the differential diagnosis of pulmonary TB.

Malignant tumors in an ancient Egyptian population.

Since it is still an open debate whether malignant tumors are mainly influenced by environmental factors, the frequency of such malignant tumors in historic populations with different living conditions is of particular interest. In the present study, we investigated the occurrence of malignant tumors affecting bone tissue in a population of mumrnies and skeletons, which had been excavated from the large necropolis of Thebes-West, Upper Egypt. Our study material comprised a series of at least 415 individuals (thereof 325 adults) dating from approx. 1500-500 B.C. All individuals had been mummified, but were severely damaged and partially broken by grave robbers, so that often only parts of the mummies/skeletons were available for investigation. The available specimens were subjected to careful macroscopic examination, while isolated findings were radiologically analyzed. Using this approach, we identified at least 4 cases showing malignant tumors affecting the skeleton. In two cases, multiple mixed osteolytic-osteoblastic lesions suggested multiple metastases from carcinomas. Two further individuals presented with multiple osteolyses (vertebra, pelvis, skull) most suggestive of multiple myeloma. The observation of at least 4 cases of malignant tumors with osseous manifestation in a series of 325 adult individuals provides clear evidence that malignant tumors were not a rare event in the ancient Egyptian study population, particularly when the limitations of a study of tumors manifested only in osseous remnants are taken into consideration. A calculation of the age- and sex-adjusted tumor frequency in our material in comparison with a recent model for such a material by Waldron (1996) indicates that the rate of malignant tumors with bone affection in our series is higher than in an English population from 1901-1905, although lower than in a comparable present day population. This clearly indicates that important factors affecting malignant tumors were effective even in historic populations.

Differential diagnosis of rib lesions: a case study from Middle Woodland southern Ontario circa 230 A.D.

The right ribs of an adult male (#18) from the LeVesconte Burial Mound in southern Ontario show extensive osteolytic and/or osteobastic lesions, some with bone thickening, interpreted herein as evidence of a chronic actinomycotic infection. In the alveolus, the presence of periapical abscesses and periodonitis with secondary inflammation may be associated with the pathogenesis of this bacterial disease by providing the normally commensurate Actinomyces israelii with the necessary conditions for their reproduction. This presumptive diagnosis, if correct, appears to represent the first case of actinomycosis in human palaeopathology. Recent literature reviews suggest that actinomycosis was not uncommon in preantibiotic populations, and that it has a high predilection for bone. Though actinomycosis can be associated with any subsistence strategy, such as, in this case, hunting and gathering, hypothetically it is most likely to occur in agricultural populations where general disease stress and age-adjusted dental pathology are highest. It is argued that in the differential diagnosis of archaeological specimens, as much attention should be given to the documentation of the natural range of variation of lesions produced by less well-known diseases, such as actinomycosis, since the disease ecology of pre-western populations differed significantly from our own.

Unusual osteolytic defects in ancient South Dakota skulls.

Unusual osteolytic defects in eight skulls culled from over 4000 ancient South Dakota burials are presented, discussed briefly, and assigned to what we think is their most likely cause. Because these are collection skeletons, histological and microbiological and microbiological confirmation of interpretations concerning specific lesions are not possible. Corroboration of our opinions has been sought through radiographs and by expert consultation elsewhere. Although our opinions are interpretative and subject to rebuttal, they can serve as a base for future research if and when similar specimens are discovered elsewhere. In addition, these specimens are indicators of other than usual ancient skull pathology from a limited geographic area, representing people who lived there during a known time frame.