Assessing diagnostic certainty for scurvy and rickets in human skeletal remains

Objectives

Identifying scurvy and rickets has important implications for understanding adaptations and variability among past communities, and bioarchaeologists now regularly evaluate these conditions. Due to the increased number of studies, cases with less clear-cut lesions and variable preservation are now frequently reported. Despite an improved understanding of the biological mechanisms for disease expression, there is a lack of consensus on the language used to express diagnostic certainty, limiting comparability. This article aims to address these issues and provide recommendations on more consistent diagnostic terminology using widely accepted diagnostic methodology based on biological mechanisms.

Materials and Methods

We review diagnostic terms used in bioarchaeology by considering published cases of rickets, scurvy and co-occurrence alongside M.B.B.'s past project notes. We also consider differences in the diagnosis of rickets and scurvy in living and archeological individuals.

Results

We provide recommendations on a framework that can be used to show diagnostic certainty in cases of rickets, scurvy, and co-occurrence. Core lesions of rickets and scurvy are used alongside a limited lexicon of diagnostic terminology based on the Istanbul protocol.

Discussion

It is not the number of lesions that determines whether an individual is assigned to a particular diagnosis category, but rather the range and expression of lesions present. Avoiding a “tick-list” approach to core lesions of these diseases will be critical to ensure that identifying rickets and scurvy continues to contribute to understanding adaptations and variability among past communities. The framework allows more consistency in diagnostic certainty, facilitating greater comparability in research.     

Brief Communication: A likely case of scurvy in a rural Early Classic Maya burial from Actun Uayazba Kab,Belize

A Maya burial of a late adolescent (Burial 98‐3) found in the rockshelter entrance of Actun Uayazba Kab (AUK), Belize, displays a combination of lesions that is consistent with scurvy. Signs include large, active lesions on the posterior surfaces of maxilla; relatively mild porotic hyperostosis along the midline of the skull on the parietals and occipital; cribra orbitalia; potential pinprick lesions on the greater wings of sphenoid and temporal; reactive lesions on the palate, temporal lines of frontal and parietals, and external and internal surfaces of zygomatics; small lesions on the popliteal surfaces of both femora; and periodontal disease. Identification of scurvy at AUK potentially informs the analysis of other primary burials and scattered bone found there and at other nearby sites, which often reveal evidence of nonspecific lesions that are usually attributed to anemia and infection, but that are also consistent with scurvy. The social and ecological context of this Protoclassic (0–AD 300) individual, who lived in a rural agricultural community with no evidence of complex social hierarchy, contrasts with typical discussions of disease among the Maya, which tend to focus on the degrading effects of overcrowding and resource deficiencies. While scurvy has been largely overlooked in the Maya area, this study supports earlier arguments for its presence that were based largely on clinical and ethnographic analogies and suggests the need to incorporate scurvy into broader synergistic models of ancient health. Am J Phys Anthropol 155:476–481, 2014. © 2014 Wiley Periodicals, Inc.     

Decomposition of skeletal remains in desert dry soil A roentgenological study

Bones from an Arabian site dating back to the 2nd millenium BC have been studied for their special decomposition patterns resulting from desert burial conditions. This bone diagenesis was caused by dissolution and recrystallization processes in the mineral matrix. Also extensive secondary mineralisation by formation of CaCO₃ could be found. This secondary contamination with carbonate has to be taken in account within biochemical analyses of excavated bones. Despite the extensive diagenetic changes routine histology could be done on the samples by the use of microradiography.     

Bodyworlds and the ethics of using human remains: a preliminary discussion

Accepting the claim that the living have some moral duties with regard to dead bodies, this paper explores those duties and how they bear on the popular travelling exhibition Bodyworlds. I argue that the concept of informed consent presupposes substantial duties to the dead, namely duties that reckon with the meaning of the act in question. An attitude of respect and not regarding human remains as mere raw material are non-alienable substantial duties. I found the ethos of Bodyworlds premature but full of promises such as public attitudes to organ donations. At the practical level I conclude that Bodyworlds should use only willed donations or unclaimed bodies for which dignified funerals are not available. In the case of live donations, Bodyworlds has a duty to participate in the medical care of needy donors. However, secrecy with regard to the source of cadavers seems to be the most troublesome aspect of Bodyworlds.     

Birth is but our death begun: A bioarchaeological assessment of skeletal emaciation in immature human skeletons in the context of environmental,social, and subsistence transition

The second millennium BC was a period of significant social and environmental changes in prehistoric India. After the disintegration of the Indus civilization, in a phase known as the Early Jorwe (1400–1000 BC), hundreds of agrarian villages flourished in the Deccan region of west-central India. Environmental degradation, combined with unsustainable agricultural practices, contributed to the abandonment of many communities around 1000 BC. Inamgaon was one of a handful of villages to persist into the Late Jorwe phase (1000–700 BC), wherein reliance on dry-plough agricultural production declined. Previous research demonstrated a significant decline in body size (stature and body mass index) through time, which is often used to infer increased levels of biocultural stress in bioarchaeology. This article assesses evidence for growth disruption in the immature human skeletal remains from Inamgaon by correlating measures of whole bone morphology with midshaft femur compact bone geometry and histology. Growth derangement is observable in immature archaeological femora as an alteration in the expected amount and distribution of bone mass and porosity in the midshaft cross-section. Cross-section shape matched expectations for older infants with the acquisition of bipedal locomotion. These results support the hypothesis that small body size was related to disruptions in homeostasis and high levels of biocultural stress in the Late Jorwe at Inamgaon. Further, the combined use of geometric properties and histological details provides a method for teasing apart the complex interactions among activity and “health,” demonstrating how biocultural stressors affect the acquisition and quality of bone mass. Am J Phys Anthropol 155:243–259, 2014. © 2014 Wiley Periodicals, Inc.     

Determination of age at death in human skeletal remains: A comparison of two techniques

Reliable palaeodemographic reconstruction is dependent upon accurate determination of age at death in human skeletal remains. Two methods, Todd (Todd, 1920, 1921) and Suchey-Brooks (Katz & Suchey, 1986), which use morphological changes of theos pubis as an indicator of age at death, were applied to a sample of Central California Indians. Life tables were constructed and the two data sets were compared. Differences between the two data sets were evident when life expectancies, mean ages, and survivorship curves were compared. Because both methods were developed using male samples, only the male data were considered valid. In a comparison between the two male data sets it became apparent that the differences lie in the upper decades depending upon which method was used. In an attempt to rectify the difference in age ranges between the two methods, a conversion of Todd phases into equivalent Suchey-Brooks phases (Katz & Suchey, 1986) was employed. Applications and limitations of both methods are discussed and it is suggested that the Suchey-Brooks method is to be perferred.     

Biomolecular identification of ancient Mycobacterium tuberculosis complex DNA in human remains from Britain and continental Europe

Tuberculosis is known to have afflicted humans throughout history and re‐emerged towards the end of the 20th century, to an extent that it was declared a global emergency in 1993. The aim of this study was to apply a rigorous analytical regime to the detection of Mycobacterium tuberculosis complex (MTBC) DNA in 77 bone and tooth samples from 70 individuals from Britain and continental Europe, spanning the 1st–19th centuries AD. We performed the work in dedicated ancient DNA facilities designed to prevent all types of modern contamination, we checked the authenticity of all products obtained by the polymerase chain reaction, and we based our conclusions on up to four replicate experiments for each sample, some carried out in an independent laboratory. We identified 12 samples that, according to our strict criteria, gave definite evidence for the presence of MTBC DNA, and another 22 that we classified as “probable” or “possible.” None of the definite samples came from vertebrae displaying lesions associated with TB. Instead, eight were from ribs displaying visceral new bone formation, one was a tooth from a skeleton with rib lesions, one was taken from a skeleton with endocranial lesions, one from an individual with lesions to the sacrum and sacroiliac joint and the last was from an individual with no lesions indicative of TB or possible TB. Our results add to information on the past temporal and geographical distribution of TB and affirm the suitability of ribs for studying ancient TB. Am J Phys Anthropol 153:178–189, 2014. © 2013 Wiley Periodicals, Inc.     

Technical note: The use and misuse of threshold diagnostic criteria in paleopathology

Weighted threshold diagnostic criteria approaches have emerged for diseases that involve skeletal/bony tissue that are readily diagnosed in the field of paleopathology such as Vitamin C deficiency (scurvy), Vitamin D deficiency (rickets) and treponemal disease. These criteria differ from traditional differential diagnosis in that they involve standardized inclusion criteria based on the lesion's specificity to the disease. Here I discuss the limitations and benefits of threshold criteria. I argue that while these criteria will benefit from further revision such as inclusion of lesion severity, and the incorporation of exclusion criteria, threshold diagnostic approaches have considerable value in the future of diagnosis in the field.     

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. Am J Phys Anthropol 151:302–310, 2013. © 2013 Wiley Periodicals, Inc.     

Age-at-death estimation in an Italian historical sample: A test of the Suchey-Brooks and transition analysis methods

A growing body of research is demonstrating increased accuracy in aging from a relatively new method, transition analysis. Although transition analysis was developed for paleodemographic research, a majority of subsequent studies have been in the forensic arena, with very little work in bioarchaeological contexts. Using the Suchey‐Brooks pubic symphysis phases, scored on a target sample of historic Italians from the island of Sardinia, we compare accuracy of aging between transition analysis combined with a Bayesian approach and the standard Suchey‐Brooks age ranges. Because of the difficulty in identifying a reasonable informative prior for bioarchaeological samples, we also compared results of both an informative prior and a uniform prior for age estimation. Published ages‐of‐transition for the Terry Collection and Balkan genocide victims were used in conjunction with parameters generated from Gompertz hazard models derived from the priors. The ages‐of‐transition and hazard parameters were utilized to calculate the highest posterior density regions, otherwise known as “coverages” or age ranges, for each Suchey‐Brooks phase. Each prior, along with the parameters, were input into cumulative binomial tests. The results indicate that the Bayesian approach outperformed the Suchey‐Brooks technique alone. The Terry Collection surpassed the Balkans as a reasonable sample from which to derive transition analysis parameters. This discrepancy between populations is due to different within phase age‐at‐death distributions that reflect differences in aging between the populations. These results indicate bioarchaeologists should strive to apply a Bayesian analysis when aging historic and archaeological populations by employing an informative prior. Am J Phys Anthropol 149:259–265, 2012. © 2012 Wiley Periodicals, Inc.     

Differential representation of human skeletal remains in eroded and redeposited coastal deposits: A case study from the Marshall Islands

A historical cemetery on Majuro Atoll, Republic of the Marshall Islands, was partially washed away during an exceptional seasonal high tide. The osteological analysis of the human remains washed out by the tides showed that the anatomical representation of the bones found on the shoreline is distinctly skewed, caused by the erosion of the graves by wave action and the differential transport of bones by waves and currents. The two major factors involved in the observed differential preservation of skeletal elements appear to be (i) the overall weight of the bone and (ii) its ability to float. Light-weighted bones, such as the phalanges, or heavily spongiotic bones, such as vertebrae and patellae, float easily and — by wave and tidal action — can be carried out to sea, leaving the heavier bones, such as femora, tibiae, or non-floating bones, such as the crania and mandibles, behind.