Palaeopathological Investigation of Human Skeletal Remains

A proposed investigation of the palaeopathology of human skeletal remains from Oxford and its environs with special reference to arthritis.

Purpose:
There will be an examination of available human skeletal material from Oxford and the surrounding area to determine the occurrence and incidence of pathology and abnormality, both congenital and acquired. Preliminary examinations of the remains to determine sex and chronological age will be carried out using the standard procedures and references for such assessments. Further from this there will be the determination of differences and similarities in the constitutional nature of the skeletal material that has been excavated from different areas of the City and its environs. Note will be made of the state of preservation, type and length of burial. This will be done to eradicate false diagnoses due to any artifacts or pseudopathological changes. From this data it will be possible to make a comparison of differences in social conditions and modes of life of the individuals whose remains will be the object of the research.

With regard to the study of the pathology special emphasis will be put on the determination of morphological and histological changes due to diseases that are Rheumatoid and Osteoarthritic in origin. Further details of the main conditions to be studied will be outlined under a following section.

Methods of Research:
Techniques employed in the above study will be photographic, radiographic and micro-radiographic. These techniques will be employed for the determination of macroscopic and microscopic bone changes. For example, analyses will be made from ground down sections of bone that have been embedded in, e.g methylmatacrylate. Such an analysis, using radiographic methods, will help to establish diagnoses of pathology, abnormality, age at death, as well as to clarify the criteria of skeletal development. In regards to pathological evidence there will be an examination for porosity perforations); sclerosis (intravital polishing); osteophytes; ankylosis; plus other evidence of bone and joint pathology.

Material for the Research:
Approximately 500 human skeletons from the City of Oxford and the surrounding area will form the basis of the study. These remains have been obtained from the Oxford Archaeological Unit. Further skeletal material will be available from certain current and future excavations. In addition interest in examining skeletal material held by the British Museum was expressed.

Some of the material comes from the protected environments of the Medieval City priories and monastic institutions. Further skeletal material comes from the lay cemeteries, churchyards and crypts of excavated ruins. Priory burials were all male (until a recent examination by the applicant revealed the presence of male and female juveniles and adolescents amongst skeletons excavated from the chapter house of Blackfriars). City burials of a lay nature, plus the skeletal remains from without the city, demonstrate a far broader spectrum of the previous populations, including infant, child, adult and senile interments.  The historical periods covered by the material date from pre-Roman times up to and through early and late medieval periods until the 17th and 18th centuries.

Work to Date on the Remains:
Preliminary examinations of some of the remains have revealed the existence of pathological changes and other abnormalities. Certainly various forms and stages of arthroses have been identified, e.g. Spondylosis cervicalis, Osteochondrosis intervertebralis, osteophytoses, ligamentous calcifications. Other pathological changes involving vertebrae indicate a possible infectious aetiological factor; perhaps Brucella could be considered as responsible? Any such diagnoses require the more sophisticated methodology outlined above to confirm tentative conclusions. Further analyses of the remains has been in order to assess age and sex, stature and dentition characteristics. Age groups for current work are delineated as Infans; Juvenis; Adultus (20 to 39); Maturus (40 to 59); and Senilis (60+). Sex determination has been by the collation of the morphological characteristics of pelvis, sternum, skull and mandible. Age determination has been by collation of the morphological evidence from the dentition, attrition, epiphyseal development, symphysis pubis, and occasionally by cautious consideration of cranial suture closure.

Outline Classification of the Main Diseases to be Considered:
These are those diseases of bones and joints classified under the general heading of Rheumatology. Full details of those that can be identified from skeletal remains are appended as Appendix 1.

Other Diseases to be Noted:
A number of other affections occur in bone. These are for the purpose of the study classified separately as diseases of a non-arthritic origin, although some may accompany Rheumatoid or arthritic diseases. Full details of those afflictions that can be identified in skeletal remains are appended as Appendix 2.

Summary:
The main aim of the research is to be a palaeopathological study of human skeletal remains. The main emphasis will be on the determination of the incidence and occurrence of bone and joint diseases that are due to rheumatoid and osteoarthritis. Complementary to this theme will be the elucidation of any other evidence of other pathological conditions in the said remains.

It is felt that such a study will contribute something to the understanding of the aetiology of the arthroses and other bone disorders. Such a study will place these diseases in a historical as well as a clinical perspective, especially in their relationship to ancient conditions and environments. Such s study may help to give a clearer indication as to the mechanisms, aetiology and persistence of these diseases in both modern and previous populations, and that such research may elucidate whether there have been any changes in the incidence and form of the outlined arthritic diseases.

Appendix 1. 

Rheumatoid and Arthritic Diseases to be Studied in Respect of Human Skeletal Remains in Oxford.

RHEUMATOID ARTHRITIS: Including developmental stages; Still’s disease.

SERO-NEGATIVE:  including Psoriatic arthritis; Reiter’s sndrome; Ankylosing spondylosis; Enteropathic arthritis.

DEGENERATIVE JOINT DISEASE: including Osteoarthroses; Cervical, dorsal, lumbar spondylosis; Osteochondroses; Sychondroses.

CRYSTAL SYNOVITIS: including gout and chondrocalcinosis.

CONNECTIVE TISSUE DISORDERS: including Scleroderma.

OTHER FORMS OF ARTHRITIS: including Acromegalic arthritis; Hypertrophic pulmonary osteoarhtropathy (which may indicate intra-thoracic disease); and Neuropathic arthritis (which may be associated with syphilis, diabetes, or syringomyelia); Sarcoidosis; Ochronosis; Myelomatosis; Haemachromatosis.

Appendix 2.

OTHER DISEASES OF BONE DISCENIBLE IN SKELETAL REMAINS

INFLAMMATION OF BONE:including Osteitis; Periostitis; Osteomyelitis; tuberculous disease of bone; Syphilitic disease of bone; Leprosy.

TUMOURS OF BONE: including Osteosarcoma; Button Osteomas.

DISEASES OF JAWS AND TEETH: icluding caries, periodontal disease; hypoplasia; chronic abscesses.

DEFORMITIES: including poliomyelitis; hip deformities; congenital dysplasia of the hip.

BONE CHANGES DUE TO ENDOCRINE DISTURBANCES: including Hyperpituitarism; and Hypopituitarism.

EFFECTS OF DIET ON BONE: including Ricketts; Osteomalacia; other deficiencies.

ACQUIRED AFFECTIONS OF UNKNOWN ORIGIN: including Paget’s disease; Osteoporosis.

CONGENITAL DEVELOPMENTAL ERRORS: including Achondroplasia; Acrocephaly; Microcephaly; other congenital anomalies.

SYNOSTOSES OF UNKNOWN ORIGIN: including Scaphocephaly; Trigonocephaly; and Plagiocephaly.

BONE CHANGES ASSOCIATED WITH BLOOD DISORDERS: including Haemophilia.

Originally accepted and supported by the Nuffield Orthopaedic Centre, Department of Medicine, University of Oxford, in 1975-1976. However it was not possible to raise the research grants to start and continue the research programme.

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