Newsletter No. 121 - Pathology - Virginia Commonwealth University

Paleopathology Club - Newsletter No. 121
http://www.pathology.vcu.edu/research/paleo/
April, 2010
IMPORTANT NEWS
Our Newsletter is ONLY available via E-mail.
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Dear Members:
The 34th Scientific Session of the Paleopathology Club will be held Sunday, February 27, 2011 from
1:30-3:00 p.m. during the:
100th Annual Meeting of
The United States and Canadian Academy of Pathology
February 27, 2011
Marriott Riverwalk & River Center
San Antonio, TX
If you would like to submit a paper for platform presentation, please send us the title and authors.
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Enclosed are the abstracts of the presentations of the Symposium of Paleopathology held in Washington,
DC, March 21, 2010.
PROGRAM
“Paleopathology and Mortuary Variability in the Pre-Hispanic Chaco Canyon”
Kerriann Marden, Smithsonian Institution, Washington, D.C.
“Paleopathology of Infectious Diseases in North America and Europe”
Donald J. Ortner, Smithsonian Institution, Washington, D.C.
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April, 2010
Page 2
Case #116
Diagnosis: Hansen’s disease (Leprosy).
Because of the combination of remodeling of the margins of the piriform aperture with destructive
remodeling of the anterior hard palate, the most likely diagnosis is leprosy. Treponematosis and
tuberculosis can cause similar lesions but remodeling of the anterior hard palate would be unusual.
Submitted by: Dr. Donald Ortner, National Museum of Natural History, Smithsonian Institution,
Washington, DC.
The answer to Case #116 can be viewed and printed in Internet Explorer 6.0 at:
http://www.pathology.vcu.edu/paleo/case.116.html
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Case #117:
History:
Year 1900: 55-year-old male with a long history of chronic disease.
Submitted by: Dr. Enrique Gerszten, Virginia Commonwealth University, Medical College of Virginia
Campus, Richmond, VA, USA.
The slide of Case #117 can be best viewed and printed in Internet Explorer 6.0 at:
http://www.pathology.vcu.edu/paleo/case.117.html
_______
Notice!
If you have an interesting slide you would like to share with other members, please send it along with its
history.
Dr. Marvin J. Allison
Dr. Enrique Gerszten
Virginia Commonwealth University
Virginia Commonwealth University
Medical College of Virginia Campus
Medical College of Virginia Campus
Department of Pathology
Department of Pathology
Richmond, VA 23298 Richmond, VA 23298
USA
USA
mallison@mcvh-vcu.edu
egerszten2@mcvh-vcu.edu

Paleopathology and Mortuary Variability in the Pre-Hispanic Chaco Canyon
Kerriann Marden, Smithsonian Institution, Washington, DC
This presentation includes three cases of pathological conditions in skeletal remains from prehistoric
Chaco Canyon, New Mexico, ca A.D. 850-950. These cases demonstrate the range of observable
pathological conditions in this small burial population, and help to provide a sense of the health
conditions at this prehistoric site. The first is an adult female who exhibits several skeletal lesions
characteristic of treponemal infection, including stellate lesions on the cranial vault, a classic
gummatous lesion on the tibial shaft, and lesions involving the nasopharynx and the clavicular shaft.
The second individual is a very young adult female who has skeletal defects consistent with healed stage
IV Legg-Calvé-Perthes disease. The capital femoral epiphysis is necrosed unilaterally, with significant
remodeling of both the femoral head and acetabulum, although the capitus is in the correct anatomical
position in relation to the femoral neck, and the neck length is normal. There are notable differences in
shaft diameter between the affected leg and its unaffected antimere, consistent with muscular atrophy
and altered gait expected with untreated Perthes’ disease.
Lastly, a third individual exhibits a pair of circular, lytic foci on the cranial vault that probably result
from a metastatic carcinoma. The proximal right femur from this individual also appears to show some
osteoclastic activity in the cancellous bone, although there is also blastic periosteal reaction in this bone.
These three cases are among several pathological conditions observed in this burial population, which,
taken together, help to paint a clearer picture of life and death in the prehistoric Southwest. When these
conditions are considered in relation to archaeological indicators of the method and location of disposal
of the bodies, we can also glean cultural information about the perception of disease in Chaco Canyon.

SELECTED REFERENCES
Aufderheide AC, Rodriguez Martin C. The Cambridge Encyclopedia of Human Paleopathology.
Cambridge University Press. 1998.
Brothwell D. Tumours and tumour-like processes. In: R. Pinhasi and S. Mays, eds. Advances in Human
Palaeopathology. 2008. Chichester, Wiley. 253-281.
Ortner DJ. Identification of Pathological Conditions in Human Skeletal Remains. 2nd ed. Academic
Press. 2003.
Resnick D. Osteochondroses. In: Bralow L, ed. Bone and Joint Imaging. 2nd ed. Philadelphia: WB
Saunders Co.1996: 960-6.
Wheeless CR. Legg Calve Perthes Disease. In: Wheeless' Textbook of Orthopaedics [online]. Available
at: http://www.wheelessonline.com/ortho/legg_calve_perthes_disease. Accessed Nov 18, 2009.

Paleopathology of Infectious Diseases in North America and Europe
Donald J. Ortner, Ph.D., D.Sc.
Department of Anthropology
Smithsonian Institution
Washington, DC 20560
Evidence of infectious disease in archaeological human skeletal samples, when combined with
cultural and other biological data, provides insight into the prevalence and significance of those diseases
in the past. Unfortunately few infectious diseases affect the skeleton and those that do, affect relatively
few patients who have one of the disorders. Infectious diseases that affect the skeleton tend to be
chronic with long-term survival of the patient with the disease.
Infectious disorders that can affect the skeleton and have been identified in archaeological human
remains include: tuberculosis, leprosy, treponematosis, ulcer, brucellosis, osteomyelitis, periostitis and
mycosis (Aufderheide and Rodríguez-Martin 1998; Ortner 2003). A major emphasis in my research for
the past twenty years has been characterizing the skeletal manifestations of leprosy (e.g., Ortner 2002,
2008) and brucellosis (Ortner 2003). I also have an ongoing research interest in treponematosis.
In the research on the paleopathology of treponematosis, unfortunately in my opinion, there has been
too much emphasis on where the venereal form originated. There has been inadequate emphasis on the
pathogenesis of and relationship between the three syndromes (syphilis, yaws, bejel) that affect the
skeleton. There is, however, increasing evidence for the presence of syphilis in the Old World well
before 1500 AD.
Differential diagnosis in human skeletal paleopathology is a challenging exercise. Fortunately the
number of disorders that can affect the skeleton is a relatively small fraction of all the diseases that cause
morbidity and mortality. Ongoing research on human skeletal paleopathology has made significant
progress in clarifying the differences between infectious disorders that can affect the skeleton.
Leprosy is one of the disorders that has received considerable emphasis over the past fifty years
including the pioneer research of Møller-Christensen (1965, 1978). In my research on human remains
from a medieval cemetery for patients with leprosy, very clear patterns of skeletal involvement occur
and the diagnosis in most cases is almost certain.
The history of leprosy in Europe is of considerable interest because of the decline and virtual
disappearance of the disorder by about 1500 AD. The reason for this decline remains a matter of
speculation that has important implications for our understanding of host/pathogen coevolution in
infectious disease.

References
Aufderheide A., and Rodríguez-Martín C. (1998). The Cambridge Encyclopedia of Human
Paleopathology. Cambridge: Cambridge University Press.
Møller-Christensen V. (1965). New Knowledge of leprosy through paleopathology. International
Journal of Leprosy 33:603-610.
Møller-Christensen V. (1978). Leprosy Changes of the Skull. Odense: Odense University Press.
Ortner, D.J. (2002). Observations on the pathogenesis of skeletal disease in leprosy. In C.A. Roberts,
M.E. Lewis and K. Manchester eds. The past and present of leprosy. Archaeological, historical,
palaeopathological and clinical approaches. Oxford, Archaeopress pp. 73-80.
Ortner, D. J. (2003). Identification of Pathological Conditions in Human Skeletal Remains, Second
Edition. Amsterdam: Academic Press.
Ortner, D.J. ( 2008). Skeletal manifestations of leprosy. In: John Magilton, Frances lee and Anthea
Boylston. ‘Lepers Outside the Gate. Chichester Excavations 10, CBA Research Report 158, Council
for British Archaeology. York: Council for British Archaeology pp. 198-207.