Pathology of the week: TB special

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We have mutiple specimens with classic skeletal changes associated with tuberculosis in our database. Here is a sneak peak at a few of the specimens that will be available to view in 3D once the Digitised Diseases website goes live.

B0002-4: Lincoln 85 DS 4.10.  This is possible gastrointestinal tuberculosis.

Right os coxae:  There is spiculated new compact bone formation on the auricular surface, which has an irregular joint surface contour.  Superoposterior to this, there is an elliptical area of bone destruction, which has smooth margins and that interrupts a portion of the posterior iliac crest.  There is a channel of reactive new compact bone and destructive porosity between the auricular surface to the inferior margin of the destructive lesion. On the gluteal surface, there is a large, but localised, area of pitting and spiculated new compact bone.

Left os coxae: On the iliac fossa there is a large area of remodelled cortical bone destruction with peripheral new woven bone extending to the anterior superior iliac spine.  Inferior to this lesion, there is a second localised area of destructive remodelling with a large area of new woven bone inferiorly and anteriorly.  There is a large area of remodelled new compact bone extending from the auricular surface to the beginning of the superior pubic ramus.  A zone of spiculated new compact bone formation is located between the greater sciatic notch and obturator foramen lying under the gluteal musculature.

Sacrum: On the anterior surface of the vertebral bodies and the right ala (the left has taphonomic damage), there is a continuous layer of new compact bone with irregular areas of remodelled destructive changes continuing into the visible surface in the foramina.  There is a delineated area of cortical destruction leaving a scooped out appearance that has a superior border of spiculated new woven bone.  This is all in the immediate area of where the rectum is located.  On the posterior surface there is destructive remodelling and pitting along the sacral spine.  The right half of the sacral auricular surface has been destroyed, and the superior surface is disorganised with irregular new compact bone.  On the left sacral auricular surface there are four large, destructive pits/pores.

B0021: Addingham (ARC 90) 134. Rib lesions associated with TB.

Left 5^th Rib: There is a fine layer of new woven bone centrally on the visceral surface of the body, which overlays thicker smooth deposits of new compact bone.

B0036: Addingham (ARC90) DS 3.22.  Pott’s Disease

1^st-10^th Thoracic vertebrae: There is bony fusion of the first to tenth thoracic (T1-10) vertebrae through the articular surfaces and fusion of the transverse processes inferiorly in T2-10.  The bodies of T4-6 have been completely destroyed, except for some of the posterior most surface lining the vertebral column, causing kyphosis of the column (Pott’s disease).  The inferior surface of the body of T1 is facing anteriorly. The inferior quarter of T1 is destroyed.  There is only a portion (an eighth) of the posterior body remaining for T2.  There is only an anterior wedge of T3 remaining.  The body of T7 has been compressed and there is loss of the inferior half of the right side of the anterior body.  There is further compression of T8-T10 and loss of the body of T9 on the left, giving the column a left lateral curvature (scoliosis).  The articulating rib heads to T3-T6 are fused to the vertebral bodies.  There is a depression into the inferior body of T10.  There is porotic destruction to the transverse processes of T1-T10, especially T7-T10.  Extensive pitting is observed on the spinous processes of T7-T10.

B0063: Hereford Cathedral (HE93a) 2472. Pott’s Disease

9^th-12^th Thoracic vertebrae (T9-12): There is bony fusion of the ninth to the twelfth thoracic (T9-T12) vertebrae anteriorly through the anterior longitudinal ligament and between T10 and T11 through the posterior longitudinal ligament, posterior body, and between the articular facets.  The body of T10 is almost completely destroyed, leaving a posterior remnant.  The body of T11 is compressed anteriorly leading to kyphosis of the vertebral column (Pott’s disease).  The joint space between the bodies of T9-T10 and T11-T12 are maintained with extensive bone destruction of the inferior bodies of T9 and T11.  There is irregular new compact bone formation on the superior bodies of T10 and T12.

B0037: Chichester (CH 86) 307.  Cranial lesions in TB.

Cranium:  There is a destructive lesion on the right parietal situated approximately in the centre of the bossing, which perforates the inner and outer tables.  The ectocranial margin is sharp and irregular.  On the endocranial surface the lesion has sharp margins, is smaller and more irregular than the external lesion, and has surrounding radial striated new woven bone.

B0039: Castleton Roman Vicus 1980. Ossification of pleura in TB.

Ossified pleura: This is an oval specimen of ossified pleura, which has jagged edges and disorganised surface on one side and a smooth surface on the other.

Potentially explosive: health and safety issues and historic radiographs

By now regular visitors will be familiar with the textured 3D laser scans and pathological descriptions we frequently put up to show the public what we are up to and what to look forward to when the project goes live later this year.

In addition to the 3D models and descriptions there will be radiographs (and CT scans). Some of the radiographs will be newly created for the project, something I have been working on for the last few months. We also will be digitising historic radiographs. At Bradford we have a scanner for digitising radiographs. It was used in the From Cemetery to Clinic project to digitise the radiography archive of leprosy patients produced by Jos Anderson almost 40 years ago.

We have a large archive of historic radiographs to digitise for Digitised Diseases. Historic radiographs provide excellent context for the discussion of health and disease. The x-ray was discovered by Wilhelm Röntgen, a professor of physics in Bavaria in 1895. It was immediately apparent that this technique would be of huge value for clinicians. In 1896 an x-ray department had been set up at the Glasgow Royal Infirmary, one of the first radiology departments in the world.

Early radiographs were recorded on glass plates with an emulsion. Just before the outbreak of WWI, the Eastman Kodak company developed a cellulose nitrate film for radiography. Cellulose nitrate was also the material used to make cinematographic film.

Essentially nitrate-based x-ray film is based on nitrocellulose (guncotton!) plasticised with camphor coated with an emulsion. It is highly flammable and potentially explosive and degrades easily, giving off toxic gases. This has obvious health and safety issues attached to it!

Luckily in the early 1920s safety film was developed for radiography. This comprised an emulsion on a cellulose acetate backing, which is much slower burning. From the 1950s to the present day polyester based films are used. These are much more stable and resist chemical and physical changes as it ages.

The video below from YouTube shows the difference between safety film (in this case 35mm cinematography film, but same principles apply) and cellulose nitrate film when it catches fire.

We were fairly sure that none of the radiographs we have were not cellulose nitrate based films. However, it is good practice to write complete a COSHH form and do a risk assessment before any digitisation work was carried out.

After looking at the older, more degraded films we were sure that none of the films were cellulose nitrate based. This is how we went about our assessment:

1. We removed the most degraded radiographic films to a fume cupboard so they could out-gas.

2. Wearing PPE we took out the radiographs and looked at them. Degradation in some cases was very obvious.

3. We know that from the early 1930s nitrate film and the word “nitrate” on the edge of the film. Safety film, either cellulose acetate or polyester, had the word “safety” on the edge. I found a few examples of the “safety” stamp, but no “nitrate” stamps.

4. Other radiographs had a manufacturer on. This radiograph from the 1950s is labelled “Ilford”, who make radiographic and photographic film. I was able to check that this stock was indeed safety film.

5. Looking at the dates and conditions of the radiographs in question we could rule out all of them being cellulose nitrate, as they were either too late (i.e. post 1933) or their appearance was not consistent with cellulose nitrate film. The example below shows a very wrinkled radiograph with “channeling”. It is quite brittle and has a feint vinegar smell, which is normal for old cellulose acetate radiographs.

Some of the radiographs are extremely brittle or warped, which will present interesting conservation and digitisation decisions later on, as they are not suitable for running through the radiograph scanner. We have a number of trained conservators on the project, including the PI Dr. Andy Wilson, who will make decisions regarding how these radiographs are treated in the coming weeks.

If we had found cellulose nitrate radiographs we are fortunate to have cold storage facilities here in Bradford. We also have the very excellent National Media Museum only a short walk away, who have experts on the storage of old celluloid film – luckily we didn’t have to contact them!

References

Film Identification, National Park Service, US Department of the Interior

History, Science, Preservation and Treatment of Cellulose Nitrate Still Film

Managing X-ray Films as Federal Records, National Archives and Records Administration, Office of Records Services, College Park, MD (2000)

Nitrate film, National Media Museum (nd)

The Dangers of Cellulose Nitrate Film, Health and Safety Executive (2013)

Pathology of the Week

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This individual is from the medieval layers of the Gilbertine priory of St. Andrew’s Fishergate, York.  We would like to thank York Archaeological Trust for the opportunity to present these specimens. The tibia described here is part of a display at Barley Hall, about life and disease in the past.

This individual has multiple bones presenting with haematogenous osteomyelitis, including the right clavicle and humerus, sternum, and right and left tibiae and fibulae. Osteomyelitis is an infection and inflammation of the bone caused by invading pyogenic or mycobacteria, which enters the bone either through the bloodstream, from an adjacent contaminated site, and direct implantation (ie penetrating injuries).  Classic bony signs of osteomyelitis include an involucrum (a layer of new bone that encases the dead bone), a sequestrum (a segment of dead bone), and a cloaca (an opening in the involucrum that communicates with a sinus, which leads to the medullary cavity and allows for the transportation of pus to the surface) (Resnick 1995).

Sternum

There is developmental delay in fusion of the sternal segments.  The manubrium is dysplastic, with reduction in superoinferior height and disorganisation of the surfaces of the costal notches, sternoclavicular joints and the jugular notch.  There is anteroposterior expansion of the manubrium and compact bone formation on the visceral surface and within the jugular notch.  Two cloacae are located on the visceral surface of the manubrium just superior to the manubriosternal joint, one centrally and the other laterally on the right side.  The lateral cloaca is surrounded by pitting and has direct communication with the anterior surface within the costal notch.

Right clavicle

There are two cloacae on the sternal end of the clavicle inferiorly, which are internally connected by sinuses that drain to the anterior and posterior surfaces.  Both cloacae are surrounded by pitting.  A possible third very small cloaca is located on the superior surface of the sternal end.  From this small hole is an open channel that runs laterally.  Alongside the channel are areas of new bone.

Right humerus

The proximal half of the shaft is greatly expanded, mainly the anterior surface.  Four cloacae are located on the anterior surface, which are connected internally through sinuses that communicate directly with the medullary cavity. The surrounding bone is heavily pitted.

External measurements of the cloacae:

Superior most- c. 12.2mm superoinferior x c.8.3mm mediolateral

Mid-lateral- c. 11.3mm superoinferior x c.6.4mm mediolateral

Mid-medial- c. 18.3mm superoinferior x c.12.6mm mediolateral

Inferior most- c. 19mm superoinferior x c.16.9mm mediolateral

Fused left os coxae and sacrum

These two bones are fused through the sacroiliac joint.  There is also irregular compact bone on the superior and anterior surface at the joint, which is porous.  The surface of the os coxae has extensive fine pitting along the superior, anterior and posterior margins of the joint.  The inferior iliac spine is largely absent due to strong ligamentous attachments that have created three deep depressions in the bone surface.

Fused right tibia and talus

The distal half of the bone is greatly expanded though proliferation of irregular compact bone (involucrum), which extends across the tibiotalar joint and covers all non-articular surfaces of the talus.  The new bone also extends onto the proximal half of the shaft but is less extensive.  There is extensive pitting across the new bone surface.  On the anteromedial surface of the distal half is a sub-circular cloaca, which measures c.6.6mm in diameter at its greatest.  A further irregularly shaped cloaca is located on the fibular notch posteriorly, c.6.9mm superoinferior x c.3.5mm anteroposterior.

Left fibula

The distal third of the shaft is expanded, with extensive compact bone (involucrum).  The whole of the distal third of the shaft has heavy fine pitting and porosity.  On the lateral surface are two large cloacae connected by an underlying sinus that contains a long, thin sequestrum.  The superior cloaca measures c. 11mm superoinferior x c.8.8mm mediolateral and the inferior cloaca measures c. 9.4mm superoinferior x c.5.1mm mediolateral.  There is a further shallow lytic lesion on the lateral surface superior to the two cloacae measuring c. 3-5mm in diameter.

Resnick, D. 1995. Diagnosis of Bone and Joint Disorders. W.B. Sunders, Philadelphia.

Pathology of the Week

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This skeleton is from the Hospital of St. James and St. Mary Magdalene, Chichester, a medieval leprosarium.   The individual had metastatic carcinoma of the prostate (prostate cancer).  Metastatic carcinoma of the prostate is characterised by osteosclerotic lesions and deposition of periosteal new bone (Ortner et al 1991). A mixture of pathological lesions distributed throughout the skeleton that are also consistent with the individual having co-existing leprosy.  However, bones from this individual that have leprous lesions or a mixture of lesions from both diseases have been omitted from this project to prevent confusion.

 

Chichester (CH86) 273

There are multiple destructive lesions throughout this individual’s skeleton.  More internal lesions are visible when the x-ray is viewed.  Many of the bones have large areas of active new bone (woven bone).

Cranium

The majority of the ectocranial surface is covered in diffuse fine pitting and porosity, with multiple localised areas of clustered porosity throughout.  There is a mixture of pitting, porosity and new woven bone covering a large area inferior to the temporal lines on the frontal and temporal on the left side and a smaller area on the left side in the same area, but more inferiorly.  The superior surface of the left orbit is covered in a patchy layer of new woven bone.  Similarly, the anterior half of the endocranial surface has irregular areas of new woven bone, especially along the sigmoid sinus and meningeal (arterial) grooves.

Mandible

The lingual and buccal surfaces of the right ascending ramus are covered in a layer of coarse woven bone.  The patchy distribution along these surfaces is likely due to post-mortem damage and would have been more extensive.  The left ramus has two small zones of new woven bone, one inferior to the mandibular notch on the buccal surface and the other on the medial side of the neck of the condylar process.  Both surfaces of the right ascending ramus and the lingual surface of the left side have scattered porosity.

Clavicle

The shaft has extensive porosity throughout and is covered in a layer of coarse woven bone in the middle two-thirds.   Post-mortem damage obscures the extent of the new bone formation; it is likely to have been more extensive as there are small patches of woven bone on the inferior surface of the acromial end.  A portion of the new bone on the inferior surface of the shaft exhibits areas of smoothing (remodelling).

Scapula

The majority of this bone is covered in multiple fine osteolytic lesions and a layer of coarse woven bone, sparing only areas of the blade and glenoid fossa.   Post-mortem damage obscures the extent of the new bone formation; it is likely to have been more extensive.

Ribs

There are multiple fine osteolytic lesions in areas of throughout the external surface of the rib bodies.  The visceral surfaces of the ribs have zones of new woven bone on the body, neck and head.  Post-mortem damage obscures the extent of the new bone formation; it is likely to have been more extensive.

Vertebrae

There are multiple fine osteolytic lesions on the anterior and lateral surfaces of the vertebral bodies.

Note:

Ortner D.J., Manchester K., and Lee F.  1991. Metastatic Carcinoma in a Leper Skeleton from a Medieval Cemetery in Chichester, England.  International Journal of Osteoarchaeology 1: 91-98.

Pathology of the Week

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We would like to thank York Archaeological Trust (YAT) for the opportunity to present to you this fantastic example of advanced ankylosing spondylitis from Swinegate, York (1989-90.28).  

This is SK55 (3505) with ankylosed seventh cervical to tenth thoracic, first to seventh right ribs and first to eighth left ribs.

The vertebral column has continuous smooth fusion anteriorly through the formation of syndesmophytes, giving the inferior portion if the spine a “bamboo”- like appearance.   There is also fusion posteriorly between the vertebrae through the articular facets and ossification of ligamenta flava. The ribs are fused to the vertebrae through ossification of their anterior and posterior ligamentous attachments.   There would have been further vertebral fusion of the superior lumbar vertebrae, evidenced by the calcification of the intervertebral disc on the inferior surface of the body of the tenth thoracic vertebra.  The superior articular facets of the seventh cervical vertebra have heavy pitting and porosity.

Digitised Diseases goes to Knoxville

 

Last week Jo Buckberry and her PhD student attended the PPA (Paleopathology Association) and AAPA (American Association of Physical Anthropologists) meetings in Knoxville. We both took along textured 3D models of pathological bones form our sites which were created as part of the Digitised Diseases project, which allowed conference delegates to investigate the pathologies in more detail, and gave us a valuable opportunity to promote the project.

Jo presented a poster on the skeletal remains of a head excavated in Heslington, York, which contained the preserved remains of ‘Britain’s Oldest Brain’ (O’Connor et al 2011). The paper focussed on the probable cause of death: the individual had a peri-mortem fracture to the second cervical vertebra, separating the body from the neural arch (a so-called ‘Hangman’s fracture’). On the front of the vertebrae was a series of nine shallow peri-mortem incisions, indicating the individual had been decapitated in a careful, measured manner. No bones from below this point were recovered, indicating the articulated head had been deposited in a pit.

Ceilidh presented the evidence of pathology from Viking-era cemeteries in Orkney. Importantly, the pathologies present were all chronic conditions, with no evidence of inter-personal violence, suggesting that these Viking populations were not violent raiders, but peaceful settlers.

A pathological femur from skeleton 34, from Ceilidh Lerwick’s PhD research (see here for more information on this specimen)

We thank York Archaeological Trust and the National Museums Scotland for giving us permission to scan these bones for Digitised Diseases while they are on loan to the University of Bradford.

Pathology of the week

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We recently were granted permission to add some fantastic specimens from York Archaeological Trust.  This specimen comes from St. Andrew’s Fishergate and is now on display at Barley Hall, York (http://barleyhall.co.uk/).  The mass on the right is fantastic example of how large osteomata, which are benign neoplasms, can get.

Mandible

There is a large lobulated mass of compact bone on the right ascending ramus.  The mass measures c. 56.4mm superoinferior x c. 42.1mm anteroposterior x c. 30mm mediolateral.  The medial surface of the assenting ramis is heavily pitted.

Co-existing pathology:Teeth lost pre-mortem: LL3,5,6: LR4,5,6.  Teeth lost post-mortem: LL1,2,3,4,7,8: LR 1,2,3,4,,7,8.  LL7, LR7 severe mesial tilt indicating LL6, LR6 had been lost when individual aged 12 -18 years.

Conference Report: Society for American Archaeology 78th Annual Meeting, Honolulu, Hawai’i & visit to JPAC-CIL

Aloha!

A representative from the Digitised Diseases project (Emma, plus advisory panel member Rob Janaway) were lucky enough to get the chance to attend the Society for American Archaeology 78th Annual Meeting in Honolulu, Hawai’i.

Foliage at the Hawai’i Convention Center

Emma was presenting some of the findings from her recently defended PhD, but was also on hand on the University of Bradford stand in the Kamehameha III Exhibition room to talk about Digitised Diseases. The feedback was overwhelmingly positive, with one tenured professor from a US institution telling us she was already using the 3D models from From Cemetery to Clinic in her teaching. Many undergraduate and postgraduate students also said they thought the project would definitely help them with their studies.

There were a number of digitisation projects and exhibitors at the conference, indicating the growing importance of 3D laser scanning in archaeology, for example we met representatives from the Center for Digital Archaeology at UC Berkeley and saw numerous use of terrestrial 3D laser scanning for in situ remains, for example a lovely project currently being undertaken at Çatalhöyük. 

Hawai’i is also home to the Joint Prisoner of War/Missing in Action Command Central Identification Laboratory (JPAC-CIL). Their civilian staff are tasked with the mission to conduct global search, recovery, and laboratory operations to identify unaccounted-for Americans from past conflicts. The work carried out by JAPC-CIL is highly regarded by forensic anthropologists and archaeologists the world over. JPAC-CIL also run a highly regarded Forensic Science Academy which specialises in skeletal analysis.

Over the duration of the SAA conference, scientists from all over the world visited JPAC to present their research to the JPAC-CIL staff. Emma gave a 50 min presentation on the two JISC funded Digitisation projects that have been based at Bradford. The feedback was again really positive. A key part of understanding the range of normal human anatomy is to recognise pathological changes that may drastically affect the appearance of bone. Digitised Diseases should further aid the students at the Forensic Science Academy to observe pathological changes in bone and (hopefully) provide the more senior anthropologists with a valuable reference guide, in addition to key palaeopathology texts.

Image from JPAC Teams Facebook page (https://www.facebook.com/JPACTeams)

The staff at JPAC-CIL made us feel very welcome and provided us with helpful feedback. It was an amazing experience and a real privilege to be able to see first hand the important work carried out in identifying American casualties from past conflicts.

Pathology of the Week

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April Fool

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This skull was a recent acquisition at the University of Branford, donated to us by the eminent Professor H. Oxley from Leeds.  After scanning the cranium we conducted morphometirical analysis and compared it with all known modern and fossil hominid morphology.  We have also compared this morphology and measurements with known skulls misshapen by cultural deformation.  After intense scrutiny from an international team of scientists, we can confirm that the cranial shape is natural; however, it does not resemble any known hominid species.  Further, we had initial difficulty in scanning the specimen as it seems to have an anomalous magnetic field.  We have tested the material for all known probable causes of this abnormality, but have yet to find its cause.   Renowned archaeologist Professor I. Jones from the University of Chicago is currently acquiring further artifacts in Nazca, Peru.  He says he will not until hang up his hat until this mystery is solved.

Cranium

There is considerable modification of the cranial vault.  The cranium is flattened anteroposteriorly on the frontal, occipital and posterior portion of the parietals. The cranium vault is broad and high.   The individual has a cranial index of 115.89 and a cranial length-height index of 106.6, which is highly hyperbrachycrany (very broad headed) and hypsicrany (high skull).   The cranium is asymmetric, with the left side larger and more bulbous than the right.

Maximum length (g-op)- 151mm; Maximum breadth (eu-eu)- 175mm; Basion-Bregma Height (ba-b)-161mm; Cranial base length (ba-n)- 89mm; Upper facial height (n-pr)-72mm; Minimum Frontal breadth (ft-ft)-98mm; Upper facial breadth (fmt-fmt)-107mm; Nasal height (n-ns)- 47.5mm; Nasal breadth (al-al)-22.5mm; Orbital breadth (d-ec)-38.5mm Left, 40.5mm Right; Orbital height-35.5mm Left, 34mm Right; Frontal Cord (n-b)-102mm; Parietal cord (b-l)-97mm; Occipital cord (l-o)-96mm

(Updated information about this specimen will be available in full, once the project website goes live).

Pathology of the Week

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This is an individual from Westness, Orkney who has posttraumatic osteolysis of the femoral neck.  In this case osteolysis could have been initiated by a traumatic event or abnormal stress resulting in fracture of the neck.  The rate of absorption of the neck is rapid and has been found to take as little as 23 days. The femoral head may remain intact the acetabulum, but it becomes devascularised (Lambiase et al. 1999).

Right femur

The femoral neck is absent, with no indication of infection.  There is a continuous cortical surface over the neck region from the anterior to the posterior margins.  The trochanteric fossa is enlarged.  Little evidence remains for new bone formation; however, inferior to the trochanteric fossa is a large ovoid post-mortem depression that precludes observations of bony changes in this area.  There is a large shallow depression–likely caused by stress on the musculature and ligamanets–that is located at the intertrochanteric line and extending inferiolaterally.  There is an enlargement of the anterior portion of the greater tubercle and enthesopytes adjacent to the lesser tubercle.

Surrounding the fovea is a large area of bone destruction and exposure of the trabeculae with new irregular compact bone along the margin.  This does not have the appearance of avascular necrosis.   Along the inferior margin is an area of osteophytosis.  There is post-mortem damage to the lateral portion of the femoral head and, therefore, it is not known what bony changes would have occurred in response to the osteolysis of the neck.

Lambiase, R.E., Levine, S.M., Froelich, J.A, 1999. Rapid osteolysis of the femoral neck after fracture. American Journal Roentgenology, 172: 489-491