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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.

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