Two cases of neurogenic paralysis in medieval skeletal samples from Croatia

A possible case of paralysis in early modern Vilnius and the implications for social care

OBJECTIVE

To present a case of possible paralysis from early modern Vilnius and to discuss the potential level of care that was provided in the society of that time.

MATERIALS

A partially disturbed skeleton of a young female from a 16th-17th century Orthodox Christian cemetery.

METHODS

Macroscopic, osteometric and X-ray examinations coupled with a literature review aimed at providing a differential diagnosis.

RESULTS

The skeletal remains showed signs of disuse atrophy most probably due to a neurological disorder acquired in the woman's late teens. Differentials suggest that the observed limb atrophy was most likely a consequence of poliomyelitis.

CONCLUSIONS

The case of a young female with paralysis presented in this paper could serve as an example of care provided by her household.

SIGNIFICANCE

This study substantially contributes to further understanding of the nature and quality of care provided to disabled individuals in their households even in the absence of written sources.

LIMITATIONS

There is a degree of diagnostic ambiguity due to the application of routine clinical criteria to paleopathological cases.

SUGGESTIONS FOR FURTHER RESEARCH

The article makes several recommendations for future research, e.g., systematic investigation of possible cases of bone atrophy in a broader sociocultural context, as well as searching for evidence of gastrointestinal infections, especially poliomyelitis, supplemented by the application of biomolecular technologies.

Challenging definitions and diagnostic approaches for ancient rare diseases: The case of poliomyelitis

OBJECTIVE

This paper aims to contribute to the definition of ancient rare diseases in skeletons displaying pathologies associated with paralysis. It uses a new suite of methods, which can be applied to challenging cases of possible paralysis in archaeologically-derived human skeletal material, specifically applied to the identification of poliomyelitis.

MATERIALS

An adult male skeleton from Roman Halbturn, Austria.

METHODS

Morphological and entheseal change analyses, CT scans, X-rays, cross-section morphology, and histology, alongside modern clinical, as well as historic, literature were used to discuss paralyses.

RESULTS

The results suggest a diagnosis of poliomyelitis; now considered a rare disease, but perhaps ubiquitous in antiquity, thus complicating the definition of 'rare disease'.

CONCLUSIONS

The integrated methodological procedures employed for this case constitutes a replicable and thorough approach to diagnosis, and explores the nature of ancient rare diseases. Due to the socio-environmental aspects of poliomyelitis transmission, it is likely that polio was likely not rare in the past. Therefore, the definition of 'rare diseases in the past' must include rarely occurring rarely diagnosed diseases due to biases and challenges within the archaeological and environmental record.

SIGNIFICANCE

The developed suite of methods has not been applied to establish a diagnosis of polio in the past.

LIMITATIONS

The individual considered in this study is fairly well-preserved; thus, this set of analyses may not be applicable to all remains where preservation is poor or highly fragmentary, and the discussion of rare diseases requires relatively secure diagnoses and context.

SUGGESTIONS FOR FURTHER RESEARCH

Large collections and series of skeletal human remains are recommended to develop definitive conclusions.

Asymmetric midshaft femur remodeling in an adult male with left sided hip joint ankylosis, Metal Period Nagsabaran, Philippines

OBJECTIVE

This study investigated microstructural changes of the right and left midshaft femur in an archaeological individual afflicted with left-sided hip joint ankylosis to assess whether increased cortical porosity was present as a result of leg disuse.

MATERIALS

The individual is a middle-aged adult male excavated from the Metal Period (∼2000 BP) Nagsabaran, Luzon Island, Philippines.

METHODS

Following standard examination of femur gross anatomy and differential diagnosis of the hip joint fusion, ∼1 cm thick posterior midshaft femur samples were removed for microstructural examination. Using static histomorphometry, bone multi-cellular unit activity from Haversian canal (vascular pore) density, area, and circularity was reconstructed. Spatial positioning of Haversian canals was mapped using Geographic Information Systems software. Phosphate, carbonate, and carbonate:phosphate ratios were obtained using synchrotron-sourced Fourier transform infrared microspectroscopy.

RESULTS

The left femur had greater cortical pore density, with smaller and rounder vascular canals, in addition to lower matrix levels of phosphate and carbonate, when compared to the right femur.

CONCLUSIONS

Our data indicate compromised bone tissue in the left femur, and conform to expected bone functional adaptation paradigms of remodeling responses to pathological and biomechanical changes.

SIGNIFICANCE

The preservation of this individual's hip abnormality created a unique opportunity to evaluate intra-skeletal bone health asymmetry, which may help other researchers evaluate the presence of limb disuse in archaeological samples.

LIMITATIONS

A lack of lower limb data limits our interpretations to femur remodeling only.

SUGGESTIONS FOR FURTHER RESEARCH

Future research efforts should aim to examine the presence of remodeling changes in all bones of the lower limb.

LAYUNIN

Gamit ang buto ng magkabilang pemur ng isang taong natagpuan sa isang archaeological site na may sakit na ankylosis sa kaliwang balakang, pinag-aralan ang iba't-ibang microstructures galing sa gitnang bahagi o midshaft ng pemur upang malaman kung may makikitang mataas na cortical porosity ang buto dahil hindi ito malimit gamitin.

GAMIT

Ang pinag-aaralang buto ay galing sa isang indibidwal na tinatayang middle-age na lalaki na namuhay noong Panahon ng Metal (∼2000 BP) sa Nagsabaran, Cagayan, Republika ng Pilipinas.

PAMAMARAAN

Matapos ang unang pagkilatis sa femur at ang pagkilala ng sakit sa balakang, kumuha ng ∼1 sentimetro ng buto galing sa midshaft ng pemur upang lalong mapag-aralan ang kanyang microstructure. Gamit ang static histomorphometry, napag-aralan ang mga naiwang bakas ng multi-cellular unit activity ayon sa kapal, laki at pagkakabilog ng Haversian canal (vascular pore). Gumamit din ng Geographic Information Systems (GIS) software upang mapag-aralan ang kaugnayan ng posisyon ng Haversian canal. Panghuli, gumamit din ng synchroton-sourced Fourier transform infrared (sFTIR) microspectroscopy upang makuha ang bilang ng phosphate, carbonate, at carbonate:phosphate ratio.

RESULTA

Napag-alaman na ang kaliwang pemur ay mayroong higit na maraming cortical pores, maliit at mabilog na vascular canals, at mababang bilang ng phosphate, carbonate kung ihahambing sa kanang pemur.

KONKLUSYON

Ayon sa aming datos, ang kaliwang pemur ay umaayon sa mga katangian ng isang butong may sakit. Sumunod din ito sa inaasahang bone functional adaptation paradigms of remodeling ng buto dahil may sakit at hindi nagamit.

KAHALAGAHAN

Dahil maganda ang pagkakalibing ng buto ng balakang, nagkaroon ng pagkakataong makilatis ang kalusugan ng sinaunang-tao sa pamamagitan ng pag-aaral ng kalusugan ng buto. Dagdag pa, makakatulong din ito upang malaman kung ibang mananaliksik ang pag-aaral ng ibang butong hindi nagagamit mula sa archaeological site.

LIMITASYON

Dahil walang nakuhang ibang buto mula sa binti at paa, ang pemur lang ang naimbestigahan.

MUNGKAHI PARA SA MGA SUSUNOD NA PAG-AARAL

Kung magkakaroon ng pagkakataon sa susunod, dapat maimbistigahan ang lahat ng buto ng binti (lower limb).