Modern Paleopathology, The Study of Diagnostic Approach to Ancient Diseases, Their Pathology and Epidemiology : Let There Be Light, the Light of Science and Critical Thinking

The study of paleopathology has two very different constituencies, the medical scientist and the zoologist/paleontologist/anthropologist. Their investigative procedures and professional jargon are different, sometimes to the point of mutual incomprehensibility. Paleontologists/anthropologists/zoologists have a limited data base for the characterization and interpretation of pathology. This must come from the human and veterinary medical experience. What, beyond intellectual satisfaction, can the health care community expect from this relationship? The past history of the appearance and dispersal of infectious disease and cancer is of considerable theoretical importance and leads to new insights on the nature and transmission of diseases that are otherwise ambiguous. The discovery of rheumatoid arthritis in pre-Columbian North America exemplifies insights gained. The current effort delineates osseous impact of disease (as manifest in clinical populations diagnosed in life), representation in the zoologic, paleontologic and anthropologic record, and assessment techniques that can be confidently applied. The chapters form “columns” that provide the foundation for scientific critical thinking. The actual integration of the information is in its application. Our purpose is to provide a data base and atlas of actually documented skeletal impact of diseases (as population phenomenon), an initial data base of reported skeletal pathology, and a methodology for expanding this to new arenas. The first section of the book examines the scientific basis of paleopathology, its transition from speculation-based musings, resolution of misconceptions and the denouement of paleo-epidemiology. The second section provides holistic analysis of the gamut of pathology/diseases with significant skeletal impact, with a validated archeologic/zoological/paleontological record. The third section provides a glossary to resolve the semantic challenges inherent to interdisciplinary efforts. The fourth section provides an atlas of pathology representation in the fossil record. Ultimately, this book intends to present a scientifically-validated approach to recognition of disease in the archeological, zoological and paleontological record, superseding previous speculation-based offerings. Foreword: Pathology Foreword: Anthropology-Archeology Foreword: Paleontologic Foreword: Veterinary Medicine Preface Acknowledgments Contents About the Authors Part I: Scientific Basis for Paleopathology Chapter 1: Philosophy of Science Paleopathology as a Science Origins of Paleopathology Transition from Speculation to Science Speculation Approach Diagnostic Nihilism Actualism Intrinsic, Contextual, and Inferential Considerations Pathology Speaks for Itself Vetting Premises Reproducibility and Bias in Study Samples Cultural/Geologic Context Theoretical/Philosophical Considerations Fundamentals of a Scientific Approach “Spectral” Diagnoses The Testable Hypothesis Collaborative Approaches, Learning Curves, and Semantics Understanding Controversy Application of Scientific Methodology Establishment of Criteria for Disease Recognition Paleoepidemiology Documented Reproducibility Database Behavior Inferences as to Life Impediments Denouement Chapter 2: Osseous Structures and Their Response Repertoire The Nature of Bone The Nature of Growth Cortical and Trabecular Bone Bone Types and Structures Lamellar Bone Woven Bone Metaplastic Bone Dermal Bone Medullary Bone Pachycephalosaurid Skull Lesions Periosteum Bone Atrophy Epiphyseal Clefts Osseous Structures of Biologic Origin and Their Mimics Antlers Enamel Dentine and Dermal Bone Healing Bone Response to “Stress” Density Osteosclerosis and Hyperostosis Limited or Focal Hyperostosis “Growth Arrest” Lines: Actually Growth Restoration Lines Size and Shape Expansion Bowing Remodeling Cribotic Bone Alterations Erosive Disease Peri-lesional Alterations Cortical Integrity Osteolysis Periosteal Reaction Cortical Hyperostosis Enthesial Reaction (See Also Chap. 7) Bone Ankylosis/Fusion Vertebrae Are Special Osteophytes and Shape Variation Lumbar Lordosis and Vertebral Shape Hemivertebrae Vertebral Endplates Defects Surface Deposits Schmorl’s Nodes Linear Defects Zoologic/Paleontologic Record Hips Are Special Cribra Femora Allen’s Fossa Herniation Pit Impingement Syndromes Poirier’s Facet Femoral Plaque Ballooned Bones Variations on a Theme Chapter 3: Documentation of Preservation Petrifaction/Ossification Semantics Extra-skeletal Phenomena and Their Mimics Uroliths Gallstones Bezoars Regurgitalites Gastroliths Coprolites Hydatid Cysts Leiomyoma: Uterine Fibroids Thyroid Nodules Calcified Tissue Nodules Calcified Lymph Nodes Renal Masses Gastrointestinal Disease-Related Calcifications Intervertebral Disk Calcification (See Also Chap. 5) Lithopedian Teratoma Myositis Ossificans Fibrodysplasia Ossificans Progressiva (FOP) Calcific Masses of Unclear Derivation Soft Tissue Preservation Structures Skin Red Blood Cells Parasites Diet and Gastrointestinal Content Trackways Microscopic Preservation Mummies Molecular Preservation Protein DNA Lipids Denouement Chapter 4: Postmortem Alterations of Bone (Diagenic Changes) and Their Interpretation The Challenge Mechanical and Meteorological Factors Biologic Factors Chemical Factors Denouement Chapter 5: Critical Thinking Identifies Misconceptions and False Trails Illusion: Unsupportable Diagnoses Porosity: A Phenomenon in Search of Significance Location of Cortical bone Alterations Within or on a Bone Melanoma Diagnosed on Basis of Color Changes Ochronosis: Where Technique and Logic Collide Observations Without Controls Apparent Lack of Reliability of Testing Bone Density Blood Group Misunderstanding of Clinical Medicine Apparently Untestable Diagnoses Rheumatoid Factor Histocompatibility Antigen (HLA-B27) Unfounded Notions Untested Criteria: Problematic Topics in Paleopathology The Myth of the Osteological Paradox The Myth that Disease-Induced Bone Alterations Documented in Known Afflicted Individuals Cannot Serve as Models for General Recognition of Disease The Myth that Disease-Induced Bone Alterations Observed in Humans Cannot Serve as Models that Are Comparable to that in Other Species The Myth that Disease-Induced Bone Alterations Alter Sufficiently over Time to Preclude Comparison with Observations in Modern Individuals The Myth of Osteologic Manifestations of Iron Deficiency The External Appearance of Normal Cortical Bone The Myth of Nonspecific Periosteal Reaction Sphenoid Porosity Identifies Scurvy The Mythology Related to Interpretation of Enthesial Changes The Mythology of Cranial Suture Fusion as a Measure of Age Evolution of Virulence Conflating Interpretation with Observation Assumption that Presence of Pathology Implies Impairment Conflating Severity and Disability Questionable Approaches: Superficiality Taking Attributions at Face Value Failure to Validate Limited Differential Diagnostic Considerations Application of Statistical Techniques Stress as a “Scapegoat” Apparent Attempt to Obviate Inconvenient Evidence (Powell and Cook 2005a, b) Bias Resolution Chapter 6: Diagnostic Approach/Techniques Macroscopy and Surface Imaging Radiologic Techniques Theory Standard X-Ray Technique Fluoroscopy Xeroradiography and Its Replacement for Edge Enhancement and Increased Resolution Magnification Radiography Tomography Computerized Tomography Micro-CT Magnetic Resonance Imaging Three-Dimensional Images Special Considerations Sacroiliac Joints Zygapophyseal Joints Sinuses Microscopy Direct Light Microscopy Raman/Infrared Spectroscopy Immuno-Microscopy Electron Microscopy and X-Ray Diffraction Three-Dimensional versus Two-Dimensional Imaging Molecular Techniques DNA Protein Identification, Proteomics, and Isotope Analysis Lipids Part II: Holistic Analysis of Pathology/Diseases with Significant Skeletal Impact Chapter 7: Mechanically Derived Phenomena Direct and Indirect Evidence Bone Bruises and Other Trauma-Related Bone Evidence Bite, Claw, and Horn Injuries Exostoses Osteochondroma Osteochondritis and Osteochondrosis Osteochondritis Osteochondrosis Schmorl’s Nodes (See Chap. 2) Fractures Epidemiology Mechanisms Greenstick Fractures Vertebral Fractures Pilon and Impact Fractures Spondylolisthesis Implications Spontaneous Osteonecrosis Fracture Healing The Zoologic/Paleontologic Record Stress Fractures Nature Epidemiology Appearance Differential Diagnosis The Zoologic/Paleontologic Record Enthesial Phenomena Fibrodysplasia Ossificans Progressiva (See Chap. 3) Tendon Avulsions Diffuse Idiopathic Skeletal Hyperostosis (DISH) Axial Skeleton Peripheral Skeleton Significance Differential Diagnosis Spondylosis Deformans (See Below) Spondyloarthropathy (See Chap. 8) Osteoarthritis Neuropathic Arthritis and Calcium Pyrophosphate Deposition Disease (See Below and Chap. 8) Miscellaneous The Anthropologic/Zoologic/Paleontologic Record Osteoarthritis Semantics Nature of Disease Differential Diagnostic Consideration Recognition of Osteoarthritis Eburnation as a Source of Confusion Pathophysiology Misdirection The Anthropologic Record Age Primary and Secondary Patterns Shoulder Elbow Wrist Vertebra The Zoologic/Paleontologic Record Erosive Osteoarthritis Neuropathic Arthritis Disability Denouement Speculations as to Behavior Implications Chapter 8: Inflammatory Arthritis Rheumatoid Arthritis Rheumatoid Erosions Character Rheumatoid Joint Distribution Reproducibility Differential Diagnosis Contrast with Spondyloarthropathy (See Below) Contrast with Gout (See Below) Contrast with Calcium Pyrophosphate Deposition Disease (See Below) Contrast with Infectious Arthritis (See Chap. 9) Contrast with Osteoarthritis (See Chap. 7) Validation of the Rheumatoid Arthritis Recognition in Defleshed Bones Anthropologic Aspects of Rheumatoid Arthritis Diagnostic Confusion: The Lumper-Splitter Controversy Distinguishing Criteria Biomechanical Evidence Archaeological Record Subgroup Comparison Nature of Erosive Arthritis in Animals Conclusion Pseudo-rheumatoid: Unsubstantiated Diagnoses Absence of a Zoological/Paleontological Record Spondyloarthropathy Nomenclature Character Ankylosing Spondylitis and Inflammatory Bowel Disease Psoriatic Arthritis, Reactive Arthritis, and Undifferentiated Forms Differential Diagnostic Considerations Infectious Spondylitis Diffuse Idiopathic Skeletal Hyperostosis and Ligamentous Ossification (See Chap. 7) Rheumatoid Arthritis (See Above) Calcium Pyrophosphate Deposition Disease (See Below) Gout (See Below) The Archaeological Record New World North America South America Old World Europe Africa Asia The Zoological/Paleontologic Record Trans-phylogenetic Distribution Epidemiology Denouement Juvenile Arthritis Juvenile Rheumatoid Arthritis/Juvenile Inflammatory Arthritis Nature of Disease Osteology Differential Diagnosis of the Pauciarticular Variety Juvenile Spondyloarthropathy (JSpA) Archaeological Record Gout Nature of Disease Character Skeletal Distribution of Lesions Population Prevalence and Predisposition Differential Diagnosis Anthropologic Record Zoologic/Paleontologic Record Calcium Pyrophosphate Deposition Disease (CPPD) Character of Disease Axial Disease Erosion Mimics Pseudo-rheumatoid Manifestations Primary Versus Secondary Alternative Interpretation of Deposits on Bone Differential Considerations Archaeological Record Zoologic/Paleontologic Record Chapter 9: Infectious Disease Bone Infection Neutrophil and Heterophil-Responsive Infections Character Radiology Histology Differential Diagnosis Archaeological Record Zoologic/Paleontologic Evidence of Infectious Disease Melioidosis Erysipelothrix Sinus Infections Chronic Recurrent Multifocal Osteomyelitis (SAPHO) Character Archaeological Record Zoological/Paleontologic Record Special Considerations Actinomyces: The Branching, Acid-Fast Bacteria Character Archaeological Record Zoologic/Paleontologic Record Brucellosis Character Archaeological Record Zoologic/Paleontologic Record Plague Trachoma Osteoperiostitis Mycobacterial Disease Non-lepromatous Mycobacterial Disease Mycobacterium Tuberculosis Character Archaeological Record Zoologic/Paleontologic Record Mycobacterium bovis Atypical Mycobacterium Tuberculosis Mimics Tuberculosis-Like Findings in the Paleontologic Record Sarcoidosis Mycobacterium Leprae Character Archaeological Record Zoologic/Paleontologic Record Fungal Disease Histoplasmosis Blastomycosis Coccidioidomycosis Paracoccidioidomycosis Cryptococcus Candidiasis Sporotrichosis Archaeological Record Zoologic/Paleontologic Record Treponemal Disease Character of Disease Syphilis Bejel Yaws The Data The Preconceived Notion Reproducibility of Findings Pinta Distinguishing Among the Treponematoses Ancillary Issues Differential Diagnosis from Non-treponemal Disease Treponematosis: Anthropology-Related Considerations Syphilis North America Entry of Treponemal Disease Character and Distribution of Disease East of the Sierras Character and Distribution of Disease West of the Sierras Mexico Alternative Perspective South America and the Caribbean Documentation of Existence at Site of Columbian Contact: Prior to Columbus Denouement Africa Europe Asia and Asian Pacific Asian Pacific Mainland Asia Zoologic/Paleontologic Record Parasitic Infections Trichomonas Echinococcus Malaria Ticks Archaeological Record Zoologic/Paleontologic Viral Disease Variola Rubella Cytomegalovirus Anthrax Poliomyelitis Hantavirus Archaeological Zoologic/Paleontologic Evolutionary Misconceptions of Infectious Disease Evolution of Infectious Disease Chapter 10: Hematologic Disease Text Bleeding Disorders Anemia Porotic Hyperostosis and the Myth of Its Attribution to Iron Deficiency Anemia The Obverse: Iron Deficiency Produces Hypoplastic Marrow Absence of Skull Changes from Documented Primary Iron Deficiency Fallacy of Skeletal Recognition of Iron Deficiency Deficiency-Derived Anemia Hemolytic Anemia Overlooked Hemolytic Anemia Thalassemia: Also Known as Cooley’s or Mediterranean Anemia Sickle Cell Anemia Anthropologic Record Sickle Cell Zoologic/Paleontologic Record Chapter 11: Metabolic/Endocrine Disorders Growth Lines Osteoporosis Growth Hormone Overproduction Growth Hormone Underproduction Thyroid-Related Disorders Hyperparathyroidism Hypoparathyroidism Miscellaneous Endocrine Disorders Thiamine and Niacin (Pellagra) Deficiency Hypervitaminosis A Hypovitaminosis A Vitamin C Deficiency (Scurvy) Osseous Manifestations The Falsified Sphenoid Porosity Speculation Documented Archaeological Cases Suggested Cases That Likely Have Other Explanations Documented Zoologic/Paleontologic Cases Osteomalacia and Rickets Renal Osteodystrophy Leontiasis Ossea The Archaeological/Zoologic/Paleontologic Record Homocystinuria Hyperphosphatasia/Hyperphosphatemia Hypophosphatasia Osteosclerotic Diseases Osteopetrosis Avian Osteopetrosis Mammalian Osteopetrosis Osteopetrosis in Dinosaurs Melorheostosis Paget’s Disease of Bone “Osteoperiostitis” Liver Disease Iron Storage Disease Copper Storage Disease Copper Deficiency Molybdenum Toxicity Ochronosis Infiltrative Diseases Type IIa Hyperlipoproteinemia Multicentric Reticulohistiocytosis Lysosomal Storage Diseases Gaucher’s Disease Mucopolysaccharidosis (MPS) Type I Mucopolysaccharidosis (Hurler Syndrome) Type II Mucopolysaccharidosis (Hunter Syndrome) Type III Mucopolysaccharidosis (Sanfilippo Syndrome) Type VI Mucopolysaccharidosis (Maroteaux-Lamy Disease) Type VII Mucopolysaccharidosis GM1 Gangliosidosis GM2 Gangliosidosis (β-Hexosaminidase Deficiency) I-Cell Disease: Mucolipidosis II Mucolipidosis III: Pseudo-Hurler Polydystrophy Mannosidosis Niemann-Pick Disease Membranous Lipodystrophy Farber’s Lipogranulomatosis Miscellaneous Storage Diseases Amyloidosis Mast Cell Disease Manganese Deficiency Pancreatic Disease Metabolic Diseases Associated with Increased Bone Density Oxalosis Fluorosis Bismuth-Related Silicosis Mercury-Related Lead-Related Congenital Dwarfism Teratology Klippel-Feil Syndrome Arthrogryposis Miscellaneous Archaeological Record Zoologic/Paleontologic Record Epiphyseal Abnormalities Osteochondrosis Homeobox Disorders Axial Skeleton Segmentation Disorders Shape Modification Schmorl’s Nodes Slipped Femoral Epiphyses Scheuermann’s Disease Spina Bifida Third Metatarsal-Tarsal Joint Coalitions Fused Carapace or Plastron Inherited Osteosclerotic Phenomenon Melorheostosis Pregnancy-Related Issues Chapter 12: Vascular Phenomenon Hemangiomas and Vascular Anomalies Aneurysms Vascular Considerations Related to Red Blood Cell Size Bone Infarcts Avascular Necrosis Nature Etiology Protective Mechanisms Anthropologic Record Zoologic/Paleontologic Record Chapter 13: Bone Neoplasia and Skeletal Dysplasia Introduction Peto’s Paradox Skeletal Dysplasia Bone Cysts Bone Islands Osteogenic Bone Tumors Osteoma Hamartoma Osteoblastoma Osteosarcoma Periosteal Osteosarcoma Parosteal Osteosarcoma Cartilaginous Bone Tumors Chondroma Enchondroma Chondroblastoma Chondromyxoid Fibroma Chondrosarcoma Fibroma Giant Cell Tumors Ewing Sarcoma Soft Tissue Sarcomas Chordromas Vascular Tumors Lipid Cell Tumors Liposclerosing Myxofibrous Tumor Histiocytic Tumors Neurofibromatosis Leukemia and Lymphoma Leukemia Lymphoma Multiple Myeloma Characteristics Differential Diagnosis Waldenström’s Macroglobulinemia Metastatic Cancer Hypertrophic Osteoarthropathy Osseous Characteristics Differential Diagnosis Significance Mandibular Masses Adamantinoma The Archaeologic Record Dysplasias Bony Overgrowths Benign Tumors Histiocytosis Malignant Tumors Primary Bone Tumors Direct Spread Metastatic Cancer Hypertrophic Osteoarthropathy Multiple Myeloma Leukemia The Zoologic/Paleontologic Record Hypertrophic Osteoarthropathy Chapter 14: Cranial Phenomena Fronto-Parietal Pores Marrow Expansion (Porotic Hyperostosis) Producing Hair-on-End Appearance Documentation Misdiagnosis Attributions: False and Challenged (See Chap. 5) Oldest Recognition Frontal Bossing Sinusitis Cholesteatoma Otitis Media Cribra Orbitalia Initial Perspective Anatomy Clarified Conflation with Porotic Hyperostosis Past Attributions Phylogenetic Distribution Cribotic Humeri and Femora Pressure Phenomenon Skull Defects Attributed to Parasites Caries Sicca Endocranial Impressions and Serpens Endocrania Symmetrica Cranial Hyperostosis Hyperostosis Frontalis Interna Meningioma Cranial Hemangiomas Parietal Thinning External Auditory Exostoses Dental Chapter 15: Case Studies A Point in Time Angulated Vertebral Column Anomalous Anomaly Articular Surface Defects Beware Taphonomy Chasing Ghosts Crooked Smile Crossing Barriers Excavated Vertebrae Hats Off Holey Skull Il y à – There Exists It Is Not Acne Lion Face Location, Location, Location Lumpy Joints Optical Illusion Rays, but Not of Sunshine Recognizing Trees in the Forest Saber Shin Deformity Swollen Spines The Striation Neologism Ticks and Fleas To Be or Not to Be What Does Not Belong Whittling with Fused Feet Glossary Bibliography Index