Paleopathology of Children

Identification of Pathological Conditions in the Human Skeletal Remains of Non-Adults

Mary Lewis

• Publisher: Academic Press
• Year: 2017
• ISBN:
  9780124104396
• Topic: Medicina
• Subtopic: Patología

Palaeopathology of Children: Identification of Pathological Conditions in the Human Skeletal Remains of Non-Adults provides archaeological examples of pathological child remains with varying degrees of disease manifestation, and where possible, presents illustrations of individually affected bones to help with identification. The structure and inclusion of photographs and summary diagnostic tables make this suitable for use as a textbook. Each chapter includes a table of international archaeological cases collated by the author from published and unpublished literature.

Child skeletal remains come in a variety of different sizes, with bones appearing and fusing at different times during growth. Identifying pathology in such unfamiliar bones can be a challenge, and we often rely on photographs of clinical radiographs or intact anatomical specimens to try and interpret the lesions we see in archaeological material. These are usually the most extreme examples of the disease, and do not account for the wide degree of variation we may see in skeletal remains.

• Provides a comprehensive review of the types of pathological conditions identified in non-adult skeletal remains
• Contains chapters that tackle a particular disease classification
• Features for each condition are described and illustrated to aid in the identification

Chapter 1

Biology and Significance of the Nonadult Skeleton

Abstract

This chapter introduced the importance of the study of child paleopathology to our understanding of health in the past. The development of child studies is discussed, along with a brief outline of growth and development, bone modeling and remodeling, and the evolving immune system. Issues regarding hidden heterogeneity, frailty, diseases selectivity, lesion expression, and differential diagnoses are explored in regard to the study of a child’s skeletal remains.

Keywords

Differential diagnosis; Frailty; History; Immunity; Pediatric bone

Chapter Outline

Introduction

Skeletal Development and Ossification

Intramembranous Ossification

Endochondral Ossification

Bone Formation and Remodeling

Pattern and Timing of Ossification

Immune System Development

Immunity in the Newborn

Immunity in the Child

Immunity in the Adolescent

Exploring Immunodeficiency in Bioarchaeology

The Developmental Origins of Health and Disease Hypothesis

Factors in Pediatric Paleopathology

Themes in Child Paleopathology

Hidden Heterogeneity of Frailty and Selective Mortality

Measuring Specificity

A “Slew” of Possibles: Methodological Rigor, Transparency, and Objectivity

Differential Diagnosis

Comorbidity and Cooccurrence

References

Introduction

A child's skeleton carries a wealth of information about their physical and social life; from their birth, growth and development, diet and age at death, to the social and economic factors that exposed them to trauma and disease at different stages of their brief lives. Cultural attitudes dictated where and how infants and children were buried, when they assumed their gender identity, if they were sacrificed or exposed to physical abuse, and at what age they were set to work or considered adults. As vulnerable members of a society who are wholly dependent on the care of others, understanding the survival of infants has the potential to provide an accurate measure of a population’s ability to adapt to their particular environmental circumstances (Mensforth et al., 1978). Children have emerged as important social actors in the past, contributing to material culture and influencing the archeological record (Baxter, 2006, 2008), and we are increasingly aware of their importance to our understanding of past society, culture, and the life lived (Halcrow and Tayles, 2011). A child's genetic inheritance may determine their level of frailty and susceptibility to disease and death, but their health is profoundly influenced by overlapping and interconnected socioeconomic layers, comprising their family, immediate social environment, and cultural norms that dictate their lives (World Health Organisation, 1993) (Fig. 1.1). As children age and begin to interact with their peers and their wider surroundings they are exposed to new physical hazards and pathogens (Halcrow and Tayles, 2011; Kamp, 2006), and these risks increase as they enter adolescence (Lewis et al., 2015). Hence, our understanding of disease and trauma in a child in the past must also be informed by their physical age and transforming social identity that influenced their freedoms and experience of risk.

Early reports of pathological lesions in children's skeletal remains are rare, perhaps due to a previous misconception that these individuals would have died too soon for lesions of chronic disease to be expressed on their skeleton. Child paleopathology had a few early pioneers. The earliest report of pathology in a child from an archeological context was by Shattock (1905) who identified bladder stones in a 16-year-old and an “adolescent male” from Egypt. In 1915, Bolk examined premature cranial suture closure in nonadult skulls from a cemetery in Amsterdam, while Derry (1938) described tuberculosis in a 9-year-old. Williams et al. (1941) suggested multiple myeloma for the lytic lesions present in a 10-year-old from 13th-century Rochester, New York, and 10 years later, Stewart and Spoehr (1951) argued for the presence of yaws in a 14-year-old from Malaysia. This case still remains as one of the few examples of yaws in the paleopathological literature. In England, Brothwell (1958) identified leprosy in an isolated child skull from medieval Scarborough Castle, and Wells (1961) described the first case of Scheuermann’s disease in paleopathology in the spine of a 16-year-old female from Bronze Age Dorset. Brothwell (1960) continued to highlight the importance of examining nonadult skeletons adding a potential case of Down syndrome to his body of research. In the 1970s, studies that focused on dental disease (Lunt, 1972; Moore and Corbett, 1973, 1975, 1976) and physiological stress indicators demonstrated the potential of population analysis over individual case studies for understanding child health (Cook and Buikstra, 1979; Mensforth et al., 1978; Mulinski, 1976). A series of articles by Ortner et al. (Ortner and Utermohle, 1981; Ortner, 1984; Ortner and Hunter, 1981) highlighted juvenile arthritis, osteomyelitis, and scurvy, while Hinkes (1983), Hummert (1983), and Storey (1986) carried out the first large-scale studies that concentrated on the health of children from the Grasshopper Pueblo, Sudan, and Mexico, respectively. At the same time, Schultz (1984) began extensive research into the histological evidence for disease in prehistoric child samples from numerous sites across Europe. By the late 1990s studies of nonadult paleopathology had become more commonplace, and today the discipline has fully matured. Our analysis has gone beyond simple identification to a more nuanced approach to the investigation of comorbidity and cooccurrence of disease in childhood (Crandall and Klaus, 2014; Schattmann et al., 2016; Snoddy et al., 2016) and the role children play in our understanding of sacrifice, caregiving, and violence in the past (Crandall et al., 2012; Kato et al., 2007; Klaus, 2014a; Mays, 2014). Advances have been made in the identification of accidental and nonaccidental trauma (Verlinden and Lewis, 2015; Wheeler et al., 2013), tuberculosis (Lewis, 2011; Santos and Roberts, 2001), mercury treatment in syphilis (Ioannou et al., 2015), anemia, rickets, scurvy (Brickley and Ives, 2008; Stark, 2014; Zuckerman et al., 2014), and upper respiratory tract infections (Krenz-Niedbała and Łukasik, 2016a,b), while dental disease is now receiving much more detailed attention (Halcrow et al., 2013). Scurvy is perhaps the most commonly reported child disease in the paleopathological literature. Initially, only reported as isolated cases, it has become recognized as a powerful tool in understanding issues surrounding food shortages, weaning practices, subsistence transitions, social control and marginalization, genetic susceptibility, and the coexistence of cancer and gastrointestinal diseases (Bourbou, 2014; Buckley, 2014; Crandall, 2014; Halcrow et al., 2014; Lewis, 2010). Reflecting advances in adult paleopathology, the identification of diseases in a child’s remains through the use of ancient deoxyribonucleic acid (aDNA) analysis is also on the increase (Dabernat and Crubézy, 2010; Montiel et al., 2012; Pálfi et al., 2000; Rubini et al., 2014).

Figure 1.1 Overlapping and interconnected socioeconomic factors that influence children's health and their lived experience. After the World Health Organisation, 1993. The Health of Young People. A Challenge and a Promise. WHO, Geneva, p. 3.

Despite the rising popularity of nonadult paleopathology, there are still challenges. Many pertain to the nature of growing bone. For example, rickets appears readily as large quantities of structurally inferior new bone are rapidly deposited at the growth plate, while in mature bone a slower rate of turnover means lesions take much longer to appear and are more subtle (Brickley et al., 2005). Conversely, accelerated growth then allows the inferior bone to be quickly replaced by normal tissue as the minerals needed for normal bone formation are once again received, causing both the macroscopic and radiographic signs of the disease to disappear from the skeleton within months (Harris, 1933). The highly plastic nature of children’s bones means that they are less prone to complete fracture, but instead suffer partial breaks (greenstick fractures), buckling or bowing deformities that are hard to identify in dry bone (Lewis, 2000, 2007, 2014). We are still unable to effectively distinguish between new bone formation as the result of infection or trauma, from that which forms as part of the normal growth process in young children, often hindering our ability to explore such pathology in children younger than 4 years of age. In ad...