Rationale and Objectives
Our study provides a critical assessment of osteological and radiological techniques in the analysis of bioarchaeological samples for evidence of pathology. Teams of physicians, anthropologists, historians, and archaeologists have used these methods to provide a clearer picture of health and disease burden in the past. Of relevance for clinicians, these efforts have led to a reconsideration of the physiology and epidemiology of contemporary disease.
Materials and Methods
We examined 213 18th- to 19th-century adult skeletons from the crypt of St. Bride’s Church in London using two methods of skeletal analysis (osteological and radiological). All available bones were examined by an osteologist. Radiographs of the crania, humeri, pelvises, femora, and tibiae were examined by a radiologist. Identified lesions were grouped into nine standard categories used in an osteological examination, and statistical analysis was completed.
Results
Among lesion categories, and between lesion categories and age, correlations were weaker among the radiologically analyzed data than among data evaluated osteologically. Correlations between age at death and total number of lesions identified were nearly identical, regardless of the method of lesion identification.
Conclusions
Although osteological analysis seemed more sensitive in identifying infectious and neoplastic lesions, radiological analysis often provided a clearer illustration of the extent of these conditions, especially when the lesion involved a large area (eg, osteoporosis or Paget disease). Radiological analysis suggested that, as they age, men accumulate skeletal lesions more rapidly than women. Using bioarchaeological data, our study suggests the potential that radiological analysis might have in the establishment of general baseline levels of ill health in both past and present populations.
Introduction
Humans have long been fascinated with their past. The Greeks and Romans who lived 2000 years ago marveled at the Egyptian pyramids, which were already more than 2000 years old when these Greco-Roman admirers speculated about their age and wondered about the secrets hidden within them . Today, we speculate with no less fervor about how people in the past lived—but now, we have new technologies that allow us to satisfy our curiosity and contribute to our ever-growing body of knowledge about those living centuries ago and what they can teach us about our modern lives. Advanced imaging techniques have provided answers to many questions, including those related to the health of past individuals and populations and those related to contemporary populations. The Horus study, for example, used the results of computed tomography imaging to argue that evidence of atherosclerotic disease in mummies from four different populations and four different time periods emphasized how misguided we might be in attributing our clogged vasculature to our “modern lifestyle” alone .
Even as advanced imaging techniques have provided some answers, they have also raised more questions. Imaging of King Tutankhamun, for example, probably the most studied mummy of all, has yielded much information about his life but fewer clear conclusions about how he died . Interpreting the computed tomography scan of a mummy or evaluating radiographs of disarticulated bones is not as straightforward as assessing the images of a patient in a contemporary hospital: in the former case, one cannot ask the individual under study how he or she is feeling or where it hurts (or any other question about his or her life and health). The field of bioarchaeology and questions regarding how individuals died are necessarily speculative, but it is often the especially speculative inquiries that pique our interest the most. Physicians, scientists, historians, and the public alike are intrigued by how the burden of disease has changed over time , even if answers about these changes are not always straightforward. Bioarchaeology is, in some respects, like medicine itself—an art simultaneously rigorous and imprecise that, although based on generalities, must still accommodate individual variation and interpretation. Standards of evaluating skeletons for lesions using accepted methods of osteological analysis and inspection have been developed, refined, and tested through decades of meticulous research and study; fewer studies have focused on developing associated standards for imaging techniques used in bioarchaeological contexts . Imaging is often employed only when osteological analysis is inconclusive, an approach that selects the “most interesting” samples for radiological analysis while overlooking the potential of imaging to identify lesions that might not be readily apparent by osteological evaluation. In other cases, the entire sample is imaged, but the number of skeletons imaged is too small for meaningful statistical analysis .
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Materials and Methods
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Results
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TABLE 1
Average Number of Lesions Identified per Skeleton, with Percentages Given as Percentage of the Total Average Number of Lesions
Lesion Category Avg. Number of Lesions (COD) (%) Avg. Number of Lesions (AOD) (%) Avg. Number of Lesions (RD) (%) Circulatory 0.08 (2.6) 0.03 (1.4) 0.02 (1.5) Congenital 0.60 (19.0) 0.22 (10.0) 0.06 (4.5) Infectious 0.52 (16.5) 0.49 (22.1) 0.13 (9.7) Joints 0.75 (23.7) 0.21 (9.5) 0.43 (32.1) Metabolic 0.12 (3.9) 0.11 (5.0) 0.27 (20.1) Miscellaneous 0.61 (19.3) 0.88 (40.0) 0.29 (21.6) Neoplastic 0.10 (3.3) 0.11 (5.0) 0.06 (4.5) Trauma 0.37 (11.7) 0.17 (7.7) 0.08 (6.0) Total avg number of lesions per skeleton 3.15 2.22 1.34
AOD, adjusted osteological data set; avg, average; COD, complete osteological data set; RD, radiological data set. Note that not all of the percentages add up to 100% because of rounding.
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Discussion
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Acknowledgments
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