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The 43rd Scientific Session of the Paleopathology Club was held Sunday, March 1, 2020 from 1:30-3:00 p.m. during the:
109th Annual Meeting of
The United States and Canadian Academy of Pathology
Los Angeles Convention Center
Los Angeles, CA, U.S.A.
Sunday, March 1, 2020
1:30 PM – 3:00 PM
Enrique Gerszten, Program Co-Chairman
Virginia Commonwealth University
Medical College of Virginia Campus
Pedro L. Fernández, Program Co-Chairman
University Autonoma of Barcelona
Topic: “Paleopathology Around the Globe”
“Pathology after Cranial Deformation and Trephination in Prehistoric Peru”
Danielle S. Kurin, University of California, Santa Barbara, CA
“Paleopathology in China and Mongolia”
Christine Lee, California State University, Los Angeles, CA
“Paleopathology Techniques for the Study of Mummies”
Pedro L. Fernández, University Autonoma of Barcelona, Spain
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Pictured from left to right: Pedro L. Fernández; Christine Lee, Danielle S. Kurin and Enrique Gerszten
The abstracts of their presentations are enclosed.
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Answer to Case 148:
History: Skull from Chanka Culture, Andahuaylas, Peru (ca. AD 1150-1250).
Diagnosis: Artificial Cranial deformation.
Submitted by: Danielle S. Kurin, University of California, Santa Barbara, CA
The slide of Case 148 can be best viewed and printed in Internet Explorer 6.0 at:
case 148 [View Image]
Pathology after Cranial Deformation and Trephination in Prehistoric Peru
Danielle S. Kurin, University of California, Santa Barbara, CA
Ancient Peruvians intervened in the development and integrity of the neurocranium in dramatic fashion through the implementation of intentional head-shaping, called cranial modification, and less often, through craniotomies known as trepanations. Understanding the interplay between bone pathology and invasive cultural practices is aided by a bioarchaeological approach.
This paper evaluates the interplay of paleopathological impacts of cranial plasticity and cranioplasties on over 300 crania excavated from high-altitude archaeological sites in south central Apurimac, Peru. Both cranial modification and trepanation were innovative practices for the time and region. Their emergence coincides with a time of increasing violence and deprivation that began about 850 years ago and lasted three centuries. During this tumultuous era, rates of cranial trauma indicative of interpersonal violence skyrocketed from 7% to 49% (p<0.0001; N=295).And while cranial modification and trepanations were non-existent during times of peace, during times of strife, 75% of crania were intentionally deformed (p=0.0001;N=309) trepanation rates rose to as high as 12.5% (p=0.0293; N=256).
Cranial modification occurred in infancy. Geometric morphometric analyses of crania suggest that head-shaping contraptions were generally similar, but unstandardized, suggesting a process enacted by generally knowledgeable caretakers within the home. The resulting elongated skull, crystallized in early childhood, appears to have had no long-term pathophysiological sequelae. Yet the social impacts of those who underwent cranial modification were deadly. For it was that particular sector of society who disproportionately endured overwhelming hardship, increasing morbidity and violent mortality. To wit: within the population, only 32% of regular crania have head wounds, while 58% of modified crania show signs of severe- often lethal--head fractures (p=0.0007;N=207).
Another invasive tradition, trepanation, the intentional, surgical removal of part of the cranium, has a long history of use in the ancient Andes. Among the 32 crania with trepanations in this study, a third had been operated on more than once. Two-thirds of affected crania had trepanations which impacted risky areas like musculature, sinuses, and sutures. Various surgical techniques were being employed concurrently throughout the region with different rates of success, signaled by short term healing. Scraping trepanations evinced the highest survival rate (100%); circular grooving (56%), drilling and boring (9%), and linear cutting (0%) were far less successful. Half of those with trepanat ions also show signs of head trauma, and 10% evince trepanations made over areas of diseased bone. Perioperative procedures like hair shaving, poultice application, and cranioplasty use were therapeutic, not punitive. The relative ubiquity of post-mortem trepanations of different dimensions made using different-sized bits, signal a systematic effort to better understand cranial anatomy and improve surgical techniques.
Finally, the Peruvian population reported here restricted the use of trepanation to particular segments of society. Trepanations were not practiced on sub-adults; those with catastrophic head trauma and with non-lethal facial fractures were also excluded as patients. Moreover although males and females experienced similar trauma frequencies, trepanations were almost exclusively afforded to males. In similar fashion, those with cranial modification experienced head wounds at a significantly higher rate than their neighbors with natural heads, but trepanation frequencies were similar between the groups.
A couple of different factors may account for the extensive and pervasive dispersal of a new surgical technique such as trepanation. The physiological and psychosocial trauma which necessitated therapeutic trepanations might have been heightened due to endemic violence and a decreased quality of life, evinced by high rates of cranial trauma and increasing signs of disease. And while moderate head injury seems to be the impetus for intervention in many cases of trepanation, other motivations may have included physiological or psychosomatic factors. Surgical intervention was also mediated by social factors. Despite the fact that stress and violence impacted much of the population, trepanations were primarily reserved for adult men; surgery was proportionally withheld from women, youths, and groups who practiced cranial modification.
Both cranial modifications and trepanations were quickly and widely adopted, but not highly standardized. Basic precepts such as how to wrap a restrictive turban --or make a surgical incision, as well as the profile of suitable patient, seem to have been shared across the region. Ubiquity in technique suggests that practitioners throughout the region shared a common understanding of where to intervene on the vault, and how to perform craniotomies, and occasionally craniotomies, and likely employed roughly similar tool-kits. These results speak to the maturation of distinct culturally informed understandings of how to reshape and heal an incomplete or unwell body in the ancient past.
Allison, MJ and A Pezzia. 1976.Treatment of Head Wounds in Pre-Columbian and Colonial Peru. MV Quarterly. 12(2) :74-79.
Gerszten PC and Gerszten E: Intentional cranial deformation: A disappearing form of self mutilation. Neurosurgery 37(3):374-382, 1995.
Gerszten PC, Gerszten E, Allison AJ: Diseases of the skull in Pre-Columbian South American mummies. Neurosurgery 42(5):1145-1152, 1998.
Verano,J. 2016. Holes in the Head: The Art and Archaeology of Trepanation in Ancient Peru. Dumbarton Oaks Pre-Columbian Art and Archaeology Studies Series. Harvard University Press. 352 p.
Paleopathology in China and Mongolia
Christine Lee, California State University, Los Angeles, CA
Communist East Asia has had a long period of political isolation, and coupled with the language barrier, few paleopathological studies have been accessible outside of the region. Pateopathology in East Asia has been traditionally based on individual case studies. Research incorporating a populational or regional scope are a new concept. The following will be an introduction to three case studies and two populational studies conducted in China and Mongolia over the last 15 years. The following include populations ancestral to modern day Chinese, Mongolian, Tibetan, and Uighurs,covering over 4000 years of history.
1. Foot Binding (1644-1912) Henan, China. Footbinding was a culturally driven body modification unique to Chinese history, lasting almost 1000 years. It was one of the most complex and debilitating techniques used to ensure marriageability. Footbinding started in early childhood, lasting two years, when the foot bones could be molded into the desired shape By the late imperial period in China, almost 100% of all ethnically Chinese women had footbinding. The tarsals, metatarsals, and phalanges are permanently altered in shape and size. This results in issues with walking gait, balance, muscle strength, and bone density. Women with footbinding suffered higher rates of muscle atrophy, lower leg infection, and trauma from falls.
2. Leprosy (2200-1600 BC), Gansu, China. Leprosy is an ancient disease which has evolved with humans for thousands of years. The origin and antiquity of leprosy is still debated. The earliest archaeological case is from the Harappan civilization in India. This study presents several slightly later cases from northwest China. The population density was high enough for leprosy to be endemic in the region. All of these individuals were buried within the population, so they were not quarantined as in Western Christian cemeteries. Two individuals show evidence of leprosy infection during early childhood. Paleopathological evidence included rounding out of the nasal aperture, antemortem loss of the incisors, and penciling of the hands and feet.
3. Ankylosing Spondylolysis (93-234), Orkhon, Mongolia. Ankylosing spondylolysis is an autoimmune disease with a possible genetic predisposition. It is not uncommon in archaeological context. It is predominately found in males. One case of ankylosing spondylolysis was found in a female. She had been buried with her husband. Based on nonmetric traits and historical documents they were probably closely related.
4. Pituitary Tumor (209 BC-93 AD) Khovd, Mongolia. An elite tomb was found with a nine-year old individual. This child was very tall for his age and had an unusually large skull. A possible diagnosis of a pituitary tumor was made.
5. Osteosarcoma (500-221 BC), Xinjiang, China. A young male burial was found with a facial deformity. The left temporal exhibited a bone tumor. This was a slow growing tumor as the mandible was altered to accommodate the growth. The bone growth probably started during childhood.
Ebrey P. 2002. Shifting Western interpretations of footbinding,1300-1890. In: Ebrey P, editor. Gu Y, Li J, and Li Z. 2013. Deformation of female footbinding in China. Journal of Clinical Rheumatology 19: 418.
Ko.D. 2005. Cinderella's sisters: A revisionist history of footbinding.Berkeley:University of Berkley Press.
Qin W, Lei W, Wu Z, Liu D,Zhang W, Yang B. 2008. Morphogenetic features of foot-binding deformity. J. Fourth Mil Med Univ 14:1328-1330.
Stone PK. 2012. Binding women : Ethnology, skeletal deformations and violence against women.
Moller-Christensen V. 1967.Evidence of leprosy in earlier peoples. In Brothwell D and Sandison AT eds. Diseases in antiquity. Springfield: Charles C. Thomas p 295-305.
Robbins G, Tripathy VM, Misra VN, Mohanty RK, Shinde VS, Gray KM,Schug MD.2009.Ancient skeletal evidence for leprosy in India (2000 BC). PloS ONE 4:1-8.
Tayles N and Buckley HR. 2004.Leprosy and tuberculosis in Iron Age south east Asia? American Journal of Physical Anthropology. 125 :239-256.
Wu Y. 2009. Leprosy in China : a history. New York: Columbia University Press.
Alt KW,Adler CP, Buitrago-Tellez, Lohrke B. 2002. Infant Osteosarcoma. International Journal of Osteoarchaeology 12:442-448.
Capasso L,Tota G. 1990.Antiquity of Osteosarcoma . International Journal of Osteoarchaeology.
Strauhal E, Vyhnaek L,Horackova L, Benesova L, Nemeckova A. 1997. A Case of Osteosarcoma in a Late Medieval-Early Modern Skull from Kyjov (Czech Republic). 7: 82-90.
Mulhern OM. 2005 .A Probable Case of Gigantism in a Fifth Dynasty Skeleton from the Western Cemetery at Giza, Egypt. International Journal of Osteoarchaeology 15: 261-275.
Inoue K, Takigawa W, Sato W,Kumagi M,Dodo Y,Katayama, K. 2005 . A Possible Case of Spondyloarthropathy in a Prehistoric Japanese Skeleton. International Journal of Osteoarchaeology 15:186-195.
"Paleopathology Techniques for the Study of Mummies"
Pedro L. Fernandez, University Autonoma of Barcelona, Spain
Paleopathology has classically been related to the study of pathological bones, since these are the most common remains found at archaeological sites due to their durability. Yet, the study of partially or completely mummified individuals imposed the need for precise histological techniques capable of extracting valuable new information from soft tissue. Paramount examples of the latter are the numerous and variegated studies performed in such incredibly well preserved subjects as the Tyrol man ,and Egyptian or Andean mummies [2,3]. Paleopathologists can thus analyse ancient mummified human or animal remains from a pathological point of view for which techniques and tools such as light and electron microscopy after adequate rehydration (Ruffer's solutions) [4-6], immunohistochemistry and molecular biology  can be used after the autopsy of the subject. In some instances, however, only small samples such as tru-cut or small biopsies are available. Despite degradation of tissues, partial preservation of their structure and content after a natural or artificial mummification process often allows the extraction of valuable biological data which sometimes provides interesting historical information. For example, there are abundant evidences of infectious diseases such as tuberculosis, treponematosis, paracoccidiomicosis, malaria or parasites in ancient mummies [8-11].
Both neoplastic and non-neoplastic conditions have been reported in ancient bodies. Among the former, different types of neoplasms such as histiocytomas, adenocarcinomas and metastases have been described in mummified tissues [12-14]. It is interesting to point out that cancers are rarely encountered in palaeopathological studies, which could have several explanations including the absence of chemical environmental contamination, shorter life expectancy or simply the disappearance of tissue evidence given the frequent origin in and involvement of soft tissues.
In some instances there is the rare opportunity to study the remains of historically important subjects. Paramount examples are the reported death of Francesco I of Medici by malaria and the severe gout of Emperor Charles V of Haugsburg, which most likely influenced some historical events during the XVI century [15,16]. Another example is the study of the family lineage and the pathologies affecting Tutankhamun and his possible cause of death, which have been widely covered by the media and have led to a renewed interest in Paleopathology .
In addition to the above analysis of historical subjects, other possible fruitful applications of paleopathology involve the use of mummified samples for analysing social habits, such as tattooing , medical skills [19,20] and diet [21,22], from which a great deal of valuable anthropological knowledge can be extracted.
It can be thus concluded that Paleopathology is a scientific crossroad nurtured by history, archaeology, anthropology and medicine and it is in a unique position to provide all of these fields with an integrated vision of diseases and lifestyle habits which can help to understand how humans, and sometimes animals, lived and died in ancient times.
1. Seidler H, Bernhard W, Teschler-Nicola M, Platzer W, zur Nedden D, Henn R, Oberhauser A, Sj0vold T: Some anthropological aspects of the prehistoric Tyrolean ice man. Science 1992;258:455-7.
2. Walker R, Parsche F, Bierbrier M, McKerrow JH: Tissue identification and histologic study of six lung specimens from Egyptian mummies. Am J Phys Anthropol 1987;72:43-8.
3. Aufderheide AC, Mufioz I, Arriaza B: Seven Chinchorro mummies and the prehistory of northern Chile. Am J Phys Anthropol 1993 ;91:189-201.
4. Ruffer MA: Pathological notes on the royal mummies of the Cairo museum; in Moodie RL (ed): Studies in the Paleopathology of Egypt. Chicago, Univ. of Chicago Press 1921, pp166-178 .
5. Gerszten PC, Gerszten E, Allison MJ: Ultrastructure of a well-preserved lymphocyte from a mummified human. J Electron Microsc (Tokyo) 1997,46:443-445.
6. Mekota AM, Vermehren M: Determination of optimal rehydration, fixation and stammg methods for histological and immunohistochemical analysis of mummified soft tissues. Biotech Histochem 2005; 80:7-13.
7. Paabo S: Molecular cloning of Ancient Egyptian mummy DNA. Nature l 985;314:644-5
8. Zink AR, Sola C, Reischl U, Grabner W, Rastogi N, Wolf H, Nerlich AG: Characterization of Mycobacterium tuberculosis complex DNAs from Egyptian mummies by spoligotyping. J Clin Microbiol 2003;41 :359-67.
9 El-Najjar MY: Human treponematosis and tuberculosis : evidence from the New World. Am J Phys Anthropol 1979;51:599-618.
10. Allison MJ, Gerszten E, Shadomy HJ, Munizaga J, Gonzalez M: Paracoccidioidomycosis in a Northern Chilean mummy. Bull N Y Acad Med 1979;55:670-83.
11. Allison MJ, Bergman T, Gerszten E: Further studies on fecal parasites in antiquity. Am J Clin Pathol 1999 ;112:605-9.
12. M. R. Zimmerman: A possible histiocytoma in an Egyptian mummy. Arch.Dermatol 1981;117
13. Marchetti A, Pellegrini S, Bevilacqua G, Fornaciari G: K-ras mutation in the tumour of Ferrante I of Aragon, King of Naples. Lancet 1996; 347:1272.
14. David AR, Zimmerman MR: Cancer: an old disease, a new disease or something in between? Nat Rev 2010; 10:728-733.
15. Fomaciari G, Giuffra V, Ferroglio E, Bianucci R: Malaria was "the killer" of Francesco I de Medici (1531-1587). Am J Med 2010;123:568-9.
16. Ordi J , Alonso PL, de Zulueta J, Esteban J, Velasco M, Mas E, Campo E, Fernandez PL: The severe gout of Holy Roman Emperor Charles V. N Engl J Med 2006; 355:516-20.
17. Hawaas Z: Tut's family secrets. Nat Geographic 2010;218:34-59.
18. Dorfer L, Moser M, Bahr F, Spindler K, Egarter-Vigl E, Giullen S, Dohr G, Kenner T: A medical report from the stone age? Lancet 1999;354:1023-1025.
19. Capasso L: 5300 years ago, the Ice Man used natural laxatives and antibiotics. Lancet 1998;352: 1864.
20. Andrushko VA, Verano JW: Prehistoric trepanation in the Cuzco region of Peru: a view into an ancient Andean practice. Am J Phys Anthropol 2008;137:4-13.
21. Rollo F, Ubaldi M, Ermini L, Marota I: Otzi's last meals: DNA analysis of the intestinal content of the Neolithic glacier mummy from the Alps. Proc Natl Acad Sci U S A 2002;99:12594-9.
22. David AR, Kershaw A, Heagerty A: Atherosclerosis and diet in ancient Egypt. Lancet 2010;375:718-9.
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