Jelena Bekvalac

Oral Health and Frailty in the Medieval English Cemetery of St Mary Graces

The analysis of oral pathologies is routinely a part of bioarcheological and paleopathological investigations. Oral health, while certainly interesting by itself, is also potentially informative about general or systemic health. Numerous studies within modern populations have shown associations between oral pathologies and other diseases, such as cardiovascular disease, certain types of cancer, and pulmonary infections. This article addresses the question of how oral health was associated with general health in past populations by examining the relationship between two oral pathologies (periodontal disease and dental caries) and the risk of mortality in a cemetery sample from medieval England. The effects of periodontitis and dental caries on risk of death were assessed using a sample of 190 individuals from the St Mary Graces cemetery, London, dating to approximately AD 1350-1538. The results suggest that the oral pathologies are associated with elevated risks of mortality in the St Mary Graces cemetery such that individuals with periodontitis and dental caries were more likely to die than their peers without such pathologies. The results shown here suggest that these oral pathologies can be used as informative indicators of general health in past populations.

The association between periodontal disease and periosteal lesions in the St. Mary Graces cemetery, London, England A.D. 1350-1538.

Numerous studies have demonstrated significant associations between periodontal disease and many other diseases in living populations, and some studies have shown that individuals with periodontal disease are at elevated risks of mortality. Recent analysis of a medieval skeletal sample from London has also shown that periodontal disease was associated with increased risks of mortality in the past. This study examines whether periodontal disease is associated with periosteal lesions in a skeletal sample from the urban St. Mary Graces cemetery (n = 265) from medieval London. The results reveal a significant association between periodontal disease and periosteal lesions in the St. Mary Graces sample (i.e., individuals with periodontal disease were also likely to have periosteal lesions), and the association between the two is independent of age. The association between the two pathological conditions might reflect underlying reduced immune competence and thus heightened susceptibility to pathogens that cause periodontal disease or periosteal lesions, exposure to an environmental factor, or underlying heightened inflammatory responses.

Wealth, health and frailty in industrial-era London

Abstract Background: Socioeconomic status is a powerful predictor of mortality in living populations, as status affects exposure or access to a variety of factors that impact health and survival, such as diet, healthcare, infectious disease and pollution. Aim: This study examines the effect of socioeconomic status on mortality and survival in London during a period spanning the early 18th through mid-19th centuries. During this period, London experienced rapid industrialization and heightened class distinctions. This study examines whether low-socioeconomic status was associated with reduced survival at a time when the distinctions between social strata were peaking. Subjects and methods: The samples for this study are drawn from three skeletal assemblages in London that represent lower and higher social strata. The upper socioeconomic status sample (n = 394) is from Chelsea Old Church and St Bride’s Fleet Street (crypt assemblage). The low socioeconomic status sample (n = 474) is from St. Bride’s Lower Churchyard (also known as St Bride’s Farringdon Street). The effect of status on mortality and survival is assessed using hazard analysis and Kaplan–Meier analysis. Results: The results reveal elevated mortality and reduced survival for lower socioeconomic status children, but no strong effect of status on adult mortality or survival. Conclusion: These results might indicate strong selective mortality operating during childhood or the effects of migration in the industrial-era population of London.

A Post-mortem Evaluation of the Degree of Mobility in an Individual with Severe Kyphoscoliosis Using Direct Digital Radiography (DR) and Multi-Detector Computed Tomography (MDCT)

Since 2010, the Bioanthropology Research Institute at Quinnipiac University, in collaboration with the Inforce Foundation, Cranfield Forensic Institute at Cranfield University and the Centre for Human Bioarchaeology, Museum of London, has established a temporary field radiographic facility under St Bride’s Church, Fleet Street, London, in order to conduct a radiographic survey of the skeletal remains of 227 individuals from the eighteenth and nineteenth centuries interred in the crypt and retained in the church. The collection constitutes a unique assemblage of skeletal remains covering a date range of 1676–1852/1853, with biographical data and detailed parish records. One of the skeletons demonstrated not only severe kyphoscoliosis, but also an uncharacteristic robustness of the femora and humeri for such a severe spinal deformity. Based on initial radiographs, it was determined the remains were stable enough to be transported to St Bartholomew’s Hospital for additional examination using multi-detector computed tomography to better visualize the internal structure of the skeleton. This chapter considers the different diagnoses derived from the radiographic studies and the analysis in attempting to establish the individual’s degree of mobility and impairment, placed in conjunction with the social conditions for the parish at this time.

Hyperostosis frontalis interna in female historic skeletal populations: Age, sex hormones and the impact of industrialization

OBJECTIVES This analysis aims to investigate the impact of industrialization on the prevalence of Hyperostosis Frontalis Interna (HFI), focusing on the roles of age and parity to examine the claim that longevity and changing reproductive patterns have led to increased rates in modern populations. MATERIALS AND METHODS A total of 138 individuals from two documented London skeletal assemblages of the Industrial period were analyzed employing macroscopic observation, digital radiography and MicroCT scanning to establish the prevalence rates of HFI according to modern clinical standards. Statistical analysis was also undertaken on a sub-sample of 51 females of post-menopausal age to identify any relationship between parity and HFI. RESULTS The majority of cases of HFI were found in older females, reflecting clinical observations. The prevalence rates of HFI corresponded well to those predicted from the proportion of old age females present within populations. Age was therefore shown to be a predominant factor in HFI presence. A plateau in HFI prevalence was noted from the age of 50-59 years onwards. No statistically significant relationship was found between parity and HFI. DISCUSSION When recorded consistently, HFI was positively correlated with age and longevity but had also increased among old age females over time. Our results suggest that nulliparity co-occurs with HFI but is not a primary factor in its pathogenesis. Key factors in HFI presence in females are likely to be increased androgens and the dysregulation of insulin and insulin-like growth factor-1.

Biological and cultural drivers of oral microbiota in Medieval and Post-Medieval London, UK

The trillions of microorganisms that live in association with the human body (microbiota) are critical for human health and disease, but there is a limited understanding of how cultural and environmental factors shaped our microbiota diversity through time. However, biomolecular remnants of the human oral microbiota - recovered from the calcified dental plaque (calculus) of our long-dead ancestors - are providing a new means of exploring this key relationship of our evolutionary history. Here, we correlate extensive experimental, archaeological, and biological metadata with 128 ancient dental calculus specimens from Medieval and Post-Medieval London, UK (1066 – 1853 CE). We identify a significant association between microbiota and oral geography (i.e. tooth type and tooth surface), which has confounded ancient microbiota studies to date. By controlling for oral geography, however, we identify the first associations between ancient microbiota and cultural and environmental signatures. We find significant links between ancient British microbiota structure and health, including skeletal markers of stress that may reflect low socioeconomic status. Furthermore, this study provides baseline data to explore factors that drive microbiota differentiation within and between ancient populations and highlights the potential of ancient microbiota to infer detailed health and sociocultural information about the past.

Evaluating the relationship between lesion burden and aging among the skeletons of an 18th-19th century London cemetery using osteological and radiological analysis

Study of disease in the past can help illuminate patterns of human health, disease, and aging in the present. As average human life expectancy and incidence of chronic disease have increased in the last century, efforts to understand this epidemiologic shift have led to more investigation of healthy aging. Using osteological and radiological methods of analysis, this study examined 212 mostly nineteenth century adult skeletons from the crypt of St. Bride’s in London, in order to investigate the relationship between age-at-death, sex, and number of lesions observed in bone. Lesions were classified into macro-level categories according to the Rapid Method for Recording Human Skeletal Data, and the correlation between age group and number of lesions in each category, as well as the total number of lesions, were analyzed. Correlations between age-at-death and the number and type of lesions were compared across both methods of analysis. A greater total number of lesions and a greater number of types of lesions was observed for the osteologically analyzed data, compared to the radiologically analyzed data. Correlations between age-at-death and specific pathology groups were in general weak, though stronger for the osteologically analyzed data. For each method of analysis, there were statistically significant differences between the total number of lesions and age group, with total number of lesions increasing with age, regardless of method of analysis. Joint and metabolic lesions were the most significant predictors of age-at-death. The correlations between total lesions observed and age-at-death were similar for radiologically and osteologically analyzed data, for the same set of bones. This suggests that, for the bones analyzed, while the number of lesions recorded differed according to method of analysis, the relationship between overall observed lesion burden and age-at-death was similar for both osteological and radiological analysis.

Reliability evaluation of inter-eminence line, Akagi and Dalury lines for intraoperative tibial rotation: An osteology-based study

BACKGROUND This large osteology study examined the reliability, reproducibility and correlation between previously described tibial tray rotation alignment lines (including Akagi and Dalury lines). In addition, it described a novel inter-eminence line utilising the tibial plateau inter-condylar eminences as a landmark. METHODS A total of 214 post-medieval (18-19th centuries) skeletal tibia were examined. The inter/intra-observer variation and correlation between reference lines were measured. RESULTS Inter-observer reproducibility was excellent and there were no differences between Akagi, Dalury, and inter-eminence lines. Similarly, intra-observer reliability was excellent for Akagi, Dalury, and inter-eminence lines. Qualitative review of tibial inter-condylar eminences suggested that these could be easily identifiable. When taking the medial angle from a medial-lateral reference line, the Akagi line showed a mean of 96.90° (±10.27), inter-eminence line 94.52° (±12.84), and Dalury line 88.06° (±11.75). The angle produced by the Dalury line was significantly different from both the Akagi and inter-eminence lines (P≤0.001). The Akagi line and inter-eminence line showed a strong correlation (r=0.74). The Dalury line showed a weaker correlation with both the Akagi line (r=0.69) and inter-eminence line (r=0.40). CONCLUSION This study suggested that tibial rotation lines showed excellent intra/inter-observer reliability and reproducibility. The novel and easily drawn inter-eminence line showed strong correlation with the Akagi line and could be used for tibial tray rotational alignment in total knee arthroplasty.