Unusual pathological condition in the lower extremities of a skeleton from ancient Israel.код для вставкиСкачать
AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 91249-250 (1993) Notes and Comments Unusual Pathological Condition in the Lower Extremities of a Skeleton From Ancient Israel Keith Manchester Calvin Wells Laboratory, Department of Archaeological Sciences, Uniuersity of Bradford, Bradford, West Yorkshire, BD7 1DP England The report by Hershkovitz et al. (1992) is particularly interesting with regard to the provenance, burial circumstance, and period of the specimen. However, this interest lies not in the diagnosis stated, namely, Madura foot, but in what I propose is a more likely diagnosis, that of leprosy. Madura foot is usually a unilateral phenomenon and the osseous change is characterized by extensive destructive cavitation with multiple draining sinuses, affecting the tarsus and metatarsus. In advanced disease the distal zones of the tibia and fibula may be similarly affected. Although osseous ankylosis may occur, possibly associated with secondary pyogenic sepsis, there is little associated proliferative new bone formation in maduromycosis per se. In the specimen described the pathological changes are bilateral, affecting the tarsus, metatarsus, and tibiae and fibulae. The metatarsals described and illustrated in Figures 5 and 6 exhibit cortical pitting and irregularity compatible with pyogenic infection secondary to the plantar ulceration associated with leprous peripheral neuropathy. The metatarsophalangeal and tarsometatarsal joint surface changes may be associated with septic arthritis. The fourth metatarsal exhibits shaft thinning compatable with concentric diaphyseal remodelling (Andersen et al., 1992). The calcanei illustrated in Figures 3 and 4 exhibit gross surface inflammatory change together with the cavitation and sinus formation of osteomyelitis in the anterior aspect of the right cal0 1993 WILEY-LISS, INC. caneus. The abnormal talocalcaneal articulation in the left foot is compatible with talocalcaneal dislocation. This is due to leprous motor and sensory neuropathy creating a neuropathic (viz. Charcot) joint, and is associated with tarsal disintegration (Kulkarni and Mehta, 1983; Kulkarni, Mehta, Sane, and Sharangpani, 1985; Andersen and Manchester, 1988).The scenario therefore is of collapsed, anesthetic, and ulcerated feet with secondary pyogenic infection of deep and, no doubt, superficial tissues. The sequel of these septic changes is ascending infection in the lower leg producing the bilateral tibiofibular chronic inflammatory surface change (Moller-Christensen, 1961; Andersen, 1969). These pathological changes are almost pathognomonic of leprosy. The bilateral nature of the lesions indicates that the individual suffered from lepromatous (low resistance) leprosy. The authors comment that the cranium was fragmentary and it is assumed therefore that the rhinomaxillary syndrome of lepromatous leprosy (Andersen and Manchester, 1992)was not observed. No comment was made about the upper limbs, but gross osseous normality in the hands does not negate a diagnosis of leprosy. This is an important specimen in the history of leprosy. It is one of few from this early period in Israel and may be contemporaneous with the Judean specimens from the Monastery of Martillous and the Monastery of St. John the Baptist, described by Zias (1985). The specimen from Bet Guvrin is from a family tomb, therefore indicating that segregation, either ostracism or therapeutic, was not practiced in this case. It is significant too that this specimen, like all other early specimens, is of lepromatous leprosy. Received June 9, 1992; accepted October 2,1992. 250 K. MANCHESTER LITERATURE CITED Andersen J G (1969)Studies in the Mediaeval Diagnosis of Leprosy in Denmark. Copenhagen: Costers Bogtrykkeri, pp. 115-116. Andersen JG and Manchester K (1988) Dorsal tarsal exostoses in leprosy: A palaeopathological and radiological study. J. Archaeol. Sci. 1 5 5 - 5 6 . Andersen JG and Manchester K (1992) The rhinomaxillary syndrome in leprosy: A clinical, radiological and palaeopathological study. Int. J. Osteoarchaeol. 2r121-129. Andersen JG, Manchester K, and Mi RS (1992) Diaphyseal remodelling in leprosy: A radiological and palaeopathological study. Int. J . Osteoarchaeol. 2:211-219. Hershkovitz I, Spiers M, Katznelson A, and Arensburg B (1992) Unusual pathological condition in the lower extremities of a skeleton from ancient Israel. Am. J . Phys. Anthropol. 88(1);23-26. Kulkarni VN and Mehta J M (1983) Tarsal disintegration (T.D.)in leprosy. Lepr. in India 55/2):338-370. Kulkarni VN, Mehta JM, Sane SB, and Sharangpani RC (1985) Study of tarsal disintegration in leprosy. Proceedings of the International Conference on Biomechanics and Clinical Kinesiology of Hand and Foot. I.I.T. Madras, India. pp. 121-124. Moller-Christensen V (1961) Bone Changes in Leprosy. Copenhagen: Munksgaard, pp. 4 2 4 3 . Zias J (1985) Leprosy in the Byzantine monasteries of the Judean Desert. Koroth 9(1-2):242-248.