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ABSTRACT
Pagets disease has beer, ascribed several times to specimens
of archeological bone but, in the absence of microscopic examination, the
evidence remains insubstantial. Suspected metabolic bone disease is described here in the archeological remains of a skeleton from a 16th century
burial ground at Wells Cathedral, England and from a single medieval
sacrum recovered from a large deposit of disarticulated bones from a churchyard at Barton-on-Humber, England. Radiographs showed apparent structural abnormality in one femoral shaft and calcaneus and in the isolated
sacrum. Histomorphometry on undecalcified bone cores confirmed the regions
of abnormality and showed not only increased trabecular width but also areas
of mosaic woven bone together with extensive resorption cavities; these
features contrasted with the normal structure and organized lamellar bone
from sites elsewhere. Despite post-interment changes in surrounding tissues,
the morphological stability of some of the osteocytes was remarkable. Preservation of the histology was sufficient to permit the assignment of a metabolic
bone disorder and the nature of the sclerosis was consistent with Pagets
disease. o 1992 Wiley-Liss, Inc.
Although Pagets disease was recognised
as a clinical condition only one hundred
years ago, there are reports describing the
existence from neolithic times (Denniger,
1933; Wells and Woodhouse, 19753. However, it is generally acknowledged that
much of the evidence is fragmentary and
ambiguous, lacking histological confirmation, and regularly attributing an occurrence where it is either geographically or
ethnically unlikely (Kanis, 1991).As preparative techniques for undecalcified bone histology have improved, so the use of the small
trephine sample for the optical microscopy
of ancient skeletal remains has increased
(Smith et al., 1981; Stout and Teitelbaum,
1976a,b; Stout, 1978; Weinstein et al.,
1981). By applying histological techniques
this communication seeks to add the dimension of microscopy to the gross structural
information derived from the archeological
remains of two abnormal medieval skeletons with suspected metabolic bone disease.
0 1992 WILEY-LISS. INC
Optical comparison with contemporary normal and pathological material is also made.
MATERIALS AND METHODS
The skeletal remains, from two individuals, consisted of the lower half of the male
skeleton (SK270), probably aged over 45
years, discovered in a 16th century grave in
an excavated burial ground at Wells Cathedral and an isolated medieval sacrum recovered from large deposits of disarticulated
bone, from a churchyard excavation at Barton-on-Humber, South Humberside. Morphological changes were evident; for example, the left femoral shaft was enlarged and
the surface texture of the right and left calcanei differed. Radiographs were prepared
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throughout both normal and pathological regions and fine details of the fibrous nature
of the collagenous extracellular matrix at
their periphery was still apparent (Fig. 5e).
Some osteocyte lacunae, together with their
canaliculi, were unusually large and had
probably been subjected to processes of at-
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Fig. 4. Non-physiologicalchanges in the sixteenth century bone. a) Sharply defined irregular areas of
demineralization (arrows); von Kossa stain, x 50. b) A trabecula exhibiting a reticulated mineralized
matrix (arrow) surrounding clear areas of attrition. Goldner stain, x 375.
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J.E. AARON ET AL
Trabecular width (micron)
400
0 s calcis
0 s calcis
Sacrum
Sacrum
ease; Nordin, 1973) and osteoblastic metastases may share similar sclerotic histology, only one condition apparently presents
with thick trabeculae of mosaic bone in the
adult male, On the basis of the thick and
irregular trabecular structure, the deeply
defined resorption cavities, the significant
areas of mosaic woven bone, the discontinuous and localized nature of the abnormality, and the favourable comparison with contemporary pathological preparations, it is
concluded t ha t the bone disease manifest in
these medieval remains is Pagets disease.
This may be the first incidence of Pagets
disease to be assigned histologically, since
even one of the most reliable studies, that of
Wells and Woodhouse (1975),lacks any histological confirmation of the proposed condition.
ACKNOWLEDGMENT
We are indebted to Monique Beneton for
histological preparation. The support of the
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