SEVERE NON-SPECIFIC INFECTIOUS PROCESSES FROM LATE MEDIEVAL PERIOD ( Portugal )

We report some pathological cases affecting two late medieval individuals coming from necropolises located in the North of Portugal. The first case refers to a male individual, recovered at the church of S. João Baptista at Carra zeda de Ansiães, who died, probably, during his fifties. He presents a surface inflammation, or periostitis of tibias, fibulas and femurs. We are in the presence of a significant inflammation involving multiple elements, which is in relation with a widespread and systemic infectious process. The clear signs of maxillary sinusitis as well as the acute palatal infection confirm the general state of infection. The second case reports to the skeletal remains of a female exhumed from the medieval necropolis of S. Pedro at the site of Castelo de Numão. This woman shows in her skeleton, an advanced and unusual ossification affecting some ribs. There is bone growth in the insertion area of the deltoid on the right humerus. There are also exostosis in the insertion zone of tibiofibular ligaments and degenerative changes were noted in several articulations namely in vertebrae, foot bones and sternoclavicular articulation. Chronic infection is the most probable etiology to the rib lesions observed. INTRODUCTION In this paper we report two cases of osteological remains that presented severe non-specific infectious processes. The two skeletons were recovered in the North of Portugal, in different locations. They will be presented in as two separate case studies. In both cases the medieval provenance of the osteological remains was inferred on the basis of tomb typology, as well as through the analyses of historical documents (PEREIRA e SOARES, 1997; LOPES et al., 1998a; LOPES et al., 1998b). The church of S. João Baptista existed, already, during the reign of D. Pedro (14th century). Its construction was consigned to the 12th-13th centuries, or the first half of the 14th century (PEREIRA e SOARES, 1997). In a wider context, this monument is part of the medieval village of Ansiães. At the present time, this medieval small town is the subject of a research project, which aims to comprehend what happened to the peopling of the region, and its subsequent depopulation throughout the 16th and 17th centuries. CASE STUDY NUMBER ONE The first case refers to the remains of a male individual (F E R E M B A C H et al., 1979; S T E E L E , 1976; SILVA, 1995) who probably died during his fifties (according to Masset's (1982) method, based on cranial suture obliteration). This skeleton was recovered at the church of S. João Baptista at Carrazeda de Ansiães. The most noteworthy pathological features of the skeleton were the lesions observed on the tibiae, femora and fibulae. These bones present a bilateral surface inflammation of the periosteum, and an expansion of the cortical bone. The inflammatory process manifests itself as fine pitting, longitudinal striation and sequentially, plaque-like new bone formation on the original cortical surface (Fig. 1); no loci of active reaction were found. The lesions are remarkably similar in all bones. The radiological analysis showed that a considerable cortical thickening and me dullar cavity is retained in the mentioned bones (see Fig. 1). Radius and ulna also present an expansion of the cortex. The lesions on the skull appear to be confined to the face (both zygomatic bones) and forehead. There is some post mortem damage, which complicates the gathering of information. The lesions consist of periosteal bone, which shows only a slight evidence of porosity; these changes are particularly circumscribed to the zygomatic bones. Other infectious processes were noted in the osteological remains of the individual. Due to the significative oral pathologies surveyed, the oral cavity presents itself as another focus of an infectious phenomenon; severe dental attrition, caries, abscesses and ante mortem tooth loss were recorded. In summary, in both mandible and maxilla, 17 teeth were lost during life; in the remaining 13 teeth, there is one strong carie (with complete destruction of the crown); 3 abscesses were diagnosed; alveolar reabsorption is noticed as well as periodontal disease. Dental wear is severe: in the upper jaw the average is 7.6 (S M I T H's scale, 1984) whereas in the lower jaw the average is 5.6. The mandibular body seems to have suffered a slight thickening of the corpus, whereas in the maxilla the palatal surface presents some bone reaction, that can be describe as an irregular pitting. Because the alveoli present an active bone formation, with a non-complete obstruction of the alveolus, in both maxilla and mandible, the loss of ante mortem teeth occurred near the individual's death. The nasal sinuses also present bone reaction, with distinct new bone formation (Fig. 2). Degenerative changes, in the cervical and thoracic vertebrae, were also recorded. In the remaining skeleton, the post mortem damage precludes the observation of other pathological modification, which could contribute to an overall picture of the pattern of lesions of this individual. DIFFERENTIALDIAGNOSIS There is a significant inflammatory process that is widespread in all the long bones of the individual. The most probable diagnoses for the lesions observed is periostitis (ORTNER and PUTSCHAR, 1981; ZIMMERMAN and KELLEY, 1982; KROGMAN and ISCAN, 1986; ROTHSCHILD and MARTIN, 1993; AUFDERHEIDE and RODRÍGUEZ-MARTÍN,1998). This pathological condition can be seen as a manifestation of a generalize disease, by the involvement of the surface of the bones due to a possible osteitis or osteomyelitis, or even as an extension of an adjacent soft tissue infection to the bone (AUFDERHEIDE and RODRÍGUEZ-MARTÍN, 1998). A chronic skin ulcer or a hemorrhage can also be considered (ROBERTS and MANCHESTER, 1995). A traumatic etiology was precluded by X-ray analysis. Since no cloacae, sequestra or invulcra is present, the diagnostic of osteomielitis becomes impossible (ORTNER and PUTSHARD, 1981). Regarding the dental pathologies surveyed, they can suggest both an abrasive diet, and also that fermentable carbohydrate could be an important component of the diet. Although there was an absence of a true perforation of the sinuses, a probable etiological condition leading to the maxillary sinuses infection was the dental abscess in the upper jaw. We can hypothesis that all the affected zones are interrelated, with a primary focus of infection, from which bacteria could have spread, to the all skeleton (ROBERTS and MANCHESTER, 1995). The bacteria could be transported, from a remote spetic focus, by the bloodstream. The infectious process appears not to be active at the time of death, because no active lesions were found, except the ones related with the ante mortem tooth loss. Therefore it becomes plausible that this individual had suffered from o general process of septicemia, which did not cause his death. 2 Pósters Severe non-specific infectious processes fron Late Medieval Period (Portugal)