The present work is the first Russian publication on human paleopathology covering a period from the Neanderthaloid stage and up to recent times. A number of monographs dealing with paleopathology of man and animals have been published in some other countries. Being of a definite scientific importance they accounted for the fact that the new branch of science has been acknowledged as such and gave rise to a growing interest to further investigations carried along that line. However, all those papers seem to lack the exhaustive completeness of observed data that is characteristic of the present book. Having proved the existence of many pathological changes in bygone epochs the authors of respective publications never attempted to show the value of their finds for practical application in medicine of the present day, particularly as a means of making modern X-ray diagnostics more accurate. While this is one of the main objects the present monograph is aiming at. There is no doubt that a good knowledge of the past, to which we are closely linked, helps us to acquire a better insight and understanding of the present.
Anatomical and radiological studies of osseous remains of man found in excavations, enable us to throw light on the duration of human life in far off days, on the rate of senility process in the bone-and-joint system, on the frequency of injury and illnesses, as well as on the peculiarities of the course they took.
Judging by the state of skeletons the duration of human life was brief. Skeletons showing signs of physiological senility, characteristic of advanced and old age have rarely been found. Great was the death rate in young children with no apparent changes in the skeleton. Thus, for instance, bones of children constituted about 33 p. c. of the total skeleton finds in the Sarkel-on-the-Don barrows, dated to the X–XII c. c. A. D. There is no doubt that death rate in childhood was still much greater. The fact is confirmed by evidence obtained from excavated barrows in Khakass district (from a later period of the neolithic epoch and until the I c. A. D.), as well as in the Trans-baikal region (back from the Bronze Age up to I c. A. D.), and in other places.
Centuries and millenniums ago as in our days pathological changes in macerated bones showed considerable individual variability, according to the size and severity of the lesion and the number of bones affected. However much those may vary, some fundamental characteristics of every pathologic process are essentially the same. This enables us to recognize abnormalities and morbid changes (both in their early stages and in a far advanced stage) observed in human skeletons of any epoch, from the early Stone Age and up to our days.
Degenerative dystrophic lesions of joints and semi-joints, as premature symptoms of senility, proved to be the most frequent conditions observed in skeletons. Those are deformative arthrosis, spondylosis and spondyloarthro-sis, as well as osteochondrosis of the intervertebral disks.
The extent and severity of these lesions as well as the number of bones affected are rarely as considerable in modern man as they had been in far off epochs. Premature infirmity due to degenerative dystrophic lesions of the locomotion apparatus of the human body had once been a most frequent phenomenon (Khakass district, from the late neolithic epoch, Bronze Age and up to the I c. A. D.; Eski-Kermen, Crimea, V–XII c. c. A. D.; Lake Ladoga region, XI–XII c. c. A. D.; Sarkel, X–XII c. c. A. D. and other regions).
In some regions traumatic lesions have been most frequent, battle injuries inclusive (Transbaikalia, the Selenga region, nomads of the VIII–XII v. c.; borderline town and fortress Sarkel, X–XII с. c.; Eski-Kermen, V–XII с. c.). Satisfactory union of fragments may be not unfrequently observed even in medial fractures of the femoral neck (South Siberia, a nomad VIII–X c. c. A. D.; Sarkel, X–XII с. c.). Unsatisfactory results have been observed in fractures, where the ends of the fractured bone overlapped each other (since extension was not applied), and also in complicated fractures. However, the number of bones bearing traces of complicated fractures, on the whole, is not great.
Frequently the nature of injury enabled us to learn something about the weapon that inflicted it. It refers not only to instances when fragments of flint or bronze arrowheads have been found in the injured bones. The discovery of such finds witnessed to the fact in what epoch the tragic event occurred.
For many kinds of weapons definite types of injury are most typical. The nature of multiple injuries inflicted with side-arms, in many cases, is a proof of the extraordinary cruelty of the invaders. It is obvious from the nature of wounds inflicted to Andrei Bogolyubsky, the massacre of the defenders and inhabitants of the right-bank Tsymlyansky fortress (early IX c.), the slaughter of women and children that inhabited Izyaslavl (1241), the nature of wounds of some Sarkel inhabitants (X–XII с. c.).
Sometimes extensive ossificating myositis developed due to heavy injuries of the locomotion apparatus. The newly-formed bony growths were greater in size than the adjacent tubular bones (Eski-Kermen, Crimea, V–XII с. c.; Tok-Kalah, near Nucus, VII–VIII с. c.).
Facts proving extreme antiquity of surgery are most convincing. Even in the remotest past, surgery of the bones might result in healing without any complications, no suppurative processes in particular. Such is the evidence of little finger amputation in a female hand of the mesolithic epoch (Crimea, Murzak-Kobah cave). The same is witnessed by complete healing of trepanation aperture in a mesolithic skull (Ukraine, Vasilyevka 3, Dniepropetrovsk district), and in two skulls of the neolithic epoch (same district). Successful issue has been observed following surgery for frost-bite, complicated by bone necrosis (Sarkel, X–XII с. c.).
Excessive physical strain, particularly in youth, frequently caused chondro-hernia in the vertebral bodies resulting in fixation of a considerable portion of the spine (Altai, early Bronze Age period and later Sarkel, X–XII с. c.; N. Caucasus, XIII–XIV с. c., etc.).
Tuberculous lesions of the spinal column and joints were not unfrequent (Western Manych, later Bronze Age period, I millennium В. C.; various regions of Siberia, I c. A. D. and later; Sarkel, X–XII c. c. showing a number of tuberculous lesions). Some individuals suffering from tuberculous spondylitis had lived for many years or even for decades.
There were many instances of osteomyelitis (Transbaikalia, Selenga region, I c. A. D.; nomads of the VIII–X с. c.; Sarkel, X–XII с. c.). An extremely grave case of osteomyelitis of the whole length of the humerus is of special interest, being characterized by central necrosis with multiple, sequesters partly still preserved, and multiple cloacas; the patient doubtlessly perished from amyloidosis (Eski-Kermen, VIII–X с. c.).
In 4 cases it has been possible to recognize typical changes due to Bech-terew’s disease, namely ankylopoietic spondyloarthritis (Sarkel, X–XII с. c.; Eski-Kermen, V–VIII с. c.). Some of the patients must have lived for many years, in spite of the gravest deformation in the spinal column.
Doubtless evidence of syphilitic lesions have been found in precolumbian days. The most ancient finds of the kind (syphilitic ostitis and periostitis of the tibia) are dated to the middle of the II millennium В. C. (Bronze Age in Transbaikalia, the Selenga region). In the same region 3 more cases of syphilis have been found in people that lived in the I c. A. D. A number of similar finds have been made in skulls and tubular human bones dated to X–XI c. c. (Sarkel). There are separate finds of the same nature made in lake Ladoga region, XI–XII с. c., in Eski-Kermen, V–XII с. c.). One instance of lesions resulting from tabes dorsalis, i. e. postsyphilitic lesions (arthropathia tabica) has been observed in Sarkel in barrows of the X–XII c. c. However, those were individual and not mass syphilitic cases, the latter remaining typical for Western Europe of the postcolumbian epoch; similar lesions have also been found in a great number of skeletons in burials of old Vyatka (XVII–XVIII с. c.).
Deformation in the bodies of the lower thoracic vertebra, due to continuous pressure of aortic aneurysm has been found in nomads of VIII–X c. c. (Altai district).
The presence of typical groove-like depressions crossing several costal bones is worthy of note. It is the result of pressure exercised by strongly dilated arteries in congenital lesion of the great cardiac vessels, i. e. the coarctation of the aorta in a young girl in the adolescent period (Krasnoyarsk district, Karasuk culture, X–VIII с. с. В. C.).
There were several finds of partial aseptic bone necrosis (osteochondrolysis of the Koenig’s disease type) (Sarkel, X–XII с. c.; Eski-Kermen, V–XII с. c.).
It became possible to date the antiquity of the Urovsky disease (Kaschin — Beck disease). The area where this endemic condition had once raged was much greater than it is nowadays. Characteristic lesions have been observed in human bones pertaining to later neolithic epoch along the banks of the Selenga; also in the same region in the Bronze Age, V–VI с. с. В. С., I c. A. D. and up to VIII–X c. c. Typical Kashin — Beck lesion has been observed in a skeleton from a Kazakhstan barrow dated to XVI c. (3000 kms. away from the endemic centre of the present day).
Benignant growths and tumour-like formations are not at all rare in fossil bones. 14 osteomas have been registered in Eski-Kermen (V–XII с. c.). There are several cases of enchondroma and exchondroma (Sarkel, X–XII с. c.), osteochondroma (Krasnoyarsk district, XV–V с. с. В. C.; Eski-Kermen, V–XII с. c.), osteochondromatosis of joints (Sarkel, X–XII с. c.), multiple hemangiomatta of vertebral bodies (Altai district, nomad of the VIII–X c. c.) several cases of multiple cartilaginous exostosis (in different regions and in different epochs).
Typical multiple myelomatous perforated lesions in the cranial vault of a middle-aged man have been found in the Altai district (in a nomad of VIII–X с. c.).
Various kinds of metastases of cancer in bones, usually multiple metasta-ses, mainly in the vertebral bodies have been registered. We also came across osteolythic sclerosing and mixed metastases. The most ancient find was metastases in vertebra] bodies of a comparatively young female that had lived in North Kazakhstan in the Andronovsky bronze epoch (about XV с. В. C.). Other observations date back to the VII century В. C. (near Saragash lake of Krasnoyarsk district), to the III с. В. C. in the territory of the Tuvinsky A. S. S. R., to the I с. В. C. in the barrow near Biysk. Several cases of multiple cancerous metastases in the vertebral bodies, in the brain and face cranium, and in the skeleton of the limbs have been noted in the inhabitants of Sarkel (X–XII с. c.). Cases of simultaneous presence of cancerous osteophytosis (ossified cancerous periostitis), especially where the lower jaw is involved, together with osteolythic lesions in other bones are especially worthy of note (Sarkel, X–XII с. c.). We have found similar lesions in the brain cranium and in the lower jaw of the famous traveller and ethnographist N. N. Miklukho-Maklai, who died in 1888 at the age of 41 of a disease that remained undiagnosed.
All sorts of abnormalities of development have often been registered as well as occassional actual deformities of the skeleton (Krasnoyarsk district — Aphanasyevsky Culture, Karasuk Culture, Eski-Kermen, V–XII с. c., Ladoga lake region, XI–XII с. c., Sarkel, X–XII с. c.). Twice, malformation of female pelvis impeding normal child-birth has been witnessed (rightbank Tsymlyansky fortress, beginning of the IX c.; Sarkel, X–XII с. c.).
Adaptational and compensatory changes are most remarkable. A manifestation of which is the development of parostosis in short, and more rarely in long tubular bones (Eski-Kermen, V–XII с. c., Sarkel, X–XII с. c., Izyaslavl, 1241), and newly formed osseous rims, torus mandibularis et maxillaris. Bony rims have been most frequently observed in the jawbones of more ancient man (the later neolithic and bronze epoch in the Ukraine and Siberia), while in later periods they become less frequent (the lower jaw of a Scythian king from the Kul-Obah barrow, IV с. В. C.; Eski-Kermen, V–XII с. c., Sarkel, X–XII с. c.).
The fact that invalids and helpless cripples had the chance of existing for many years, in those far off days, is evidence of certain definite social relations and conditions of life, of the presence of a sense of duty and care taken by members of families and kinsmen.
Pathological changes and malformations of the skeleton are sometimes so characteristic that they enable us to depict the peculiar appearance and behaviour of a given individual with convincing exactness. This is done with respect to a number of historical persons (e. g. Yaroslav Mudry, Andrei Bogolyubsky and some others). Such anatomical and radiological data made possible an unusual medico-legal investigation carried on ages and millenniums after the event.
Many years examination of fossil bones, the comparative study of histo-rico-archeological, anatomical, anthropological and radiological data contributed to the formation of new theoretically and practically important branches of science, namely age-group and individual roentgeno-osteology, roentgeno-anthropology and roentgeno-paleopathology. The above research helped to improve clinical roentgenodiagnostics.