Osteomyelitis variolosa: A probable mediaeval case combined with unilateral sacroiliitis

Highlights

• Few osteoarticular sequelae of smallpox are described in paleopathological literature.

• Our case represents a late stage of the disease affecting the elbows.

• Well preserved bones supply osteologists with useful pathological data.

• Our mediaeval case is the oldest known.

• It holds great interest for paleoepidemiology.

Abstract

Osteoarticular sequelae of smallpox (osteomyelitis variolosa) are uncommon today. Such lesions may be observed occasionally, however, in countries where the disease has been endemic. Without other forms of documentation, it is possible to suggest a diagnosis of smallpox in ancient skeletal remains and thus make a significant contribution to understanding the history of this disease. We have examined a subadult male (Skeleton 833), 15–17 years old at the time of death, who presents bilateral bone manifestations of the elbows suggestive of smallpox. No other bone is similarly affected. In addition, he presents a left sacroiliitis deemed to be a brucellar manifestation. Skeleton 833 is one of at least 730 individuals from an exhaustive excavation of a mediaeval necropolis at Pont-sur-Seine (Aube, north-eastern France). Radiocarbon dating of his bones yields a date of between AD 1022 and 1155 (calibrated), thus apparently the oldest case described to date. The other published cases correspond to more recent periods with a well established historical context. We argue that this example of osteomyelitis variolosa.

Introduction

Smallpox is a disease no longer taught in medical schools. Last diagnosed in Somalia during 1977, declared eradicated by the World Health Organization on 8 May 1980, and sometimes considered a potential biological weapon (Geddes, 2006), this deadly infectious epidemic disease is unique to humans and leaves rare osteoarticular sequelae attesting to its presence in clinically diagnosed individuals. Such recent orthopaedic curiosities are still published, most often after fortuitous discovery or fracture of fragile bone (Nema et al., 2012). Such recent cases supplement research conducted during epidemics in Africa (Cockshott and MacGregor, 1958, Cockshott and MacGregor, 1959, Davidson and Palmer, 1963, Eeckels et al., 1964). Paleopathologists may use such knowledge in studies of the rare archaeological cases of smallpox; we found only three references to this diagnosis in archaeological materials, all published since the disease was eradicated (Jackes, 1983, Ortner, 2003, Ortner, 2007, Powers and Walker, 2008). It is likely that other paleopathological cases have gone unnoticed. This is why we present a skeleton with several lesions suggesting late-stage smallpox.