Pe ec © Héad pf the National Survey of Anthrogiglogy and sts er ts Se ote Canta Pee os esa ee eee ae Beene ase cs ©. Departiment of Anthropology “= = fenceJournal of Paleontology - Monographic Publication 3 Luigi Capasso Head of the National Survey of Anthropology and Paleopathology ‘Archaeological Museum - Chieti (Italy) Kennets A, R. KENNEDY Division of Biological Sciences i ‘Commell University Ithaca - New York (USA) Cyntuia A. WILCZAK Departiment of Anthropolozy Cornell University Whaca - New York (USA) ATLAS OF OCCUPATIONAL MARKERS ON | HUMAN REMAINS Edigrafital S.p.A. - Teramo 1999© 1998 by Associazione Antropologica Abruzzese - Journal of Paleopathology, Via dei Tintori, 1 - Chieti, Italy Published by Edigrafital SpA - S. Atto - Teramo - Italy ‘This book isin copyright subject to statutory exception and to the provisions of relevant collective licensing agreements, no reproduction of any part may take place without the writen permission of Associazione Antropologica ‘Abruzzese - Journal of Paleopathology First edition Printed in Italy Capasso Luigi, Kennedy Kenneth A.R., Wilezak Cynthia A, Atlas of occupational markers of human remains p. 184 cm, 27.5x21.5 Included Bibliographical references including a preface by De Stefano G.F. and Hauser G. 1. Paleopathology ‘On the cover: Relief of Coiner's Workshop (Imperial age, I century A.D.) Numismatical Collection - National Archeological Museum - Chieti - Italy aPREFACE We feel it an honour to be invited by the authors to contribute a preface to their volume, for we are most pleased to see this evidence of continuing interest in nonmetrical variations in human remains following the publication of our own atlas of “epigenetic variants of the human skull” (Hauser & De Stefano, 1989). The two volumes could hardly be more different. Our atlas dealt with intrinsically innocuous minor skeletal variants of the human skull, normal phenotypic variant morphologies, setting out the basic facts for each, their nomenclature, gross anatomy, function, embryology and development, genetics, medical relevance if any, methodology and frequency variation within and between popu- lations. The volume by Capasso, Kennedy and Wilezak deals mainly with the postcranial skeletal 4nd other tissues, is not restricted to normal variants, for some are frankly pathological and the ‘majority pose the question of where normal variation ends and pathology begins. The value of this book lies largely in its potential. It is not a diagnostic text for sports or occupa tional medicine. It makes few attempts to validate the explanations proposed for the various forma- tions, but sets them out as ideas waiting to be tested. Admittedly testing experimentally is out of the question, but empirical testing is possible, For instance, if a feature is interpreted in a case report as developing as a result of vigorous and protracted canoeing, then it may appear in other peoples who practise similar canoeing activities, and should be looked for, always bearing in mind that minor variations in posture or in action may set up a different pattern of stresses on the’ skeleton. This is one reason why the book is so useful; it tells the investigator of skeletal remains what to look for, and opens up the possibility of quantitative comparison through analyses of the frequencies of the trait in different populations and subpopulations. A second reason is that it takes the reader away from simple description and makes him think about process, the determinants of morphological developments and how they exert their influences. Thirdly this book demonstrates the importance of an interdisciplinary approach by the physical anthropologist investigating human remains. In particular it shows that he must work closely with the archeologist excavating a site and absorb from him his wholistic view of a people and their way of life, their culture, their society. To help interpret his observations he needs to take into account the cultural studies of activity and behaviour patterns recorded in extant hunter-gatherer and simple horticultural peoples. From the biological point of view he needs to be aware of relevant orthopedics, pathology, dentistry and other medical specialities. We regard this book as forward looking in that it opens the door for future work in a variety of directions. Of the many skeletal series from archeological sites reported in the past, few give descriptive morphological details and only a very small minority specifically consider the traits and factors mentioned in the book. Readers responsible for collections will be prompted to check in them the occurrence of the conditions described. Occupational medicine may well be prompted to enquire into or provide information on the specificity of condition and cause. Such work will enlarge our knowledge of past populations and how they lived. Prof. GIAN FRANCO De STEFANO University of Rome - Tor Vergata Prof. GeRrup Hauser University of Wien ee osINTRODUCTION So-called “markers of occupational stress” (MOS) are (1) distinctive morphologies or (2) true pathological alterations that can develop as a result of work-related activities. The first recognition of the medical and legal aspects of specific anatomical modifications of bones, teeth, hair, nails, and soft tissue structures as markers of occupational stress is attributed to Francesco Ronchese of the Boston University School of Medicine, who published “Occupational Marks and Other Physical Signs: A Guide to Personal Identification” in 1948. Ronchese drew upon his own clinical cases as well as upon those of his predecessors who had pioneered the fields of “trade medicine” during the emergence of the industrial revolution in the Western World (Ramazzini, 1705; Thackrah, 1831; Lane, 1887a). Complementing the alliance of industrial medicine with orthopedics and athletic (sports) medicine was the rapprochement of biological anthropology’s abiding investigations into how habitual activities of both prehistoric and modern peoples may be reconstructed from morphological variations in skeletal and dental struc- tures (Broca, 1868, Turmer, 1887, Manouvrier, 1893, Charles, 1893-1894). Today scientific studies of markers of occupational stress are applied within the medical-legal spheres of forensic anthro- pology, as well as in paleodemographic investigations of earlier populations recovered from archaeological excavations. Reconstruction of activity patterns, health profiles and lifestyles of extinct populations through accurate analyses of the skeletal record provides data otherwise unobtainable from artifacts, stratigraphy of habitation and production areas, or historic records alone. A survey of the published literature regarding occupational markers on human remains, published in 1989, documented more than 145 cases mentioned in scientific and popular writing, in industrial medicine, and anthropology (Kennedy, 1989). Assessing the reliability of the diagnosis of each marker was beyond the scope of the study. Subsequent research by an increasing number of biolo- gical anthropologists has revealed the difficulties involved in determining reasonably correct identifi- cation markers, their degrees of expression, and etiologies (Wilezak and Kennedy, 1997). Untested interpretations persist in the published literature, partly because testing human subjects in a clinical context is neither feasible nor appropriate. For example, the hypothesis that excessive joint activity leads to degenerative joint disease is debatable; rather, changes at articular loci must be weighed against behaviors that exacerbate the natural processes of aging and sexual differences. Unfortunately, in many cases animal experimentation fails to offer results consistent with human responses to stress. Nor do standards exist that could assist the investigator in making accurate diagnoses. Many interpretations of MOS have been anecdotal and highly speculative. However, progress is apparent in the realization that a specific modification of osseous or dental tissue may not be attributable to a single activity pattern, but rather to a wide range of habitual behaviors. In certain cases, it is the overall pattern of stress that best defines those activities in which an individual may have engaged over a lifetime. Thus, a proper diagnosis may be limited to stating that an individual had engaged in strenuous labor, as suggested by skeletal modifications in certain anatomical regions, e.g. the thorax, the long bones of the extremities, the pedal appendages, etc. This approach takes into account the entire individual, not a few isolated markers on bones or teeth. Furthermore, this approach embraces the configurations of a broad range of cultural practices that may have wrought distinctive bone remodeling or changes in teeth. A better understanding of how bone remodeling takes place, and an understanding of which kinds of modifications may de- velop within recognized vz to yield more reliable diagnosticresults than do the older strategies of matching specific bone or dental modifications with a list of possible pathological or occupational markers. As the study of osseous and dental modifications produced by habitual activity patterns has gained recognition within the scientific community, categories of MOS have been established. Some investigators have focused their attention on specific musculoskeletal stress markers (MSM) in cases where a muscle or tendon inserts ue of bone via the periosteum, or where hypertrophy of muscular attachments to bone are apparent (Merbs, 1983, Hawkey and Merbs, 1995). Others have examined activity-induced patterns in the robustness of limb bone length and thickness ratios (RD), dental abrasion (Lukaes and Pastor, 1988), and changes in the structure of hair and nails (Capasso, 1994). ‘At a symposium entitled, “Activity Patterns and Musculoskeletal Stress Markers. An Integrative Approach to Bioarcheological Questions”, held in 1997 during the sixty-sixth annual meeting of the American Association of Physical Anthropologists in Saint Louis, Missouri, participants presented papers on a wide range of topics, including the effects of trauma and disease upon bone remodeling and their associations with markers of habitual stress; effects of age, sex, and handedness described in quantitative measurements of loci of muscle insertions; detection of signs of microtrauma, sex and age differences with respect to markers observed on one or both sides of the skeleton; degrees of osteoarthritic pathology in individuals practicing different survival strategies of hunting/foraging and agriculture; evidence for “compassionate care” of disabled members of ancient societies; ito the cortical relationships of health and socioeconomic status to occupational activities of people from historic cemeteries and for whom medical records exist. Organized by Jane Patterson and Diane E Hawkey, this symposium heralds the emergence of innovative theoretical and methological developments in the study of MOS that transcend many of the earlier procedures practiced in the realm of forensic anthropology and paleodemography. This volume is a guide to a number of forms of anatomical variations encountered in human bones, teeth, nails and hair that have been discussed in the literature. We are well aware that this is not an exhaustive coverage of MOS, but rather a broad sampling, with representative photographs and drawings of certain anatomical features associated with habitual activity patterns. In preparing this volume we gathered relevant sources mentioned in the literature of specific morphologies and pathological alterations that are demonstrably associated with various kinds of activities. We expect readers of the Atlas to undestand that in most cases the ties between the presence of a given morphological or pathological characteristic and a given activity are not univocal. When a MOS is a specific morphology, it is often the phenotypic expression of a mixture of genetic and environmental factors (including those attributable to the habits of the subject); from one case to another different components can predominate. Though there are certainly some MOS that are uni- vocally related to work-related environmental factors, in most cases the extent of genetic influence is unknown. When the MOS is a true pathology, the etiologic factors that normally cause the con- dition also come into play, and the final answer may be influenced by the way the individual subject reacts to the etiologic agent. Therefore, in these cases the stress factors that correlate with the activity simply contribute, to varying degrees, to the individual's response, in other words to the appearance and degree of development of each individual MOS. ‘Two examples will help to clarify this statement. The so-called “olecranic spur” (Form no 65) is the osseous metaplasia of the insertion of the tendon of the humeral tricipitis muscle on the olecra- non. This metaplasia results in a more or less prominent, extremely characteristic bony spur. Themetaplasia is caused by repeated microtraumas that affect those who use the triceps under con- ditions of stress: indeed, it is known as the “woodchopper’s lesion”, As a result of some systemic pathological conditions, some individuals develop a generalized ossification of the osseous insertion points of tendons and ligaments; this condition is known as diffuse idiopathic skeletal hyperostosi and is characterized by the simultaneous formation of bony spurs in several areas of the body. There are mild forms of DISH, and there is probably a condition of diathesis, that is to say, genetic predisposition, to ossifying entesopathies and syndesmopathies. In these subjects ectopic ossifications can also develop in places other than tendons and ligaments, for example in cartilage or fibrous tissues. The olecranic spur can, therefore, also develop as a result, of DISH, it will be indistinguishable from that typical of woodchoppers, and can occur in an indi- vidual who does not habitually contract his triceps. The same morphology, the olecranic thickening, thus has several etiologies. To make a correct diagnosis, it is therefore important to examine the entire skeleton with care, consider the asymmetry of the lesions (incompatibility with the preferen- tial lateral development that is always present) and the concomitant presence of other lesions. ‘The osteosarcoma of the tibia (form no, 114) is another case in point. It is a clear example of a profession-related bone disease, and a fact appreciated by the women who painted, However, one obviously cannot conclude that the presence of an osteosarcoma is unequivocal evidence that the person suffering from it was a watch painter; indeed, cases of osteosarcoma have been observed in the skeletal remains of people who lived long before the invention of the watch. The Atlas is a collection of possible MOS, and we expect our colleagues will find it useful, as it gathers the bibliographical information, visual documentation, and descriptions of what is currently known into a single volume. With regards to the visual documentation, we note that it is qualitatively variable, this is because we chose to use the original illustrations published by the researchers though many photographs are mediocre; our aim was to collect the material available to present as objective as possible an overview of the work done to date. We hope that this Atlas will prove useful to our colleagues in the disciplines of anthropology, paleopathology and the forensic sciences. Lurct Capasso Kennedy A.R. Kennedy Cynthia A Wilezak Chieti, 7.10.97 ‘Acknowledgements ‘The Authors wish to acknowledge the generosity of those colleagues who have furnished photographic and textural materials for this Atlas (their names are cited in the captions of the individual illustrations). We have sought to acknowledge each donor in the appropriate section of the text, as well as to give credit to publishers who gave permission to reproduce some of the photographs. The Italian author wishes to thank the following people, who have assisted us in various aspects Miss Nadia Rabottini, Mrs Salvatore Caramiello, Dr Ruggero D’ Anastasio and Dr Luisa Di Domenicantonio. The American authors wish to thank the following people, who have assisted us: Mrs Rose-Marie Brainard, Miss Laura Linke, and Mrs. Anne Carson, Certain facilities were provided by the Soprintendenza Archeologica dell’ Abruzzo (Chieti) and by the Section of Ecology and Systematics of the Division of Biological Sciences, Cornell University.-[- OcCUPATIONAL MARKERS ON THE BONESTOPOGRAPHIC POSITION ON THE SKELETON: OCCIPITAL BONE Form No. OCCIPITAL AND PERI-ASTERIONIC SUPERSTRUCTURES sysovrnts Ectocranial superstructure is a generalized term which refers to crests or tuberosities of the cranium and, along with the more spatially specific term of occipital superstructures (OSSs), was first used to describe morphological features used in the phylogenetic analy- sis of carly hominids (Weidenreich, 1940; Hublin, 1988; Heathcote et al., 1996, nd.). However, the struc- tures of interest here are associated with specific muscle insertions and populations rather than with the general morphological features of the cranium used in phyloge: nies, ‘Three types of bilaterally occurring ectocranial superstructures were described in modern human popu: lations by the early 20th century and more recent work has documented the highest frequencies and strongest development in certain Oceanic populations (Ecker, 1878; Waldeyer, 1909; Hasebe, 1935; Arai, 1970; Pietrusewsky et al., 1992; Heathcote et al., 1992; Heathcote et al. 1995; Heathcote et al., n.d.). Two of thi superstructures occur directly on the occipital, and although the third tubercle is found near the parietal- mastoid suture, they are collectively referred to as C 1) torus occipitalis, supranuchal tubercle, tubercle of Hasebe, tubercle development on the occipital tori (ror) 2) processus retromastoideus, bilateral tubercles, tuber- Cles of the retromastoid processes (PR) 3) peri-asterionic tubercles, tuberculum supramastoi- deum posterius, posterior supramastoid tubercles (TSP), A review of the history of OSSs nomenclature can be found in Heathcote et al. (1996) and Sava (n.d). The preferred terminology for these OSSs is that of recent researchers (Arai, 1970; Anderson, 1992; Hanson, 1995; Heathcote et al., 1992: Heatheote et al. n.d.) Heathcote et al. 1995; ‘This marker consists of three separate hypertrophies which may, although not necessarily, co-occur. One pair of tubercles is found at the insertion site of the trapezius, slightly superior to the semispinalis capitis (TOT), along the superior nuchal line. In the most pronounced cases, oval tubercles are found on either side of the mid-line while less developed examples show linear roughening along the aponeurotic attachment of the trapezius. The largest tubercles reported by Hanson (1995) were 11x14 mm and maximally projected on the left S mm and on the right 7mm in a Chamorro female, although Heathcote et al. (1995) found the average frequency and degree of tubercle development was greater in males. ‘Also included within this group of OSSs are retro- mastoid processes (PR) which occur at the superior oblique insertion site just below the inferior nuchal line and lateral to the recius capitis muscles. Periasterionie tubercles (TSP) develop at the superior and medial end of the sternocleidomastoid insertion where it converges with the occipitofrontalis (Anderson, 1992). While included collectively in the general category of OSS, ‘TSP are found near the parietal-mastoid suture either running across or confined to the parietal or temporal bones (Heathcote et al, n.d.). These superstructures also appear to coincide with a generalized thickening of the cranial vault and spondylolysis of the fifth lumbar ver- tebra, although the frequency of this association is not known (Hanson, 1993) In order to facilitate comparative studies of OSSs, scoring procedures that utilize both qualitative and 2 (A) and Stage 4 (B) TOT which ilustrates the continuous nature of this structure from roughening of the aponeurotic ata cchment ofthe tapezius through more diserete tubercles. (Reproduced with permission from Heatheote, 1996: fig. 1)re 2, Marked develops e 4) of PR permission from Heatheote, 1996, fig. 2 (Reproduced with Figure 3 permission from Heathcote, quantitative criteria have been developed. Each super: structure is scored on a five point scale (0-4), corre. sponding to total absence through massive development for each trait, A detailed protocol for this scoring dure is available in Heathcote et al. (1996). proce: Given the current knowledge of OSS distribution. the possibility of genetic or epigenetic influences cannot be dismissed. The development of OSS may be influenced by overall eranial form, variation in the form of the occipital tori, muscle morphology, of differences in the structural properties of bone. Heathcote et al (1996, n.d.) suggested that OSSs have multifactorial etiologies involving an underlying collagen defect that would produce an increased susceptibility to bio: mechanical siress at muscle insertions, a conclusion supported by the high frequencies of collagen defects observed in the skin of Guamanian Chamorros. This hypothesis, which combines global epigenetic and general environmental influences, illustrates the com- plexity of interpreting markers of occupational stress and the difficulty of directly linking labor patterns to skeletal anomalies. The presence of these tuberosities at specific insertion sites supports the contention that 12 muscular stress also is a factor in their development given the large number of enthesopathies documented at other skeletal locations. One objection to this functional interpretation could be made on a morphological basis since the most marked forms of TOT and TSP are large tubercles while the insertions of the trapezius and sternocleidomastoid are long, thin aponcuroses. However, the most stron developed examples appear to be at one end of a contin uum which includes linear roughening along the apo- neurotic insertions and may reflect variability in these attachments (Heathcote et al, 1995). If this is the case, the high frequency of well-developed OSSs may reflect thicker attachments than the commonly described apo- neuroses in individuals with tubercle development Specific muscular actions of the upper trapezius (TOT) include the rotation of the clavicle during seapu- lar elevation and support for the distal clavicle when carrying loads with the arms held straight along the sides of the trunk. The superior obliques (PR) are active, as postural muscles, as well as contributing to bending, the neck backwards when they are bilaterally active or rotating the neck toward the unilaterally active side. Finally, the sternocleidomastoid (SCM) acts to draw the neck forward and up in a supine position as well as rais ing the thorax during forced respiration when the supe- rior end is fixed. In addition, when unilaterally active, the sternocleidomastoid will bend the neck toward the shoulder of the active side and rotate the neck and face toward the opposite side (Heathcote et al., 199: While the etiology of these tubercles has not been fully established, it has been proposed that they develop with recurrent extension/flexion of the head and neck which is supported by their bilaterality. If spondylolysis does prove to occur with these superstructures, it would suggest that external loading may also play a role since the horizontal transport of heavy loads involves the lumbar spine in stabilization (Anderson, 1992). OSSs rarely occur outside of indigenous populations of Oceania, and high frequencies of individuals with strong development of all three superstructures have only been documented in the Mariana Islands and Tonga (Heathcote & al., n.d.). Because of this, attention has been focused on activities which are widespread within this region, Possible occupational factors in OSS devel- opment include: mining or working in a confined space in a chronically flexed position, climbing coconut palm trees, carrying heavy weights with the arms held down, heavy construction work such as the building of mega- lithie structures, diving, long distance canoeing, and throwing activities, as in throwing slingstones. In sup- port of the diving hypotheses, 80% of the Chamorros from Gogna-Gun, Guam, with auditory exostoses had OSS scores from moderate to massive (Heathcote et a n.). Although intriguing, this observation on a small sample (5 of 76) from a single series is insufficient to postulate direct casual correlations. Anderson (1992), Arai (1970), Ecker (1878), Hanson (1993), Hasebe (1935), Heathcote et al. (1992), Heathcote et al (1995), Heathcote et al. (1996), Heathcote et al. (n. d.), Hublin (1988), Pietrusewsky (1992), Sava (n.d.), Waldeyer (1909), Weidenrich (1940).OCCIPITAL BONE SUPRA-INION DEPRESSION A depression on the occipital bone at the center of the squama superior to inion that is associated with evidence of vertical occipital deformation. Children under one year of age often show an active lesion with lytic and osteoblastic activity resulting in a marked depression. One case has been reported of reactive bone deposition on the endocranial surface of the occiput, opposite the exterior lesion. In older children and adults, a circular depression is found of remodeled bone and sclerotic scarring Mechanical pressure of friction of the occipital may be the primary cause of the lesions through the obstr tion of circulation to produce a localized necrosis and ischematic ulcers (Holliday, 1993). Additionally, frie: tion may serve to exacerbate or predispose an individual to other conditions such as bacterial, fungal, and paras tic infections. There are several agents that may cause supra- inion depressions to develop. Impetigo - whose causative agent may be cither staphylococcal, streptococcal, or both - begins in the ostia of hair follicles and mechani- cal pressure may increase the likelihood that the infec- tion progresses to abscesses, furuncles, or carbuncles. Form No, Tinea capitis (ringworm) is a fungal infection that is, primarily superficial, but givei ces it can progress to a pyogenic, tion and form a type of carbuncle known as a kerion The only animal parasite commonly found on the scalp s Pediculus capitis (head lice). With mechanical irritation, the bites of the louse may lead to a secondary bacterial infection that results in abscessin the proper circumstan- ranulomatous infec- vuruncles. Supra-inion depressions were reported by Stewart (1971; 1976) in North and South American erania and he attributed them to lesions caused by gradleboarding, In support of this causative cultural practice was the 22.2% incidence of depressions in deformed crania versus thei presence in only 9.3% of undeformed crania. Also, in a population from southwestern New Mexico, active lesions were only found in infants under one year of a and no similar lesions were found on any other bone (Holliday, 1993). The ag the position of the distribution of active lesions, ssions, and their association ly sug: anical irritation st that with vertically deformed crania stron cradleboards are the source of the mech: BIBLIOGRAPHIC REFERENCES: Holliday (1993), Stewart (1971), Stewart (1976). Figure 4. Beui lesions are showa in A and B with a more extensive, active lesion in C, The J bone ‘arows in D thin and remodel shown by illustrates the healed condition. (Reprinted with permission from Holliday 1993: 286,TOPOGRAPHIC POSITION ON THE SKELETON: CRANIAL BASE Fortn No. RING FRACTURE (IMPRESSION-TYPE) Ring fractures of the cranial base are centered around the foramen magnum which may be completely or incompletely encircled. While classical ring fractures also involve the middle fossa, impression-type ring fractures are asymmetrical and confined 1o the floor of the posterior fossa (Voigt and Skid, 1974), STRESS FACTORS: Impression-type ring fractures are the result of the forceful impact of the vertebral column against the base of the skull. The column may be rammed forcefully into the base due to ischial impact forces trasmitted through the spine or by axial loading to the skull crown (Maeda et al., 1993; Voigt and Skéld, 1974). Because of the nature of the injury, ring fractures usually result in instantaneous death. (OCCUPATIONAL ACTIVIEYGES Ring fractures occur due to severe trauma and repor- ted cases in the medical literature are overwhelmingly the result of motor vehicle accidents. However, the less common impression-type fractures can also be caused by a fall to the ground from a height when the indivi- dual lands on the buttocks, as well as by violence to the top of the head. Both ring fractures and Jefferson burst fractures of the atlas were reported in enslaved individuals interred during the 17 and 18! century in the New York African Burial Ground (Blakey, personal communication; Hill et al., 1995; Mack et al., 1995). The presence of these two types of cranial fractures suggests that the traditio- nal West and Central African method of carrying loads on the top of the head was continued in the United States, Other evidence for strenuous load carrying is evident in the limbs with enthesopathies of the attach- ments of brachialis, pectoralis major, and along the sspera, In combination, these markers could be ve of lifting loads from a squat and their place- ‘ment on top of the head during erect posture. Blakey (personal communication), Hill et al. (1995), Mack et al. (1995), Maeda et al. (1993), Voigt and Sk6ld (1974). Figure 6. Endocranial view of oceipital fragment of a ring fracture iMlustrating the bevelled margins in an adult female from the New York African Burial Ground, Burial #107. (Photograph courtesy of Michael L. Blakey and the New York African Burial Ground Project, Howard University, US. General Services Administration). Figure §. Unhealed ring fracture of the eranial base in an adult female from the New York Africa Burial Ground, Busial #107, (Photograph courtesy of the New York African Burial Ground Project, Howard University, U.S. General Services Administration)TOPOGRAPHIC POSITION ON THE SKELETON; Form No, MASTOID PROCESS, 4 HYPERTROPHY OF THE MASTOID PROCESS syvowyas holding the head upright against an extension loading of the neck. Hypertrophy of the mastoid process results in decreased sexual dimorphism when enlargement occurs, in the females of a population but not in males. A decreased dimorphism is seen in the mastoid hei (from the Frankfurt Plane to mastoidale) relative to head circumference and in the mastoid area measured rove to the uumpline use, where burdens are suspended upon the back with a strap around the forehead. In Chumash Indian women of southern California this resulted in hypertrophy of the mastoid (Davidson, n.d.; 1992). In contrast, when burdens ate carried by Chumash men, they are typically suspended across the shoulder and thus mastoid size is unaffected. from the posterior aspect of the digastric tympanic plate and porion The stemocleidomastoid normally acts to flex the neck when it is bilaterally active, but in this case it is BIBLIOGRAPHIC REFERENCES Davidson (1992), Davidson (n..) digastric FESS poral bone use for comparisons. (Reproduced with permission from Davidson, nd: fig. 3) sre 7. The shaded portion indicates the mastoid area of the tem:TOPOGRAPHIC POSITION ON THE SKELETON, MAXILLA PALATINE TORUS SyNonvas: TORUS MAXILLARIES MEDIANUS, TORUS PALATINUS, MEDIANUS, TORUS PALATINUS TRANSVERSUS, DESCRIPTION OF ANATOMICAL STRUCTURE Palatine (ori are bony ridges beginning on the palatine bones that extend and diverge anteriorly on both sides of the midpalatal suture. Variations occur in the height, width, and anterior extension onto the hard palate. In some cases the elevation may terminate beyond the isive foramen, and a narrow ridge of bone (sutural ridge) along both sides of the intermaxillary suture often co-occurs, Because the sutural ridge is also found in the absence of palatine tori, Halffman et al, (1992) consider these to be two distinct traits There is evidence that tori result from masticatory stress, although genetic and nutritional factors may also play a role in their development Palatine tori are primarily associated with circumpo- lar populations including Eskimos, Icelandics, and Lapps. Although its distribution has led some authors to classify this as a racial trait (e.g. Chew and Tan, 1984; Oschinsky, 1964; Sawyer et al., 1979), the strongest evidence for environmental factors in its development comes from studies of populations after migration Convergence in trait frequency with indigenous cir- cumpolar populations and a migrant European Norse sample has been observed which supports an environ- mental component in tori development following European settlement (Scott et al., 1992; Halffman et all 1992), Lower trait frequencies and degrees of develop- ment are seen in medieval Icelandics, Norwegians, and Early Settlement Greenlandic Norse when compared to Middle to Late Settlements of Greenland. It has been proposed that in medieval Norse populations, increased masticatory stress due to changes in diet and food preparation techniques could account for the elevated incidence of tori in this high latitude populations. These changes include lower dependence on domestic animals and dairy products, increased reliance on air-dried meat, and the Shortage of wood for fuel. As pointed out by Halffman et al. (1992), changes in the frequency of this trait have also been observed in 16 Form No. Figure 8. Greenlandic Norse, Palatine torus Garden VI, male (1100-1250 AD), Eastern the Laboratory of Biological Anthropolog: University of Copenhagen. (Photo by Seot), ul manillary exostosis lement. Stored at Panum Institute, ie 9. Greenlandic Norse A.S, 123. Palatine torus and maxillary exostosis. Eastern Settlement (1150-1350 AD), Benedicti Nunnery. A. occlusal view: B, posterior view (Photo by Scott, 1986), Stored at the Laboratory of Biological Anthropology, Panum iy of Copenh Institute, UniverFigure 10, Medieval | 1 exostosis, Stored | I populations after immigration to the United States. American Chinese, Blacks, and Whites all have signifi- cantly greater palatine tori development than “are observed in broad lated groups from their respective 1992), While no one has denied the genetic component of this trait, it gy is more complex than simple The relative effect of environmental continental homeland” (Halffman et al., appears that the etiolo; inheritance. factors in trait development may vary under different circumstances. Also increasing the likelihood that environmental factors may play a role in the development of palatine ori is the age frequency distribution. Woo (1950) repor ed the presence of palatine tori in fetal palates, but Miller and Roth (1940) found that it most frequently «the Peabody Museum, Har sal University. (Photo by Scott, 1985) "gure 11. Medieval Icelander: palatine torus, Stored atthe Peabody Museum, Harvard University. Phat by Scot, 1985 develops after the age of seven. Others have found increases in both size and frequency of palatine tori throughout adolescence that may continue after attainment of skeletal maturity (Miller and Roth, 1940: Woo, 1950: 1953; Tapazian, 1977 Axelsson and Hedegaard, 1985), however, there are also reports which contradict the: in frequency (e.g. King and Kin 1983). Kolas et al wge-related increases 1981; Balaez et all Axelsson and Hedegaard (1985), Balaez et al. (1983), Chew and Tan (1984), Halffman et al. (1992), King and Kin, (1981), Kolas etal. (1953), Miller and Roth (1940), Oschinsky (1964), Sawyer et al. (1979), Seott et al. (1992), Tapazian (1977), Vienna et al. (1991), Woo (1950).MANDIBLI TORUS MANDULARIS One or more swellings or lobes on the left and right lingual surfaces of the mandibular body composed of normal compact bone. They are usually found in the canine/premolar region, but they may extend distally t0 the molar region. As with palatine tori, the etiology appears to be complex. Genetics, nutrition, and masticatory stress may all play a role in the development of this marker however the pattern of variation has been more difficult to interpret than that of palatine tori The highest frequencies are found in cireumpolar populations, but the occurrence of this trait is not corre: lated with torus palatinus (Bennett, 1973; Scott ct al 1992). Evidence for environmental influences comes from studies showing a lower degree of expression and development of mandibular tori among acculturated Eskimos subsisting largely on European-type diets, ‘when compared to Eskimos dependent on more traditional diets (Mayhall, et al. 1970; Mayhall and Mayhall, 1971). Convergence of different populations living in the same environment has also been documented (Hrdliéka, 1940; Jorgensen, 1953). However, Bennett (1973) concluded that there is no persuasive evidence indicative of an environmental component in the deve~ lopment of this trait In the Greenlandic Norse populations, the relation- ship of Arctic environments and tori development is Form No, 6 less clear than with palatine tori (Scott et al., 1992). Overall the Greenlandic sample shows a higher degree of mandibular torus development than its European counterpart, but the highest frequency and development is found in the Early Settlement. Variation occurs among populations of Mid - to Late Settlements. As with palatine tori, there appears to be an age component in development, but mandibular tori have not been documented in children under 12 years of age. It also is likely that sex chromosomes modify tori development (Alvesalo et al., 1996) BIDLIOGRAPHIC REFERENCES: Alvesalo et al, (1996), Bennett (1973), Hrdlie“ka (1940). Jorgensen (1953), Mayhall et al. (1970), Mayhall and Mayhall (1971), Scot etal, (1992), Figure 12. Medieval Icelander (1000-1500 AD): mandibular torus. Stored at the Peabody Museum, Harvard University. (Drawing by R. D'Anastasio from a photo by Scot, 1985). Figure 13. Greenlandic Norse: mandibular toms, ‘Western Settlement (c2. 1200-1350 AD), Anavik UL, Stored atthe Laboratory of Biological Anthropology, Panur Institute, University of Copenhagen. (Photo by Seott, 1986),TOPOGRAPHIC FOSETION ON THE SKELETON: Form No, MANDIBLE, 7 MANDIBULAR CONDYLE TUBERCLES SYNONYNS: wind instrument would produce the required stress Later, a family member confirmed this conclusion with DESCRIPTION OF ANATOMICAL STRUCTURE. the information that the deceased was a clarinet player Sharp tubercles on the medial and lateral aspects of (Angel and Caldwell, 1984). Additional cases of ptcry- the anterior-inferior surfaces of the mandibular condyle. goid exostoses were also reported in two wind instru- ment players submitted for examination by law enforce- ment agencies (Angel, 1982). STRESS FACTORS: Protrusion of the jaw by the lower head of the lateral pterygoids may produce tubercles. SIDLIOGRAPHIC REFERENCES: Angel (1982), Angel and Caldwell (1984). This marker was described in an autopsied indivi- dual and it was initially hypothesized that playing a Figure 14, Sharp tubercles on the ‘medial and lateral surfaces of the lft ceondyle shown in anterior view. Prom Angel and Caldwell, 1984: 170: courtesy of Charles C. Thomas, Publisher Lid, Springfield, Iino). 19TOPOGRAPINC POSITION ON THE SKELETON; Form No. MANDIBLE 8 MANDIBULAR GONIAL EVERSION SYNONYMS, muscles against an extension force applied to the forehead. Gonial eversion occurs with roughening along occursniovat acrvitvaes the inferiolateral edge of the mandibular body at the Tumpline use by Canadian fur traders where loads insertion of the platysma. There is also “squaring” of were suspended on the back from a strap across the the anterior portion of the horizontal ramus that gives forehead (Lai and Lovell, 1992). Chewing leather boots the jaw a broad and angular appearance. among Eskimo females (Oschinsky, 1964). Jaw tension produced by the masseter and platysma Lai und Lovell (1992), Oschinsky (1964). re 15, Gonial eversion with roughening atthe inferior border of the horizontal ramus where the platysma inserts. (Reproduced with permission from Lai and Lovell, 1992: 231, fig 10)TOPOGRAPHIC POSITION ON THE SKELETON: MANDIBLE NAME MANDIBLE PHOSPHORIC NECROSIS DESCRIPTION OF ANATOMICAL STRUCTURE The contact of phosphorus directly with the mandi ble produces a bone necrosis with periosteal activation ‘and new bone formation sub-periostally. This has the eral aspect of a mandibular osteomyelitis. Exposure to yellow phosphorus vapors produces lesions in buccal mucosa. Through these lesions phos phorus comes in contact with periostium and bone which produces a large bony necrosis associated with Figure 16, Phosphorus necrosis of mandible with “involuerum” {Unsttue of Pathological Anatomy, University of Zurich, Switzerland Reproduced with permission from Ortner & Putschar, 1981) Form No, 9 new subperiostal bone formations. Dessiccated mandi bles, after a long time of exposure, appear completely covered by very large deposition of new bone plates covering a necrotic bone ("“involucrum”). During the 19% century, workers in match factories xposed to yellow phosphorus vapors. The were heav substitution of yellow phosphorus by red phosphorus led to the complete disappearance of necrosis. BIBLIOGRAPHIC Ascenzi (1976),Form No. ‘TYMPANIC PORTION AND ACOUSTIC MEATUS OF THE TEMPORAL BONE, 10 NAME: AUDITORY EXOSTOSES SYNONYMS AUDITORY TORI, EAR EXOSTOSES, AURAL EXOSTOSES EXOSTOSES OF THE EXTERNAL AUDITORY CANAL, EXOSTO- SES OF THE AUDITORY BONY MEATUS, OSTEOMA OF THE EXTERNAL AUDITORY MEATUS, OSTEOMA OF THE TYMPANIC RING, DESCRIPTION OF ANNTOMICAL STRUCTURE: Auditory exostoses are bony excrescences within the auditory bony meatus and may appear as irregular bony masses, sessile or pedunculate, They are usually bilater- al, and horizontally elongate as they extend onto the bony wall of a great part of the meatus. They occur much more frequently in males than females and usval- ly affect individuals over 25 years of age (Capasso, 1987), It is possible to distinguish three major types of auditory exostoses on the basis of their position within the auditory bone canal: (1) only on the anterior wall, 2) only on the posterior wall and (3) both on the ante- rior and posterior walls. Sometimes auditory exostoses almost completely occlude the bony meatus. Histologically the exostoses consist of normal spongy bone covered by a thick coating of compact bone. Exostoses result from exposure of the ear canal to cold water that results in hyperemia and local excitation of the periosteum inducing osteoblastic activity. (OCCUPATIONAL ACTIVITYUES: Auditory exostoses are associated with habitual diving for exploitation of aquatic food resources by Upper Palacolithic and Mesolithic Europeans, native Californians, and Tasmanians (Frayer, 1988). It is also seen in pre-Columbian Peruvians of coastal villages who regularly engaged in cold-water baths and Romans who were regular visitors to the baths and thermae (Ascenzi and Balistreri, 1975; Capasso, 1987). Manzi (1991) found that only middle-class males from the 1st- 3rd century A.D. in Rome exhibited auditory exostoses. Presumably women and lower-class men did not parti cipate in the entire thermae ritual of saunas and hot baths followed by the thermic shock of immersion in cold water, Auditory exostoses are also one of the few markers for which experimental evidence is available. In human subjects, erythemia and hyperemia continued for 45 minutes after irrigation of the external auditory meatus with cold water, but only for one minute if warm water was used, and auditory exostoses were induced in gui nea pigs with cold water irrigation (Van Gilse, 1938; Fowler and Osmun, 1942), This cold water etiology was confirmed in a survey of exostoses’ fre- quency in the archeological record where it was found that the incidence was gene- rally low in polar, tropical, and inland populations, but high in middle latitude peoples who were dependent on aquati resources (Kennedy, 1986). Howerer this etiology has been reevaluated and it is, likely that additional mechanisms also induce exostoses. (Hutchinson et al., 1997) BIBLIOGRAPHIC REFERENCES: Ascenzi and Balistreri (1975), Capasso (1987), Fowler and Osmun (1942), Frayer (1988), Hutchinson et al. (1997), Kennedy (1986). Manzi et al. (1991), Van Gilse (1938). Figure 17. Various types of auditory exostoses. ‘Necropolis of Ancon, Peru (about 1000-1500 AD). ‘Stored atthe National Museum of Anthropology, University of Florence, Avauditory exostoses only on the anterior wall Band C: auditory exostoses only on the posterior wall: B, E, and F auditory exostoses both on the anterior and posterior wal (Photos by L, Capasso)TEMPOROMANDIBULAR JOINT Font No, u TEMPOROMANDIBULAR JOINT OSTEOARTHRITIS DESCRIPTION OF ANATOMICAL STRUCTURE Osteoarthritis of the temporomandibular joint may be unilateral or bilateral and displays the typical pattern of lipping, porosity, and eburnation of the articular sur- faces. Osteoarthritis at this joint results from masticatory pressure arising from chewing or the use of the teeth as, power tools Sadlermiut males show bilateral osteoarthritis of this joint implicating activities that place equal stress on the right and left sides (Merbs, 1983). Stress was often placed upon the temporomandibular joints when the dentition was used by males for power gripping, as in holding sled dog leads and fishing lines. Bow drills, which were used for boring single holes or as a saw by drilling multiple holes in close proximity, utilized a mouthpiece that resulted in considerable stress across both joints. In contrast, female Sadlermiuts showed a greater involvement of the left side. Softening of skins and leather for boots by chewing occupied a consider able part of the day, and by holding the object in the left hand the dominant hand was free to perform other tasks. Merbs (1983). Figure 18. Osteoarthritis ofthe left temporomandibular joint. A: lateral view: B: basal view; C: mandible with condylar asyrumetry; D: parti= cular view of the mandibular fossa of the temporal bone: Bronze A panicular view of the mandibular condyle. Grotta dallo Scoglictt, Grosset, sored at the National Museum of Anthropology, Florence. (Photos by L. Capasso).TOPOGRAPHIC POSITION ON THE SKELETON VERTEBRAL COLUMN Fort No, 12 SPONDYLOLYSIS AND SPONDYLOLISTHESIS SYNONYMS: Spondylolysis is a condition characterized by verte- bral separation that involves the interarticular area, the pedicle, or the lamina. Lower lumbar spondylolysis is ‘common in Eskimo populations and is often accompa nied by compression of lumbar disks and osteophytic development. Forward slippage of the vertebral column (spondylolisthesis) is also frequently observed in cases of bilateral separation. Heavy physical stress in association with erect posture and lumbar curvature introduces a shearing component to the normal vertical compressive force (Thieme, 1950). Consistent with this etiology is the absence of spondylolysis in non-human vertebrates. While posture may increase susceptibility, the actual development of lumbar breakdown is dependent on environmental stresses, Comparisons of bone mineral values and the inci- dence of spondylolysis indicate that vertical forces are likely to produce Compression fracture in individuals, with low mineral levels and spondylolysis in those with high values (Merbs, 1989). ‘Anatomical factors which may predispose an ind dual to this condition include: a longer presacral spine, an inclined superior sacral surface, increased lumbar curvature, reduced depth and curvature of the superior saeral articular facets, and lumbarization of S-1 (Stewart, 1953; 1956). Asymmetrical tumbarization places particularly severe stress on the isthmus between the superior and inferior articular processes on the side of freer movement. The morphology of the arch may also be a contributing factor if the processes are unusually Jarge and impinge on the isthmus, if the isthmus is narrow, or if itis weakened by large foramina (Nathan, 19. Spondylolysis of Lat the pedicle ina Female from Si. Lawrence Island, Alaska. (Reproduced with permis- sion fom Stewart, 1953: 944, fig. 6). 1959). Even with these predisposing factors, a stress is usually required to trigger this condition, It may be due to an acute trauma, but fati- gue fractures are more common (Wilise et al, 1975; Merbs, 1996). igure 20, Spondylolysis of Ls atthe pedicle in an adult male from Hercw lancum (subject no. $1). 79 AD. Stored at the Laboratory of Anthropology, National Archaeolo: gical Muscum, Chieti (Photo by L. Di Domenicantonio) Ecological factors and the intense physi cal labor in circumpo- lar populations, such as Eski-mos and Lapps, have resulted in a high frequency of spondytolysis in these regions (Thieme 1950; Stewart, 1953; Merbs. 1983), High rates of this pathology.are also associated with the performance of heavy labor, rigorous training among military recruits, and athletic activities such as rowing, gymnastics, and football (Merbs, 1989), In addition to the stresses they place on the vertebral bodies, compressive forces gencrated during activities, such as heavy lifting, are transmitted through the neural arches at the point of maximum lumbar curvature. While chronic stress is the primary etiology, Merbs. and Euler (1985) observed in the skeleton of an Anasazi women spondylolysis which was unlikely to have arisen asa fatigue fracture. In this case, due to its association with a tibial fracture and a thoracic compressive fracture, the spondylolysis was more likely to have been the result of acute trauma, Atypical spondylolysis may a be congenital or pathological (Merbs, 1996) BIBLIOGRAPHIC REFERENCES: Merbs (1983; 1989; 1996), Merbs and Euler (1985), Nathan (1959), Stewart (1953; 1956), Thieme (1950), Wiltse etal, (1975). Figure 21. Spondylolysis of Ly (the posterior free part of the vertebral arch ‘wax discarded during archaeological excavation), Note the great development ‘of te osteophytes at the corner of the bodies ofthe vertbrae situated caudally with respect t the spondylolysis: such is ‘a consequence of the spondylolysthesis ‘Adult male from Herculaneum (subject tno. 31); 79 A.D. Stored atthe Laboratory ‘of Anthropalogs Museum, Chieti (Photo by L, Di Domenicantonio). National ArchaeologicalTEBRAL COLUMN SNOWMOBILER’S BACK VERTEBRAL COMPRESSION FRACTURE DESCRIPTION OF ANATOMICAL STRUCTURE Vertical compression fractures of thoraco-lumbar vertebrae can cause anterior “wedging” of the vertebrae. This condition may be accompanied by marked kypho- sis in severe cases and varying degrees of posterior displacement. Axial loading can also result in herniation of the nucleus pulposus and consequent end plate frac- turing of the vertebral body which occurs with 50% of the force required for a compression fracture. STRESS FACTORS) This type of fracture is caused by vertical compres sive forces that are intensified with asymmetrical load- ing. The maximum spinal tolerance occurs in an erect posture and, as a result, forward head displacement, forward arm position, and flexion of the trunk and hips decrease the tolerable level of impact force Figure 22. Female Sadlermiut ‘with compression fracture of Ta (Reproduced with permission from Merb, 1983: 114, fig 5D), Form No, 13 Vertebral compression fractures are due (0 travel over rough terrain in vehicles with poor shock-absorb- ing capabilities. If the vehicle is traveling over an un- even surface of leaves the ground, the body is propelled forward and upward and it rarely comes down in erect posture. This condition has been reported due to sled- ding and tobogganing by Sadlermiuts (Merbs, 1983), snowmobile riding (Roberts et al., 1971), and cart riding by medieval Germans (Grimm, 1959). It is also seen in parachute jumpers and, althou: may occur in falls. In the Sadlermiut fractures of this hature are most common in the thoracic vertebrae of females versus their more common occurrence in the The superior location of injuries in females is a result of carrying loads, such as a child, on the back while sledding (Merbs, 1983: 1989), lumbar vertebrae of males, Grimm (1959), Merbs (1983; 1989), Roberts et al. (1971),TOPOGRAPHIC POSITION ON THE SKELETON: VERTEBRAL COLUMN NAME: SPONDYLOLYSIS Separation of the interarticular area, the pedicle, or lamina of the vertebrae (see Form no. 12). Bending at the hip while keeping the legs extended at the knee which reduces lumbar curvature and increases stress in the lumbar spine (Stewart, 1956). This is in (contrast to the notion that lumbar curvature increases. the incidence of spondylolysis by introducing a shear~ ing component to compressive forces, although the two theories are not mutually exclusive (Thieme, 1950). The extended leg posture may not be sufficient by itself but it may make the lumbar vertebrae more susceptible to torsional forces generated during work (Merbs, 1983). Figure 23. Extended leg work posture of Eskimo women cleani Form No. 14 ‘OCCUPATIONAL ACTIVITYUES) In Alaskan natives, Stewart (1953; 1956) attributed the high incidence of spondylolysis to postural habits. While kayaking the legs must be held in the extended position, but this position is also used when sitting or standing and working with materials on the ground. Merbs (1983) suggested that torsional forces during this, posture, as when standing and cutting a carcass, may also be linked to handedness and explain the incidence of unilateral separation. [BIBLIOGRAPHIC REFERENCES: Merbs (1983), Stewart (1953; 1956), Thieme (1950), sealskin, (Reproduced with permission from Stewart, 1953: 947, fig 10, Original photo taken at Wales, Alaska in 1936 by Henry B. Collins, Jr, now property ofthe National Geographic Society), 26VERTEBRAL COLUMN KYPHOTIC SPINE A spinal deformation consisting of a predominant kyphosis with slight scoliosis of the lower thoracic region and little compensatory lordosis. Spinal flexion and lateral bending This condition signifies long periods of sitting on a hard surface. Although many occupations may require this posture, an individual from the 18"-early 19 cen- tury in Norwich, England, was identified as a tailor due to the presence of this condition in conjunction with fibular bowing (Wells, 1967). Other occupations consid- ered were weaving and shoemaking. Walls (1967). Figure 24, Predominant kyphosis of the lower th (Or inal drawn by R. D’Anastasio). Form No, 15VERTEBRAL COLUMN Form No 16 CERVICAL VERTEBRAL FUSION AND FACETING Atlas fused to the oceiput with no evidence of fora- men or transverse processes (occipitalization). Fusion also occurs between C2 and C3 (included in Klippel~ Fiel syndrome), but here the foramen and processes are normally developed. The odontoid process is bevelled and leaves a deep impression at its point of contact with the atlas, when the neck is extended. The inferior articu- lar facets of the atlas exhibit an abnormal degree of con- vexity. In addition, contact facets are found on the opposing surfaces of the spinous processes of C3 and C4, the inferior surface of the spinous process of Cy. and the occipital bone dorsal to the foramen magnum and to the right of the midline, which is probably due to contact with the atlas. Other manifestations that occur at C3 and Cy are osteophytic development on the dorsal vertebral bodies which extend into the neural canal and forms deep impressions of the inferior articular processes, of C3 on Ca just dorsal to the superior articular facets Oceipitalization of the atlas and fusion of C2 with C: are developmental defects, but the fusions increase stress at the atlanto-axial articulation, especially during flexion and extension. The pattern of the remaining changes from the occiput through Cais compatible with extreme hyperextension of the neck aggravated by loss of mobility due to the congenital vertebral fusion, ‘OCCUPATIONAL ACTIVTIVGES) Tumpline use, when a load is carried by a strap across the forehead, pulls the head backwards and the neck hyperextends against the force of the load (Merbs and Euler, 1985), Carrying objects in this manner places, stress on the dorsal aspects of the upper cervical verte- brae. BIBLIOGRAPHIC REFERENCES Merbs and Euler (1985). Figure 25, Fusion ofthe first cervical vertebrae with the base of the skull, The arrow shows a contact facet ca sed by the opposition of the C2 spinous proc (Reproduced with permission from Merbs and Bul 1985: 383, fig. 2 and Wiley-Liss, Ine)-OPOGRAPHIC POSITION ON THE SKELETON Form No, VERTEBRAL COLUMN 7 FRUIT-PICKER’S CERVICAL SPINE OsreopHYTosis. DESCRIPTION OF ANATOMICAL STRUCTURE Slight arthritic lipping of Cy and C5 centra and extreme lipping of Cp and Cr. The greatest involvement of the cervical vertebrae due to the stress of bipedality is expected at Cs/Co which corresponds to the point of highest cervical cur- vature (Nathan, 1962). Extreme development of osteoarthritis in a position below this, at Co and C7, could be expected with habitual extension stress in this, region. Development of osteoarthritis at Ce and C7 has been described in a presumed citrus fruit-picker from Dade County, Florida. During harvesting would be extended when viewing fruit above the head (Wienker and Wood, 1988), the neck and head Nathan (1962), Wienker and Wood (1988). gure 26, Osteophyte development on the cervical spines of C, to C, that illustrates the expected pattern ‘of greatest development between C/C (Reprinted with permission from Nathan, 1962: 248, fig. 8 some modifications) 2»VERTEBRAL COLUMN SHIP-TRIMMER’S JOINT DESCRIPTION OF ANATOMICAL STRUCTURE Excayation of the pedicles of L3 and Ls combined with complete spondylolysis and spondylolisthesis of Lg, At the site of this displacement, a new joint forms that is surrounded by a loose elastic capsule. The upper joint ma in is formed by the spine and lower a processes of L3 as well as at the inferior surface of the excavated pedicle from Lg. The lower joint consists of the spine’ and lamina of Ly and the superior articular processes of Ls. This i accompanied by robusticity of the articular and spinous processes of Ls and sacral vertebrae, The adjoining margins of Ly and Ls exhibit lipping which is concentrated af the left anterio-superior edge of Ls and produce a shelf” of bone which can support La when there is lateral displacement due to rotation and flexion/extension of the superiot spinal column. Irregular margins are also present along the sacroiliac joint, Formation of a joint betweeh spiious processes of ‘Wo contigubus vertebrae is called Baastrap’s syndrome, ‘Spondylosis and excayation of the lumbar pedicles due to-loaded overextension combined with flexion, This movement also-entails trunk rotation cégtered at the site of the new joint that permits more extensive rotation than the ndrmal arrangement of the articular processes allows. ‘This condition was described ‘in a ship-trimmer brought to Guy’s Hospital, London, in 1886 (Lane, 1887). the ship's equilibriwn is stable. During this activity, the torso is rotated as the trunk flexes forward and to the ght when coal is shoveled. The trunk is then extended Ship-trimming involves arranging coal so that to the leftas the load is thrown great distances, Lane (1887), Figure 27. Median section of lumbar and sacral vertebrae that shows the new articulation between L, and L m Lane, I887a: 40 Drawn by R, D’ Anastasio fi 30 Form No, 18TOPOGRAPHIC FOSITION ON THE SKELETON Form No VERTEBRAL COLUMN 19 SCOLIOSIS LATERAL CURVATURE OF THE SPINE Al the body that supports the burden, extends from the lumbar to the thoracic regions. At the upper end of the curve, a convexity is directed to the opposite side with a much smaller degree of curvature. curvature, with convexity towards the side of Compensation on one side of the body results in a posture where the spinal column is in lateral curvature with the convexity toward the side where the load is carried. This curvature extends from the lower cervical vertebrae to the sacrum. When the burden is carried upon the sho der, pressure passes from the shoulder through the claviele and ribs. This results in the smaller secondary curvature. With habitual stresses, breakdown of the lumber fibrocartl deformation. The condition is more likely to affect young children where the muscular supports of the spine are underdeveloped. wes results in permanent spinal Scoliosis has been described in 19 century Ei laborers, particularly very young children, who carried heavy burdens on one shoulder or in one hand, and in ‘ar Volterra and Pisa Tuscan alabaster stone miners 1 (Lane, 1885; 1886; Hunter, 1962). Lane (1885; 1886), Hunter (1962). re 28. Scoliosis with double curvature Drawn by R. D' Anastasio) 31‘TOPOGRAPHIC POSITION OY THE SKELETON Form No. VERTEBRAL COLUMN 20 SCOLIOSIS SYNONYMS DESCRIPTION OF ANATOMICAL STRUCTURE: Severe scoliosis (55°) with the convexity in the mid thoracic region is centered at Tz, Ts, and To. As is com- ‘mon in this condition, there is marked asymmetry of the ribs and the posterior articulations may ankylose. ‘Thackrah (1831) found this condition in conjunetion with pelvic deformation, but Wells (1967) attributed the pelvic deformation to rickets. STRESS FACTORS This condition has been described in 19th century English weavers who were forced into an asymmetric sitting posture due to the positioning of the loom con- trols. “Weaver's bottom” (chronic ischial bursitis: see Form no, 87) was another consequence of this occupa- tion. Flexion and lateral bending resulted in further aggravation of the scoliotic condition. OCCUPATIONAL ACTIVITIES: Scoliosis caused by long periods of sitting at a weaving loom and the flexion and bending required in combined with nutritional deficiency (Wells, 1967). In the case of looms with single pedals, the operator was more restricted in movement when lifting the heddles (wires through which the warp threads are passed) compared to operators at looms with multiple pedals where positional changes occurred more frequently In addition, some looms required that the shuttle carrying the weft thread be thrown across by hand and the loom design sometimes made this physically awkward. The beating of the weft required pushing or pulling on a weighty transverse beam which placed stress on the spine and arms, This resulted in muscle fatigue, sagging posture and aggravation of idiopathic deformities. BIBLIOGRAPHIC REFERENCES: Figure 29, Anterior view of female scoliotic spine with rib asymame- ‘Thackrah (1831), Wells (1967). tay and deformation, (From Wells 1967: 40. ig. 1).