Porotic hyperostosis in Sardinia

F. Germana

Porotic Hyperostosis

Sojrintendenza delle Antic/&d per le Province di Sassari e Nuoro, Italy

This paper aims to present the results of an investigation on the cranial remains of three adult individuals found in the Iocality named S’Isterri d’Olzu (Sassari) in Sardinia and dating back to the Bronze Age. All the bone remains showed changes corresponding to those of porotic hyperostosis. The conclusion is drawn that this material is unable to provide a solution of the problem of the origin of thalassemia in Sardinia even though in the same region the present incidence of the disease is particularly high.

A. Ascenzi Zsfituto di Anatomia e Istologia Patologica dell’ik’versitd Policlinico “Umberto I”” Yiale Regina Elena 324,’ 00161 Roma, Italy Received 22 October 1978 and accepted 15 December

Porotic

hyperostosis

symmetrically

is a generic

texture.

disease producing

of medullary

It is quite

hyperostosis

either

primary

porotic

demonstrate

hyperostosis

Therefore

of thalassemia.

causing

marrow.

is the only suitable when

a very interesting

by any

the skeleton

It follows that, in

proof of the existence

the skeleton

is the only

Paleolithic

the course

B.C.-have

with porotic

Age,

of Greek

been objectively

In the hope of finding

& Balistreri

hyperostosis

an answer

hypotheses-one

and the other colonisation

(1977)

discovered

syndromes were able to

up to this time

of thalassemia

stating

suggesting

that

of the peninsula

in Italy.

that the disorder the same

beginning

goes

disorder

in the 8th

proved. to the questions

stosis, and with the aim of acquiring we turned our attention

Ascenzi

since in some re-

haemopathic

of the date of the appearance

of the two conflicting

to the Upper

problem

of Mediterranean

Recently,

remains

the establishment

neither

during

constitutes

there is a high incidence

that skeletal

do not permit

Italy,

be induced

of the bone marrow,

or secondary,

by a

associated with reduction

how such a lesion could

the excess of haemopoietic

porotic

hyperplasia,

and, in particular,

spread

to a type of bone lesion characterized

that time has preserved.

In Italy,

century

obvious

in the volume

to contain

terms,

gions of this country

back

term applied

increase in the volume of the skeleton,

an increase

to adapt its capacity paleopathological remains

1978

distributed

of the bone

in Sardinia

new information

to some skeletal remains

of the etiology

of porotic

on the origins recently

hypero-

of thalassemia

in

found by D. F. Germana

in Sardinia. Although thalassemia, case,

this island is presently few of the skeletal

and they have

been vaguely Maxia The

never

mentioned

one of the regions

remains

been

show porotic

submitted

clumsy

to a systematic

in the anthropological

publications

et al. (1973), and Messeri (1969). remains concerned in this paper come from S’Isterri

little town of Ossi, in the province of Sassari. of prehistoric monuments, and the skeletal which

of Italy with a high incidence hyperostosis,

the Sardinian

archaeologists

and half-ruined

largely intercommunicating

construction rooms.

investigation. of Maxia d’Olzu,

They

& Floris a locality

have

(1961), near the

This locality is known for a certain number material was found in one of those tombs

call “domu partially

of

even dubious in some

de janas”,

i.e. “fairy

dug out of the rock,

At the time it was first recognized

house”.

It is a

consisting

of two

in 1971, the place

Journal of Human Evolution (1980) 9, 75-78 0047~2484~80/010075

+ 06

$02.OOJO

@ 1980 Academic

Press Inc. (London)

Limited

76

F.

GERMANA

AND

A.

ASCENZI

had already been visited, and fictile and anthropological distributed. The skeletal remains were remnants of about mixed with objects Among

of the Bonnanaro

these skeletal remains

calvariae.

The mutilations

and disarrangements

culture,

material was chaotically 30 individuals and were

dating from the Bronze

our attention

was particularly

were posthumous

Age.

drawn to two incomplete

and were certainly

results of the pillaging

of the tomb.

The jrst c&aria (No. I/SID 22067) is made up of three easily assembled fragments. It includes the frontal, parietal and occipital bones, all more or less incomplete. Its configuration

is purse-like

with a dolichomorphic

appearance.

The frontal

profile is of

a female type and there is an occipital chignon. The coronal suture is completely closed both internally and externally. The sagittal suture is still very slightly visible on the external

side but completely

partially

present

closed

in its left portion,

on the internal is open.

From

deduce that the skull was that of an individual the frontal porosis

la).

between

ploic structure In contrast

This

condition

bregma

shows an abnormally

to the thickening

thickness.

Radiographic

a typical

table

in the portion Moreover,

Id).

to the porotic

second cahzria

(No.

2/SID

around

completely

section

closed.

is porotic.

placed

compactness toward

eminently

in

represent

Although

the

a natiform

There

the external

indicate

is thickening

bone.

The

external

side

(Plate

In general

that

2~).

one caught

our attention.

large part corresponds

to a parietal

posed coronal

although

suture,

It is of the

and inter-

of the sagittal

suture

the skull belonged

to an

of the frontal

bone,

and the bone

evident on examination

table especially the porotic

Radiological

of the porotic hyperostosis

the first. depression

Both externally portion

shows a coarse porosis alternating

of the structure.

frontal localization

configuration.

findings

than

A noticeable

suture and the posterior

are noted

& Haas (1966).

mutilated

bones.

small vas-

criba orbitalia

is notably

of a

thinned

in some point with state is somewhat

examination

confirms

an disthe

which, on the other hand shows

a diffuse distribution and presents no preferential trabecular orientation. words, no “hair-on-end” appearance is clearly detectable. Among the remaining cranial fragments found in the “domu de janas” d’Olzu,

lb).

normal

and porosis

to Nathan

This finding is particularly

of the frontal

and the diploic trabeculation increased

orbits

is even more

and parietal

These

20 and 30.

the fracture

transverse

(Plate

are almost 1 c).

made

ant1 the di-

trabeculae

bone (Plate

of \iith

bone section

above the orbits there are numerous

22066)

frontal

suture gives the calvaria

between

only the frontal

on the roof of both

nally the right side of the coronal individual

of bone

the parietals

type (Plate Za, b), according

of quite incomplete

are almost

associated

does not show discontinuities producing a drawing skull in the active phase of which characterizes the “hair-on-end”

nevertheless

sagittal

Examination

thickening

in a transverse

network bone,

on11

bone

(Plate

The

suture,

of the sutures WC can

shows that the thickening

cular

composed

obvious

rarefied

the disease, pertaining

lambdoid

Both the bone tables are thinned

skull involving

of the frontal

with fine arabesques holes

shows a clear

of the frontal

examination

“hair-on-end”

external

appears

and glabella.

The

about 30.-40 years old*.

bone in the area of the fracture

(Plate

halfway

side.

the condition

In

other

of S’Isterri

This is a rectangular fragment (No. 4) which in bone and to a lesser extent to a frontal. The inter-

totally

closed

on the inner

side, has a single

limited

* The age was tentatively calculated using the data furnished by Wingate Todd & Lyon (1924-25), and taking into account the suggestions of Masset (197 1).

77

POROTIC HYPEROSTOSIS IN SARDINIA

closed point

on the outside.

about 30 years of age. both

tables,

expansion

especially (Plate

We can infer that the skull was that of an individual

A parietal

section reveals that this bone is thickened.

the internal,

2d).

Thus

it

are

seems

thinned

and

possible

to

the

diploe

recognize

of

Moreover,

shows considerable

the

signs

of porotic

hyperostosis. The

cranial

agreeing

remains

of S’Isterri

with the generic

possible to establish The surprising

d’Olzu

diagnosis

the nature

that they diminish with Neumann’s

here

show pathological

hyperostosis.

as the individual Law according

to adults.

of porotic approaches

to which,

whose entire bone marrow is hemopoietic,

It is known that, especially

hyperostosis

are seen in children

adult life (Caffey,

contrary

to what

By contrast,

induces

a volumetric

things,

the behaviour

Chauffard.

in the child even a small hyperplasia increase

Generally,

since the illness usually infancy

the skeletal

in the hereditary

in this disease, develops

changes

above reported

bone changes

cases, are, among

takes place

in the child,

with no bad results to his

This explains

spherocytosis

example,

characteristic

But if the disease appears major

in drepanocitosis,

for diagnostic

on the postcranial

concomitant

osteomyelitic

notable significance. At any rate, it seems worthy to mention were found in several

individuals

purposes

(Ascenzi,

and arthritic

that both hyperostosis

buried

in other

points

in

(Letterer,

of the porotic hyperplasia

other things, information

changes

and

appreciable,

It is known that in other bones lesions can vary from one disease to another additional

other

of Minkowski

to those of thalassemia

the true nature

marrow

among

are not particularly

only after adolescence.

can correspond

1949). What is missing, in order to establish

This agrees

of the hemopoietic

in the bone and its cavities.

of the skeleton

and

1937).

in the adult half of the bone marrow is adipose,

of this, the adult can double the volume of his marrow

skeleton.

changes

Now we shall see if it is

of such a lesion.

fact is that these skulls belonged

in the skull, the most serious changes

Because

reported

of porotic

in the

skeleton. revealing

1976).

Thus,

lesions

arise with

for

and porotic bone changes

of the same site.

So in the

polyandrous tomb of “Ena and Muros” situated in the district of Ossi, Maxia & Floris (1961) drew attention to other cranial remains showing probable signs of porotic hyperostosis.

On the other hand,

the finding of the same lesions in more

coming from the same district does not necessarily

than

suggest the possibility

one individual of an hereditary

factors are realized to be capable of having harmful effects on disease. Environmental an entire population. Porotic hyperostosis has been observed to result from malnutrition, such as lack of iron (Lanzkowsky, and from parasitic

In any case, it appears necessary an affliction

and of Vitamin (Chini,

1939;

D (Hamper1

Chini,

Paternb

& Weiss, & Nicotra,

195511, 1938:).

to keep in mind that this type of skeletal lesion is mainly

of infancy.

In conclusion,

the hyperostosic

of three individuals to the Bronze

buried

Age cannot

present incidence

The authors

1977)

diseases like malaria

be attributed

of thalassemia

are indebted

nical assistance.

and porotic

in the “domus

changes observed in the cranial remains of S’lsterri d’Olzu and going back

de janas”

to a well-established

in Sardinia

to Mr A. Benvenuti

is particularly

disease,

even though

the

high.

and Mr L. Virgilii

for their precious tech-

78

F. GERMANA

AND

A. ASCENZI

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and and in cell 37,

293-324.

Chini, V. (1939).

Su alcuni rapporti

tra infezione malarica

e sindromi tipo Cooley.

Haematologica

20,

88-96.

Chini, V., Paterno, P. & Nicotra, A. (1938). Primi risultati di indagini radiologiche sullo scheletro di malarici cronici. Bollettino della Societd medico-chirurgica di Catania 6, 536-541. Hamper], H. & Weiss, P. (1955). Ueber die spongiijse Hyperostose an Schadeln aus Alt-Peru. Virchozcs Archiv 327,

629-642.

Lanzkowsky, P. (1977). Osseous changes in iron deficiency anemia. Implications for paleopathology. In (E. Cockburn, Ed.) Porotic Hyperostosis: An enquiry, Monograph 2, 23-34. Detroit: Paleopathology Association Publisher. Letterer, E. (1949). Ueber den “Biirstenschadel” und seine Bedeutung. Zentralblatt fir allgemeine Pathologie und pathologische Anatomie 85, 244-266.

Masset,

C. (1971).

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