Approaches to the investigation of periosteal new bone formation in palaeopathology

The aims of this thesis were to investigate the relationship between periosteal new bone formation, commonly termed "periostitis", and a number of infectious, metabolic, and traumatic pathological conditions frequently encountered in archaeological populations, and to determine and critically evaluate how palaeopathologists have interpreted proliferative periosteal reactions in human skeletal remains. Human long bones demonstrating periosteal new bone formation and illustrating various disease processes were studied from documented pathological specimens archived in London-based pathology museums. The samples were subjected to macroscopic, radiographic, and SEM-backscattered electron imaging analyses to determine if the characteristics of the periosteal lesions were specific to the corresponding disease states. These investigative techniques were then applied to an archaeological human skeletal population. The results of the analyses have demonstrated that no qualitative or quantitative characteristics of periosteal new bone formation emerged that were specific to individual disease states. Instead, the analyses resulted in the identification of characteristics that overlapped the various disease categories. It was established that disease duration, rather than disease type, was one of the most important determinants of periosteal lesion appearance. The results demonstrated the importance of radiography in determining frequencies of proliferative periosteal reactions. A critical analysis of the palaeopathological literature pertaining to the recording and interpretation of proliferative periosteal reactions has determined that the varied pathogenesis of periosteal new bone formation has been largely ignored, focussing on an interpretation of "non-specific infection", frequently within the parameters of the skeletal stress response. Assumptions as to the infectious aetiology of periosteal lesions have become embedded into the palaeopathological literature potentially skewing the results of skeletal population-based palaeoepidemiological studies. In light of these factors, guidelines for the recording of periosteal new bone formation are provided.