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The presence of tuberculosis in Danish skeletons AD 800-1800 – from skeletal data to paleoepidemiological analyses

Dorthe Dangvard Pedersen, Biological Anthropologist, MSc.

 

This PhD project is conducted at ADBOU under Faculty of Health Sciences, University of Southern Denmark. Main supervisor is Professor, DMSc Jesper Boldsen, Head of ADBOU and co supervisor is Professor DMSc Hans Jørn Kolmos, Department of Clinical Microbiology, Odense University Hospital.

Recently archaeological excavations in the area around the cathedral in the Danish town Ribe have uncovered more than 700 skeletons. The total number of skeletons from Ribe counts approx. 1,500 individuals. The skeletons are dated from Viking age until early modern times (AD 800 - 1800). The interdisciplinary project 'Ofelia - people through 1,000 years' financed by Velux foundation is set out to study the population of Ribe through 1,000 years from archaeological, chemical and anthropological perspectives. The project is a collaboration between Sydvestjyske museer (Museum of South Western Jutland), CHART – research unit cultural heritage and archaeometry at SDU and ADBOU. The PhD project is an anthropological contribution to this.

 

Background

There was a great increase in the prevalence of TB during the rapid industrial development and urbanization in the 18th century in Western Europe. The disease thrived in the poor and polluted environment of the overcrowded towns. From the mid-19th century TB death rates declined. The causes behind this pre-antibiotic era decline are believed to be multi-factorial but are not fully understood. TB has re-emerged in the last 20 years causing the WHO to declare the disease a global health emergency in 1993. This rise which primarily is seen in developing countries is caused by increased population density, poverty and co-infection with human immunodeficiency virus (HIV). On a global scale refugees and immigrants from high TB incidence countries are causing a further rise in TB on the European continent. The evolvement and spread of total drug-resistant TB bacilli makes it difficult to medicate against the disease which also adds to the potential devastating world-wide socioeconomic consequences of TB.

This PhD project is aimed at developing methods that enables the study of TB in skeletal samples. The research will make it possible to gain insights into the impact of TB in past populations. Studying the patterns of presence of TB in the past where no medical intervention was available can help us understand the mechanisms behind the spread of TB in the present. Such can contribute to drawing up guidelines for societal efforts to control and prevent the spread of TB in the near future. 

Main research topics

  • Developing a set of osteological tools for detecting TB in skeletal samples. The method includes lesions in ribs, spine, hip joint, sacroiliac joint, knee joint and elbow joint.
  • Validating the osteological method by associating the TB-related lesions with actual TB diagnosis. This is done through data collected from skeletons with known TB status in Terry skeletal collection, Smithsonian Institution, Washington and Bass donated collection, University of Tennessee, Knoxville. 
  • Using the osteological method to collect data for estimating the epidemiological properties and the prevalence of TB in the past.
  • Comparing lesion patterns related to pulmonary TB in Terry skeletal collection and in Medieval and Post Medieval Ribe. The aims is study whether there is a difference across time in lesion patterns and in this way to get insights into host and pathogen interactions.