An Early christian chapel and burial ground on the Isle of Ensay Outer Hebrides Scotland with a study of the skeletal remains. 9780860546733, 9781407318363

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An Early Christian Chapel and Burial Ground on the Isle of Ensay, Outer Hebrides, Scotland with a study of the skeletal remains

A. E. W. Miles

BAR British Series 212 · 1989

B.A.R.

5, Centremead, Osney Mead, Oxford OX2 ODQ, England.

GENERAL EDITORS A.R. Hands, B.Sc., M.A., D.Phil. D.R. Walke r, M.A.

BAR 212,1989 An Early Christian Chapel and Burial G round on the Isle of Ensay. @ A. E. W. Miles,1989 The author’s moral rights under the 1988 UK Copyright, Designs and Patents Act are hereby expressly asserted. All rights reserved. No part of this work may be copied, reproduced, stored, sold, distributed, scanned, saved in any form of digital format or transmitted in any form digitally, without the written permission of the Publisher. ISBN 9780860546733 paperback ISBN 9781407318363 e-book DOI https://doi.org/10.30861/9780860546733 A catalogue record for this book is available from the British Library This book is available at www.barpublishing.com

C ONTENTS P age G ENERAL A CCOUNT

1

T he i sland

1

T he b urial g round

8

T he c hapel

1 1

T he p erimeter w all

1 3

B lackhouse f oundations a nd o ther w alls a djacent t o t he b urial g round

1 6

T he i nterments

2 1

A ssociated a rtifacts

2 4

D ates o f i nterments

2 6

I NFORMATION D ERIVED F ROM T HE S KELETAL R EMAINS

2 7

S ex

2 7

A ges

2 8

S tatures

3 4

G eneral f eatures o f t he d entitions

3 4

C ranial c haracteristics a nd g enetic a ffinities

3 5

M etopism

4 1

B athrocephaly

4 3

S keletal o r s keletally-associated e vidence o f d isorders

4 6

I ntroduction

4 6

D evelopmental a nomalies o f t he s pine

4 6

L umbo-sacral p seudo-arthroses

4 9

P remature a ge c hanges i n r ibs

5 3

O steoporosis

5 6

E xtra-skeletal m ineralization

6 4

B ony i njuries

6 6

P age i )

G eneral

6 6

i i)

C ompression f ractures a nd o ther i njuries o f v ertebral b odies

7 5

i ii) F ractures o f n eural a rches o f l umbar v ertebrae

7 9

N on-specific s uppurative d isorders

8 7

S keletal t uberculosis

9 4

S keletal s yphilis

9 8

D egenerative j oint d isease

1 01

i )

O steo-arthrosis o f s ynovial j oints

1 02

i i)

D egenerative s pondylosis ( spondylitis d eformans)

1 06

i ii) S chmorl n odes D iffuse i diopathic s keletal h yperostosis ( DISH)

1 16 1 17

R heumatoid a rthritis

1 20

A nkylosing s pondylitis

1 24

O ther c auses o f a nkylosis o f v ertebrae

1 27

N eoplasia a nd s imilar l esions

1 30

M iscellaneous l esions

1 34

P eriodontal d isease

1 40

D ental c aries

1 47

D ISCUSSION

1 59

T he c hapel

1 59

T he p ebbles

1 62

T he i nvesting w all

1 62

T he c hapel s ite

1 63

D ate o f t he e ngulfment o f t he c hapel b y s andblows

1 65

P opulation o f E nsay

1 69

U ncoffined b urials

1 75

P age T he a ge-at-death d istribution o f t he i nterments

1 76

S tatures

1 79

C auses o f m orbidity a nd d eath

1 80

F uture o f t he s ite

1 85

A PPENDIX A

1 86

A PPENDIX B

1 88

A CKNOWLEDGEMENTS

1 91

S UMMARY

1 92

R EFERENCES

1 93

i ii

i v

G ENERAL A CCOUNT T he i sland E nsay i s a s mall i sland i n t he S ound o f H arris ( NG R ef. 9 75 8 69. F ig. 1 ). I t i s t riangular i n s hape a nd a bout 1 .6km l ong x 0 .8km w ide a t i ts n orthern e nd. T he l ong a xis o f t he i sland l ies a pproximately N NW t o S SE . T he n ame o f t he i sland, c ommonly p ronounced E say o r A esay a mong t he l ocal G aelic s peakers, a ccording t o I an A . F raser ( personal c ommunication), " derives f rom a N orse e ngi m eaning m eadow , w hich i n c ombination w ith t he w ord f or i sland, 1 . . 1 Lo r A I Lg ives e ngis-ey. T here i s al oss o f t he m edial n g i n t he p rocess o f p ost-Norse G aelicisation , w hich g ives t he c urrent G aelic p ronunciation ." M uch o f t he n orth-western h alf i s f ertile m achair, t hat i s g rasso vergrown s and, a nd m ost o f t he m ore r ocky p art s hows e vidence o f i ntensive p ast c ultivation i n t he f orm o f l azy-beds, t hat i s o riginal p eat s oil d rained b y d itches a bout 1 .0m w ide b etween w hich t he s oil w as h eaped u p o ver a dded l ayers o f s ea-weed a nd s hell-sand t o f orm a p attern o f c ultivable r aised b eds a bout 2 .0 - 2 .5m w ide ( Macdonald, 1 978 . F igs. 2 a nd 3 ). T he c entral p art o f t he s outh-eastern h alf o f t he i sland r emains r ocky a nd b oggy e xcept f or a w ide z one a t i ts p eriphery w hich i s l azy-bedded. T here i s o ne h abitable h ouse, E nsay H ouse, w hich l ooks o n t o t he b ay o n t he e ast s ide o f t he i sland. A ssociated w ith i t a re t he r uins, o ne n ow p artially r estored, o f w hat w ere p robably t hree o r f our c ottages a nd s ome f arm b uildings. A s mall c hapel n earby i s s aid t o d ate f rom t he 1 6th c entury. T here a re a f ew t races o f o ther h ouses o n t he i sland, i ncluding t he g rass-overgrown f oundations o f a b lack-house a nd t he r emains o f o ther b lack-houses, t o b e d escribed l ater, e xposed b y s oil e rosion b eside t he b urial g round. A w alk a round t he i sland, n oting t he l azy-beds t hat e xtend i nto t he m ost u npromising c orners b etween r ock m asses, s uggests t hat t he f amilies t hat m ade t hem m ust h ave b een u nder t remendous p ressure t o s crape a l iving. I t i s n ot p ossible t o b e c ertain w hether t he p attern o f l azy-beds i s v ery a ncient, g oing b ack t o w hen t he W estern I slands m ay h ave b een m uch m ore d ensely p opulated t han i n a ny r ecorded p eriod, t hat i s p re-15th c entury, p erhaps V iking t imes w hen t he p opulation w as u nable e asily t o s pread t o t he m ainland, o r w hether t he p attern w as e stablished d uring t he m ainland H ighland c learances ( c. 1 770) a nd l ater c learances o n H arris ( c. 1 800). A ccording t o F enton ( 1987), t he s econd h alf o f t he 1 8th c entury w as a p eriod w hen, c oinciding w ith t he i ntroduction o f t he p otato, m uch m arginal l and i n t he H ighlands a nd I slands w as b rought u nder c ultivat ion b y t he c onstruction o f l azy-beds. T he i ncentive w ould h ave b een t he p opulation i ncrease t hat, a s w ill b e d iscussed l ater, o ccurred a t

F ig. 1 . M ap o f E nsay b ased o n 6 i nch t o m ile O rdnance S urvey M ap o f 1 970 m odified s o t hat t he b urial g round i s d epicted a s ac ircle a s i n S urvey m ap o f 1 882. S ites w here a B ronze A ge c ist ( 1967) a nd B ronze A ge p ottery e tc. ( 1969) w ere f ound a re i ndicated. I nset s hows O uter H ebrides c hain o f i slands i n r elation t o w est c oast o f m ainland S cotland a nd S kye . A rrow i ndicates p osition o f E nsay i n t he S ound o f H arris.

1

t hat t ime. I t s eems p ossible t hat t he p attern o f l azy-beds s een m ost o f E nsay t oday w as c reated t hen.

o ver

T he e arly d escriptions o f t he W estern I sles r efer t o E nsay i n t erms t hat s uggest t hat i t w as a n e xceptionally f ertile i sland . T he d iscovery b y R .W . M unro o f am ore c omplete m anuscript o f M onro's " Description o f t he W estern I sles o f S cotland c alled H ybrides", w hich i ncludes E nsay a mong m ore t han 4 0 i slands t o w hich t here i s n o r eference i n t he m any e arlier p rinted v ersions, s hows t hat S ir D onald M onro, H igh D ean o f t he I sles, v isited t he i sland i n 1 549 a nd w rote o f i t ( Munro 1 961), " ane I le c allit E nisay, q uhairin Mcc loyd o f H arey h es a d welling p lace, a ne f air m ayne l and, w eill i nhabite a nd m anurit a ne m ile l ang, h alf m ile b raid", t he m anurit h ere m eaning c ultivated. M onro r eferred t o o nly f ew i nstances o f s mall i slands d welt o n b y a m ajor p roprietor s o t hat t he r eference t o aM acLeod d welling h ouse o n E nsay s uggests a m ark o f f avour. M artin M artin ( 1703, p . 1 24), r eporting w hat h e s aw i n 1 695, s aid o f E nsay, " for t he m ost p art a rable g round, w hich i s f ruitful i n c orn a nd g rass." T he r emains o f o ld l azy-beds, n ow g rass-grown a nd f allow , t hat a re t o b e s een t oday, e nable o ne t o v isualize w hat M artin s aw , a nd p erhaps M onro b efore h im . I n S inclair's S tatistical A ccount o f S cotland ( 1794, 1 0: 3 45), E nsay w as d escribed b y t he P resbyter o f U ist, t he R ev. J ohn M acleod, a s " verdant a ll o ver, a nd h aving a g ood s oil w ell-cultivated". T he 1 851 C ensus r ecorded t hat E nsay " is a f ine p lace f or c rop a s t here i s a g reat d eal o f l evel g round a nd a n a bundance o f s eaweed a lways t o b e f ound o n i ts s hores. T here i s at acksman r esident o n i t." S ince a ncient t imes, t he i sland w as p art o f t he H arris l ands o f t he M acLeod c lan o f D unvegan, S kye. T owards t he e nd o f h is l ife, i n 1 772, N orman M acLeod, t he 2 2nd C hief, w as d eeply i n d ebt a nd, i n 1 779 , t he H arris l ands, t ogether w ith S t. K ilda a nd B erneray, w ere s old b y t he g randson w ho s ucceeded a s 2 3rd C hief, t o C aptain A lexander M acLeod, a m ember o f t he d istant B ernera M acLeods w ho , a s t he c aptain o f t he E ast I ndiaman, M ansfield, h ad b ecome w ealthy. S uch l arge-scale s ale o f c lan l ands h ad b een a lien u nder t he t raditional c lan s ystem , b ut b ecame a f eature o f t he d estruction o f t he s ystem t hat f ollowed t he d efeat o f t he J acobites a t C ulloden i n 1 745. H owever, t he l ands b enefited u nder t he n ew o wner ( Grant, I .F ., 1 959) w ho i ntroduced m any i mprovements; h e e ncpuraged t he f ishing i ndustry b y i mproving h arbours ( Knox, 1 787) a nd a dvancing m oney t o i ndividual f ishermen t o b uy b oats ( Mackenzie, W .C ., 1 903, p . 4 85). H e i s s aid t o h ave s taved o ff t he i ntroduction o f t he l arge-scale s heep f arming t hat w as l eading t o t he n otorious c learances a nd d epopulation. C aptain M acLeod w as s ucceeded o n h is d eath i n 1 790 b y h is s on a nd t hen g randson . T he e state s uffered b ecause b oth w ere a bsentee l andlords. B y 1 834, t he e state w as g reatly i n d ebt a nd w as s old t o t he E arl o f D unmore, S t. K ilda h aving b een s old s eparately i n 1 804. L ater, t he E arl d isposed o f s ome o f t he p eripheral p arts o f t he H arris e state. E nsay w as s old i n 1 856 t o A rchibald S tewart, " tacksman o f D unvegan". A s D unvegan C astle w as s till t he p rincipal h ome o f t he M acLeod C hiefs, i t i s l ikely t hat t he S tewarts h ad b een t acksmen ( steward/principal t enant) o f t he f amily. S ome c onfirmation o f t his d erives f rom t he s tatement b y J .S. G rant ( 1987, p . 1 65), b ased o n e vidence g iven a t t he N apier C ommission o f I nquiry i nto t he C ondition

2

F ig. 2 . A rea o n n orth-western p art o f t he i sland s howing c omplex s ystem o f l azy-beds a ccording w ith s lope o f t he g round.

1 F i rst s od

2

3

H alf-made b ed

Comp leted b ed

n

S eaweed a nd

t urned

Untouched s o il P otatoes

R ock L oose s o il f ro m

s he l l-sand

d itch

F ig. 3 . D iagram s howing m anner o f c onstruction o f l azy-beds ( Derived f rom M acdonald, 1 978). T he d itches w ere c ut i n d irections t o d rain t he l and a nd s ods t urned t o e ither s ide o n t o t he i ntervening s trips o f l and p reviously c overed w ith s eaweed a nd s hell s and b rought f rom t he b eaches a nd i n w hich p otatoes m ight b e p lanted. A s s ods a nd s oil f rom t he d itches b uilt u p, m ore s eaweed a nd s and w ere p laced a s a lternate l ayers c opped w ith m ore s oil. D imensions h ere a re a pproximate a nd w ere v ariable. L azy m ay m ean u ntilled, a n o bsolete m eaning; t he b eds i s d ug ( Fenton, 1 987, p . 1 05).

3

o nly t he p art b etween

o f C rofters a nd C ottars i n t he H ighlands a nd I slands ( 1884), t hat a D onald S tewart w as f actor t o t he M acleod w ho s old H arris t o t he E arl o f D unmore i n 1 834. T he p ost o f f actor o r t acksman w as c ommonly a lmost h ereditary. H owever, A rchibald S tewart's f ather w as W illiam S tewart d escribed i n t he P arish D eath R ecords a s f armer ( Appendix A ). I t i s p robable t hat, s oon a fter 1 856, A rchibald S tewart r eplaced t he o ld s ystem o f m ultiple t enantship o n E nsay b y ac entralized s ingle f arm ; t his i s s uggested b y t he c hange i n t he n ature o f t he p opulation s hown b y t he C ensus r ecords. T he f irst C ensuses, 1 841 a nd 1 851 ( Table 1 . T he r ecord f or 1 851 i s d educed), s how t hat t here w ere t hree a nd t wo f amily-households r espectively, e ach i ncluding a p roportion o f c hildren, o n E nsay; b ut i n 1 861 t here w as o nly o ne f amily-household ( a m an, h is w ife a nd s ix c hildren a nd a g randson); t he o ther h ousehold c onsisted o f s ix a dults, c ollectively b earing t hree d ifferent s urnames. I n n o s ubsequent c ensuses w ere a ny c hildren r ecorded. T here a re v erbal r ecords t hat A rchibald S tewart a nd t he l ater S tewarts f armed t he i sland i nnovatively a nd w ith u nusual e fficiency. T hey i mproved t he l and d rainage s ystem a nd c reated s everal l arge f ields, w hich c an b e i dentified t oday a nd w hich b efore h ad b een w orked w ith t he c as c hrom o r f oot p lough ( Macdonald, D ., 1 978). T heir f arm s tock, a part f rom h orses, i s s aid t o h ave b een t welve c attle a nd s eventy s heep, w hich s eems s mall, b ut t hey w ere p edigree b easts a nd, e specially t he c attle, w ere f amous i n t he W estern I sles f or t heir h igh q uality. M uch o f t he a bove i nformation a bout t he S tewarts d erives f rom a n a ccount l eft b y t he l ate G avin F erguson o f L ondon b ased o n w hat h ad b een h anded d own v erbally a mong t he i nhabitants o f H arris a nd B erneray i n p articular. I n 1 937, E nsay w as s old t o S imon M ackenzie o f L everburgh w hose d escendants c ontinue t o m aintain c attle a nd s heep t here t o t he p resent t ime. N o-one h as l ived o n t he i sland, a part f rom a f ew w eeks a t a t ime, s ince 1 937. A rchibald S tewart d ied o n E nsay i n A ugust 1 880 a gc,d 9 2 y ears, b ut h e i s s aid n ot t o h ave b een b uried t here; h e w as p robably b uried i n L uskintyre o n t he w est ( machair) c oast o f H arris . H e w as c hildless a nd t he p roperty p assed t o an ephew J ohn S tewart w ho b ecame k nown a s " of E nsay" ( Kelly, 1 903) a nd i s s aid t o h ave a cquired P abbay a nd t o h ave i ntroduced r ed d eer t here f rom Y orkshire. H e d ied i n 1 899 a nd w as s ucceeded b y a s on W illiam ( Appendix A ). I t i s c urious t hat, i n t he 1 0-year C ensuses, n o S tewart i s r ecorded a s r esident o n E nsay u ntil t hat o f 1 891 w hen i t i s r ecorded t hat D onald A lexander S tewart ( no a ge g iven) a nd h is s ister M ary ( aged 3 6 y ears) w ere i n E nsay H ouse t ogether w ith n ine s ervants ( Table 2 ), t hat h ouse b eing t he o nly o ne o ccupied. T hey w ere a n ephew a nd n iece o f A rchibald a nd p robably c ousins o f J ohn S tewart ( Appendix A ). I t i s l ikely t hat t hey w ere s taying o n E nsay a t t he t ime o f t he C ensus i n t he a bsence o f J ohn S tewart. E nsay w as v isited b y m any d iverse m embers o f t he S tewart f amily a nd n ever w as t he m ain r esidence o f a ny o f t hem . E nsay H ouse a ppears t o h ave b een b uilt o n, a nd p robably

4

p artially

T able 1 .

P opulation o f E nsay f rom c ensus r ecords, b eginning i n 1 841.

D ate

M ale

F emale

T otal

1 841

7 (2)

9 (5)

1 6

4

3

1 851

7 (2)

7 (6)

1 4*

3 *

2 *

1 861

1 0(4)

5 (1)

1 5

2

1

1 871

5 (0)

1 (0)

6

E nsay H ouse o nly

1

1 881

3 (0)

3 (0)

6

E nsay H ouse o nly

1

1 891

6 (0)

5 (0)

E nsay H ouse o nly

1

1 901

4

4

8

E nsay H ouse o nly

1

1 911

4

2

6

E nsay H ouse o nly

2

1 921

8

4

E nsay H ouse o nly

?

1 931

4

4

8

E nsay H ouse o nly

?

1 951

2

0

2

E nsay H ouse o nly

1

1

1 2

N o . o f h ouses o ccupied

F amilyh ouseholds

T he n umerals i n b rackets i ndicate t he n umber o f c hildren b elow 1 5 y ears o f a ge i n e ach c ategory. A fter 1 891, t he n ames a nd a ges a re n ot r ecorded. T he t erm f amily-household i s i ntended t o r efer t o a f amily u nit, a s j udged f rom t he s urnames a nd a ges, o ccupying a h ouse, i n c ontrast t o t wo i nstances o f h ouses o ccupied e ither b y o ne m an ( 1841) o r t wo m en , d escribed a s s hepherds, o f d ifferent s urnames ( 1851). T he 1 851 C ensus c ombined K illigray w ith E nsay w ith a t otal p opulat ion o f 2 4 i n f our h ouseholds. T o o btain t he f igures g iven i n t he T able, ah ousehold o f s even p eople ( four m ales a nd t hree f emales, a ll u nmarried) w as d educted b ecause t here i s a n i ndication o n t he o riginal r ecord s heets t hat i t b elonged t o K illigray. K illigray's p opulation w as s ix i n 1 841 a nd f ive i n 1 861. E nsay H ouse w as p robably b uilt d uring t he p eriod 1 856-1861.

5

T able 2

C ensus 1 891 I sle o f E nsay E nsay H ouse

D onald A lexander S tewart M ary S tewart,

S ister

F armer

b . K ilmuir, S kye

U /m

3 6

E ffie M cDougall

U /m

5 7 D om .

M arion S tewart

U /m

2 3 C ook

b . S nizort, S kye

K ate M cKay

U /m

1 9 D om . s ervt.

b . K ilmuir, S kye

M arion M cDonald

U /m

2 0 D airymaid

b . N . U ist

J ohn M cKenzie

m .

4 0 F arm s ervt.

b . H arris

A ngus M cLeod

U /m

3 2

t

i t

D onald M cLeod

U /m

3 5

t

t

E wan M cLennan

U /m

1 9

I t

t i

J ohn F erguson

m .

4 6 H and o n y acht

I t

O nly E nsay H ouse o ccupied;

s ervt.

b . N . U ist

1 7 r ooms w ith w indows.

T otal 1 1 i nhabitants; 5 G aelic s peakers, 6 G aelic a nd E nglish s peakers.

r eplaced, a n e arlier h ouse. T he o ld p art c onsists a t p resent o f s even i dentifiable r ooms a nd t he n ew p art o f s even r ooms a lso. T he e xact d ate o f t he b uilding o f E nsay H ouse i s u ncertain. A lthough t his d ate i s n ot i mportant t o t he m ain t heme o f t he p resent a ccount, t he h istory o f t he h ouse i s o f s ome g eneral i nterest. T he f irst r eference t o E nsay H ouse a ppears i n t he 1 871 C ensus w hich r ecords " only E nsay H ouse [ 14 r ooms w ith o ne o r m ore w indows] o ccupied, b y A lexander M cDougall, l and o verseer". T here i s n o r eference t o t he H ouse i n t he 1 861 o r e arlier C ensuses . T hus t he o ld h ouse s eems t o h ave b een c onverted i nto E nsay H ouse d uring t he p eriod 1 861-1871 a nd t herefore b y A rchibald S tewart. A s h e w ould h ave b een 8 2 y ears o f a ge i n 1 871, i t s eems l ikely t o h ave b een s oon a fter h e

6

p urchased t he p roperty i n 1 856 r ather t han l ater. I n a ny c ase, a s t he C ensus i s b ased o n o ccupants o f h ouses o n t he d ay o f t he C ensus a nd A rchibald S tewart a nd h is f amily c ould h ave b een a bsent a t t he t ime b ecause i t i s c ertain t hat h e h ad o ther h ouses e lsewhere, i t i s p ossible t hat E nsay H ouse e xisted i n 1 861. O ne o f t he h ouses r ecorded i n t he C ensus i n t hat y ear a s u noccupied c ould h ave b een E nsay H ouse. I f avour t he v iew t hat i t w as b uilt s ometime b etween 1 856-1861. N evertheless, t he p ossibility o f a n e arlier d ate, i .e. o f E nsay H ouse b eing b uilt i n L ord D unmore 's t ime, i s w orth c onsidering . L etters e xist f rom t he l ate C hristina M audesley o f M elbourne, A ustralia , g rand-daughter o f W illiam M cAskill, r ecorded i n t he 1 851 C ensus a s a n a gricultural l abourer ( in f act, a c ow-man) a ged 3 0 y ears, w ho e migrated t o A ustralia l ater t hat y ear w ith h is w ife a nd f our c hildren . M rs. M audesley r ecalled v ividly i n 1 973 , w hen s he w as 7 3 y ears o f a ge, h earing h er g randfather t ell o f t he t acksman C hristopher M cRae w atching f rom " the w all o f t he b ig h ouse" f or b oats c oming a cross t o t he i sland. ( Christopher M cRae i s r ecorded i n t he 1 851 C ensus a s b oatbuilder, a ged 3 0 , l iving o n E nsay w ith h is w ife a nd f ive c hildren). S he a lso s ays t hat h er a unt ( nine y ears o f a ge w hen s he l eft E nsay) r ecounted h ow " the l ady f rom t he b ig h ouse" c ame t o h elp " prepare t he p orridge" w hen h er s ister w as b orn. A lthough t hese r eferences t o " the b ig h ouse" m ay s uggest t hat E nsay H ouse w as i n e xistence i n 1 851, i t i s n ecessary t o r ecall t hat h er g randfather w as t ranslating i n h is o wn m ind f rom t he G aelic a nd, f urthermore, t hat t he o ld h ome o f s even r ooms, a nd p ossibly t wo o r t hree m ore e ventually r eplaced b y t he n ew p art o f E nsay H ouse a nd o ccupied a t l east i n p art b y t he t acksman , w ould h ave b een a b ig h ouse t o a c ow-man a nd h is f amily. T he p reamble t o t he 1 851 c ensus s ays, " Ensay c an b oast o f ag entleman 's s eat"; t he o ld h ouse o f s even o r m ore r ooms, e specially i f t here w as q uarters f or o ccasional o ccupancy b y t he p roprietor, a s w ell a s p ermanent q uarters f or h is t acksman, c ould a nswer t his d escription. A n a dditional p oint i s t hat t o p ropose t hat E nsay H ouse e xisted i n 1 851 v irtually a ssumes t hat i t w as b uilt f or t he 7 th E arl o f D unmore w ho w as s till a c hild o r, i f b uilt b y t he 6 th E arl, w as b uilt b efore 1 845. AG aelic b allad s aid t o h ave b een c omposed b y a" bard f rom P abbay" a t t he t ime o f t he b uilding o f E nsay H ouse h as b een h anded d own b y w ord o f m outh . S imon M ackenzie, B .A . ( Aberdeen), g randson o f S imon M ackenzie w ho p urchased t he i sland f rom t he S tewarts i n 1 937 h as b een k ind e nough t o p rovide m e w ith a w ritten v ersion o f t he G aelic b allad a nd h is E nglish t ranslation o f i t. T hey a re b oth r eproduced a s A ppendix B . T he C ensus r ecords t hat h ave s everal t imes b een r eferred t o c ontain m uch m ore f ascinating d etail t han i t i s s trictly a ppropriate t o m ention h ere. H owever, t wo m ore i tems h ave s ome r elevance. T he 1 841 C ensus r ecords t hat o nly n ine o f t he s ixteen i nhabitants w ere b orn i n t he C ounty o f I nverness w hich i ncluded E nsay a nd H arris a s w ell a s a l arge a rea i ncluding t he t own o f I nverness; t he o ther s even ( three m ales a nd f our f emales a ll b earing S cottish s urnames) w ere b orn o utside t hat C ounty. T his s uggests t hat i n t he l ast c entury t here w as m ore p opulation m obility i n t hose p arts t han m ight b e s upposed. F inally, i n

7

F ig. 4 . G eneral v iew o f b urial s ite a nd s and-dune a rea f rom s outh i n 1 966. T he g rass-covered h ummock n ear t he c entre i s a bout t he c entre o f t he b urial a rea. A rrow i ndicates p osition o f t he i nvesting w all. T he r ailed g rave i s t o t he r ight, t he r ailing t ilted b y l oss o f i ts f oundat ions.

t he 1 861 E nsay C ensus t he t erm s cholar b egins t o b e p laced a gainst s ome, b ut n ot a ll, c hildren a ged 1 0-15 y ears . H owever, t he p reamble t o t his v olume m entions t hat t he t erm i s " lacking i n p recision o f m eaning". I t i s l ikely t hat i n r espect o f E nsay i t m eant n o m ore t han t hat t he c hildren w ere o f s chool a ge o r i t m eant s imply t hat t hey c ould r ead a nd w rite. T he 1 881 C ensus b egan t o r ecord t hose w ho c ould s peak E nglish a s w ell a s G aelic.

T he b urial g round ( Fig. 4 ) C lose t o t he n orth-western s hore o f t he i sland ( Fig. 4 ), a mong p rominent s and d unes, i s t he b urial g round, n ow m uch w ind-eroded. I t c orresponds i n p osition w ith t he b urial g round m arked a s a s mall c ircle o n t he e arliest 6 -inch t o t he m ile O rdnance S urvey m ap o f 1 878 ( published 1 882). T he a rea , t o b e d escribed i n f ull d etail l ater, c ontains o ne n amed g rave, t hat o f D onald S tewart 1 888, e nclosed w ithin s piked r ailings r esting i n s andstone m asonry ( Fig. 4 ). T he o ther g raves w ould h ave b een o riginally m arked, a s a re t hose o n n eighbouring i slands, e .g. P abbay, b y u pright s labs a nd b oulders. T here i s e vidence t hat a t s ome t ime s ubsequent t o 1 888 t here w ere p eriods o f b uilding u p o f t he o ld d unes b y w ind-blown s and b ecause t he s pikes o f t he r ailings o f t he S tewart g rave b ear r emains o f t imber h ammered o n t o t hem t o p rotect c attle a t a t ime w hen t he s pikes w ere o nly a f oot o r t wo a bove t he g round. T his i s s aid t o b e i n a bout 1 930 . I n a bout 1 963, t he g rass-cover o ver t he b urial a rea b ecame b roken t hrough a nd a p rocess o f r apid e rosion b y w inter w inds b egan, w ith c onsequent e xposure o f t he g raves. D onald S tewart o f t he r ailed g rave w ho, a ccording t o t he p olished g ranite t ablet, d ied o n D ecember 4 th , 1 888 , w as a n ephew o f A rchibald a nd e ither a b rother o r c ousin o f J ohn S tewart a lready m entioned. D onald w as a d eeply r eligious m an o f t he P resbyterian p ersuasion ,

8

u nlike m ost o f t he S tewarts w ho w ere E piscopal C hurch o f S cotland w ith a s prinkling o f C atholics. H e r emained a b achelor a nd w as p robably a l ay p reacher. A s earch o f t he p arish r ecords a t R egister H ouse, E dinburgh, s how t hat D onald S tewart d id n ot d ie o n E nsay o r a nywhere i n t he P arish o f H arris . A s f rom 1 860 t he p lace o f b urial w as n ot r ecorded, t here i s n o r ecord o f h is b urial o n E nsay. I n a ddition, b oth t he S cottish R ecords o f D eath a nd t hose o f E ngland a nd W ales s how n o r ecord o f t he d eath o f aD onald S tewart o n D ecember 4 th , 1 888. I t w as p ossible t o e xamine h is c offin b efore i t w as r e-interred ( twice). I t w as a v ery e laborate a nd e xpensive o ne w ith a n i nner e ncasement o f s oldered z inc. T he w ooden o uter c offin b ore t races o f a c omplete o riginal c overing o f b lack o r p urple v elvet, a nd a d ecorative t rimming o f l ace-like e mbossed l ead s trips w as m ore o r l ess i ntact . T he s ealed i nner c offin s uggests t hat t he b ody w as e mbalmed a nd t ransported f rom a far, p ossibly f rom o utside t he B ritish I sles . F urther d etails o f t he h istory o f E nsay H ouse a nd o f t he S tewart f amily w ould b e i nappropriate h ere b ut a re w orthy o f r ecord, s o s ome a re g iven i n a n A ppendix A , i ncluding t he p ossibility t hat D onald S tewart d ied i n D unoon , A rgyllshire. A t o ur f irst v isit i n 1 966 , t he s ite w as a m ore o r l ess f lat a rea o f b are s and l ittered w ith h uman b ones, u nworked s labs a nd b oulders; a t t he c entre, t here w as a 3 m h igh g rass-topped h ummock f rom t he s andy s ides o f w hich p rojected b ones a t l ower l evels a nd c offins a t h igher l evels ( Fig. 4 ). T he a rea w as p artially e ncircled b y a l ow w all o f b oulders a nd s labs e nclosing a n a rea 3 5m i n d iameter. O n t he s eaward s ide, n early h alf t he e ncircling w all w as p erched o n t he t op o f a s teep s lope, a bout 6 m h igh, l eading d irectly d own t o t he b each . P arts o f t he w all w ere b eginning t o s lide d own t he s lope. W e p egged o ut t he a rea, d ividing i t i nto n umbered r ectangles 8 f t x 4 f t ( 2.4 x 1 .2m) a nd r ecovered a nd r ecorded t he s cattered s keletal m aterial. T he a rea w as t hen s ystematically e xcavated, r ecovering a ll t he i ntact a nd s emi-intact i nterments t o ad epth o f a bout 1 .0m , n amely t he d epth o f s and i t w as e stimated w as b eing b lown a way e ach y ear. T he r emains o f a bout 8 0 i ndividuals w ere r escued. I n t he s ummer o f 1 967, i t w as f ound t hat m ore i nterments w ere e xposed a nd t he h ummock h ad b een w ind-eroded t o a bout h alf i ts s ize. A f urther 1 10 i nterments w ere r ecovered, i ncluding a ll t hose w ithin t he h ummock. T he s ite w as v isited i n m ost s ubsequent y ears a nd e ach t ime a f ew m ore i nterments w ere f ound e xposed a nd w ere r escued. T he s urroundi ng w all b ecame g radually m ore e xposed u ntil i t b ecame e vident t hat i t i s i ndeed a c omplete c ircle o r n ear c ircle. T he r ailings o f t he S tewart g rave b ecame g reatly u ndermined s o t hat t hey l eaned a t g rotesque a ngles. H is c offin c ame c ompletely t o t he s urface i n 1 969 a nd w as r e-interred o n t he s ame s ite, a p rocedure w hich h ad t o b e r epeated i n 1 980 . I t c an b e e stimated t hat, s ince 1 966, a t t he c entre o f t he s ite t he l evel i s n ow a bout 5 m b elow t he o riginal g rass c over r epresented b y t he h ummock . I n 1 971, a s hort l ength o f d rystone w alling h ad b ecome e xposed, w hich o n e xploration w as f ound t o b e t he t op o f t he e ast g able e nd o f a b uilding w ith e xternal d imensions a bout 7 .2m x 4 .6m a nd w ith a c losely

9

F ig. 5 . E xcavated e astern g able e nd o f c hapel i n 1 971. a ltar a nd p ebbles o n s ill o f t he w indow c an b e s een.

T he s tone-slab

e ast-west o rientation. E ach g able w all h ad a n e mbrasured s lit w indow b eneath a s tout s tone l intel. T here w as a d oor-opening o n t he s outh w all. T he i nternal f ace o f t he e ast g able w as e xplored c ompletely d own t o f loor l evel a nd a p latform c omposed o f b oulders a nd s labs, p resumed t o b e a n a ltar, w as d iscovered b elow t he e ast w indow ( Fig . 5 ). A s mall a rea •o f t he f loor, a nd t he f oundations o f t he w all, i n t he n orth-east c orner t o t he l eft o f t he a ltar, w ere e xplored. N o a rtifacts w ere f ound b ut c are w as t aken o nly t o d isturb t he a rea s ufficiently t o a scertain t he g eneral c haracter o f t he b uilding a nd i n p articular n ot t o. d isturb t he f loor. T he a rea w as t hen i nfilled w ith t he o riginal s and. N o s keletal r emains h ave b een f ound w ithin t he w alls o f t he b uilding, e xcept f or t hose o f an ew-born l amb n ot m uch b elow t he l evel o f t he t op o f t he w all. I n s ubsequent y ears, m uch o f t he b uilding h as b ecome e xposed b y t he c ontinuous w ind-erosion a nd a t t he p resent t ime b oth g able e nds a re a bove t he s urface, t he w est o ne t o t he l evel o f t he w indow s ill a nd t he e ast o ne o n t he i nner s urface t o al evel a l ittle b elow t he w indow L intel. T he g reater p art o f t he o uter s urface o f t he e ast g able e nd, w here s everal i nterments w ere f ound, i s s till l argely i ntact b ecause o ver t he y ears w e h ave p iled b oulders a nd s labs o f s tone a gainst i t. T he t ops o f t he n orth a nd s outh w alls h ave a lso b ecome e xposed.

1 0

U nfortunately t he e xposure o f t he w alls h as c ontinued, i n s pite o f a nnual e fforts t o r e-cover w ith s and a nd b oulders a nd t o p ersuade m arran g rass t o g row , a nd t he t ops o f t he w alls a re f alling a way, a p rocess c onsiderably h astened b y t he t rampling o f c attle a nd s heep. T he e rosion h as b rought t o l ight i nterments i mmediately t he o utside s urface o f t he e ast-gable w all ( see l ater, p . 2 3).

a gainst

T he c hapel ( Figs. 5 , 6a nd 7 ) T he i nternal d imensions a re, m easured n ear t he t op, 6 m l ong b y 3 .2m w ide; t he n orth a nd s outh w alls a re 2 .4m h igh a nd a t t he g able e nds, 3 .6m h igh . A t t he t op, t he w alls a re a bout 0 .6m t hick, b ut t he n orth w all, w hich i t w as p ossible t o m easure a t a bout m id-height b ecause p art o f t he n orth f ace w as e xcavated, w as a l ittle o ver 1 .0m t hick a t t hat l evel, s o i t s eems l ikely t hat t he w alls a re t hicker s till a t t he b ase. T he e xternal d imensions a t t he l evel o f t he t op o f t he n orth a nd s outh w alls w ere a bout 7 .3m x 4 .6m . T he f oundation c ourse i n t he n orth-east c orner t hat w as e xcavated f rom w ithin r ested o n w hat a ppeared t o b e s and w ithout t he b lackness o f p lant r esidues. T he c ourse c onsisted o f s labs l arger t han t hose a bove a nd, o n t he i nternal s ide, t he o nly o ne e xplored, p rojected a bout 1 00mm b eyond t he w all a bove. T he w indow i n t he m iddle o f t he e ast g able w all i s 1 .02m h igh o n i ts i nternal a spect ( Fig. 5 ) a nd 0 .56m w ide a nd t apers t o a n e xternal v ertical s lit a bout 1 5cm w ide, b ut i ts e xternal a spect w as n ot e xcavated. T he w indow i n t he w est g able e nd i s s imilarly s ituated b ut s maller. I t i s 5 1cm h igh a nd i nternally 3 0cm w ide, i ts e xternal s litl ike o pening i s 1 5cm w ide. B oth w indows h ave s tone-slab l intels. I n t he s outh w all, t here i s a d oor o pening 0 .76m w ide, 0 .8m f rom t he s outh-west a ngle o f t he b uilding. T he s tone l intel o f t his d oorway i s s plit a nd t he w all f or a bout 1 .5m e ast o f i t b ulges i nwards s lightly. T hat t his i s t he d oorway i s i nference, b ecause i t w as o nly e xcavated t o 1 .0m b elow t he l intel a nd f rom t he i nner a spect. H owever, i t w as n ot e mbrasured a nd s ufficient o f t he b uilding w as e xcavated t o b e s ure t hat t here w as n o o ther d oor o pening. • T he p latform o r p resumed a ltar b elow t he e ast w indow 1 .0m w ide, 0 .6m d eep a nd 1 .0m h igh. T wo r ough s teps a bout f ormed i ts f ront ( Fig . 5 ).

w as a bout 0 .5m h igh

T he s mall a rea o f f loor t hat w as e xplored i n t he n orth-east c orner t o t he l eft o f t he a ltar w as c omposed o f s and w ithout p aving, a lthough t here w ere s ome s lightly f lat b oulders t hat m ay h ave f ormed a f loor. T he w alls a re c onstructed o f t ops o f t he n orth a nd s outh w alls r ounded b oulders. T here i s n o H owever, i n m any p laces b oth o n w alls, t here a re t races o f t heir m ortar w hich c ontains m uch b roken

1 1

d rystone s labs c arefully f itted. T he c onsist o f o ne o r t wo c ourses o f m ore t race o f m ortar b etween t he s labs. t he i nner a nd o uter s urfaces o f t he h aving b een f aced w ith a c oarse l ime s ea s hell ( Fig. 8 ).

Z

3 .2 m

6 Om

D oo r

1 .0 m

F ig.

6 .

D iagrammatic p lan o f c hapel.

F ig. 7 . C hapel f rom w est i n 1 980. S ince 1 971, s oil e rosion h as e xposed t he u pper p arts o f b oth g able w alls a nd t he o utlines o f t he o ther w alls c an b e t raced. B reak-up o f t he r ailed g rave h as m uch i ncreased s ince 1 966 ( cf. F ig. 4 ). A rrow i ndicates a rea o n t he w est w all s till p artially c overed w ith m ortar.

1 2

F ig. 8 . U pper p art o f o uter s urface o f e ast g able w all i n 1 977. a re m any a dherent r emains o f s hell-mortar r endering o n t he o uter s urfaces o f t he s labs b ut n one b etween t he s labs.

T here

H igh u p o n t he n orth w all n ear t he n orth-east c orner a nd j ust b elow t he l evel o f t he r ounded b oulders, t here w as a s mall i rregular o pening, a bout 2 30mm w ide a nd 1 50mm h igh, l ooking o ut t o s ea. T his o pening h ad n o s lab l intel; t here w ere m erely t wo o void b oulders a bove. I t w as a s i f s ome s tones h ad b een p ulled o ut o r h ad d ropped o ut. H owever, b eing a n o pening t hrough t he w hole t hickness o f t he w all, i t s uggests t hat t he w all m ay h ave b een b uilt i n t his f ashion t o p rovide a m eans o f l ooking o ut. R esting o n t he s ill o f t he e ast w indow w ere f ive r ounded p ebbles, a s w ell a s s ome m ore i rregular s tones ( Fig. 5 ). A t l east t wo o f t hese p ebbles w ere o f q uartz, t he l argest b eing o void a nd a bout 1 30mm i n d iameter.

T he w all i nvesting t he s ite ( Figs. 9 a nd 1 0) A s t he N t o Sd iameter o f t he w all i s 4 1m .and i ts E t o W d iameter i s 3 4m , i t i s o val r ather t han s trictly c ircular, b ut i t i s l ikely t hat i ts n orthern s eaward e nd h ad s lid b odily t owards t he b each s o t hat o riginally i t w as p robably c ircular. J udging f rom t he b oulders t hat h ave f allen d own t he o utside s lopes, t he w all m ay o riginally h ave b een h igher b y a s m uch a s 1 .0m , b ut a t p resent i s u p t o 0 .75m t hick . I t s eems t o h ave b een b uilt m ainly o f l arge w ater-rounded b oulders b ut w ith s ome l arge s labs a f ew o f w hich w ere m ore o r l ess v ertically p laced. A t t he c entre o f t he e ast s ide, a n arrow s lab s tands v ertically 1 .4m a bove t he w all l ike a s tanding s tone. T his h as n ever b een a c arefully c onstructed d rystone w all o f w orkm anship s imilar t o t he c hapel. N o s pecial f oundations a re e vident; i ts b ase i s a bout l evel w ith t he t ops o f t he c hapel g ables.

1 3

1i nter ment beneath

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41m V e r t ica l s tand ing s tone . App rox .a rea a nd p os i t ion o f i n ne r wa l led r ec tang le . On ly s o l id l i ne e xcava ted t o r evea l wa l l a t l e as t 1 .2 m h i gh .

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o o O u t l ine o f c hape l( 1 97 1 )

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• W ind e rosiQn o f t he s and w ithin t he w all s ince 1 966 h as g radually r evealed a s ubsidiary w all o f r ounded b oulders e xtending f rom t he i nner a spect o f t he s outh-eastern p art o f t he m ain w all a t a s lightly l ower l evel ( Fig. 9 ). T his w all i s l ess t hick t han t he m ain w all a nd e ncloses a r ectangular a rea a bout 4 .5 x 4 .0m . N o i nterments h ave b een f ound w ithin t his a rea o r i n i ts v icinity. F igure 1 0 s hows d iagrammatically t he i nter-relationships t he v arious l evels r eferred t o.

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I n 1 972, a s e rosion o f a n a djacent d une t o t he w est o f t he b urial s ite p roceeded t o t he p oint w hen i ts c apping w ith t urf w as f inally l ost, t he r emains o f t he f oundations o f a nother s ystem o f w alls u p t o a bout 0 .6m h igh b ecame e xposed. T he m ain p art o f t his s ystem e ncloses a r ectangular a rea a bout 8 m x4 .6m w ith r ounded c orners a nd w hat i s c ertainly a d oorway 0 .65m w ide a l ittle t o t he n orth o f t he m iddle o f t he e ast w all. A lmost o pposite t his d oorway i s ag ap 0 .74m w ide o n t he o pposite w all w hich c ould b e a nother d oorway. T he w alls a re a bout 0 .75m t hick a nd a re b uilt o f i nner a nd o uter l ayers o f r ound b oulders a nd f lat s labs w ith s maller s tones b etween . T he s tones h ave d rifted a part i n t he e nclosing s and b ut i t i s e asy t o e nvisage t hem o riginally f orming a c ompact w all. E xtending f rom t he o utside o f t he s outh w all, t here i s a nother l ess t hick ( about 0 .53m) w all e nclosing a n a rea 3 .8m n orth-south a nd 3 .2m e ast-west. T here i s a n i ll-defined g ap, 0 .6m w ide, w hich i s a p robable d oorway n ear t he m iddle o f t he e ast w all. T he d imensions a nd o ther f eatures a re c onsistent w ith t his w alled a rea b eing t he f oundations o f a s mall b lackhouse, a ssociated p erhaps w ith a s mall l ean-to b uilding . I t i s s ituated a bout 6 0m t o t he w est o f t he w all e nclosing t he b urial s ite. I n 1 984, a bout 3 m s outh o f t he f oundations o f t he b lackhouse a nd e mbedded s uperficially i n t he s ame s urface o f c ompact d ark s oil o n w hich t he f oundations o f t he b lackhouse r est, a b ronze r ing b rooch ( Fig. 1 1) w as r ecovered. I t s eems l ikely t o h ave b een u nmoved f rom i ts n atural l evel e xposed b y w ind e rosion a nd t herefore t o b e c ontemporary w ith t he b lackhouse. T he f ollowing r eport b y D r. D .H . C aldwell o f t he R oyal M useum o f S cotland, E dinburgh , s uggests t hat i t i s a 1 3th-14th c entury b rooch , w hich i s i n a ccord w ith t he g eneral d ate p ostulated h ere f or t he p eriod o f c hapel u sage. " Copper-alloy r ing b rooch o riginally c oated w ith t in. T he f ront s ide h as t hree r ounded s ections a lternating w ith t hree f lat o nes. T he p in h as a s imple l oop h ead. O nly s light t races o f at in-lead a lloy c overing r emain , e specially o n t he i nside o f t he r ing. T wo a reas w ere s ubjected t o e nergy d ispersive X -ray f luorescence ( XRF) a nalysis i n t he N ational M useums' R esearch L aboratory ( Analytical R esearch S ection R eport N o. 8 7/43) t o b ack u p t he v isual i dentification o f t hese t races. " It i s ap oor r elation o f as mall g roup o f o ctagonal s ilver b rooches w ith a lternate f lat a nd r ounded s urfaces , d ating t o t he 1 3th-14th c entury, f or e xample t wo i n t he R oyal M useum o f S cotland ( KO 2 6 a nd K O 2 0) f ound w ith c oin h oards . T he f irst w as d iscovered i n B rechin i n 1 891 a nd i s t hought t o h ave b een d eposited c . 1 332-6. T he s econd c omes

1 6

1 1

1 2

F ig. 1 1. D rawing, b y M iss M arion O 'Neil, o f t he c opper-alloy r ing b rooch w ith t races o f a n o riginal c oating o f t in. P robably 1 3th-14th c entury ( Dr. D .H . C aldwell). F ound c lose t o t he b lackhouse w est o f t he b urial s ite. T wo-thirds n atural s ize.

F ig. 1 2. D rawing, b y M iss M arion O 'Neil, o f t he p art o f ak nife h andle f ound i n t he v icinity o f t he r ing b rooch c lose t o t he b lackhouse w est o f t he b urial s ite. T he t ang i s o f c orroded i ron w ith b one p lates a nd c opper-alloy r ivets. N atural s ize.

1 3

F ig. 1 3. D rawing o f t he r econstructed p ot ( Pot 1 1) f ound i n aw alln iche i n t he r emains o f ab lackhouse a bout 1 00m t o t he w est o f t he w alled b urial a rea. D omestic w are w ithout d ecoration t hat c ould h ave b een m ade a s e arly a s 1 500 A D b ut a lso s imilar t o H ebridean v essels a ttributed t o t he 1 8th c entury ( Dr. A . L ane). H alf n atural s ize.

1 7

f rom t he s ite o f t he C romwellian F ort i n A yr a nd w as b uried b etween t he y ears 1 292 a nd 1 360. B oth h ave e ngraved d ecoration [ see J .D.A . T hompson , I nventory o f B ritish C oin H oards A D 6 00 - 1 500 ( Royal N umismatic S ociety, 1 956), p ls. V IIa a nd D 4; a nd D .M . M etcalf, ' the E vidence o f S cottish C oin H oards f or M onetary H istory, 100-1600 ' i n C oinage i n M edieval S cotland ( 1100-1600), e d. D .M . M etcalf ( Brit. A rchaeol. R eport 4 5, 1 977) n os. 1 08 a nd 6 3 f or d ating.]"

I n 1 988, w hat s eemed t o b e ak nife-handle ( Fig. 1 2), c onsisting o f ar usted i ron b lade h eld b etween t wo p lates o f b one b y b ronze o r b rass r ivets w as f ound e mbedded i n t he s urface o utside t he b lackhouse c lose t o w here t he b ronze b rooch h ad b een f ound i n 1 984. T he k nife-handle a nd b rooch w ould h ave b een a t a bout t he s ame l evel b ecause i n 1 984 t he s urface c onsisted o f c ompacted d ark s oil; a ll t he c overing s and h ad b een b lown a way. I n 1 988 a lso , t he b roken r im o f ap ot w as o bserved i n t he s and a mong t he r emains o f t he w est w all o f t he b lackhouse. E xcavation r evealed b eneath t he r im m any o ther s herds w hich e ventually, w hen r econstructed, f ormed t he g reater p art o f ar ound-bottomed p ot 1 9.5cm h igh , a nd 2 1.5cm i n g reatest w idth w ith a n o pening 1 3.0cm i n d iameter. T he r emains o f t he p ot w ere r esting a t v arious l evels i n t he s and o n a s tone s lab w hich f ormed t he b ase o f aw all n iche, 4 5cm w ide a nd a bout 2 2cm d eep o n t he i nside o f t he w est w all o f t he b lackhouse. T his p ot w ill b e r eferred t o a s E nsay p ot I I b ecause a p ot ( see l ater) h ad b een d iscovered s everal y ears e arlier w ithin t he b urial s ite. I t s eems l ikely t hat i t h ad b een l eft b ehind, p erhaps b ecause i t w as c racked a nd n ot o f m uch v alue, a t t he t ime t he h ouse h ad t o b e a bandoned b ecause o f t he s andblows. T he p ot t hus m ight p rovide e vidence o f t he d ate o f t hose e vents. T he p ot w as b roken i nto f ragments a lmost c ertainly b y t he f eet o f c attle i n r ecent y ears d uring t he p rogressive e xposure o f t he s ite b y w ind e rosion. U nfortunately, a s w ill b e s een f rom t he f ollowing r eport k indly p rovided b y D r. A lan L ane o f t he D epartment o f A rcheology, U niversity C ollege, C ardiff C F1 1 XL , t he p ot c annot a t p resent b e d ated m ore n arrowly t han p robably o f t he p eriod 1 500-1700 A D . " This s econd E nsay v essel c omprises s ome e ight r im s herds a nd s eventy-six b ody/base f ragments f rom a c omplete o r n ear c omplete v essel ( Fig . 1 3). I ts f abric c ontains a m ass o f s mall a ngular f ragm ents o f q uartz, f eldspar, m ica a nd m afic m inerals a nd o ccasional r ock f ragments o f g neiss a s w ell a s a s mall q uantity o f s hell . T his s uggests t hat i t w as m anufactured f rom c lay d erived f rom a g lacial d eposit o f e roded L ewisian G neiss s uch a s f orms t he i sland o f E nsay. T he p resence o f s hell i ndicates t he m anufacture o f t he v essel a djacent t o m achair d eposits. T he v essel w all i s 4 -5mm t hick a nd c omparatively f ine t extured t hough ' brittle' i n f eel.

1 8

T he v essel i s ag lobular s houldered j ar w ith a n u pright r im . I t i s n ot w heel-made. T he r im t op i s f lattened a nd i rregularly w avy b ut t hat m ay n ot b e i ntentional. T he b ase i s r ounded w ith n o c lear j unction b etween b ase a nd w all. T his i s a n i nteresting v essel s imilar i n f orm t o t he l ate c raggans . P rofessor M iles h as s uggested t hat t he h ouse f rom w hich t his v essel c ame w as b uried p re-AD 1 500 . A lthough t he p ot m ight d ate a s e arly a s t his I w ould e xpect a l ater d ate f or t his f orm . I t i s s imilar t o a 1 8th c entury v essel f rom D un C uier o n B arra ( Young 1 956, p . 2 96) a nd t o u nstratified s herds f rom O ld A rnol, L ewis. T here i s n o m odern p ublished s tudy o f t his m aterial a nd l ittle f or t he p receding c enturies. T he a ssemblage f rom B reachacha C astle o n C oll d oes h ave a r ange o f f orms w hich a pparently d ate t o t he s ixteenth t o n ineteenth c enturies ( Turner a nd D unbar 1 970 , p . 1 82-5) b ut t here a re t oo f ew v essels t o a llow t he c onstruction o f a s ecure s equence. T he U dal, N orth U ist, h as p ottery f or t he p eriod f rom t he t welfth t o s eventeenth c entury ( Crawford a nd S witsur 1 977) b ut n one o f i t i s p ublished. I n s ummary, t here i s l ittle e vidence f or a f irm d ating f or t he E nsay p ot. T he s ite e vidence s uggests a p re-AD 1 500 d ate w hile s tylistic s imilarity t o t he l ate c raggans m ight s uggest a l ater d ate."

D r. D .H . C aldwell, R oyal M useum o f S cotland, h as b een k ind e nough t o c onfirm t hat t he k nife h andle ( Fig. 1 2) i s p art o f t he g rip o f a s cale t ang k nife o f i ron w ith p lates o f b one a nd c opper-alloy r ivets . T he k nife i s o f ak ind t hat m ight h ave b een m ade a nd u sed o ver a w ide s pan o f t ime - t he s o-called m edieval p eriod. I t i s n ot p ossible t o d ate i t m ore e xactly. • W ind e rosion o f t he s and a ll a round t he b urial s ite i s n ow s o a dvanced t hat c onsiderable a reas a re n ow e xposed o f w hat m ust h ave b een t he b asic l evel o f t he l and b efore t he s and b lows t hat c reated t he s and d unes. T his s urface i s f lat, b rown a nd c ompact a nd i s c omposed o f a b rown s oil w hich i s f laky w hen d ry a nd m ouldable, l ike c lay, w hen m oist; i ts t exture a nd a ppearance a re q uite d ifferent f rom t hose o f t he d unes. T he v arious w idely-separated a reas o f t his l and s urface t hat a re e xposed a ll s eem t o b e p art o f a c ontinuous f lat a rea; t he c ontinuity c an b e b est s een o n t he s eaward s ide w here m ainly s ea e rosion h as e xposed a c ross-section o f t he c ontours o f b oth t he d une w ith w hich t he b urial g round i s a ssociated a nd t he r emains o f t he a djacent d une t o i ts w est a ssociated w ith t he b lackhouse. I n t he s eaward f ace o f t he b urial g round d une b elow t he l evel o f t he i nvesting w all t hat s urmounts i t, t hin l ayers o f s oil d arkened b y p lant r esidues c an b e c learly d iscerned ( Fig. 1 4). T hese b ands i ndicate p ast p hases o f g rass-cover i n t he h istory o f t he s ite ( see l ater, p . 2 1 ) . T he

1 9

F ig. 1 4. V iew o f e roded w estern s ide o f b urial s ite. M ore o r l ess i ntact p erimeter w all c an b e s een b ut t o t he l eft, t he s eaward s ide, m uch o f t he w all h as t umbled d own t he s loping s urface. N umerals i ndicate s uccessive m ajor s oil b ands w ith s and l ayers b etween. T here a re s ome s ubsidiary b ands ( for e xample a rrowed a rea) t hat d o n ot e xtend r ight a cross t he s ite.

b asic l and l evel j ust d escribed c an b e c learly s een t o b e c ontinuous w ith t he l owest o f t hese b ands a nd w ith t he d ark-soil s urface o n w hich t he b lackhouse f oundations r est. F urthermore, m easured o bservations o n p hotographs, t aken a gainst t he s ea-horizon, o f t he t wo s ites, t he b lackhouse o ne a nd t he M anish c hapel s ite i n w hich t he t op o f t he e ast g able, k nown t o b e 3 .6m a bove t he f oundations, i s v isible, h ave e stablished t hat f oundations o f t he t wo b uildings a re a t t he s ame l evel, c onfirming t hat M anish c hapel a s w ell a s t he b lackhouse w ere b uilt o n t he b asic l and l evel n ow e xposed. T hus t h i 3y w ere c ontemporary i n t he s ense t hat b oth w ere b uilt b efore t he s andblows t hat c reated t he d unes. A l ittle t o t he s outh o f t he w all e nclosing t he b urial g round a nd a bout o pposite t he r ailed g rave, a nd r esting o n t he b asic l and l evel r eferred t o , t here a re r ows o f b oulders w hich m ust b e t he r emains o f a w all e nclosing a r ectangular a rea a bout 9 .1m x 5 .8m , t he l onger w alls b eing o rientated a pproximately n orth-south. T he a rea i s d ivided b y s imilar r emains o f aw all a bout 4 .0m n orth o f t he s outh w all i nto a l arger n orthern r ectangular a rea a nd a s maller s outhern o ne. T here a re a f ew g aps i n t he r ows o f s tones b ut n one i s w ide e nough t o s uggest a d oorway. A lthough a t p resent t hese s o-called w alls c onsist o f l ittle m ore t han s traight r ows o f b oulders o f v arious s izes, i t s eems h ighly l ikely t hat t hey a re t he r emains o f m ore s ubstantial w alls. T he s ize o f t he a rea t hey e nclose i s al ittle s maller t han t hat o f t he m ain r oom o f t he b lackhouse t o t he w est, b ut c ould b e t hought o f a s t he c ramped q uarters f or a f amily, t hat i s ab lackhouse. A lternatively, t hey m ight h ave b een s ome s ort o f e nclosure f or t he m anagement o f a nimals, s uch a s a s heep-shearing a rea. 2 0

A s a lready i ndicated, t hese r ows o f s tones a re o n t he e xposed l and l evel a bout 6 .5m b elow t he b urial s ite w all a nd a t t he s ame l evel a s t he f oundations o f t he c hapel i tself a nd, p resumably, t ogether w ith t he b lackhouse t o t he w est, m ore o r l ess c ontemporary w ith i t.

T he i nterments A ll, w ith o ne e xception t o b e r eferred t o s eparately, w ere s upine w ith h eads t o t he w est w ith h ands o ver t he p elvis o r o ccasionally a t t he s ides ( Figs. 1 5 a nd 1 6). T he o nly a ccompanying a rtifacts a part f rom t he r emains o f t he c offins w ere a n o ccasional p earl b utton a nd a f ew s traight b rass p ins s ometimes s tuck b y g reen c orrosion t o t he f ace o r s ide o f t he h ead. G reen s tains o n s kulls w ere a lso f ound w here s hroud p ins h ad c orroded b eyond r ecognition . B ecause s o m uch o f t he b urial a rea w as s everely e roded b efore e xcavations s tarted a nd t he l imited e xcavations u ndertaken e ach y ear h ad t o b e o pportunist, d etermined l argely b y w hat t he w inds o f t he p revious w inter h ad r evealed, e xcavation o f t he i nterments a s a c ompletely r eliable o rderly s eries w as n ot p ossible. T hat t here h ad b een s everal p eriods o f b uild-up o f t he s urface o f t he s ite b y s andb lows w as s hown b y a t l east f ive m ajor s oil b ands, d ark w ith p lant r esidues, t hat c ould b e s een a cross t he e xposed s eaward s urface o f t he s ite ( Fig. 1 4), a s w ell a s s ome s ubsidiary o nes t hat o nly p artially c rossed i t. T he d eepest o f t he m ajor o nes c orresponds w ith t he l evel t hat o therwise h as b een e stablished a s t he p robable l evel o n w hich t he c hapel a nd s ome a djacent b uilding h ad b een b uilt ( p. 1 9 ) . T his s eems t o b e g ood e vidence t hat t here w ere s everal p hases i n t he i ncrements o f s and t hat e ngulfed t he c hapel a nd i n w hich t he i nterments w ere b eing m ade, a nd o n w hich i n d ue c ourse t he i nvesting w all w as b uilt. T his e vidence o f p rogressive i ntermittent b uilding c ould n ot d isclose a ny p revious p eriods w hen t he g rass c over o f t he s ite h ad b een b roken w ith c onsequent r eduction i n t he h eight o f t he s ite. A s a g rass c over p rovides c onsiderable p rotection w hereas t here i s n one a gainst s and b lowing o n t o s uch a s ite , i t i s r easonable t o a ssume t hat p eriods o f r eduction i n h eight w ere m uch l ess f requent t han t he d emonstrated i ncreases d uring t he h istory o f t he s ite . I t s eems s afe, t herefore, t o a ssume t hat, i n g eneral, t he d eeper i nterments w ere e arlier t han t he m ore s uperficial o nes. I t i s q uite i mpossible t o c orrelate t he l evels o f t he r escued i nterments i n a n e xact w ay w ith t he l evels o f t he s oil b ands s een o n t he s eaward s urface o f t he d une. T he i nterments t hat c ould b e s een i n t he s ides o f t he h ummock , a nd w hich l ater w ere e xcavated a s a n o rderly s eries t hrough t he w hole d epth o f t he s ite, p rovided e vidence o f a p rogressively m ore a ncient s eries . F or i nstance, w ithin t he h ummock t he m ost s uperficial i nterments w ere w ithin s till-identifiable p lanks o f c offin w ood, w ith n ot g reatly e roded c ast-iron f actory-made c offin h andles s uggestive o f t he l atter h alf o f t he l ast c entury. A t t he s lightly l ower l evel, t he c offin w ood w as m uch m ore r otted a nd b elow t hat w as a l ayer w here t he o nly t race o f c offins w as w ell-delineated d ark b ands i n t he s urrounding s and ( Fig . 1 6). T he m ost c ommon c offin h andles f ound i n t hese d eeper l ayers w ere o f w rought i ron o f s imple s hape. A bout t wo-thirds ( 2.5m) b elow t he s urface o f t he h ummock a nd i n a ll t he i nterments b elow t hat l evel a ll o ver t he s ite, a ll s igns o f c offins w ere n otably a bsent.

2 1

F ig. 1 5. P air o f s keletons a t l evel D s o c lose t ogether, w ith t hat o n l eft ( A 5 0Y/67D . F emale, 3 5 y ears) s lightly o verlapping t he o ther ( A 5 0Z/67D . M ale, 3 5 y ears), t hat i t i s l ikely t hat t hey w ere b oth i nterred a t t he s ame t ime. L ower-limb b ones o f t he s keleton o n l eft h ave b een r emoved. o f b oth a re c rossed o ver p elves . T here w as n o t race o f c offin.

H ands

F ig. 1 6. P artially-exposed g rave ( A 4 9/66C . F emale, 5 0 y ears) a t l evel C . P resence o f an ow-rotted c offin i s i ndicated b y d istinct z one o f b lackening b y r otted-wood r esidues i n s urrounding s and. T he o utline o f t he z one s uggests t hat t he c offin s ides c ollapsed i nwards i n r egion o f p elvis. N o c offin h andles w ere f ound.

2 2

T able 3 .

L aboratory R eference

C arbon-14 A ges

C onventional C arbon-14 A ge B P

C alibrated D ate A D ( Stuiver, 1 982)

G U-1451

2 55 + 6 0

1 640 + 8 0

G U-1452

3 60 + 5 5

1 530 + 7 5

3 10 + 4 0*

1 585 + 6 0*

4 20 + 1 10

1 480 + 1 00

H AR 6414

T he d ates o f t he t wo s pecimens ( GU) f ound a gainst t he W est w all o f t he c hapel p resented a s aw eighted m ean . T he m ean c alibrated d ate o f t he G U s pecimens c overs t he r ange A D 1 525 t o A D 1 645 o n t he 1 s igma ( 68% c onfidence) c riterion [ AD 1 465 t o A D 1 705 o n t he 2 s igma ( 95% c onfidence) c riterion]. T he c alibrated d ate o f t he H AR s pecimen f rom t he p erimeter w all o f t he b urial g round c overs t he c orresponding r anges A D 1 380 t o A D 1 580 ( 1 s igma) a nd A D 1 280 t o A D 1 680 ( 2 s igma).

A f ew b urials s howed s igns o f d isturbance b y l ater o nes. A f ew i nterments i n t he d eepest l ayers w ere u nder l arge u nworked s tone s labs s upported o n b oulders . A part f rom t hose t o b e d escribed t hat w ere a gainst t he e ast w all o f t he c hapel, m ost o f t he i nterments s o f ar e xposed w ere i n a n a rea a l ittle s outh-west o f t he c entre o f t he w alled a rea ( Fig. 9 ). E xceptions w ere p arts o f a s keleton o f aw oman a ged a bout 3 5 y ears f ound i n 1 983 a mong t he f oundations o f t he n orth s ide o f t he i nvesting w all; o bviously t his b urial h ad b een d isturbed b y t he b uilding o f t he w all. P arts o f a n a dult s keleton w ere f ound o n t he s lope j ust o utside t he w all o n t he e ast s ide ( Fig. 9 ), a nd t he r emains o f t hree n eonatal i nfants w ere f ound i n t he s and t hat c overed t he s outh-western p art o f t he w all t hat b ecame f ully e xposed i n 1 971. D uring t he w inter o f 1 978, t here w as e xceptionally s evere e rosion a nd m uch o f t he u pper h alf o f t he e ast g able w all b ecame e xposed, r evdaling a s eries o f i nterments o utside t he e ast e nd o f t he c hapel w ith t he s kulls u p t o 1 5cm f rom t he o uter f ace o f t he g able w all. T hese m ust h ave b een i nterred c arefully a gainst t he w all w hile e ither t he t op o f t he w all w as v isible o r a t l east i ts p resence w as k nown. T hese i nterments a nd s ome d uring s ubsequent s easons, a mounting t o 2 0 i n a ll, w ere r ecovered d own t o al evel o f 1 .5m b elow t he t op o f t he g able, t hat i s a bout o ne-half o f t he t otal h eight o f t he w all. B ones f rom t wo o f t he d eepest o f t he i nterments c lose t o t he e ast g able, a t t he s ame l evel b ut 1 .5m a part, w ere c arbon-dated b y t he R adiocarbon D ating L aboratory, T he U niversity, G lasgow G 12 8 QC ( Dr. M .J . S tenhouse). C arbon-dating p rocedures o n a s ample o f t he b ones f rom t he i nterment d isturbed b y t he b uilding o f t he p erimeter w all w ere s tarted a t G lasgow , b ut t ransferred t o t he I sotope M easurements L aboratory. H arwell L aboratory, U K A tomic E nergy A uthority, O X11 O RA ( Dr. A .J . W alker) w here a pparatus w as a vailable t hat c ould h andle t he u nusually s mall a mount o f C O2 y ielded b y c ombustion o f t he s ample. T able 3 g ives t he f indings f rom t he t hree s amples. A n a dditional m ean 2 3

I

I

5 .0 c m

F ig. 1 7. D rawing, b y M iss A . T ownshend, o f t he r econstructed r im o f t he p ot ( Pot I ) f ound w ithin t he b urial s ite. D omestic w are t hat c ould h ave b een m ade 1 4th-17th c enturies ( Dr. A . L ane). As oot-blackened r ounded p iece, f ound i n a ssociation, c ould h ave b een t he b ase o f t he p ot. H alf n atural s ize.

c alibration d ate i s g iven f or t he t wo G lasgow s amples b ecause t hey w ere j udged t o c ome f rom t he s ame l evel a nd c lose t o e ach o ther; f urtherm ore, o n t he b asis o f t he s tandard d eviations, t he d ates f or t he t wo, i n s trict s tatistical t erms, a re n ot s eparable. A t reatment d evised b y R .L . O tlet o f t he H arwell L aboratory w as u sed t o p rovide t he m ean d ates f rom t he S tuiver ( 1982) c urve. T hey w ere o btained b y o verlaying Oe a ppropriate G aussian d istribution r epresenting t he c onventional i g C a ge, w ith i ts a ssociated p robabilities o n t he a ctual c alibration c urve.

A ssociated a rtifacts I n 1 980 , t he b roken f ragments o f ap ot w ere f ound a t a l evel 1 .3m b elow t hat o f t he t ops o f t he g able w alls a nd 6 .5m t o t he S W o f t he w est e nd o f t he c hapel. T he f ragments f itted t o f orm t he r im a nd p robable u pper t hird o f ap ot w ith a r im d iameter o f 2 2cm ( Fig . 1 7), t ogether w ith a s oot-blackened r ounded p iece w hich c ould b e p art o f t he l ower p art o f t he p ot. I n 1 983 , a t a bout t he s ame l evel a s t he p ot b ut 5 .0m d istant f rom i t, c . 2 .5m f rom t he w est e nd o f t he c hapel, a s ingle c oin, a bout 2 .0cm d iameter, w as f ound. I t a ppeared t o b e i n s itu , t hough e xposed b y t he w inds o f t he p revious w inter. N either p ot n or c oin w ere a ssociated w ith i nterments ( Fig. 1 0). I a m i ndebted t o D r. A lan L ane o f t he D epartment o f A rchaeology, U niversity C ollege, C ardiff, f or t he f ollowing r eport o n t he p ot ( Ensay P ot I ): " Complete r im a nd p arts o f t he u pper b ody o f a v essel w ith a s lightly o ut-turned/bevelled r im d ecorated w ith a ngled s lashing o n t he r im e dge. T he v essel w ill p robably h ave h ad a g lobular b ody, o r as light s houlder. T he v essel i s h and m ade a nd c omparatively w ell-fired w ith s andy f abric, b uff/ o range i n c olour t hroughout. T he d iameter o f t he r im i s 2 1-22cm a nd t he a verage t hickness o f t he w alls 7 -9mm . T he s urviving h eight i s n early 8 cm . 2 4

M M

I I11 1 1l i1 1 1 11 1 11 i '

t iiiiiiiiiiiisittiatitti

F ig. 1 8. Am uch-worn J ames I V ( 1488-1513) p laque o f b illon, t ype I V ( Dr. P .H. C aldwell) f ound w ithin t he b urial g round a t l evel D . M ag. x 3. T he d ate o f t he v essel i s u ncertain t hough t he g eneral c haracteristics m ay b e b est f itted i n M edieval t o p ost-Medieval c ontexts; i ts f eatures a re n ot e asily p aralleled i n e arly s ite a ssemblages."

D r. L ane's e xperience i ncludes o ther H ebridean s ites a nd h is o pinion t akes a ccount o f t he f act t hat, i n t he H ebrides, m edieval c haracteristics p ersisted i n d omestic w are u ntil q uite l ate. T hus t he p ot c an h ardly b e g iven a d ate m ore p recise t hat 1 4th-17th c enturies. I a m i ndebted t o D r. D .H . C aldwell, o f t he R oyal S cotland, f or t he f ollowing r eport o n t he c oin ( Fig. 1 8):

M useum

o f

" James I V ( 1488-1513) p laque o f b illon ( silver m uch d ebased w ith c opper o r t in), t ype I V . B urns 2 7 ( Burns, 1 887) o r v ariant ( too w orn t o b e s ure). W eight 2 6.8546 g rains. I t i s n ot p ossible t o s ay w hen i t w as m inted. F rom t he a mount o f w ear i t c ould h ave b een i n c irculation f or a s m uch a s 5 0 y ears."

I n 1 975, a b uckle ( Fig . 1 9) w as f ound l ying l oosely o n t he s urface o f t he s ite a bout w here t he c oin w as l ater f ound. B ecause i t w as l ying l oose a nd t herefore c ould h ave c ome f rom a ny o f t he l evels a bove, i t c ould b e o f l ittle v alue f or d ating p urposes. D r. C aldwell d escribed i t a s f ollows: as trap-end b uckle o f c opper a lloy c onsisting o f a r ing, d ecorated w ith h ammered d epressions a t t he p eriphery , a round w hich i s b ent a p in o f f lat m etal t hat p ierces t he l ooped-round s trap w hich o riginally e nclosed a b elt o f l eather. T he s trap h as a p attern o f i ndentations a long i ts e dge a nd i s h eld b y a c opper-alloy r ivet. L ike t he k nife-handle ( p.19), i t c annot b e d ated m ore c losely t han a s o f t he m edieval p eriod. 2 5

u s e= e 2

F ig. 1 9. D rawing, b y M iss M arion O 'Neil, o f t he b uckle o f c opper a lloy. T he r ing o f t he b uckle i s d ecorated w ith d epress ions. T he p in i s o f f lat m etal b ent r ound t he s moothly r ounded a pposing e nds o f t he r ing a nd p asses t hrough a n o pening i n t he s trap t he e dge o f w hich h as a p attern o f i ndentations. T he s trap i s h eld b y a r ivet. N atural s ize.

9

D ates o f i nterments T here i s e vidence t hat t he i ndigenous p opulation o f t he i sland h ad l eft i t b y a bout 1 875. A p arty, p robably c onsisting o f m ore t han o ne f amily, i s k nown t o h ave e migrated t o A ustralia a t t hat t ime. T he p opulation l ater c onsisted o f t he s mall f amily w ho o wned t he i sland a nd t he m ain h ouse, t he S tewarts, a nd a f ew o f t heir f arm a nd h ouse s ervants. I t i s n ot k nown f or c ertain w hether a ny o f t hese d ied a nd w ere b uried o n t he i sland w hich s ince a bout t he f irst W orld W ar h as b een u noccupied a part f rom a n o ccasional o ccupant o f t he h ouse. H owever, i t i s k nown t hat d uring t he t ime t he i sland h ad b een u noccupied, i nterments h ave b een m ade o f p eople w ho d ied o n H arris a nd w ho w ere b uried o n E nsay e ither b ecause o f s ome f amily c onnection w ith t he i sland o r b ecause o f t he l imited b urial f acilities o n t he r ocky t errain o f H arris . A p resent i nhabitant o f n eighbouring L everburgh r emembers b eing p resent a s a l ittle b oy a t h is g randmother's b urial o n E nsay i n 1 926. I t s eems p ossible, a lthough I h ave n ot d iscovered a ny c onvincing e vidence , t hat d uring e arlier t imes b urial o n E nsay w as c ommon f or m any w ho d ied o n H arris. T he p roblem o f i nterment o n r ocky H arris i s w ell d ocumented; f or e xample, L everburgh , t he t own o n H arris o pposite E nsay, u ses t he c emetery a t S corastavore, 7 km a way o n t he m achair w est c oast o f H arris . T hus t he d ate o f t he m ost s uperficial i nterments c an b e r egarded a s r ecent, t hat i s l ater t han t he m id-19th c entury. T hose l ocated j ust o utside t he e ast w all o f t he c hapel a re a t a bout t he l evel o f t he d eepest i nterments s o f ar l ocated, a nd a ppear t o d ate f rom a bout t he t ime t he c hapel b ecame b uried i n t he s and w hich , a s d iscussed l ater, i s e stimated t o b e a bout A D 1 500 . A lthough t here w as n o c ompletely r eliable a ge-stratification o f t he m aterial, i t c ould b e d ivided, m ainly f rom t he f ield r ecords, i nto g roups w hich w ere g iven t entative d ates a s f ollows ( the n umbers o f i ndividuals r ecovered i n e ach g roup a re i n b rackets): G roup A

1 800

A D t o r ecent ( 111)

G roup B

1 700

-

1 800

A D

( 71)

G roup C

1 600

-

1 700

A D

( 88)

G roup D

1 500

-

1 600

A D

( 146)

G roup D i s t he b est a ttested o ne b ecause i t c onsists e ntirely o f s keletal r emains r ecovered b efore b eing s eriously d isturbed b y w ind e rosion ; f urthermore t hese r emains w ere m ore r eliably d ated b ecause 2 6

t hey c ame f rom l evels w ithin a bout a m etre a bove o r b elow t he l evel a t w hich t he t wo c arbon-dated s pecimens w ere f ound. G roups A a nd B i n p articular o n t he o ther h and c ontained s ome s kulls a nd o ther b ones g athered w hen w e f irst a rrived a t t he s ite i n 1 966 a nd w ere f rom i nterments t hat h ad a lready b een g rossly d isturbed b y t he e rosion .

I NFORMATION D ERIVED F ROM T HE S KELETAL R EMAINS S ex T he a dults w ere s exed u sing t he c onventional m orphological c riteria, f or t extual g uidance r elying m ainly u pon S tewart ( 1976). T he p rimary s ex c haracters o f t he p elvis, w hich c an g ive a ccuracy o f t he o rder o f 9 5% ( Smith 1 980), w ere u sed w herever p ossible; r eliance w as n ext p laced o n t he s kull w hich i s s aid t o p rovide a n a ccuracy o f u p t o a bout 8 5% ( Keen, 1 950); s ometimes r eliance h ad t o b e m ainly o n t he o verall d imensions o f t he f emur. H owever, t he d egree o f s ex d imorphism v aries i n d ifferent p opulations ( Genoves, 1 969), e specially i n r espect o f s econdary c haracters s uch a s t he g eneral r obustness o f b ones a nd t he p rominence o f m uscle m arkings; f or i nstance, s ex d imorphism t ends t o b e l ess i n p opulations w here t he w omen s hare a bout e qually t he p hysical h ard l abour w ith m en. T hus, i t i s a dvisable t o e stablish t he v alue o f e ach m etric c riterion w ithin t he g roup b eing s tudied, a s c an b e d one i f as ufficient n umber c an b e s exed o n t he b asis o f t he m ost r eliable s ex d iscriminator, t he p elvis. T his w as d one o n t he E nsay m aterial f or a n umber o f l ong-bone m easurements, i n p articular o f t he f emur. T he m ids haft c ircumference o f t he f emur h as t he a dvantage t hat i t c an b e e mployed e ven w hen t he b one h as b een s everely d amaged; f urthermore , B lack ( 1978) a nd o thers ( DiBennardo a nd T aylor, 1 979) h ave s hown i t t o b e a b etter s ex d iscriminator t han m ost o ther d imensions, i ncluding f emur l ength . T he s haft c ircumference w as m easured w ith a f abric t ape o n 6 5 f emale f emurs a nd 5 6 m ale f emurs a ssociated w ith r eliably-sexable p elves. A t -test s howed t hat t he m ale m ean c ircumference ( 90 .6cm) w as s ignificantly g reater t han t he f emale m ean ( 81.5cm) ( Table 4 ). T he m id : -point ( 87.2cm) b etween t he s preads a round t he t wo m eans w as t hen

T able 4 . C ircumference a nd b icondylar w idth o f E nsay f emurs a s s ex d iscriminators w ith d efinitive s exing i ndependently f rom a ssociated p elvic b ones.

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F emur b icondylar w idth

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4 16 E nsay Deeths

Deaths i n 1960 r educed

England & Wales t o t he

sa me t otal

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70-

65-

60-

55-

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50-

I nfant Mortality

( 0-1yr)

1960 I nfant Mortality Ensay Child

Nu mber o f Deaths .

45-

Mortality

= 281 per t housand =

( 0-5yr)

=

1960 Child Mortal ity

20

= 4 18 36

40-

35 -1

30

25-

20 -

1 5

1 0

5

0

5

1 0

1 5

20

25

30

35

40

45

50

55

60

65

70

75

80

85

90

Age a t Death

F ig. 2 2. E stimated a ges o f t he 4 16 E nsay d eaths. S maller p ie d iagram s hows p roportions o f j uveniles ( below 2 0 y ears) t o a dults i n t he t otal p opulation o f 4 16, p roportion o f n eonatal a nd s ex p roportions o f t he a dults. T he d istributions i n t he f our l evels w ere s imilar. T he h istogram d epicts ( unshaded c olumns) t he a ges o f t he 4 1 E nsay d eaths i n 5 -year g roups. Ah istogram ( shaded c olumns) r epresenting t he a ge d istribution o f 4 16 h ypothetical d eaths f or a 1 960 p opulation i s s uperimposed. L arger p ie d iagram d epicts t he a ge d istribution w ithin t he 0 -5 y ear g roup . D eaths b efore 1 y ear a re f urther a nalyzed a s f etal, f ull-term , n eonatal, f irst a nd s econd h alves o f f irst y ear.

3 2

Group B

Group A

Grou p D

Group C

F ig. 2 3. P ie d iagrams, s imilar t o l arger o ne i n F ig. 2 2, s howing s imilarity i n a ge d istribution o f d eaths i n t he 0 -5 y ear p eriod f or t he d ate-estimated g roups.

t hat a h igh p roportion, a bout o ne-third, o f t he j uvenile d eaths w ere n eonatal o nes, t hat i s w ere e stimated t o h ave o ccurred w ithin o ne m onth o f b irth . A s w ill b e d iscussed l ater ( p.179), a p roportion o f t hese i s l ikely t o h ave b een s till-births. T he p ie d iagram i n F igure 2 3 s hows t hat t he a ge d istributions o f d eaths i n t he 0 -5 y ear p eriod, s eparated i nto t he f our d ifferent l evels, w ere s imilar, t hough w ith a s uggestion o f ah igher p roportion o f i nfantile ( 0-1 y ear) i n t he m ost r ecent l evel A ( later t han 1 800 A D). T he a ge-at-death d istribution o n E nsay s hown b y F igures 2 2 a nd w ill b e d iscussed f urther l ater ( p .176).

3 3

2 3

1 86-190 -

ST AT U RE S

o F

86 d ' mean 1 81-185

1 86

EN S A Y

A D ULTS

s tature

1 6 6 .2c m SD 5 .5

1 00 9 mean s tature

1 5 5 .2c m SD 5 .2

( 6 ')

176-1 80

1 71-1 75

_1 6 6 -1 70 • ; ( 5 '6" ) «

e E

e

1 61-165

^ c ; e • 1 - 1 56 160

1 51-1 55 ( 5 ')

1 46-150

1 41-1 45

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9 1 11 _ 111 1 92 71 9 19 19

1 36-140 — ( 46 " )

5

1 0

1 5

20

Nu mbers o f

2 5

30

35

40

Adu lts

F ig. 2 4. H istogram s howing s tatures o f t he 1 86 E nsay a dult m ales a nd f emales e stimated f rom t he l ong b ones.

S tatures S tature o f a t otal o f 1 86 o f t he a dults w as c alculated f rom t he l engths o f l ong b ones, m ostly f rom t he c ombined l engths o f f emur a nd t ibia, u sing t he a nthropometric f ormulae o f T rotter a nd G leser ( 1958) a nd T rotter ( 1970) f or c aucasoid m ales a nd f emales ( Fig. 2 4). A lthough b ased m ainly o n d ata f rom U .S. W orld W ar I I a nd K orean W ar d ead, a nd p redominantly o n m ales, t hese d ata a re i n g eneral r egarded a s h aving a m ore s ound b asis t han a ny o ther. T he p ossibility o f e rror i s , o f c ourse, c onsiderable, e specially w hen a pplied t o a ncient p opulations, a s 'is d iscussed b y W ells ( 1963).

G eneral f eatures o f t he d entitions I n g eneral, t he t ooth a rches w ere w ell-formed; t here w ere a f ew m isplaced t eeth, f or i nstance a n u nerupted c anine l ying h orizontally i n t he p alate, b ut c rowding o f t eeth i n t he a rches a nd n on-eruption o r i mpaction o f t hird m olars w as u ncommon. T he n otable f eatures w ere t he a mount o f t ooth w ear a nd t he n umbers o f c heek t eeth t hat h ad b een l ost i n t he e lderly s ubjects. T he r ate o f t ooth w ear i n t he l evel D s ubjects o f t he 1 500 A D p eriod s eemed g reater t han i n t hose o f l evel B o f t he 1 8th c entury p eriod; i n l evel D s ubjects, t he a mount o f w ear o f t he o cclusal s urfaces o f t he f irst m olars i n t he y oung a dults o f a bout 2 0 y ears o f a ge, j udged f rom e vidence o f r ecent e ruption o f t he t hird m olars, w as o nly s lightly l ess t han t hat f ound i n A nglo-Saxons o f t he p eriod 7 00 A D ( Miles, 1 962).

3 4

F ig. 2 5. G ross d eposits o f d ental c alculus ( tartar) o n t he c rowns o f t he t eeth o f m an a ged 4 0 y ears ( F/80D), o f t he k ind t hat t ends t o b e a ssociated w ith m outh-breathing .

I n t he s kulls f rom a ll l evels, a g reat d eal o f c alculus ( tartar) h ad f ormed o n t he c rowns o f t he t eeth . I n m any, t here w ere p articularly g ross d eposits o n t he f ront t eeth ( Fig . 2 5). A s I h ave p ostulated i n r espect o f s imilar f indings i n ag roup o f A nglo-Saxon b urials ( Miles, 1 962, 1 969), t hese d eposits o f t artar m ay h ave b een f ormed d uring a p eriod o f w eeks o r m onths o f i llness b efore d eath a ssociated w ith m outh b reathing a nd t he c onsumption o f s oft s ick-bed t ypes o f f ood. T artar d eposits, p eriodontal d isease a nd d ental c aries w ill b e d ealt w ith i n l ater s ections.

C ranial c haracteristics a nd g enetic a ffinities T he s keleton c an p rovide e vidence o f t he g enetic a ffinities a nd d ifferences b etween p opulations. T hese a re b est s een i n t he o verall s hape o f t he s kull w hich i s m ainly g enetically d etermined a nd t hought t o b e b ut l ittle a ffected b y e nvironmental f actors s uch a s d iet. C riteria f or t he c omparison o f s kull s hape, e xpressed b y s ome i ndices a nd v arious d imensions, h ave b een l ong s tandardized; t he o nly d ispute i s h ow m any d imensions i t i s w orthwhile c omparing . M ore t han 8 0 h ave b een u sed ( Morant a nd H oadley, 1 931) a nd 3 1 s tandardized c ranial m easurements a nd i ndices w ere u sed t o c alculate K arl P earson 's n ow d isused C oefficient o f R acial L ikeness ( Morant, 1 924; P earson, 1 926). A t t he p resent t ime, i t i s g enerally c onsidered t hat t he u se o f s o m any o nly l eads t o a " drowning i n a s ea o f d ata" s ituation. A lthough I h ave r ecorded a l arge n umber o f d imensions, f ar t oo m any t o p ublish h ere, a nd t hey w ill r emain a vailable f or s ubsequent w orkers, I h ave h ere o nly m ade u se o f t he m ain e xternal d imensions o f t he b raincase, l ength , b readth a nd h eight a nd t he t hree i ndices, c ranial ( cephalic) ( length-breadth), v ertical i ndex ( length-height) a nd t ransverse ( breadth-height), a nd u pper f acial i ndex ( face h eight-width), i n t o m ake a c omparison w ith t he s mall a mount o f s imilar m aterial o f t he s ame p eriod.

i ndex i ndex o rder a bout

T he i ndices g ive a r easonable b asis f or c omparing t he g eneral s hape o f t he b raincase b ut t he a ctual d imensions n eed t o b e c onsidered t o d etect d ifferences i n s ize; h ence t he m eans o f t he m easurements o f l ength, b readth a nd h eight h ave a lso b een i ncluded. F inally, a lthough f or c omparing g roups o f s kulls t he m eans o f t he v arious d imensions a nd i ndices m ust b e u sed, t he r anges o f v ariation m ust b e t aken a ccount o f b ecause f ew g roups o f s kulls a re c losely h omogeneous i n s hape a nd s ize. T here a re t wo a dditional s kull n on-metric f eatures, m etopism b athrycephaly, t hat i t i s r elevant t o c ompare.

3 5

a nd

I n t he f irst p lace, d ifferences w ere l ooked f or b etween t he f our d ifferent l evels . N o s tatistically s ignificant d ifferences w ere f ound i n r espect o f t he c ranial f eatures m entioned o r f or t hat m atter s ome p ost-cranial s keletal f eatures s uch a s h umero-femoral a nd i ntermembral ( arm-leg) i ndices ( Krogman 1 973, p . 2 00) e ven b etween t hose g roups r epresenting t he l argest p eriod i nterval, l evels A a nd D . H owever, t he n umber o f a dults ( 44 f or c ranial i ndex i n l evel A , 2 0 i n l evel B , 3 7 i n l evel C a nd 6 7 i n l evel D ) i n t he g roups w ere t oo s mall f or i t t o b e l ikely t hat o ther t han g ross d ifferences w ould b e d etected. H ence, t he d etailed d ata f or t he v arious l evels w ill n ot b e g iven h ere, e xcept f or m etopism a nd b athrocephaly ( see l ater s ections) i n r espect o f w hich s ome i nteresting d ifferences w ere f ound. T he d ata f or t he l argest a nd b est a ttested l evel D g roup ( p.26 ) w ill b e c onsidered i n d etail b ecause i t c an b e c ompared w ith t he d ata f or a nother S cottish g roup o f s imilar d ate. T he o nly o ther l arge e nough b ody o f S cottish s keletal m aterial o f a bout t he s ame p eriod a s a ny o f t he E nsay g roups i s t he C armelite F riary C ollection h oused i n t he D epartment o f A natomy o f A berdeen U niversity. T his c ollection d erives f rom t hree f riary s ites w hich h ave a ll b een d ated a s c . 1 300-1600 A D a nd w hich t herefore c orresponds r easonably w ell w ith t he E nsay l evel D g roup ( 1500-1600 A D). T he C armelite C ollection i s a t p resent b eing s tudied c omprehensively, b ut I a m a ble t o q uote s ome o f t he f indings t hrough t he k indness o f D rs. J uliet F . C ross a nd M argaret F . B ruce a nd m ake a c omparison b etween t he C armelite a nd E nsay l evel D c rania ( Table 5 ). D ata a re a vailable f or a nother c ollection o f s kulls r escued f rom a v ariety o f b urial g roups i n v arious p arts o f S cotland ( Turner, 1 905) a t a bout t he t urn o f t he c entury. T hese s kulls w ere s aid t o b e p robably 1 8th c entury. I ncluding a d etailed c omparison w ith t hose d ata h ere d oes n ot s eem a ppropriate. H owever, t o w iden t he c omparison o f S cottish s kull i ndices t o i nclude t hose o f g enetically m ore d istant p opulations, a c omparison w as m ade w ith R omano-British ( approx. 2 00-400 A D) d ata f rom t he T rentholme D rive, Y ork , C ollection a nd w ith t hose ( Macdonnell, 1 904) f rom o ne o f t he n otable L ondon p lague-pit c ollect ions, f airly r eliably d ated a s 1 7th c entury ( Whitechapel c ollection, s till a vailable f or s tudy a t t he B ritish M useum ( Natural H istory) L ondon ( Table 5 ). T here w ere n o s ignificant s ex d ifferences i n s kull i ndices

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c omplex c ombinations o f m orphological f eatures c an b e e xpressed a nd c ompared b y u sing m ultivariate a nalytical t echniques b ut t hese s eem o nly w orthwhile b etween g roups o f s kulls t hat s how s ubstantial d ifferences o f c ranial i ndex. T o t he n aked e ye t he d ifferences b etween s kulls t hat a re t owards t he e xtreme o f d olichocephaly a nd b rachycephaly a re q uite s triking. I n r espect o f c ranial i ndex, t he m ajority o f b oth t he E nsay l evel Da nd C armelite p opulations c ome i nto t he c ategory o f m esocephalic b ut t he E nsay g roup h as a m ean i ndex s lightly l ower a nd i s o n t he w hole m ore l ong-headed t han t he C armelite. T his d ifference, t hough n ot l arge, i s s tatistically h ighly s ignificant. H owever, i n b oth g roups t he r ange i s q uite c onsiderable; t his i s s hown w hen t he p ercentages o f s kulls i n t he c onventional a rbitrary c ategorizations o f c ranial i ndex a re e xamined ( Table 6 ). I t i s t o b e n oted t hat t here a re s ome s tatistically s ignificant d ifferences b etween t he s kull m easurements o f t wo o f t he C armelite f riary s ites ( Dr. J .F . C ross, p ersonal c ommunicat ion). A ssuming t hat d olichocephaly a nd b rachycephaly m ay r epresent d ifferent g enes, t he p attern o f t hese c ategorizations i n t he g roups c ould b e s ome i ndication o f g enetic m ixture . B ecause o f t he h istorical e vidence t hat t he T rentholme R omano-British r emains a re o f a m ixed p opulation, t he c ategories a mong t hose r emains h ave b een i ncluded i n T able 6 f or c omparison.

4 0

T he d ata e xpressed i n t his w ay d o n ot s eem t o p rovide a s trong b asis f or a rguing t hat a ny o f t hese t hree g roups i s m ore b imodal t han t he o thers. I f d olichocephaly i s g enetic i n o rigin , i t c ould b e s aid t hat t he g enetic c omponent f or i t i s s tronger i n t he C armelite p opulat ion t han i n e ither t he E nsay l evel D o r t he T rentholme p opulations. A lthough t he m ean f or c ranium l ength o f t he E nsay s kulls w as s lightly b ut s tatistically h igher t han t he C armelite o nes, i n a ccord w ith t heir g reater d olichocephaly, t he d ata f or c ranial b readth a nd h eight d oes n ot s uggest a ny s ignificant d ifference i n s ize b etween t he E nsay D l evel a nd t he C armelite s kulls ( Table 5 ). T he t ransverse i ndex ( breadth-height) i s a lso s lightly, b ut s tatistically s ignificantly, h igher i n t he E nsay m aterial, i n a ccord w ith i ts b eing i n g eneral s lightly l ess b road t han t he C armelite . T he v ertical i ndices ( length-height) o f t he t wo p opulations s howed n o d ifference w orth t aking n ote o f; t his i s b orne o ut b y t he a bsence o f s ignificant d ifference b etween t he m eans f or h eight. C omparing t he E nsay D w ith t he T rentholme R omano-British a nd W hitechapel g roups, t here w ere s light d ifferences i n c ranial i ndex ( highly s ignificant i n W hitechapel o nly) t ransverse i ndex ( highly s ignificant i n b oth) a nd v ertical i ndex ( significant o nly i n T rentholme). B etween b oth S cottish g roups a nd t he T rentholme a nd W hitechapel g roups, t he c ranial i ndices w ere v ery h ighly s ignificantly l arger ( less s o b etween E nsay a nd T rentholme) a nd t he t ransverse i ndices w ere s ignificantly l ower i n t he S cottish g roups; t here w as b ut l ittle d ifference i n v ertical i ndices. I n o ther w ords, t he d ifference b etween t he t wo S cottish g roups w as, a s m ight b e p redicted, l ess t han b etween t hem a nd t he t wo E nglish g roups a nd l ess t han t he d ifference b etween t he R omano-British a nd t he W hitechapel g roups. F urthermore, a s f ar a s t hese s kull m easurements a re c oncerned, t he f indings s eemed t o s upport, a s w ould b e p redicted, a c loser a ffinity t han b etween t hem a nd t he R omano-British a nd W hitechapel o r b etween t hose t wo E nglish g roups.

M etopism ( metope G k . - f orehead) T he i nter-frontal o r m etopic s uture b etween t he f rontal b ones i s u sually c losed b y t he f irst y ear b ut t he f inal o bliteration o f t he n asal e nd i s o ften d elayed i nto l ate c hildhood. P ersistence o f t he s uture i nto a dult l ife i s n ot u ncommon a nd i s s aid t o o ccur i n a bout 1 0% o f c aucasoid a nd m ongoloid p eople, b ut i n a s ignificantly s maller p roportion o f n egroids ( Krogman , 1 973). T orgersen ( 1951) f ound e vidence t hat p ersistence o f t he m etopic s uture i s a d ominant h ereditary t rait. A mong t he 1 62 a dult E nsay s kulls, c omplete m etopism w as p resent i n 2 1% ( Table 7 ). A shley-Montagu ( 1937), w ho m ade a s earching r eview o f t he l iterature, f ound p revalences a s h igh a s 2 5% r ecorded f or s ome p eoples, b ut m ostly o nly w here t he n umber o f s kulls w as t oo s mall f or

4 1

s tatistical s ignificance. F urthermore , n ot a ll t he r ecords c oncerned t he p ersistence o f t he c omplete s uture; s ome a lmost c ertainly i ncluded t races o f a s uture, e specially t he p ersistence o f w hat i s u sually c alled a m etopic f issure f or a bout o ne o r t wo c entimetres a bout t he n asion . O nly r ecords o f c omplete s uture c an b e c ompared. W hen t he s exes o f t he E nsay s kulls w ere s eparated, t he i ncidence o f m etopism i n t he 9 3 f emales w as 2 1.% a nd i n t he 6 9 m ales 2 0 .3% , a d ifference t hat i s n ot s tatistically s ignificant. T his a bsence o f a s ex d ifference a ccords w ith o ther s tudies a lthough b y n o m eans a ll h ave s eparated t he s exes. A ccording t o E ssen-M811er ( 1928), q uoted b y T orgersen ( 1950), m ale m etopic s kulls d o n ot h ave w ell-developed m ale c haracterstics a nd s o t end t o b e c ategorized a s f emale. I n t his r espect, T orgersen 's o wn s tudy i s i mportant b ecause i t w as b ased o n r adiographs o f l iving p eople. I n ag roup o f 7 11 N orwegian a dults , h e f ound c omplete m etopic s uture i n 6 .9% o f t he m ales a nd 6 .6% o f t he f emales. Am etopic s uture w as p resent i n 1 5.9% o f t he C armelite s kulls , i n 1 0 .6% o f t he 4 7 m ales a nd 2 0 .0% o f t he 6 0 f emales. T he d ifferences o f t hese p ercentages f rom t he E nsay o nes, a lthough s eemingly l arge, a re n ot s tatistically s ignificant, p erhaps b ecause t he n umbers o f s ubjects a re t oo s mall. I n a ny c ase, t he C armelite f igures i nclude s ome i nstances o f o ther t han c omplete m etopism . I t i s o nly p ossible t o s ay t hat t he p revalence o f m etopism s eems t o b e h igh i n b oth t he E nsay a nd C armelite p opulations w hen c ompared w ith t he s mall a mount o f i nformat ion i n r espect o f E nglish a nd o ther S cottish m aterial t hat i s a vailable. 1 2.6% o f 1 60 a dult s kulls o f p robably 1 8th c entury f rom v arious p arts o f S cotland w ere m etopic ( Turner, 1 905), 1 2.65 i n t he 1 03 m ales a nd 1 0 .5% i n t he 5 7 f emales . A mong 1 13 e arly C hristian I rish s kulls ( Howells, 1 941), 7 .3% w ere m etopic a s w ere a bout 5 .0% o f t he T rentholme R omano-British a dult s kulls ( Warwick , 1 968). A m etopic s uture w as p resent i n 8 .7% ( 6.7% i n m ales, 1 0 .7% i n f emales) o f t he 2 75 a dult W hitechapel, L ondon , 1 7th c entury p lague-pit s kulls ( Macdonnell, 1 904), i n 6 .7% ( 10 .0% i n m ales, 4 .3% i n f emales) o f t he 1 20 a dult M oorfields, L ondon, p robable 1 7th c entury s kulls ( Macdonell, 1 906) a nd i n 9 .6% ( 9.0% i n m ales, 1 0 .0% i n f emales) o f t he 3 55 a dult F arringdon 1 7th c entury L ondoner s kulls ( Hooke, 1 926); a lso i n. 8 .2% ( 6.9% i n m ales, 1 1.5% i n f emales) o f 4 88 a dult S pitalfields 1 6th c entury L ondoner s kulls ( Morant a nd H oadley, 1 931). I c an t hink o f n o w ay t o a ccount f or t he h igh p revalence o f p ersistent m etopic s uture o n E nsay e xcept, a s a t entative h ypothesis, t o s uggest t hat, a s t he c ondition i s a d ominant h ereditary t rait ( Torgersen , 1 951), t he i solation o f t he p opulation a s a b reeding s tock , s temming l argely p erhaps b y c hance i n a ncient t imes f rom a f amily w hich p ossessed t his t rait , c ould h ave f avoured a p articularly h igh i ncidence o f t he c ondition. N o o ther m aterial i s a vailable f or c omparison f rom o ther H ebridean i slands o r o ther p laces w here s imilar c onditions o f i solation m ight h ave p revailed. H owever, S ullivan ( 1922) r ecorded p revalence o f t he o rder o f 2 5% i n s ome g roups o f B olivian I ndian s kulls f rom c ertain r egions, w hereas i n o ther r egions t he p revalence w as o nly a bout 1 5% , g iving r ise t o t he q uestion w hether t he h igh p revalences w ere i n g eographically-isolated g roups.

4 2

T able 7 .

M etopism i n a dult s kulls f rom t he f our d ifferent l evels.

G roup/Period

A

B

C

D

N umbers o f s kulls

A D 1 800 t o r ecent

3 9

A D 1 700 t o 1 800

2 2

A D 1 600 t o 1 700

3 7

A D 1 500 t o 1 600

6 7

T otal p opulation

N umbers w ith m etopism

d i1 8

2

9 21

5 .0

9 1

C Y 1

C Y

C Y 2 7.0 2 2.7

9 2

d i

C Y 1 5

4

1 0 9 22

9 18.2

C Y 2 6.6 2 7.0 9 2 7.0

9 6

d '2 7

C Y 1 7

9 40

c r 7 1

3 4

994

d i5 9 4

3

5 9 11

1 65

d i

P ercentages

6

9 1 1

d14 9 2 0

C r 2 2.2 2 5.0

927.5 ( 51 2 0 .3

2 0.6

921.3

S ome s upport o f t his h ypothesis e merges w hen t he p revalence o f m etopism i n t he s kulls f rom t he f our d ifferent E nsay l evels i s c onsidered ( Table 7 ). T he p revalence i s o nly h igh i n l evels B , C a nd D w hich a re c onsidered t o b elong t o t he p eriod f rom 1 500 t o a bout 1 800 A D. T he p revalence a mong s kulls b elieved t o h ave b een i nterred s ince t hen i s o nly a bout 5 %. T his d ate 1 800 A D i s a n e stimate o nly a nd r elies b ut l ittle o n t he c arbon—dating o f l evel D ; i t c ould e asily b e c loser t o 1 750 A D . T he p oint i s t hat i t c ould b e t hat t he 1 5th a nd 1 7th c enturies w ere p eriods o f g reater i solation , a nd l ess i nter— m arriage f rom a far. M y a rgument i s t hat i n t he 1 8th a nd 1 9th c enturies t here w as a l essening o f t he i solation o f t he i sland's p opulation a nd m ore i ntermarriage f rom a far; h ence t herefore m ore i mportation o f f resh g enes t o d ilute t he p ostulated d ominant t rait f or m etopism . O nly t he e xamination o f t he r emains o f o ther s imilar i sland p opulations c ould t hrow l ight o n t his m atter o r t est t he h ypothesis, o r p erhaps t he e xamination o f t he d eeper i nterments r elated t o M anish c hapel w hich p robably l ie r elated t o t he l evel o f l and o n w hich i t w as b uilt.

4 3

F ig. 2 6. L ateral v iew o f s kull, o rientated i n t he F rankfort p lane, o f w oman a ged 6 5 y ears ( A 5 1N/67C) s howing b athrocephaly w ith t he c haracteristic s helf-like p rojection o f t he o ccipital b one b eyond t he l ambda, i n t his i nstance b y a bout 0 .7 c m . T here a re m any s utural b ones i n t he l ambdoid a nd p arieto-mastoid s utures.

B athrocephaly

( bathros G k.

- s tep.)

T his i s a c ondition t hat h as b een l ittle w ritten a bout i n w hich, a t t he l ambdoid s uture b etween s quamous o ccipital a nd p arietal b ones, t he o ccipital j uts o ut b eyond t he p arietals t he i nferior m argins o f w hich a re t urned a l ittle o utwards. I n m arked i nstances ( Fig. 2 6), t here i s a d istinct s helf. A mong t he 1 56 a dult E nsay s kulls i n w hich t he o ccipital r egion w as i ntact, b athrocephaly w as p resent i n 2 8 ( 27.9%); 2 2 i nstances c ould b e c ategorized a s m arked, a t l east a s m uch a s t he s kull f igured b y M acdonell ( 1906. P late x vii). I nstances t hat w ould b e c ategorized a s s light o r d oubtful w ere i gnored. I n a t l east h alf t he s kulls a ffected, w ormian b ones w ere a ssociated w ith t he l ambdoid s uture; h owever, a n a nalysis o f t his a spect w ould n ot b e m eaningful u nless c ompared w ith t he i ncidence i n t he s kulls u naffected b y b athrocephaly. T hat i nformat ion w as u nfortunately n ot r ecorded. W hen t he s exes w ere s eparated, t he i ncidence o f b athrocephaly a mong t he 8 9 f emales w as 2 2.5% a nd a mong t he 6 7 m ales w as 1 1.9%; a lthough t he s ex d ifference s eems l arge, i t i s n ot s tatistically s ignificant ( Table 8 ). T he p revalence i s h igh c ompared t o o ther p opulations. F or i nstance, i n h er s tudy o f 3 89 s kulls f rom 1 7th c entury L ondon ( Farringdon S t.), H ooke ( 1926) f ound b athrocephaly o f m arked d egree i n s even m ales a nd s even f emales a nd o f s light d egree i n s ix o thers o f e ach s ex. T hus t he o verall p ercentage a ffected w as 6 .7% o r o nly 3 .6%

4 4

T able 8 .

B athrocephaly i n a dult s kulls f rom t he f our l evels.

B athrocephaly G roup/Period

N umbers o f s kulls

A

4 3

N umbers w ith b athrocephaly

C Y 1 9 3 9 24

c f

c : ,

d10

c r

O '14

918

c r2 0 .0

2

9 2 0 . 0 C Y 3 5.7

4 4 3.8

9 5 0 .0

9

8

937 s c r6 7

1 56

2

1

C 51 2 4

T otals

9 8.3

4 1 0

6 1

( 51 5 .3

1

9 2

2 0

3 2

P ercentages

c r

96 d

2 8

989

C Y

2

9

919

8 .3

1 3.1 9 1 6.2

c r1 1.9

922.5

i f t he s lightly a ffected a re o mitted. S he q uoted t he f indings i n a nother L ondon ( Whitechapel) c ollection o f 2 92 s kulls o f 1 7th c entury a s 5 .1% b athrocephalic. M acdonell ( 1906) r ecorded a n i ncidence o f 1 0.8% b athrocephaly a mong 1 20 L ondon ( Moorfields) s kulls p robably o f t he 1 7th c entury. A ccording t o W arwick ( 1968, p . 1 54), " a p ronounced b ulge o f t he o ccipital r egion" w as p resent i n t he m ajority o f t he 1 79 R omano-British T rentholme D rive s kulls o f b oth s exes. I t i s e vident f rom t he l ateral v iews o f s everal s kulls t hat t he b ulge c onsists o f a s light p rojection o f t he l ambdoid m argin o f t he o ccipital b one b eyond t he p arietals a nd c orresponds t o a t l east a t race o f t he b athrocephaly o f o ther w riters; i n o ne f emale s kull ( Plate x xiv) t here i s a d istinct s helf t hat w ould c orrespond w ith t he c ategory o f m oderate b athrocephaly a s u sed h ere a nd b y o thers ( Macdonell , 1 906 ; B rothwell, 1 965). W arwick 's t ext i mplies t hat t he b ulge w as m ore c ommon o r m ore t ypical o f t he f emales. I n v iew o f t he s parse l iterature o n t he s ubject, n o u seful c omment c an b e m ade o n t he h igh i ncidence o f b athrocephaly i n t he E nsay s kulls . B athrocephaly c ould b e a n e xpression o f ag enetic c ondition o r i t s eems p ossible t hat a s tunting o f g rowth o f t he s kull o f e nvironmental o rigin, s uch a s n utritional d eficiency, c ould p roduce i t. A m ore p rofound s tudy o f t he c ondition, n ot o nly i n t he E nsay s kulls b ut i n o ther c ollections, w ould b e w orth u ndertaking .

4 5

S keletal o r s keletally-associated e vidence o f d isorders I ntroduction T he s keletal r emains a re e xceptionally w ell p reserved a nd, l ying i n s and, w ere i n g eneral e asy t o r ecover w ithout d amage p rovided t hey h ad n ot b een l eft f or a w hole s eason e xposed o n t he s urface w here t hey w ere l iable t o b e d amaged b y w andering c attle o r r emoved b y v isitors t o t he i sland. H ence m any f ragile e xamples o f b one d isease w ere r ecovered a nd e ven s uch i tems a s m ineralized w alls o f l arge a rteries. M any o f t he l esions a re t ypical o f c ertain d isorders b ut o thers, m ostly l ess a dvanced l esions, a re n ot a nd t heir d iagnosis c an o nly b e d iscussed. N ot e very i nstance o f s keletal d isorder c an b e r ecorded h ere a nd i llustrated i n d etail; m any c an o nly b e c ategorized b riefly. I t m ust b e b orne i n m ind, a s w ill b e d iscussed l ater ( p.184), t hat o nly a s mall p roportion o f t he d iseases t hat c ould h ave b een t he c ause o f d eath p roduce s keletal c hanges t hat c ould h ave b een d etected. A uthoritative a ccounts o f w ell-established s keletal d isease e ntities b y n o m eans a lways i nclude e nough i nformation o n t heir c haracteristics , w hen t he s keleton i s r educed t o b are b one, t o e nable d ifferential d iagnoses t o b e m ade. A s r eaders o f t his a ccount w ill p resumably b e o f m any k inds a nd n ot a ll w ill b e f amiliar w ith d isease p rocesses, m uch m ore t han d escription w ill b e p rovided. D iscussion o f i nterpretation i s o bviously n ecessary b ut i n p laces i t s eems a ppropriate t o i nclude a lso a ccounts o f c urrent v iews o f d isease p rocesses; f or e xample r egarding p eriodontal d isease a nd d ental c aries. T he i dentity n umbers o f s pecimens w ill b e g iven; e ach i s s uffixed b y a l etter, A -D , w hich i ndicates t he l evel a t w hich t he s pecimen w as f ound, a nd t hus t he e stimated d ate.

D evelopmental a nomalies o f t he s pine T here a re f ive i nstances o f f ailure o f u nion o f t he p osterior a rch o f t he a tlas, o ne o f w hich ( Fig. 2 7) i s a ssociated w ith c omplete f usion b etween t he n eural a rches o f t he a xis a nd C 3 ; t he t ransverse p rocesses a re u nfused. A lthough n ot a pparently f used, t he p osterior m argins o f t he b odies a re i n c ontact. T he a xis a nd C 3 i n aw oman a ged 6 5 y ears ( X/80D) a re a lso u nited; t he m orphology i s a lmost e xactly t he s ame a s i n F igure 2 7 e xcept t hat t he b odies a re c ompletely u nited. T his i s a lmost c ertainly d evelopmental r ather t han a cquired f usion. T here a re f our i nstances, o ne i n ac hild o f e ight y ears ( Fig .

2 8)

a nd t hree i n a dults, o ne a m ale ( Fig. 2 9) a nd t wo f emales ( A2/67A a nd F ig. 3 1) o f f ailure o f u nion o f t he s pinous p rocesses o f L 5 a ssociated w ith s ome d egree o f f ailure o f u nion o f t he s pinous p rocesses o f t he s acral v ertebral e lements. T hese a mount t o m inor d egrees o f s pina b ifida, p robably n ot i nvolving a n o pen n eural c anal a nd t herefore n ot a ssociated w ith a ny d isability. T here a re s everal i nstances o f p artial o r s acralization o f L 5. T he q uestion w hether t he

4 6

c omplete s o-called c ondition s trictly

F ig. 2 7. D evelopmentally a bnormal a tlas, a xis a nd C 3 o f s ubject a ged 1 7 y ears ( A 4 1/67D). L eft:

S uperior s urface o f a tlas;

t he p osterior a rch i s u n-united.

R ight : L aminae o f a xis a nd C 3 a re c ompletely f used b ut t heir t ransverse p rocesses r emain s eparate. T he b odies a re i n p artial c ontact b ut u n-united.

a ffects L 5 o r a s upernumerary v ertebra , w hich c an h ardly b e d etermined u nless t he w hole s pine c an b e e xamined a nd i ts v ertebrae c ounted, w ill b e b y-passed a lthough , i n o ne i nstance ( a m ale D 2 5Y/67B) w here t he s acrum i s c omposed o f s ix e lements i nstead o f f ive, t he w hole s pine, i ncluding t he c occyx , w as r ecovered a nd i s c omposed o f t he n ormal 3 3 v ertebral e lements. F igure 3 0 s hows a n e xample o f s acralization o f L 5 i n w hich t here i s c omplete d evelopmental u nion b etween o ne t ransverse p rocess o f L 5 a nd t he s acrum o n t he l eft s ide a nd c ontact b ut w ith a s light s pace, p robably o ccupied b y f ibrous t issue, b etween t he t ransverse p rocess a nd s acrum o n t he r ight . T he a pophyseal j oints b etween L 5 a nd t he s acrum a re n ot u nited. T he w hole o f t he s pine w as n ot r ecovered s o t hat i t i s n ot p ossible t o s ay w hether L 5 i s a s upernumerary e lement. O n b oth s ides, t he a uricular a rea o f a rticulation w ith t he i lium e xtends o ver t he l ateral e lements o f S i a nd S 2 o nly a nd d oes n ot i nvolve t he u nited l eft l ateral p rocess o f L 5.

4 7

F ig. 2 8. P osterior v iew o f s acrum, L 5 a nd L 4 o f a c hild o f e ight y ears ( E/84D). S pinous p rocesses o f L 4 a re u nited; t hose o f L 5 a re i n c ontact b ut u n-united. M ost o f t he s acral c anal i s e xposed b ecause t he s pinous p rocesses h ave n ot r eached t he m idline; t hose o f S 2 a re i n c ontact b ut u n-united.

F ig. 2 9. P osterior s urface o f s acrum a nd l ower t hree l umbar v ertebrae o f m an a ged 3 0 y ears ( D46W/67A). S pinous p rocesses o f L 5 a re u nfused a nd t here i s d efective f usion o f t he a djacent s pinous p rocesses o f t he s acrum . R ight t ransverse p rocess o f L 5 i s a bnormally l arge ( broken l ines i ndicate a p iece l ost t hrough d amage) a nd r ests i n a g roove o n t he u pper s urface o f t he l ateral m ass o f s acrum . T here i s a n u nhealed f racture t hrough t he u n-united l amina o f L 5 . B ecause m ovement b etween t hese s urfaces w ould n ot h ave b een p ossible, t his c annot b e c alled a p seudo-arthrosis b ut i t i s i nteresti ng t hat t here i s l ipping o f t he m argins, a s t here i s a lso o f t he m argins o f t he n on-united b odies, r esembling t hat o f d egenerative s pondylosis. T he r est o f t he s pine s hows o nly s light s pondylotic c hanges. T here i s a nother s acrum , f rom a w oman a ged 3 5 y ears, ( D 6 1Z/67B) w hich i s o f c losely s imilar m orphology t o t he f oregoing b ut i s c omposed o f t he n ormal f ive v ertebral e lements. O n t he l eft s ide i t i s q uite n ormal b ut, o n t he r ight, S i h as a l ateral p rocess r esembling t hat o f L 5 i n F igure 3 0 w ith a s imilar i ncomplete d evelopmental u nion w ith t he r est o f t he l ateral m ass o f t he s acrum . T he s pecimen c ould b e s aid t o b e a n e xample o f p artial n on-sacralization o f S i. T here a re s everal e xamples o f d evelopmental t ransverse p rocess o f L 5 ( see n ext s ection).

4 8

e nlargement

o f

a

F ig. 3 0. A nterior v iew o f s acrum o f f emale a ged 5 5 y ears ( A 4 3Z/67D). L 5 i s p artially s acralized w ith c omplete d evelopmental u nion o f i ts l eft t ransverse p rocess t o t he l ateral m ass o f t he s acrum. O n t he r ight, t he t ransverse p rocess o f L 5 i s t hick; a b road a rea o f c ontact w ith a p rojection o f t he l ateral m ass o f t he s acrum f orms t wo i rregular c ongruent s urfaces s eparated b y a s light s pace.

L umbo-sacral p seudo-arthroses I n n ormal s ubjects, t here i s o ften o nly a bout l cm b etween t he t ransverse p rocesses o f L 5 a nd t he l ateral m ass o f t he s acrum . H ence, b earing i n m ind t he r esiliency o f t he i ntervertebral d iscs a nd t he o bservation ( DePalma a nd R othman, 1 970) t hat t he t hickness o f t he d iscs t ends t o b ecome l ess a t t he e nd o f t he d ay a nd r eturns t o n ormal a fter a p eriod o f r est, i t i s n ot s urprising t hat t here i s s ome s keletal e vidence, i n t he f orm o f f acets, t hat t he t wo m ay c ome i nto c ontact. I n s coliosis, s uch c ontact w ould b e u nilateral; i t i s e vident a lso t hat

4 9

d egenerative c hanges i n t he l umbar i ntervertebral d iscs w ould i ncrease t he c hance o f t he t ransverse p rocesses o f L 5 c oming i nto r egular o r p ermanent c ontact w ith t he s acrum . T here a re t welve i nstances i n t he f orm o f f acets w hich w ould i ndicate s uch r egular c ontact a ssociated w ith m ovement t hat a f alse j oint ( pseudo-arthrosis) w as f ormed. I n t wo o f t hese i nstances, t his c ondition i s a ssociated w ith s ome l arger d isorder, f or e xample d estruction o f t he b ody o f t he L 5 b y t uberculosis ( Fig. 6 2) a nd a s tress f racture o f L 4 ( Fig. 5 4) w hich a llowed t he l umbar s pine t o s ink u pon t he s acrum ; t he p seudo-arthrosis b etween L 5 a nd s acrum i s t hus e vidently s econdary. I n f our i nstances ( Figs. 5 3 a nd 7 5; X /66B , am ale a ged 5 0 y ears; M .East/70C, a m ale a ged 4 0 y ears), t he p seudo-arthrosis i s u nilateral, t he t ransverse p rocesses o f L 5 a re o f n ormal m orphology a part f rom t he f acet a nd t here i s g ross l ipping o f t he b odies o f t he l umbar v ertebrae a nd o ther e vidence o f d egenerative s pondylosis . T hus i t s eems t hat t he c ondition w as s econdary t o s coliosis a ssociated w ith c ollapse o f t he d isc. T here a re s ix i nstances w hich s eem t o b e p rimarily d ue t o d evelopm ental e nlargement o f t he t ransverse p rocess, w hich s ome a uthorities r egard a s e vidence o f at endency t owards s acralization o f L 5 ( Schmorl a nd J unghanns, 1 971, p . 6 2). I n t hree o f t hese, t he e nlargement o f t he t ransverse p rocess i s n ot g ross ; i t i s u nilateral i n o ne ( a m ale, A /66A), a nd b ilateral i n t he t wo o thers, b oth i n w omen ( A2/67B a nd A 312/67B) a nd o f s uch s imilar m orphology, f or i nstance i n b oth t here i s s lightly d efective c losure o f t he v ertebral c anal, t hat o nly o ne w ill b e d escribed. I n t his w oman o f 2 5 y ears ( Fig. 3 1) b oth t ransverse p rocesses o f L 5 a re u nusually l arge i n e very d imension, i ncluding t he a ntero-posterior, a nd r est i n a s acral c oncavity w hich i s s mooth o n t he l eft b ut i rregular o n t he r ight. T his s pecimen p resents a f eature t hat i s n ot s een i n a ny o f t he o ther 1 1 i nstances o f l umbo-sacral p seudoa rthrosis; t here i s e vidence i n t he f orm o f l arge f acets o n t he l ateral e xtremities o f t he l ateral p rocesses t hat t hey h ad b een i n a rticulation w ith t he i lium ; t here a re c orresponding a reas a t t he u pper m argins o f t he a uricular s urfaces o f a rticulation o f t he i lia w hich s uggest t hat t he p seudo-arthroses b etween t ransverse p rocesses a nd t he i lia a re d evelopmentally p art o f t he s acro-iliac j oint . T his s pine i s a bnormal i n t wo o ther r espects. F irstly, i t i s c omposed o f 2 5 i nstead o f 2 4 v ertebrae. S even a re o f t ypical c ervical m orphology a nd 1 2 t ypically t horacic. T he g eneral m orphology o f t he s ix b elow t hat l evel i s l umbar, f or i nstance t he f irst o ne r esembles L i i n t hat t he a rticular s urfaces o f i ts i nferior a rticular p rocesses a re l ongitudinally c onvex. H owever i ts s uperior a rticular p rocesses p resent a n u nusual f eature ( Fig. 3 1). O n t he p osterior m argin o f t he p rocess o n t he r ight a nd j ust b elow t he p osterior m argin o n t he l eft t here i s ad istinct f acet w hich m ust h ave a rticulated w ith s ome b ony p art t hat w as n ot r ecovered. I t i s m ost l ikely t hat t here h ad b een s oc alled l umbar r ibs o n b oth s ides ( Schertlein, 1 928; S chmorl a nd J unghanns, 1 971, p . 5 9) w hich w ere n ot r ecovered. T hese a re r ib-like s tructures w hich a rticulate u sually w ith t he t ransverse p rocesses a nd d evelop f rom t he s eparate o ssification c entre , h omologous w ith t he r ib e lement o f v ertebrae, t hat n ormally f orms p art o f t he t ransverse p rocesses o f l umbar v ertebrae.

5 0

F ig. 3 1. R ight: P osterior v iew o f s acrum a nd L 5 o f f emale o f 2 5 y ears ( A 3 1Z/67B). B oth t ransverse p rocesses o f L 5 a re u nusually l arge. S i Sinous p rocesses o f L 5 a nd o f S i a re n ot c ompletely f used a nd t here i s d efective c losure o f l ower p art o f t he s acral c anal p roducing a n u nusually l arge s acral h iatus. B oth t ransverse p rocesses o f L 5 r est i n c oncave f acets o n t he s acrum . L eft: L eft l ateral v iew s howing m ainly t he a uricular a rticular s urface o f s acrum w ith t he i lium , t he g reat a ntero-posterior w idth o f t he t ransverse p rocess o f L 5 a nd a f acet o n i t ( asterisk) t hat a rticulates w ith a n a rea o f i lium j ust a bove i ts a rticular s urface, s eemingly a s a n e xtension o f i t. B elow : P osterior s urfaces o f L i a nd L 2 s howing s mooth f acets ( arrowh eads), o n t he r ight, a long w hole l ength o f l ateral m argin o f t he s uperior a rticular p rocess o f L i, a nd, o n t he l eft, j ust b elow t he m argin, w hich p robably a rticulated w ith r udimentary s tructures h omologous w ith r ibs.

5 1

F ig. 3 2. P osterior v iew o f L 4, L 5 a nd s acrum o f m an a ged 4 5 y ears ( B/78D) w ith m arked a symmetry o f L 5. R ight t ransverse p rocess i s e nlarged a nd c onsists o f am ass o f b one t hat h as c ome i nto c ontact w ith a c orresponding e nlargement o f t he s acrum a nd f ormed a p seudoa rthrosis. A lthough i t i s l ikely t hat t here w as a d evelopmental a nomaly, t he l ower v ertebrae s how s igns o f d egenerative c ollapse w hich p robably p roduced s coliosis b ringing t he t ransverse p rocess i nto c ontact w ith t he s acrum. M uch o f t he b ony e nlargement m ay b e i nflammatory.

I n t he o ther t hree i nstances, t he t ransverse p rocess i s m uch e nlarged a nd m ore m alformed. T he o ne s hown i n F igure 3 2 i s t ypical o f t hese. T he e nlargement o f t he r ight t ransverse p rocess o f L 5 i s g ross b ut s eems l ikely t o h ave b een c ontributed t o b y s ome r eactive b one f ormation s econdary t o c hronic i nflammation a rising i n t he j oint f ormed w ith t he s urface o f t he s acrum . T his s urface i s c oncave t o r eceive t he c losely c ongruent s urface o f t he t ransverse p rocess o f L 5 a nd a ppears t o h ave d eveloped b y r emodelling i n r esponse t o p ressure o f t he p rocess o n i t a nd b y t he c hronic a rthritic i nflammation . T here i s l ipping o f t he b odies a nd e vidence o f d egenerative s pondylosis w ith s light s coliosis t o t he r ight w hich w ould h ave t ended t o b ring t he t ransverse p rocess i nto c ontact w ith t he s acrum a nd i ncrease t he c ongruence. I n a nother ( A50X/66C), a f emale o f 6 0 y ears, t he m orphology i s s imilar t hough t here i s l ess e vidence o f d egenerative s pondylosis. I n t he t hird i nstance, s hown i n F igure 2 9, t he e nlargement o f t he t ransverse p rocess i s l ess a nd t he s pinous p rocesses o f L 5 a re u nfused.

5 2

P remature a ge c hanges i n r ibs T he b ony p art o f e ach r ib h as a c artilaginous e xtension m edially. T he m edial e nd o f e ach r ib h as a c up-shaped d epression w hich r eceives t he c hondral c artilage. I n y outh, t hese d epressions a re s hallow a nd t he r im i s r ounded. A s a ge a dvances, s ome o ssification o ccurs a t t he e xpense o f t he c artilage a nd t he r im b ecomes s harper a nd t he d epression d eeper. I n a dvanced a ge , t he p rocess o f o ssification c ontinues a nd i s m ore i rregular s o t hat t he r im b ecomes i rregular a nd s piky w ith s omet imes s lender e longated e xtensions f rom t he u pper a nd l ower m argins. T his i s h ow t he m edial e nds o f t he r ibs h ave b een d escribed b y I scan , L oth a nd W right ( 1984) w ho h ave d eveloped t he s ystematic u se o f t he a ppearances a s a b asis f or a ssessing a ge. F igure 3 3 s hows t he m edial e nds o f s everal r ibs f rom a m ale e stimated t o b e n o o lder t han 5 5 y ears b ecause o f t he g ood f unctional c ondition o f t he d entition . T hese c hanges h ad a ffected a ll t he r ibs i n a n e xaggerated f orm i n t hat t he b ony e xtensions f rom t he r ims o f t he c oncavities a re e ven l onger a nd t hicker t han t hose d escribed a nd f igured b y I scan a nd L oth ( 1986 a , b ) a s c haracteristic o f a dvanced a ge, o ver 7 0 y ears. T he f irst r ibs a nd m anubrium w ere a ffected i n t he s ame w ay a s i s a bout t o b e d escribed i n am an o f 5 0 y ears. S everal r ibs i n a nother m an, a ged 5 0 y ears , s howed s imilar c hanges. T wo w ill b e i llustrated h ere ( Fig. 3 4) b ecause t hey s how a s harp u pward b end o f t he a ffected p ortions w hich i s a t f irst s ight p uzzling. P robably t hey a re n inth a nd t enth r ibs, t he c hondral p arts o f w hich n ormally c urve s harply u pwards t o f orm p art o f t he c hondral c omplex w hich r eaches u p t o t he s ternum . T he x yphoid p rocess o f t he s ternum i s e xpanded p robably b y ac yst o r t umour a nd i s d escribed o n p . 1 30 ( Fig. 8 3). T his m an 's s pine w as s everely a ffected b y d egenerative s pondylosis ( p. 12, F ig. 7 3) a nd t here w as a h ealed f racture o f t he r adius ( p. 6 9). I n a dvanced a ge, o r e ven b y a s e arly a s 3 0 y ears ( Williams a nd W arwick , 1 980), t he m anubrium a nd b ody o f t he s ternum m ay b ecome u nited b y o ssification o f t he c artilage b etween t hem . S everal i nstances w ere f ound i n t he E nsay r emains i n p eople e stimated t o b e o ver 5 0 y ears o f a ge. S imilarly t he f irst r ibs m ay b ecome u nited t o t he m anubrium . ( In ay oung a dult, a bout 2 cm o f t he e nd o f t he f irst r ib i s c artilaginous). T here w as o ne u nilateral e xample a nd s everal i nstances, o f w hich o ne i s s hown i n F igure 3 5 , w here a n o ssification p rocess s imilar t o t hat d escribed a bove i n r espect o f t he m edial e nds o f r ibs h ad a ffected b oth t he s ternal a nd c ostal s ides o f t he c artilage b etween t he m anubrium a nd t he f irst r ibs, s o t hat t here w ere c losely c ongruent s urfaces w hich n o d oubt a rticulated d uring l ife o r w ere s eparated o nly b y at hin l ayer o f c artilage. S ometimes t he s urfaces s eemed t o h ave b een p artially j oined b y b one w hich h ad f ractured d uring d isinterment. O nly a l ittle i s k nown a bout c onditions t hat c an i nduce o r e nhance t hese c ostal c artilage c hanges. T hey t end t o o ccur e arlier a nd b e m ore s evere a nd a l ittle d ifferent i n m ales a nd, a ccording t o I scan a nd L oth ( 1986b), t he m ale p attern h as b een f ound i n o variectomized w omen; e vidently t herefore t hey a re, l ike o ther o ssification p rocesses, u nder e ndocrine c ontrol. T hey m ay a lso b e i nduced b y s trenuous p hysical a ctivity ( Iscan e t a l , 1 984) w hich o f c ourse c ould h ave a pplied i n t he

5 3

F ig. 3 3. T he s ternal ( chondral) e nds o f s ix r ibs f rom a m an a ged 5 5 y ears ( D 4 0W/67A), i nner a spects o n t he l eft, o uter a spects o n t he r ight. T he u ppermost r ib o n t he r ight i s t he f irst r ib, t ilted t o d isplay t he d eep c oncavity. A ll t he r ib e nds s how t he c oncavities t ypical o f c osto-chondral j unctions b ut a re d eepened b y e xtensions o f b one i nto t he c artilage ; t hese e xtensions h ave a dvanced m ore r apidly i n c ertain a reas t o p roduce l ong i rregular p rojections f rom t he p eripheries a nd s ome s maller p rojections f rom t he f loors o f t he c oncavities. A rrow-heads i ndicate t he e xtent o f u nossified c artilage w ithin t he s ternal e nds o f t he r ibs.

F ig. 3 4. O uter a spects o f t he s ternal ( chondral) e nds o f t wo r ibs, p robably 9 th o r 1 0th, o f am an a ged 5 0 y ears ( D 4 6Z/67A). O ssification e xtends i nto t he s urfaces o f t he c hondral p arts o f t he r ibs t hat r each u p t o t he s ternum . A rrow-heads i ndicate t he e xtent o f u nossified c artilage w ithin t he r ib e nds.

5 4

F ig . 3 5. A nterior s urfaces o f m anubrium s terni a nd f irst r ibs o f m ale a ged 5 5 y ears ( D 2 5Z/67A) s howing o ssification e xtending f rom b oth t he c ostal a nd s ternal e nds i nto c artilage o f r ibs. C ongruity o f t he i rregular b ony s urfaces j ustifies d epicting t hem f itted c losely, s eparated o nly b y a l ittle c artilage t hat p robably r emained u nossified. O n t he r ight s ide, a n o pening i n t he o ssified s urface o pens i nto a d eep c avity w ithin, o ccupied b y u nossified c artilage. O n t he l eft, d otted l ine i ndicates p robable o utline o f s till u nossified c ostal c artilage. A rrowheads i ndicate e xtent o f u nossified c artilage w ithin t he r ibs. A rrows i ndicate t he s calene t ubercles.

e xample o f e xaggerated c osto-chondral o ssification d escribed a bove ( Fig . 3 3). T he o nly t hing n oted i n t he r est o f t he s keleton t hat c ould t hrow l ight o n w hy t his e xaggerated f orm o f o ssification h ad o ccurred w as t hat t he t hyroid a nd c ricoid c artilages w ere o ssified t o a n e xtend t hat i s u nusual e ven i n a dvanced o ld a ge. T he o bvious a lternative t o t he s uggestion t hat t he o ssification o f c artilage o ccurred p rematurely o r i n a n e xaggerated f orm i s t hat t he a ge o f t he s ubjects w as u nder-estimated. T his i s q uite p ossible; a s h as a lready b een m entioned a nd w ill b e d iscussed l ater, i t i s n ot p ossible t o s ay f or c ertain t hat t hey ( Figs. 3 3 , 3 4 a nd 3 5) w ere n ot w ell o ver 6 0 y ears o f a ge.

5 5

O steoporosis T he m ass a nd s trength o f ab one, d ependent m ainly u pon t he t hickness o f i ts t rabeculae a nd c ortex, n ormally r emain i n e quilibrium . I ncreased u se, a s i n a thletes, i ncreases t he m ass; d isuse, a s i n a l imb e ncased i n p laster f or t reatment o f a f racture, m ay l ead t o r emoval o f b one b y t hinning o f t he t rabeculae a nd c ortex, a c ondition k nown a s d isuse o steoporosis. O ther f orms o f l ocalized o steoporosis o ccur; f or i nstance i n b ones a ffected b y c hronic r heumatoid a rthritis ( see p .120). I n a dvanced a ge, i n b oth s exes, t here i s at endency f or g eneralized o steoporosis t o o ccur; t his i s i n p art c ontributed t o b y d ecreased p hysical a ctivity, b ut t he f undamental c ause i s p robably g radual f ailure o f t he e ndocrine s ystem u pon w hich b one h omeostasis d epends. I n w omen, av ariety c losely r elated t o t he p ost-menopausal s tate i s c ommon . I n s keletal m aterial, o steoporosis c an b e d etected b y t he g eneral l ightness i n w eight o f t he b ones a nd c onfirmed b y r adiography o r b y e xamination o f t rabecular s tructure i n s ections a nd e ven q uantitated i n t he s ame w ay a s i s d one i n b iopsy s pecimens o f b one f rom t he l iving. I n g eneral, t he d iagnosis o f g eneralized o steoporosis i n t he E nsay m aterial w as m ade o n t he l ightness i n w eight o f t he b ones c ombined w ith t he p resence o f s ome o f t he k nown e ffects o f o steoporosis p articularly i n t he s pine. F or i nstance, i n o steoporosis t he n ormal s light c oncavity o f t he i nferior a nd s uperior p lates o f t he b odies b ecomes g reatly e xaggerated ( hour-glass a ppearance i n r adiographs), a part f rom t he g rosser c hanges t hat f ollow c ollapse o f t he c ortex o f t he b odies, w edge-shaped b odies o r t ransverse r idges o n t he s urface a rising f rom h ealing o f o verlapping f racture o f t he c ortex . T hese g rosser c hanges c an o ccur i n c ompression i njuries o f t he n ormal s pine ( see n ext s ection). I n s ome s elected i nstances, o steoporosis w as c onfirmed i n b ones t aken t o L ondon f or r adiography. T he s keletal c hanges i nduced i n a dults b y n utritional d eficiencies ( osteomalacia) a re s omewhat s imilar e xcept t hat t he b ones b ecome d istorted a s i f s oftened. T he c hanges w ould t end t o o ccur m uch e arlier t han s enile o steoporosis, f or e xample w ould b e s een m ost t ypically d uring p regnancy. N othing s uggestive o f n utritional d eficiency w as s een i n t he s keletons a lthough i t i s l ikely t hat o nly r adiography o r s tudies o f t he s tructure o f t he b ones c ould h ave d istinguished o steomalacia f rom m ild c hanges o f s enile o steoporosis. T here a re s everal i nstances o f p ost-menopausal o steoporosis i n w omen, m ost o f w hich w ere s imply l abelled s o b ecause w ell p ast t he a ge o f m enopause. O nly o ne i nstance o f s enile o steoporosis i n am ale w as d iagnosed ( Table 9 ). T he m ost t ypical e xample o f o steoporosis i s i n a w oman a ged 6 0 y ears ( Fig. 3 6). T he b ones a re l ight i n w eight a nd, w here t he c ortex i s b roken t hrough , i t i s u nusually t hin a nd c ancellous b one o f u nusually o pen t exture c an b e s een. R adiography c onfirmed t he g eneralized o steoporosis. T he b odies o f s everal m id-thoracic v ertebrae a re w edge-shaped; i n p articular T 7, w hich i s o nly a bout 0 .8cm t hick p osteriorly a nd t apers t o a n a nterior e dge a bout 0 .3cm t hick . T 9 i s a lso d istinctly w edged a nd a ctual c rushing i s s uggested b y a t ransverse s helf-like r idge a cross i ts a nterior s urface.

5 6

T able 9 .

R atio o f h eight ( cm) o f b odies o f l umbar v ertebrae a t t heir a nterior e dges ( AH) t o h eight a t t heir c entres ( CH) i n t hree i nstances o f g eneralized o steoporosis i n f emales a nd o ne i n a m ale, c ompared w ith t hose o f a n on-osteoporotic m ale o f 5 0 y ears ( A 2 9Y/67D).

M ales A H

C H

I ndex

5 0 y ears

L i

2 .39

2 .17

9 0.8

A 29Y/67D

L 2

2 .62

2 .16

8 2.4

N ono steoporotic

L 3

2 .66

2 .2

8 2.7

L 4

2 .55

2 .2

8 6.3

L 5

2 .70

2 .2

8 1.5

L i

2 .6

2 .08

8 0.1

5 5 y ears

L 2

U nited b y

D 25Z/67A

L 3

o steophytes

L 4

2 .77

2 .08

7 5.1

L 5

2 .95

1 .95

6 6.1

5 7

F emales A H

C H

I ndex

L 1

1 .9

0 .93

4 8.9

5 5 y ears

L 2

2 .43

1 .3

5 3.5

A 42M/67D

L 3

2 .7

2 .1

7 7.8

L 4

2 .12

0 .95

4 4.8

L 5

2 .2

1 .57

7 1.4

L i

2 .63

1 .94

7 3.8

5 5 y ears

L 2

2 .65

1 .78

6 7.2

A 65Z/66B

L 3

2 .72

1 .85

6 8.0

L 4

2 .64

1 .90

7 2.0

L 5

2 .87

2 .0

7 0.0

L 1

1 .9

1 .15

6 0.5

6 5 y ears

L 2

2 .54

1 .57

6 1.8

D 41Z/67A

L 3

2 .27

1 .3

5 7.3

L 4

2 .52

1 .4

5 5.6

L 5

2 .36

1 .23

5 2.1

O nly a n i ndex b elow 7 5 c an b e r egarded a s i ndicative o f s ignificant b iconcavity. I n D 41Z/67A , t he i ndices a re c onsistently l ow . I n t he o ther i nstances o f o steoporosis, s everal v ertebrae, b ut n ot a ll, s how t he l ow i ndex o f m arked b iconcavity.

5 8

F ig. 3 6. L ateral v iew o f t horacic s pine ( T3-L1) o f w oman a ged 5 5 y ears ( A 4 2M/67D) w ith a ngular d eformity d ue t o g eneralized o steoporosis. T he b ones a re l ight i n w eight, t he c ortex i s t hin a nd p itted ( there h as a lso b een s ome s oil e rosion a nd d amage). C ollapse o f s everal b odies i s e vident, e specially o f T 9 w hich i s w edge-shaped; i ts s urface a nd t hat o f T 8 s how d eep h orizontal g rooves p roduced b y c ollapse o f t he c ortex i nwards w ith s ubsequent h ealing. T he p rofile o f T 10, o n t he o ther h and, s hows a r idge ( arrow) p roduced b y c ollapse o f t he c ortex o utw ards. T here i s s ome l ipping d ue t o o utward b ulging o f d iscs t hat h ave u ndergone d egenerative c hange ( degenerative s pondylosis).

5 9

E ricksen ( 1976) u sed a s ystem w hereby t he d egree o f b iconcavity o f t he b odies o f v ertebrae i n o steoporosis m ight b e q uantitated, n amely b y c omparing t he m easured t hickness o f t he b ody a t i ts p eriphery w ith t hat a t t he c entre, e xpressed a s a p ercentage o r r atio. T here a re, o f c ourse, p roblems i f t he p eriphery i s o steophytic o r l ipped. T able 9 g ives t hese d ata i n r espect o f t he l umbar v ertebrae o f a n umber o f e xamples o f o steoporosis i n w hich s uch m easurements w ere p ossible. T he t horacic v ertebrae o f o ne o f t hese, a w oman a ged 6 5 y ears, i s s hown i n F igure 3 7. T he r adiograph s hows t he h our-glass a ppearance p roduced b y t he b iconcave e nd-plates a nd a lso t he p rofiles o f t he t ransverse g rooves a nd r idges o ften s een o n t he a nterior a nd l ateral s urfaces o f t he b odies d ue t o c ollapse o r f racture o f t he c ortical b one . T he r adiograph a lso s hows a s potty p attern o f o pacities t hroughout t he b odies o f t he t horacic v ertebrae. T hese o pacities a re c haracteristic o f m etastatic f oci o f am ineralizing m alignant t umour, t he m ost l ikely b eing a b reast c ancer ( see p . 132). S uch m etastatic f oci c ould h ave c ontributed t o t he w eakening o f t he b odies t hat l ed t o t heir c ollapse . F ractures o f t he n eck o f t he f emur a re c ommon c omplications o f o steoporosis. N either h ealed n or u nhealed e xamples o f s uch f ractures w ere f ound i n t he E nsay m aterial. O n t he o ther h and, f racture o f t he n eck o f t he f emur i s s aid t o b e m ore a ge-related t han m enopause-related a nd t o o ccur i n g eneral a bout 1 5 y ears l ater t han v ertebral c ompression f ractures ( Revell, 1 986, p . 1 86). I t m ay b e t he E nsay w omen a ffected b y o steoporosis d id n ot l ive l ong e nough t o e xperience f racture o f t he f emur. I t m ust b e b orne i n m ind t hat t he a ges o n w hich t he a rgument i s b ased a re o nly e stimates. B ecause t here i s l iterary e vidence t hat o ctogenarians w ere n ot r are i n t he O uter H ebrides i n t he 1 8th c entury ( page 1 77) a nd n one o f t he E nsay p opulation w as e stimated t o b e o f s uch g reat a ge, i t i s p ossible, o r e ven l ikely, t hat t here w as a g eneral t endency t o u nderestimate a ge i n t he h igh-age g roups; t hose e stimated t o b e a ged 5 0 y ears a nd o ver c ould h ave b een u nder-estimated b y a s m uch a s 1 0 y ears. T here w as o ne e xample o f d isuse a trophy o f b one o f a d ifferent k ind. T he b ones o f t he l eft f oot a nd l ower l eg o f a w oman a ged 5 0 y ears ( Fig. 3 8) a re d eformed a nd m uch s maller i n e very d imension t han t hose o f t he r ight. M uscle m arkings a re p oorly d eveloped; f or i nstance, t he l inear m arkings o n t he f ibula a re n otably a bsent. T he b ones o f t he f oot a re p articularly o steoporotic. T he c ortex o f t he t arsal b ones i s t hin a nd p itted a nd m uch o f t he c ancellous b one o f t he s maller t arsals i s r eplaced b y r ounded s paces. T he d istal c ondyles o f t he l eft f emur a re s lightly s maller t han t he r ight b ut o therwise t he f emora a re o f a bout e qual s ize. T he c hanges a re c onsistent w ith d isuse o f t he l imb d ue t o p oliomyelitis o r o ther m otor p aralysis w hich p robably o ccurred i n p ost-adolescence; o therwise t he d ifference i n l ength o f t he l ong b ones w ould h ave b een g reater. T he s pine o f t his w oman s howed g eneralized o steoporosis, c onfirmed b y r adiography, w ith c ollapse o f s everal v ertebral b odies. H owever, t his o steoporosis, p robably p ost-menopausal, i s u nlikely t o b e c onnected w ith t he d isuse a trophy o f t he l eg.

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F ig. 3 7. L ateral r adiograph o f t horacic s pine ( T2-T9) o f w oman a ged 6 5 y ears ( D 4 1Z/67A) w ith g eneralized o steoporosis. P lastic m ounting r od c an b e s een; w hite m ass o ver t he s pinous p rocess o f T 8 i s p lasticine. B iconcavity a nd c ollapse o f t he b odies c an b e s een. A nterior s urface o f T 7 s hows i n p rofile d istortion p roduced b y f racture w ith o verlap o f t he c ortex a nd s ubsequent h ealing. T here a re m any s pots a nd s potty f oci o f o pacity p robably d ue t o s econdary m etastases o f am alignant n eoplasm . R ight: L ateral v iews o f T 8 ( above), s howing d eep t ransverse g rooves, a nd T 12 ( below) s howing a p rominent o blique r idge w hich w as p robably p roduced b y a h ealed f racture o f t he c ortical b one w ith t he u pper e dge o f t he f racture o ver-riding t he l ower.

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F ig. 3 8. D isuse a trophy i n b ones o f l eft l ower l eg a nd f oot o f w oman o f 5 0 y ears ( A 2 7/66A). T he p halanges w ere n ot r ecovered. L inear m uscle m arkings o n l eft f ibula a re a bsent. F oot b ones a re s mall a nd d istorted; o penings i n t he c ortex o f t he t arsal b ones l ead i nto r ounded s paces i n t he t rabecular b one.

T he c ollapse o r r eshaping o f t he o steoporotic b odies ( Fig . 3 9) s eems t o h ave b een b rought a bout b y g radual r emodelling o f t he b one r ather t han a n e pisode w ith f racture o f t he c ortex o n t he f ront o f t he b odies f ollowed b y h ealing o f t he o verlapping s urfaces a s h as b een d escribed i n r espect o f F igures 3 6 a nd 3 7. T here i s, h owever, s ome l ipping i n t he f orm o f s piky s purs o f t he k ind a ssociated w ith d egenerative s pondylosis. I t s eems l ikely t hat t he b ridges o f b one b etween L i a nd L 2 a re t he p roduct o f s ome t raumatic i ncident t hat c omplicated t he s pondylosis a nd l ed t o h aemorrhage, p resumably m ostly i n t he a nterior l ongitudinal l igament, w hich b ecame o rganized i nto b one. I t i s i nteresting t o s ee t he s ize o f t he g ap b etween t he b odies, e stimated t o b e a bout 1 .0cm a t t heir r ather c oncave c entres, w hich i ndicates t he t hickness o f t he d isc. I t s eems p ossible, i ncidentally, t hat t he d isc b etween T ll a nd T 12 w as a ctually p erforated b y t he s piky m asses o f b one a ssociated w ith t he S chmorl-type l esions. H owever, p erforation o f t he d isc i n t his w ay d oes n ot a ppear t o b e r eferred t o i n s uch e xhaustive w orks o n t his s ubject a s S chmorl a nd J unghanns ( 1971) a nd R esnick a nd N iwayama ( 1981).

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F ig. 3 9. L eft : L ateral v iew o f l ower t horacic s pine a nd t hree l umbar v ertebrae o f w oman a ged 6 0 y ears ( A 2 7/66A) d isplayed w ith a rticular f acets o f a pophyseal j oints i n c ongruence s o t hat t he b odies a re h eld a part b y t he a mount t hey p robably w ere d uring l ife. T ll a nd T 12 a re h eld a part ( arrowhead) b y i rregular m asses o f b one o n t heir e nd-plates ( views o n r ight). B odies o f T 10, T ll a nd T 12 i n p articular a re w edges haped ( radiography s howed o steoporosis) l eading t o k yphosis. B odies o f L i a nd L 2 a re b ridged b y b ilateral m asses o f b one. R ight b elow : O pposing l ateral v iew o f L i a nd L 2 s howing o ther b ony b ridge ( damaged a fter b urial). R ight a bove: U nder s urface o f T ll s hows S chmorl-type l esion c onsisting o f d eep p its s urrounded b y p roliferated d ense b one f orming r idges a nd p eaks u p t o 2 .4mm a bove t he e nd-plate s urface. U pper s urface o f T 12 s hows s imilar l esion w hich h as b roken t hrough t he r im o f t he e nd-plate o n t o p osterior s urface o f t he b ody. 6 3

F ig. 4 0. I rregular m ineralized m ass ( pointer) a bout 0 .5cm d iam ., p robably e ither a m ineralized g all-stone o r k idney s tone, f ound o n l ower r ight r ibs o f w oman a ged 6 0 y ears ( A 5 0X/66C). C urved f ragments a re t he m ineralized w all o f a c yst e ither i n l ung o r l iver.

E xtra-skeletal m ineralization S ome i rregular m ineralized f ragments, l argest 0 .3cm d iameter, f ell f rom t he f oramen m agnum o f t he s kull o f a m an a ged 3 5 y ears ( E3U/82D). I t i s i mpossible t o d raw a ny i nference f rom t his f inding e xcept t hat t he b urial i n s and p rovided e xceptional o pportunities f or s tructures t o b e p reserved a nd d etected. T here a re m any c auses o f m ineralization w ithin t he s kull. P atches o f m ineralization a re c ommon w ithin t he d ura m ater a nd f oci o f m ineralization o f a b enign k ind a re n ot u ncommon e ven w ithin t he b rain s ubstance i tself; t hey a re a lso, h owever, a f eature o f s ome i ntracranial t umours. A n i rregular m ineralized m ass, a bout 0 .5cm d iameter, a nd s everal b roken c urved m ineralized f lakes o f e gg-shell t hickness b ut w ith m uch r ougher s urfaces a nd w ith s ome a reas u p t o 1 .2mm t hick, w ere f ound l ying o n t he l ower r ibs i n t he r ight t horax o f a f emale e stimated t o b e 6 0 y ears o f a ge ( Fig. 4 0). T he c urved f ragments a lmost c ertainly a re t he m ineralized w all o f ac yst e ither i n t he s ubstance o f t he l iver o r l ung . T he m ost c ommon c yst a nd o ne w hich t ypically b ecomes m ineralized i s t he h ydatid c yst w hich i s t he e ncysted f orm o f t he t apeworm l arva, u sually t he T aenia e chinococcus ( Echinoccus g ranulosus), w here i t g ains a ccess t o t he t issues. I t w ould n ot b e o ut o f a ccord f or s ome m ore c ompact m ineralization t o o ccur i n r elation t o s uch a c yst. O n t he o ther h and, t he s mall i rregular m ass c ould b e am ineralized g allstone o r a s tone f ormed i n t he s ubstance o f t he k idney; i ts s urface i s n ot s mooth e nough t o b e a u retic c alculus.

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F ig. 4 1. F ragments o f m ineralized a rterial w alls o f b odies o f u pper t horacic v ertebrae o f m an a ged B oth s how e vidence o f b ifurcation. T hat f rom t he p robably t he b rachiocephalic a rtery a nd t hat f rom s ubclavian.

f ound o n e ach s ide 5 5 y ears ( E3V/82D). r ight s ide i s t he l eft t he

T he m ost c ommon h ost f or t he a dult w orm s tage o f t he t aenia i s t he d og w ith s heep, c attle a nd p igs a s t he i ntermediate h osts. P eople b ecome i nfected e ither b y c ontamination o f t heir f ood b y t he e ggc ontaining d og f aeces o r b y e ating i nadequately c ooked f lesh o f t he i ntermediate h osts . I t w ould s eem l ikely t hat i nfections w ith T aenia w ere c ommon a mong t he p eople o f E nsay, h ydatid c ysts b eing a n o ccasional c omplication . F our e xamples w ere f ound o f m ineralization o f t he w alls o f a rteries. I n a m an a ged 5 5 y ears ( Fig. 4 1), t here w as a t ubular m ineralized s tructure o n e ach s ide o f t he b odies o f t he u pper t horacic v ertebrae. B oth a re a bout 3 .2cm l ong b ut w ith s ome a dditional b roken f ragments, s o t hey m ay h ave b een l onger. T he l eft o ne i s u p t o 1 .6cm d iameter a nd t he r ight 2 .0cm d iameter; e ach i s c urved s lightly a nd e xpanded a t t he p resumptive d istal e nd s uggestive o f b eing a rterial w all j ust p roximal t o ab ifurcation. T he t hickness o f t hese t ubular s tructures v aries f rom t hat o f a n e gg-shell t o 3 .6mm . I t s eems l ikely t hat t he s pecimen f rom t he r ight i s t he b rachiocephalic a rtery, a nd t hat f rom t he l eft t he s ubclavian, p robably n ot t he c ommon c arotid b ecause i t h as n o b ranches. T he m ineralization w ould b e ac omplication o f a therosclerosis w hich d oes t end t o a ffect a rteries a t p oints o f s tress s uch a s s ites o f b ranches o r b ifurcations a re c onsidered t o b e .

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M ore c ertainly a n e xample o f m ineralization i n a therosclerotic p laques o f t he a orta a re s ome m ultiple c urved m ineralized f lakes, u p t o 1 .2mm t hick, f ound a t i ntervals a long t he l eft s ides o f t he b odies o f t he m id-thoracic v ertebrae a nd i n f ront o f t he b odies o f t he l ower t horacic a nd l umbar v ertebrae i n aw oman e stimated t o b e a t l east 6 0 y ears o f a ge ( Fig. 4 2). Am ineralized t ubular s tructure 5 .5cm l ong, u p t o 1 .8mm i n t hickn ess a nd w ith a n e xternal d iameter o f 1 .7cm w as f ound l ying o n t he l eft s ide o f t he b odies o f t he l umbar v ertebrae o f a w oman a ged 4 5 y ears ( Fig. 4 3). I t i s t he m ineralized w all o f a n a rtery. T he d iameter i s t oo s mall f or i t t o b e a orta ; i ts p osition a nd d iameter a ccord w ith i ts b eing t he l eft c ommon i liac a rtery. T wo t ubular s tructures s imilar t o t hose j ust d escribed, b ut o nly a bout 2 .0cm l ong a nd w ith a n e xternal d iameter o f a bout 1 .0cm , w ere a mong t he r ecovered h and b ones o f am an a ged 4 5 y ears ( A 5 5Y/66B). T here w ere a lso a t l east 2 0 c urved m ineralized f lakes s imilar t o t hose o f F igure 4 2. A lthough t he e xact p osition o f t hese t ubes a nd f lakes w as n ot r ecorded, t heir a ssociation w ith h and b ones m eans t hat t hey w ere p robably f ound i n t he l ower p elvis; t he h ands i n t hese i nterments w ere u sually c rossed i n f ront o f t he p ubes a nd h and b ones h ad o ften f allen o n t o t he l ower s acrum . T hus i t s eems l ikely t hat t he t ubes a re t he m ineralized w alls o f i liac a rteries a nd t he p laques m ay h ave c ome f rom t he l umbar a orta. A therosclerosis a ffects a rteries o f i ntermediate s ize, e specially i f t he a orta i s a ffected a s w ell, b ut t he c ondition i s u ncommon a s e arly a s 4 5 y ears o f a ge a nd e specially s o i n w omen. H owever, a therosclerosis o ccurs m uch e arlier i n b oth s exes i n d isorders o f m etabolism a ssociated w ith h ypercholesterolaemia, e ither t he i nborn d isorders o r t he a cquired o nes s uch a s d iabetes.

B ony i njuries i )

G eneral

C onsidering t he s trenuous l ife l ed b y t he i slanders, b ony i njuries w ere n ot a s c ommon a s e xpected. T here i s a p atella p ierced b y a s pikes haped p iece o r i ron ( an i solated s urface f ind). T he l eft t ibia ( the f ibula w as n ot r ecovered) o f am an a ged 2 5 y ears ( A 4 4Q/67A) e nds, a bout 1 0cm a bove t he a nkle, i n a s mooth t apering e nd, i ndicative o f a n a mputation a lmost c ertainly s urgically p erformed. T his c ame f rom t he p ost-1800 A D l evel b ut c annot b e m ore c losely d ated. M any y oung m ales m ust, d uring t hat p eriod i n p articular, a s f rom t he H ebrides i n g eneral, h ave s erved i n t he n avies, R oyal a nd m erchant. T he l eft h and o f aw oman a ged 4 0 y ears ( Fig. 4 4) s hows e vidence o f a s evere, p robably c rush, i njury w hich d estroyed m ost o f t he f ingers. H owever, a s t he t humb s urvived, t hough r igid a t t he t ip, i t p robably w as a pposable o n t he f used m etacarpals, s o t he h and w ould b y n o m eans h ave b een f unctionless.

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F ig. 4 2. M ultiple c urved m ineralized f lakes f ound t o l eft o f b odies o f t horacic v ertebrae o f w oman a ged a t l east 6 0 y ears ( A/83D) a long c ourse o f a orta. F ig. 4 3. F ragments o f m ineralized a rterial w all f ound o n l eft s ide o f b odies o f T 12 a nd L i o f w oman a ged 4 5 y ears ( J/78D). P robably l eft c ommon i liac a rtery.

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F ig. 4 4. D orsal ( posterior) v iew o f b ones o f l eft h and o f w oman a ged 4 0 y ears ( A 3 6/66B). M etacarpal o f l ittle f inger i s f used t o p roximal p halanx w hich t erminates a s a n i rregular c urved s pike w hich s hows r esorption. M etacarpal o f r ing f inger w as n ot r ecovered. M etacarpals o f m iddle a nd i ndex f ingers a nd p roximal p halanx o f r ing f inger a re j oined b y am ass o f b one f ormed o n t heir d orsal s urfaces. T he m ass a nd w hat r emains o f t he j oined b ones p resents a b lunt w edge-like i rregular d istal b order. P halanges o f t humb a re a nkylosed b ut s how n o o ther s ign o f i njury.

T here w ere s everal e xamples o f h ealed f ractured r ibs ( C 2 Z/66A; D 2 5Z/67A; b oth m ales a bout 5 0 y ears o f a ge). I n am an a ged 3 5 y ears ( Fig. 4 5), a s m any a s 1 4 f ractured r ibs w ere r ecovered. A ll w ere f rom t he l ower h alf o f t he r ib c age, e ight f rom t he l eft a nd s ix f rom t he r ight a nd m ost o f t hem h ad s ustained m ore t han o ne f racture; t here h ad p robably b een s ome t earing o f a t l east o ne c osto-vertebral j oint. A ll t he f ractures w ere w ell h ealed a nd t here h ad n ot b een m uch d isplacem ent. P robably t here h ad b een a c rush i njury t o t he l ower c hest. T here i s ah ealed s piral f racture o f t he h umerus i n am an a ged 3 5 y ears ( Fig. 4 6) w ith a s inus l eading d eeply i nto t he b one; r adiographs s how m etallic f ragments i n t he v icinity o f t he s inus s o i t c an b e c oncluded t hat t his i s ag unshot i njury; t his s pecimen w as f rom t he 1 600-1700 A D l evel. A nother h umerus, f rom a m ale a ged 2 5 y ears, s hows ah ealed b one a bcess ( see p . 8 7

)p ossibly i nitiated b y a n i njury .

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F ig. 4 5. L ower r ibs o f m an a ged 3 5 y ears ( A 4 0F/67D). A nterior s urfaces o f f ive r ibs f rom t he l eft s ide, p robably t he 9 th t o 1 2th, a re d epicted a s i f f lattened s o a s t o s how f eatures o f i njury. 9 th a nd 1 0th e ach s how t wo u nited f ractures; s ome s pikes o f n ew b one h ave b een f ormed n ear t he a ngles o f r ibs, p robably a r esult o f t earing o f m uscle. S ome p rominent s pikes o f b one h ave a lso b een f ormed a t t he t ubercle o f t he 1 0th w here i t i s a ttached t o t he t ransverse p rocess o f t he v ertebra; t his s eems t o i ndicate w renching o f t he r ib t hrough t he j oint. 1 1th a nd 1 2th h ave e ach s uffered a t l east o ne f racture. B elow i s d epicted 1 1th r ib f rom r ight s ide v iewed f rom a bove t o d isplay d eformity w hich s uggests h ealing t hrough o verlapping f ragments.

O ne o f t he m ost c ommon f ractures i n a ny s ociety, p roduced u sually b y af all o n t he o utstretched h and, i s o ne t hrough t he l ower e nd o f t he r adius a l ittle a bove t he w rist ( Colles f racture). T he d istal f ragment i s d isplaced o r b ent b ackwards a nd o ften t he r adio-ulnar j oint s uffers d amage; o ften t he s tyloid p rocess o f t he u lnar, t o t he t ip o f w hich t he i mportant m edial c ollateral l igament i s a ttached, i s b roken o ff . O ne p robable e xample o f s uch a f racture w as f ound i n t his E nsay s keletal p opulation ; t he r adius o f am an a ged 5 0 y ears ( D 4 6Z/67A) s hows a s light t ransverse e levation o n i ts a nterior a spect a bout 2 .0cm a bove t he w rist j oint a nd a s light b ackward a ngulation o f t he d istal e nd a t t hat l evel w hen v iewed f rom t he s ide. S upporting t he v iew t hat t his i s a h ealed f racture i n w hich t here w as b ut l ittle d isplacement i s t he f act t hat t he u lnar s tyloid p rocess i s o nly a s tump. T he s tump h as a f lat p itted l ipped s urface c onsistent w ith d amage i n t he p ast.

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A

4 6

4 7

F ig. 4 6 . A ntero-lateral v iew o f u pper h alf o f h umerus o f m ale a ged 3 5 y ears ( A 7 7Z/66C). C entred o ver a p itted a rea w ith o ne p it ( arrow) l eading d eeply i nto t he b one, t he s urface i s g reatly t hickened. S everal d iagonally-disposed r idges a re v isible. R adiography s hows m etallic f ragment i n c ortex ( arrowhead) a nd s everal o ther t iny f ragments m ore d eeply; i t a lso s hows, a s d o s urface r idges, t he s tructure o f a s olidly-healed s piral f racture.

F ig. 4 7. A nterior s urface o f d istal e nds o f l eft t ibia a nd f ibula, t ilted s lightly b etter t o d isplay t he a rticular s urfaces. M ale, 4 0 y ears ( M . E ast/70C); s urface f ind. B ony u nion b y m asses o f c allus a t s ite o f f racture t hrough f ibula a nd a ssociated t earing o f t ibio-fibular l igaments. O blique b roken l ines a cross f ibula i ndicates p robable s ite o f f racture. S mooth a rticular a rea m arked w ith s tar c orresponds w ith o riginal a rticular s urface o f f ibula a nd c onfirms t hat t he f ractured d istal e nd h ad b een t ilted l aterally. C entral p art o f t he a rticular s urface w here d amage w ould h ave b een m ost s evere c onsists l argely o f c allus a nd i s i rregular a nd p itted. . B lack a rea i ndicates d amage d uring r ecovery.

T he d istal e nds o f t he t ibia a nd f ibula o f am ale a ged 4 0 y ears ( Fig. 4 7) a re f used b y am ass o f c allus f ormed i n r elation t o a f racture o f t he f ibula. A s i n o ne o f t he c ommonest f ractures o f t he l ower l imb ( Po u ts f racture), t he d istal e nd o f t he f ibula h ad b een t ilted o utwards w ith t earing o f t he t ibio-fibular l igaments a s o ccurs i n h eavy t wisting f alls o n t he f oot. T he f usion o f ap roximal w ith t he m iddle p halanx ( Fig. 4 8) i n a w oman a ged 5 5 y ears w ho a lso s howed g eneralized o steoporosis ( Fig . 3 6) i s p robably d ue t o t rauma , t hat i s h aemorrhage i nto t he j oint a nd p erhaps i njury t o t he b ony s urfaces f rom , f or e xample, w renching t he j oint. T here i s t oo l ittle b ony a trophy a nd d istortion f or t his t o b e d ue t o r heumatoid a rthritis a nd n ot e nough n ew b one f ormed f or t he a nkylosis t o b e t he r esult o f a n i nfective p rocess. 7 0

T he r ight s houlder j oint o f aw oman a ged 6 5 y ears, s everal o f w hose j oints s how o steo-arthrosis ( p.102 ; F ig. 6 7), s hows c hanges o f a v ery u nusual k ind. T here i s a d istinct f acet o n t he i nferior s urface o f t he a cromion o f t he s capula e xtending a lso t o t he a djacent s urface o f t he c lavicle ( Fig. 4 9). T here i s a c orresponding s mooth, d ense, e burnated a rea o n t he u pper s urface o f t he h ead o f t he h umerus s howing t hat i t m ust h ave b een d isplaced u pwards a nd i nto d irect f unctional c ontact w ith t he a cromion. T he a rticular s urface o f t he h ead i s e xtended d ownwards b y t he f ormation o f n ew b one w hich h as a l ipped, r ounded o steophytic m argin; t his e xtension w ould h ave a rticulated w ith t he l ower p art o f t he g lenoid c avity o f t he s capula, w hich i s i rregular a nd p itted. I n o ther w ords, t he n ew b one i mproved t he f unctional c ongruity b etween t he d isplaced h ead a nd t he g lenoid s urface. T he f ormation o f n ew b one e xtends o ver t he l esser t uberosity w hich i n c onsequence i s l arger a nd s moother t han n ormal. I t a lso f ills a nd a lmost c ompletely o bliterates t he b icipital g roove b etween t he t wo t uberosities. T he g reater t uberosity i s s maller a nd s moother t han n ormal. T wo d ifferent s equences o f e vents c an b e p ostulated t o a ccount f or t hese f indings. T he f irst i s a s f ollows: i n t he s ense t hat t he h umeral h ead h ad p assed t hrough t he c apsule a nd w as p artially d isplaced f rom t he g lenoid c avity, t his i s a n u nreduced d islocation o f t he j oint. T he s hallowness o f t he g lenoid c avity i s a f eature o f t he w ide r ange o f m ovement t hat i s c haracteristic o f t he s houlder j oint; t he i ntegrity o f t he j oint i s d ependent t o a g reat e xtent o n t he m uscles t hat s urround i t, m ostly p assing b etween t he s capula a nd h umerus. O ne o f t hese m uscles i s t he s upraspinatus w hich c rosses t he s pace b etween t he a cromion a nd t he h ead t o b e i nserted i nto t he g reater t uberosity. J ust a nterior t o t he s upraspinatus t endon, w hich b lends w ith t he s ubstance o f t he c apsule, i s t he t endon o f t he l ong h ead o f t he b iceps m uscle a rising f rom t he s uperior m argin o f t he g lenoid c avity a nd p assing o ver t he h umeral h ead t o r each t he b icipital g roove o n i ts a nterior s urface b etween t he g reater a nd l esser t uberosities. T he t endon i s e nsheathed b y t he c apsule. I t i s e vident t hat t he h umeral h ead c ould o nly c ome i nto c ontact w ith t he a cromion i f a t l east t he s upraspinatus m uscle w as s everely d amaged o r d estroyed. A lthough m ost d islocations o f t he j oint a re t hrough t he a nterior p art o f t he c apsule, d islocation t hrough t he p osterior o r u pper p art s ometimes o ccurs; f or e xample, b y f alls o n t he e lbow o r w ith t he a rm a dducted a cross t he c hest ( Kessel, 1 982). M ost d islocations a re t reated a nd r educed; h ence t he e nd-result o f n on-reduction, e xcept o f t he c ommon a nterior o nes, w hich a re s aid t o b e a ssociated w ith q uite g ood f unction t hough w ith d iminished p ower, r eceive l ittle m ention i n s tandard t exts. I t s eems p ossible, h owever, t hat t his w oman s uffered a n i njury i n w hich t he h ead o f t he h umerus w as t hrust t hrough t he u pper p art o f t he c apsule, s everely d amaging t he s upraspinatus m uscle. T he d isplacement o f t he h ead w ould b e m aintained a nd p erhaps f urther d amage o r a trophy o f t he m uscle i nduced b y t he u pward p ull o f m uscles s uch a s t he d eltoid. T he d iminished s ize o f t he g reater t uberosity t o w hich t he s upraspinatus i s a ttached i s c onsistent w ith d estruction o f t he m uscle; i n f act t he e burnated a rea o f c ontact w ith t he a cromion o ccupies m uch o f t he s ite o f a ttachment o f t he s upraspinatus t endon t o t he t uberosity. T he o bliteration o f t he b icipital g roove s uggests t hat t he b iceps t endon w as a lso d amaged o r r uptured, a lthough a s hallow g roove t hat c an b e t raced o n t he s urface o f t he h umeral h ead ( Fig. 4 9) m ay h ave a ccommodated a s urviving s trand o f t he t endon.

7 1

I . tu b .

4 8

g . tub . 4 9

F ig. 4 8. A nkylosis b etween p roximal a nd m iddle p halanges o f t he h and i n w oman a ged 5 5 y ears ( A 4 2M/67D) p robably d ue t o t rauma .

F ig. 4 9.

R ight s houlder j oint o f w oman a ged 6 5 y ears ( A/83D).

A bove: T he g lenoid a rticular s urface o f t he s capula i s i rregular; t here i s a n a rticular f acet o n u nder s urface o f t he a cromion w hich e xtends a cross t he a cromio-clavicular j oint o n t o c lavicle. B elow l eft: U pper s urface o f h ead o f h umerus o rientated a s i t w ould a rticulate w ith s capula. A s mooth, r ounded s lightly d epressed a rea w ould h ave b een c overed w ith c artilage a nd a rticulated w ith u pper p art o f t he g lenoid c avity . S tar d enotes s mooth e burnated a rea t hat o ccupies m uch o f a rea o f a ttachment o f t he s upraspinatus t endon a nd a rticulates w ith t he f ace o n t he a cromion a nd c lavicle; i t i s c rossed a nteriorly b y a g roove w hich m ay h ave a ccommodated a s urviving d isplaced p art o f b iceps t endon i tself w hich p robably o ccupied t he a rrowed g roove. L esser t uberosity i s e nlarged b y d eposition o f n ew o steophytic b one w hich h as a lso o bliterated t he o riginal b icipital g roove ( arrowhead). G reater t uberosity i s s maller a nd s moother t han n ormal. R ight: P ostero-lateral v iew o f t he h ead. S tar d enotes e burnated a rea . Af aint l ine ( arrow) d emarcates o riginal a rticular s urface f rom a s lightly r aised e xtension o f t he s urface b elow .

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T he a lternative p ossibility i s t hat t he c ondition o f t he j oint w as b rought a bout b y d egenerative c hanges i n t he s upraspinatus t endon, a nd i n t he c apsule, f ollowing c hronic i njuries r ather t han a n a cute i njury. D egenerative c hanges i n t he s upraspinatus t endon, o ften u ltimately l eading t o i ts r upture, a re w ell d ocumented ( Armstrong, 1 947; K essel, 1 982) e specially i n e lderly p eople. T hey m ay b e p receded b y a l ong p eriod o f p ainful d isorder s uch a s i nflammation o f t he b ursa t hat l ies b etween t he t endon a nd t he a cromion. T he s upraspinatus t endon i s l iable t o b e p ressed a gainst t he m argin o f t he a cromion w hen t he a rm i s e levated a bove t he h ead. M ineral d eposits i n t he t endon a re a c ommon f eature o f t he d egenerative c hanges. S imilar d egenerative c hanges i n t he b iceps t endon, i ncluding t he p art i n t he b icipital g roove, a lso o ccur a nd m ay l ikewise l ead t o r upture o f t he t endon. I t w ould s eem p ossible, a nd a t l east a s l ikely a s d islocation, t hat t his i s t he t ype o f d isorder a ffecting b oth s upraspinatus a nd b iceps t endons t hat b rought a bout t he a rticulation o f t he h ead w ith t he a cromion i n t his w oman. F rom t he p osition a nd s hape o f t he e burnated a rea o n t he h umerus i t s eems l ikely t hat m ovement o f t he j oint w as n ot m uch l imited, e specially b earing i n m ind t hat t he r ange o f a ll m ovements e xcept r otation w ould b e a dded t o b y m ovement o f t he s capula. T he l oss o f t he t endon o f t he l ong h ead o f t he b iceps, o nce a dapted t o, w ould n ot b e p articularly d isabling b ecause t he s hort h ead a ttached t o t he c oracoid p rocess o f t he s capula w ould h ave r emained i ntact. T he t uberosity o f t he r adius i nto w hich t he b iceps i s i nserted i s n o s maller o n t he r ight t han o n t he l eft. T he h ead o f t he h umerus o f aw oman o f 6 5 y ears i n F igure 5 0 s hows a t t he m argins o f t he a rticular s urface, p articularly a nteriorly a nd i nferiorly, o steo-arthrotic l ipping w hich i s c ontinuous w ith a n i rregular m ass o f n ew b one o n t he l esser t uberosity; t he m ass e xtends a lso i nto t he b icipital g roove, p artly o bliterating i t t hough p art o f i t r emains a s a b lind c anal. T he b iceps t endon a ppears t o h ave b een s plit i nto t wo p arts, o ne o f w hich o ccupied a s mall g roove i n t he p osition o f t he o riginal b icipital g roove a nd t he o ther, d isplaced f orwards, o ccupied a g roove o n t he l ateral a spect o f t he n ew b one f ormed o n t he l esser t uberosity. I t s eems h ardly l ikely t hat t he o steophytosis o f o steo-arthrosis w ould d isplace t he t endon i n t he w ay t hat a ppears t o h ave h appened h ere. I t s eems m ore l ikely t hat t here w as s ome i njury t o t he t endon, p erhaps a ssociated w ith d islocation o f t he j oint, w hich d isplaced a nd d ivided i t . T he n ew b one f ormation o n t he l esser t uberosity w here t he s ub-scapularis m uscle i s a ttached s uggests t hat t here w as s ome i njury t o t hat a ttachment. P ossibly t he n ew b one w as f ormed w ithin a b lood c lot t hat b ecame v ascularised. T he m argins o f t he g lenoid c avity o f t he s capula s how m arked c hanges o n a ll s ides b ut l ess p osteriorly. T hese a mount t o a n e xtension o f t he c avity b y n ew b one w hich i s d eeply p itted ( Fig. 5 0). T he i nferior s urface o f t he t ip o f t he a cromion i s e roded p roducing a f lattened s urface i n t he s ame p osition a s t he m ore d istinct f acet i n t he p revious s pecimen ( Fig. 4 9). T here i s n o c orresponding a rea o n t he h umeral h ead s o t hat t he q uestion o f a ctual a rticulation o f t he h ead w ith t he a cromion d oes n ot a rise; i t d oes, h owever, s uggest t hat t here

7 3

5 0

F ig. 5 0. A ntero-lateral v iews o f h ead o f l eft h umerus a nd g lenoid a rea o f s capula o f w oman a ged 6 5 y ears ( X/80D). M argins o f g lenoid c avity h ave b een e xtended b y f ormation o f n ew p itted b one, e specially a nteriorly. A rrowhead i ndicates f lat e roded a rea o n t he a cromion. C o-coracoid p rocess. H umerus s hows l ipping o f m argins o f a rticular s urface a nd n odular n eW f ormation o f b one o n t he l esser t uberosity . B icipital g roove h as b een p artly o bliterated b y n ew b one b ut p art r emains a s ab lind c anal. T he b iceps t endon, o r p art o f i t, a ppears t o h ave b een d isplaced a nteriorly a nd t o l ie i n ag roove ( arrowheads) o n t he m ass o f n ew b one o n l esser t uberosity. A rrow i ndicates o riginal b icipital g roove.

F ig. 5 1. H ead o f l eft h umerus o f w oman a ged 6 0 y ears ( A 4 4Y/67C). O n a nterior s urface o f l esser t uberosity c lose t o t he a rticular s urface, t here i s f ormation o f n ew b one, c upped o ut a t i ts c entre ( arrowhead). O n a nterior s urface o f g reater t uberosity, t here i s ad eep s mooths urfaced h emispherical h ollow s uggestive o f ac yst ( arrow). S urface b etween t he t uberosities, w here t he b icipital g roove s hould b e, i s i rregular b ut s mooth .

7 4

w ere i nflammatory c hanges i n t he t issues b etween t he h ead a nd t he a cromion; p ossibly a b ursitis. T here i s e vidence o f a rthritic c hanges i n t he n earby a cromio-clavicular j oint a nd t he e rosion o n t he i nferior s urface o f t he a cromion m ight b e a n e xtension o f t hose. T he p ossibility c annot b e d iscounted t hat t his i s a nother e xample o f t he d egenerative c hanges t hat a ffect t he b iceps t endon. T here a re s ome s imilarities o f t he c hanges h ere t o t hose i n t he h umerus t hat w ill b e d escribed ( p. 1 19 ; F ig. 7 7) w hich a re a ttributed t entatively t o d iffuse i diopathic s keletal h yperostosis ( DISH). T wo s houlder j oints d escribed b y R esnick a nd N iwayama ( 1981. T heir F igs. 3 9-27 a nd 3 9-28) h ave s ome f eatures i n c ommon w ith t hose j ust d escribed ( Figs. 4 9 a nd 5 0). T he c hanges i n t he r egion o f t he b icipital g roove o f t he h umerus o f a w oman a ged 6 0 y ears i n F igure 5 1 a re p uzzling. S ome o f t he c hanges m ay b e a ttributable t o o steo-arthrosis a lthough t here i s b ut l ittle l ipping o f t he m argins o f t he a rticular s urface. T he p redominant f eature i s t he r eplacement o f t he n ormal m orphology o f t he l esser t uberosity b y a s urface t hat i s p artly s mooth a nd s lightly c oncave a nd p artly c onsists o f a c ircular a rea w hich i s c upped o ut w ith r aised i rregular m argins; t his a rea c ould h ave a ccommodated a c yst. T he b icipital g roove b etween t he t uberosities i s i ndistinct a nd p artly o ccupied b y a s mooth-walled c yst-like c avity. T he s capula s hows o nly s ome i rregular t hickening o f t he m argins o f t he g lenoid c avity. I t s eems p ossible t hat t his i s a n e xample o f t he d egenerative c hanges a lready r eferred t o w hich m ay f ollow c hronic i njury t hat c an a ffect t he b iceps t endon a nd t he a djacent t issues. I t i s c onceivable t hat s uch c hanges w ere a ssociated w ith t he f ormation o f am ass o f f ibrous t issues i n w hich d egenerative c ysts d eveloped. T hese p ressing o n t he b one m ight a ccount f or t he m orphology o f t he b one s urface. T he m arkings o f t he i nsertion o f t he b iceps o n t he t uberosity o f t he r adius a ssociated w ith b oth t hese l eft h umeri a re a s p rominent a s o n t he r ight s ide s uggesting t hat, i f t he b iceps t endons w ere d amaged, t he c oracoid h eads o f t he b iceps m ay h ave c ompensated.

i i)

C ompression f ractures v ertebral b odies

a nd

o ther

i njuries

o f

S udden p owerful c ompressive f orces e xerted o n t he s pine, a s i n f alls f rom a h eight a nd e ven l ifting h eavy o bjects, e specially i f a ssociated w ith f orced f lexion o f t he s pine, m ay p roduce s o-called c ompression f ractures o f t he b odies o f v ertebrae. T hey m ay b e l imited t o g iving-way o f t he c ortex o f e nd-plates, i n w hich c ase s ome t issue o f t he d isc m ay b e f orced t hrough i nto t he o pening i n t he c ortex; t his i s o ne w ay i n w hich S chmorl n odes a re f ormed ( see l ater). G reater f orces m ay p roduce m ore s evere c ollapse o f t he w hole b ody w ith f racture, t ransverse o r o blique, o f t he c ircumferential c ortex o f t he b ody. T he m argins o f t he f racture m ay b e d isplaced, e verted o r o verlap. E vidence o f a ll t hese t ypes o f f racture r emain i n t he b ones e ven t hough h ealing o ccurs. T here w ere m any e xamples o f s uch f ractures i n t he E nsay m aterial. S chmorl n odes p robably d ue t o a cute t rauma w ill b e d ealt w ith i n a l ater s ection.

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F ig. 5 2. 1 1th a nd 1 2th t horacic v ertebrae f rom w oman a ged 6 0 y ears ( B/71D). T here i s c omplete a nkylosis o f t he a pophyseal j oints w ith n ew-bone f ormation , p robably c allus f ormed i n c onnection w ith t rauma. H ence, t he b odies a re s eparated a s i n l ife a nd a b ony p rojection f rom i nferior e nd-plate o f T 11 c an b e s een . B ody o f T 12 i s w edge-shaped, i ts e nd-plates a re c oncave a nd i ts l ateral s urface s hows a d eep t ransverse g roove w ith a r idge o f d ense b one . F acets f or a rticulation w ith r ibs a re i rregular a nd p itted a nd a re e nlarged b y p eripheral b one f ormation.

F igure 5 2 s hows t he 1 1th a nd 1 2th t horacic v ertebrae f rom a w oman a ged 6 0 y ears i n w hich t here i s o bvious c ompression o f t he b ody o f T 12 w ith m arked b iconcavity o f t he e nd-plates. O n t he l ateral a spect o f t he b ody , t here i s a b road t ransverse g roove a nd, b elow i t, a t ransverse r idge o f d ense b one. T he a ppearance s uggests a h ealed f racture o f t he c ortical b one w ith o verlapping t hat h as p roduced t he r idge. A lthough c omplete a nkylosis t hrough a pophyseal j oints w ith t he f ormation o f s ome c allus, p robably a lso c aused b y t he t rauma, m akes i t d ifficult t o e xamine t he a pposing s urfaces o f t he b odies d irectly, a b ony p rojection o n t he i nferior e nd-plate o f T 11 c an b e d iscerned. A ccording t o D r. D .J. S toker, w ho w as k ind e nough t o r adiograph t he s pecimen, t he a ppearances a re t hose o f c ollapse o f t he b ody o f T 11 d ue t o ah igh i nternal p ressure w ithin t he b ody i tself l ikely t o h ave b een p roduced b y h yperflexion a ssociated w ith t earing o f t he l igaments a nd h aemorrhage i nto t he a pophyseal j oints w hich w ould a ccount f or t he a nkylosis.

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T wo o ther e xamples o f t ransverse r idges o n t he a nterior o r l ateral s urfaces o f v ertebral b odies s uggestive o f h ealed o verlapping f ractures o f t he c ortical b one w ere d escribed i n t he s ection d ealing w ith o steoporosis ( Fig. 3 7), b ut s everal o ther i nstances w ere e ncountered i n n on-osteoporotic s pines i n y oung a dults. A n e xample o f c ompression i njury t o a l umbar v ertebra a nd i ts a ssociated d iscs w ith s ome s pecial f eatures ( Fig . 5 5) i s d ealt w ith i n t he n ext s ection . T he i nterlocking o f t he a rticular p rocesses o f t he n eural a rches c ombined b y t he f irm b inding-together o f t he b odies b y t he d iscs t ends t o p revent h orizontal d isplacement o f t he v ertebral b odies o n o ne a nother e xcept i n t he m ost s evere d irect i njuries. I t i s, o f c ourse, v ery d ifferent i f t he n eural a rches a re n o l onger i ntact a s i n t he i nstances t o b e d escribed i n t he n ext s ection . H owever, i n am an a ged 5 5 y ears ( D 2 5Z/67A) w hose s pine h ad s uffered a n umber o f o ther i njuries, a s w ell a s t he r est o f h is s keleton b ecause t here w ere s everal o ld f ractures o f r ibs ( p. 6 8), t he b ody o f L 4 a ppeared t o h ave b een d isplaced l aterally. T he s acrum a nd l owest f our l umbar v ertebrae a re d epicted i n F igure 5 3 a rranged, b y c arefully f itting i n c ontact t he c ongruent s urfaces o f t he a pophyseal a rticular f acets, i n w hat w ere t he i nter-relationships o f t he b odies d uring l ife. T he L 5 i s t ilted, p robably b ecause t he b ody a ppears t o h ave u ndergone a c ompression i njury o n t he l eft s ide, s o t hat i ts t ransverse p rocess r ests u pon t he s acrum w here a f acet i s d iscernible. T here i s s ome g ross l ipping a ssociated w ith t he c ompression i njury a s t here i s e lsewhere i n t he o ther l umbar v ertebrae . T he b ody o f L 4 a nd t he s pine a bove t hat l evel a ppears t o h ave m oved a bout 0 .6cm t o t he l eft a nd t here h as b een s ome f urther t ilting t o t he l eft . O n t he r ight s ide, j oining L 2 a nd L 3 r igidly t ogether, t here i s a l arge r ounded m ass o f b one; t he s urface w as d amaged d uring r ecovery s o t hat i t c an b e s een t o c onsist o f am ass o f t rabecular b one a bout 1 .1cm t hick, w ith a t hin c ortex o f c ompact b one. T he a ttachment o f t he m ass e xtends o ver a bout o ne h alf o f t he h eight o f t he b ody . T he g ap b etween t he b odies o f L 2 a nd L 3 i n f ront i s r educed t o a bout 0 .4cm a nd i n p laces t he b odies a re i n c ontact p osteriorly. T he e nd-plates c an b e p artially i nspected a nd p robed; t hey a re i rregular w ith a reas o f s piky p rojections e specially i n t he v icinity o f t he b ridging b ony m ass. T he i nner s urface o f t he m ass i s i rregular a lso a nd, a lthough i ts a ttachm ent t o t he b odies c annot b e c learly s een, i t c ertainly i s n ot l imited t o z ones j ust b eyond t he r ims o f t he b odies a s a re a ll t he f ree s purs a nd l ippings. I t s eems t herefore t hat t his b ony m ass d iffers f rom t hat s hown l ater ( Fig. 7 3 , p .112) w hich i s m ore t ypical o f t he b ridging s purs a ssociated w ith d egenerative s pondylosis. I t s eems h ighly l ikely t hat t here w as a n a cute i njury t o t he d isc o f t he s ort l ikely t o b e a ssociated w ith h aemorrhage a nd t hat t he b ony m ass i s t he r esult o f o ssification o ccurring i nto t he s ubstance o f a h aematoma. I t i s c onceivable i f n ot p robable t hat t his i njury w as t he s ame o ne a s w as r esponsible f or t he l ateral d isplacement o f L 4 a nd t he c ompression o f L 5. T he g eneral l ipping h ere, a ssociated w ith S chmorl-type l esions, i s e vidence o f a dvanced d egenerative s pondylosis w hich c ould h ave o ccurred a fter t he i njuries a nd b een e nhanced b y t hem o r i ndeed d egenerative c hanges w ould h ave m ade a l ateral d isplacement m uch m ore l iable t o b e

7 7

F ig. 5 3. A nterior v iew o f l umbar v ertebrae a nd s acrum o f m an a ged 5 5 y ears ( D 2 5Z/67A) w ith l ipping a nd o ther c hanges a ssociated w ith d egenerative s pondylosis. A rrowhead p oints t o s ome o f t he s uperior a rticular f acets. M arginal b eak-like s purs b etween t he s acrum a nd b ody o f L 5 p roject b y u p t o 1 .2cm . Ar ounded m ass o f b one j oins L 2 a nd L 3; n ote b uttresses o f n ew b one t hat s upport t he b ony m ass a nd s purs b elow . • T he v ertebrae h ave b een a ssembled w ith c ongruent a pophyseal j oint f acets c arefully f itted s o t hat t he b odies a re p resumably i n t heir r elationship i n l ife. B roken l ines i ndicate m idline a xes o f t he b odies a nd s how t hat L 5 w as t ilted t o t he l eft ( its t ransverse p rocess r ests o n a f acet o n s acrum) a nd t he b ody o f L 4 w as d isplaced t o t he l eft b y a bout 0 .6cm .

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p roduced b y s ome v iolent t wisting s tress. I t i s n oteworthy t hat t he s pine a bove t his l evel s hows o ther c ompression i njuries; t he b odies o f T 10 a nd T ll s how s evere c ompression a nd t hat o f T 8 t he c ondition l ess s everely. R adiography a nd a g eneral l ightness i n w eight o f t his s pine s uggests t hat am oderate o steoporosis i s p resent; s uch a c ondition w ould h ave f avoured t he o ccurrence o f t he c ompression i njuries a nd i ndeed m ay h ave c ontributed t o t he t horacic o nes b ut t he m assiveness o f t he s pur f ormation i n t he l umbar r egion s uggests t o m e t hat t he l umbar i njuries o ccurred e arlier a s p art o f l eading a v igorous r ugged l ife.

i ii)

F ractures o f n eural a rches o f l umbar v ertebrae

T here a re s ix i nstances o f f ractures o f t he p osterior ( neural) a rches o f l umbar v ertebrae a nd o ne f racture t hrough t he l amina o f a d evelopmentally u n-united n eural a rch ( Fig. 2 9). A ll t he f ractures a re u n-united a nd m ost h ave t he a ppearances o f a f alse j oint o r p seudoa rthrosis. A t f irst i t w as t hought t hat t hese f ractures w ere p robably d ue t o d irect i njury s uch a s f alls a gainst a r ock, b ut i t w as t hen d iscovered t hat t hey c onform t o a w ell-documented t hough r are t ype o f f racture w hich h as b een t he s ubject o f c ontroversy f or s ome y ears t hough n ow i n g eneral r egarded a s s tress f ractures. I n t he l umbar r egion, i t i s m ost c ommonly L 5 t hat i s a ffected. T he f racture t ypically p asses t hrough t he a rch o bliquely o n b oth s ides b etween t he s uperior a nd i nferior a rticular p rocesses ( the s o-called p ars i nterarticularis) s o t hat t he s uperior p rocesses a re s till a ttached t o t he b ody, w hereas t he l aminae, i nferior p rocesses a nd s pinous p rocess a re f ree, a lthough o f c ourse a ttached t o t he s acrum o r, i f i t i s L 4 t hat i s a ffected, t o t he L 5 b elow. I n t he i ntact s pine, t he i nterlocking b etween s uperior a nd i nferior a rticular p rocesses i s e ssential i n m aintaining t he i nter-relationships o f t he v ertebrae; i t i s t hus n ot u ncommon, w hen t he i nferior p rocesses a re d etached, f or t he b ody, t ogether w ith t he s pine a bove, t o b e d isplaced f orwards b y p ostural f orces, a c ondition k nown a s s pondylolisthesis. T he s pinal p osture m ay h ave t o b e i n s ome c ritical p osition f or t he f racture t o o ccur, e .g. p erhaps p assing s uddenly i nto f ull e xtension. I t i s c onceivable t hat t he f orce c ausing t he f racture t ears t he d isc a nd i nitiates s ome d isplacement. B ecause t he s ites o f f ractures a re n early a lways t he s ame, i t h as b een s uggested t hat e ither t he c ondition i s a d evelopmental f ailure o f f usion o f o ssification c entres o r a d evelopmental z one o f w eakness ( Schmorl a nd J unghanns, 1 971, p p. 8 4 a nd 3 85). A lthough n ot i n a ccord w ith w ell-documented v iew o f t he w ay h uman v ertebrae d evelop, t his i s a v iew s till h eld b y s ome ( Keim , 1 982). T he c ontrary v iew ( Resnick a nd N iwayama, 1 981), n ow w idely a ccepted, i s t hat t hese f ractures a re

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T able 1 0 .

A s ummary o f t he s even e xamples o f f ractures i nvolving t he n eural a rches o f v ertebrae.

S ite o f f racture

F eatures

5 0

B ilat. p ars i nterart. L 4

D escribed i n t ext. ( Fig. 5 4)

F

5 5

B ilat. p ars i nterart. F unctioning a s L 4 a s L 5 i s s acralized.

D escribed i n t ext. ( Fig. 5 5)

D

M

3 0

B ilat. p ars i nterart. L 4. F unctioning a s L 5 a s t he t rue L 5 i s s acralized.

D escribed i n t ext.

A 40Z/66

B

M

5 0

B ilat. p ars i nterart. L 4.

F ract. s urfaces d ense, p itted, i rregular b ut c ongruent; F acets o n c ontiguous s urfaces o f s pinous p rocesses o f L 3 &L 4 s how t hat f ragment h ad t ilted u pward. B ody o f L 4 t ilted, b ut w ithout f orward m ovt. s o t hat i ts s up. a rtic. p rocesses b ear f acets o f c ontact w ith L 3.

E 7Y/82

D

M

4 0

B ilat. p ars i nterart. a nd t hrough t he l eft l amina L 5.

F ract. s urfaces c ongruent, e burnated a nd c ongruently c urved i n v ertical p lane. N o f orward m ovt. o f b ody o f L 5.

E 3Y/82

D

F

2 5

B ilat. p ars i nterart. L 4.

F ract. s urfaces c urved, c ongruent, d ense p itted b one. N o f orward m ovement o f b ody o f L 4.

S pecimen

L evel

S ex

A ge i n y ears

C 2Z/66

A

M

E /78

D

C /71

8 0

D 46W/67

A

M

3 0

R ight d evelopm entally u nu nited l amina L 5.

F ract. s urfaces i rregular w ith p rominent s pikes, n on-congruent. P robably m erely a ttached b y f ibrous s trands. ( Fig. 2 9).

s tress f ractures w hich o ccur w hen s udden m uscle a ction e xerts a f orce b eyond t he s trength o f t he b one t o w ithstand; t he c lassical e xample i s t he f racture o f t he h umerus t hat s ometimes o ccurs w hen a b all i s t hrown. T his v iew i s s upported b y f inding f ractures o f t he n eural a rches i n b allet d ancers a nd h eavy m anual w orkers ( Murray a nd J acobson, 1 971). A v ariety a ffecting t he u pper t horacic s pine w as f irst n oted a mong p reviously l ong-unemployed m en g iven w ork d igging d itches a nd i s t herefore s ometimes c alled c lay-shoveller's f racture ( Hall,

1 940).

I t i s n ot p ossible t o d escribe a ll s ix i nstances i n d etail. S ome b asic i nformation a bout e ach i s g iven i n T able 1 0 a nd t he f ollowing d escribes a nd i llustrates o ne a s b asically t ypical o f t he o thers. T he f racture i s o f L 4 o f a m an a ged 5 0 y ears ( Fig. 5 4). T he f racture s ites a re s ymmetrical t hrough t he n eural a rch a nd p ass o bliquely t hrough t he l aminae b etween t he s uperior a nd i nferior a rticular p rocesses o f L 4 ( Fig. 5 4A) t hat i s t he s uperior p rocesses a nd p edicles a re s till a ttached t o t he b ody, w hereas t he s pinous p rocess a nd l aminae, a nd t he i nferior p rocesses t hey b ear, a re f ree. T he f racture h as a llowed t he b ody o f L 4 t o m ove f orward a bout 4 .0mm b ut t he b ody h as a pparently b een r estrained f rom m oving f urther b y t he a nterior s urface o f i ts s uperior a rticular p rocess c oming i nto c ontact w ith t he p osterior m argin o f t he b ody o f L 3 w here a r eceptive c oncavity i s p resent o n b oth s ides ( Fig. 5 4A). I n a ccord w ith t his f orward m ovement o f L 4, t here h as b een a c ompensatory d eposition o f b one a t l east 4 .0mm t hick o n t he a rticular s urfaces o f i ts s uperior a rticular p rocesses w ith o steophytic g rowths a t t he l ateral m argins ( asterisk i n F ig. 5 4A). J udging f rom t he c losely c ongruent a rticular f acets o n b oth L 3 a nd t he f ree f ragment o f L 4, t he f ragment s till c ontinued t o a rticulate o ver a l arge a rea w ith L 3, a s w ell a s t hrough t he f racture s urfaces, i n s pite o f b eing e vidently t ilted u pwards a nd h aving m oved s lightly p osteriorly ( Fig. 5 4B). A rticulation w as a lso m aintained w ith L 5 b y v irtue o f m uch t hickening o f t he a rticular p rocesses. T he p redominant m ovement o f t he f ree f ragment, h owever, a ppears t o h ave b een a n u pward t ilt o f i ts s pinous p rocess w hich b rought i t i nto c ontact w ith t he i nferior s urface o f t he s pinous p rocess o f L 3 b ecause

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t here a re l arge c ongruent f lat, s lightly p itted, s urfaces w hich h ave b een g reatly e nlarged b y t he i rregular g rowth o f n ew b one a t t heir m argins ( Fig. 5 4C). S imilarly, a w ide a rea o f p seudo-arthrotic s urface i nvolves t he u pper h alf o f t he s loping p osterior s urfaces o f t he l aminae ( open a sterisks i n F ig. 5 4C) w here i t h ad a rticulated w ith c orresponding s urfaces o n t he l ower s urfaces o f t he i nferior a rticular p rocesses o f L 3. T hese a reas o n t he f ree a rch a re c ontinuous a t t he a nterior e nds o f t he l aminae w ith f acets c orresponding w ith t he s ites o f t he f ractures. T he f acets a re d istinguished b y b eing d enser a nd l ess p itted a nd b y g listening l ike p olished i vory ( eburnated). T he c orresponding s urfaces o n t he l ower s urfaces o f t he s uperior a rticular p rocesses o f L 4 a re s imilarly p olished a nd e burnated ( Fig. 5 4C). T his e burnation s uggests t hat t he p seudo-arthrotic s urfaces a t t he f racture s ites r ubbed a gainst o ne a nother m ore h eavily o r m ore c ontinuously o r r egularly t han a t t he o ther s imilar s urfaces. F inally t here h as b een s ome u pward t ilting o f L 5 b ecause t here a n e xtensive p seudo-arthrotic r elation b etween t he u pper s urfaces t he s uperior a rticular p rocesses a nd t he i nferior p rocesses o f L 4 b oth s ides ( Fig. 5 4B).

i s o f o n

A ll t he p seudo-arthrotic s urfaces m entioned a nd t he a pophyseal j oints b etween L 3, L 4 a nd L 5 s how t he m arginal o steophytes t ypical o f o steo-arthrosis, i n s harp c ontrast w ith t he b ut s lightly a ffected a pophyseal j oints b etween L 5 a nd t he s acrum a nd o f t he v ertebrae a bove t he l evel o f L 3. O ne o f t he s pecimens ( Fig. 5 5), f rom a w oman a ged 5 5 y ears, h as c lose s imilarities t o t he f oregoing, a lthough t he f ractured n eural a rch o f L 3 w as n ot r ecovered; t here i s e vidence t hat a n a rticulation c ontinued t hrough t he s ites o f f racture a nd t hat s ome t ilting u pwards o f b oth t he b ody a nd s eparated a rch o f L 3 o ccurred s o t hat t he i nferior a rticular p rocess o f L 2 a nd t he s uperior p rocess o f L 4 w ere i n c ontact w ith t he s eparated a rch. H owever, t here a re s ome m ajor d ifferences f rom t he p revious s pecimen ( Fig. 5 4) t hat d eserve d escription. T he f ifth l umbar v ertebra i s s acralized s o t hat L 4 h as t he f unctional r elationships n ormally a ssociated w ith L 5. I ts b ody h as a n a ppearance s uggestive o f s ome c ollapse; t he i nferior a nd s uperior s urfaces o f t he b ody a re f lat, d ense a nd r ough w ith m any p its a nd s ome f lat r aised a reas. A pposing s urfaces o f L 3 a nd s acralized L 5 s how s imilar c hanges. T he i nferior a nd s uperior e dges o f t he b ody o f L 4 p resent i rregular s loping s urfaces e xtending t o a s helf p rojecting u p t o a bout 0 .6mm . T he c orresponding m argin o f t he L 5 i s s imilar. T he s eparation o f t he p osterior a rch o f L 4 w ould h ave a llowed t he b ody t o m ove f orward. T his d oes a ppear t o h ave h appened t o s ome e xtent ( 0.5cm). T he c onfiguration o f t he o uter s urfaces o f t he b ody o f L 4 a nd L 5 s uggests t hat t here h ad b een g ross b ulging f orward o f t he t wo d iscs.

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A F ig. 5 4A . L eft l ateral v iew o f f our l umbar v ertebrae o f m an a ged 5 0 y ears ( CZ/66A). N eural a rch o f L 4 i s s eparated f rom t he b ody b y a n o blique f racture i mmediately p osterior t o i ts s uperior p rocess w hich, g reatly d istorted b y m arginal o steophytes, i s m arked b y a n a sterisk. T he f ree p art o f t he a rch h as b een d rawn d isplaced p osteriorly t o d isplay s ite o f f racture ( arrow) a nd i ts i nferior p rocess. U pper s yrface o f i ts s pinous p rocess b ears a l arge p seudo-arthrotic f acet ( arrowhead) w here i t h as r ubbed a gainst s pinous p rocess o f L 3. F racture e nabled b ody o f L 4 t o b e d isplaced f orwards s o t hat t he a nterior s urface o f i ts s uperior a rticular p rocess ( arrowhead) i s i n c ontact w ith b ody o f L 3 s o p reventing f urther f orward m ovement. F ive-pointed s tars i ndicate a reas o f c ontact b etween t he r oot o f t ransverse p rocess o f L 4 a nd s uperior a rticular p rocess o f L 5.

8 3

F ig. 5 4B. P osterior v iew o f L 3, L 4 a nd L 5. F ractured n eural a rch o f L 4 h as b een r emoved a nd d rawn t ilted d ownwards t o d isplay b oth i ts u pper a nd a nterior s urfaces. A rrows i ndicate f acets o f a rticulation b etween s pinous p rocesses o f L 4 a nd L 3. B lunt f ive-pointed s tars i ndicate a reas o f f racture, n ow d ense e burnated s urfaces, h ighly p olished b y m utual f riction, e specially o n t he l eft s ide. T hese a reas o n n eural a rch o f L 4 e xtend o n t o t he l aminae ( open a sterisks i n F ig. 5 4C) b y v irtue o f c ontact w ith i nferior a rticular p rocesses o f L 3. F ive-pointed s tars a re p laced o n b road a reas o f c ontact b etween s uperior a rticular p rocesses o f L 5 a nd r oots o f t ransverse p rocesses o f L 4. A rrowhead i ndicates f acet o n r ight t ransverse p rocess o f L 5 t hat a rticulated w ith s imilar f acet o n s acrum .

8 4

T he b ody o f L 4 h ad c losed u pon L 3 o r L 3 h ad t ilted b ecause f acets o n t he s uperior s urface o f t he s uperior a rticular p rocesses o f L 4 a nd o n t he i nferior s urfaces o f t he i nferior p rocesses o f L 3 s howed t hat t he t wo h ad b een i n c ontinuous c ontact. T hese s urfaces o f c ontact w ere c ontinuous w ith t he f lattened a nd s lightly-eburnated a reas o f c ontact b etween w hat h ad b een t he f ractured s urfaces t hrough t he p ars i nterarticularis. I n o ne o f t he o ther a ffected p eople, a m an a ged 3 0 y ears ( C/71), t he s acrum i s a lso c omposed o f s ix v ertebral e lements i n t hat t he p resumptive t rue L 5 i s c ompletely s acralized e xcept t hat t he e nd-plate o f t he b ody a nd t he i nferior a pophyseal f acets a re n ot c ompletely f used. T he f unctional L 5 ( true L 4) s hows s ites o f f racture t hrough t he n eural a rches i mmediately b elow t he s uperior a rticular f acets; u nfortunately t he f ree p art o f t he a rch b earing t he i nferior f acets a nd s pinous p rocesses w as n ot r ecovered. T he s urfaces o f f racture a re i rregular a nd h ealed t hough w ith s ome p itting a nd t here i s e vidence, i n t he f orm o f f acets o n t he l ower m argins o f t he i nferior a rticular p rocesses o f t he v ertebra a bove ( functional L 4) t hat L 5 h ad s lid f orward a nd t ilted b ackwards s o t hat t hese p rocesses r ested u pon t he u pper a rticular p rocesses o f L 5 a s h ad h appened i n t he p revious s pecimen ( Fig. 5 5). T here i s m arked m arginal l ipping o f t he e nd-plates o f L 5 a nd S i i n a ccord w ith t he t earing o f t he d isc t hat m ust h ave o ccurred. T here i s o nly s light l ipping o f t he o ther v ertebrae.

F ig. 5 4C. L eft: S uperior s urfaces o f L 5 a rticulated w ith f ractures eparated a rch o f L 4 w hich h as b een d rawn s lightly d isplaced i n o rder t o e mphasize t he g ap ( striped) b etween s uperior a rticular p rocesses o f L 5 a nd s urfaces o f L 4. R ight: C orresponding i nferior s urfaces o f L 4 ( less t he f ractured a rch) a rticulated w ith L 3. T he g ap ( striped) i s b etween a rticular p rocesses o f L 4 a nd L 3. O riginal a reas o f f racture ( indicated i n b oth w ith b lunt s tars, a s i n F ig. 5 4B), e nlarged b y m utual f riction, a nd a reas b eside t hem ( five-pointed s tars) o f c ontact b etween L 4 a nd s uperior a rticular p rocesses o f L 5 a re c losely c ongruent; t hey a re o f i vory-like d ensity. O pen a sterisks i ndicate a reas o f a bnormal c ontact b etween u pper m argin o f l aminae o f L 4 a nd f lattened i nferior m argins o f i nferior a rticular p rocesses o f L 3. F acets o n s pinous p rocesses a re s elf-evident.

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F ig. 5 5. A ntero-lateral v iew o f s acrum o f w oman a ged 5 5 y ears ( E/78D) w ith l owest f our l umbar v ertebrae, L 5 b eing s acralized. T he a rea o f a rticulation o f s acrum w ith i lium e xtends o n t o L 5. U pper a nd l ower s urfaces o f b ody o f L 4 e xtend f orwards a s s loping s urfaces w ith s helfl ike o steophytic m argins. L ower m argin o f L 3 a nd u pper m argin o f L 5 s how s imilar l ipping. T here h ad b een a f racture, n ow s howing c hanges o f p seudo-arthrosis , t hrough n eural a rch o f L 3, a ssociated w ith t ilting u pwards o f L 4 b ringing i ts s uperior a rticular p rocesses i nto c ontact w ith a ltered a reas o f f racture o f L 3 ( arrowheads). I nferior a rticular p rocess o f L 2 s hows f acet o f c ontact ( arrow) w ith t he u pward-tilted n eural a rch ( not r ecovered) o f L 3.

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F ig. 5 6. A nterior s urface o f u pper p art o f l eft h umerus f rom m an a ged 2 5 y ears ( A 5 4Z/66A), s howing d eep l inear d epression w ith i rregular p rojecting m argins; t he r esult o f s uppuration, p robably f ollowing a n i ncised w ound t hat i nvolved t he b one.

N on-specific s uppurative d isorders U nder t his h eading w ill b e p laced l esions d educed t o b e c aused b y t he s o-called n on-specific i nfections, m ainly s taphylococci a nd s treptococci, t o d istinguish f rom l esions s uch a s t uberculosis i n w hich t here i s a f orm o f p us b ut t he c ause i s a s pecific m icro-organism . A part f rom m inor t ooth a bscesses w hich w ere c ommon-place a mong t hose o ver 4 0 y ears, m ostly s econdary t o t ooth w ear a nd p eriodontal d isease, t here w ere f ewer s uppurative b one d isorders t han m ight h ave b een e xpected; e specially b earing i n m ind t hat m ost s uch l esions w ould b e e xpected t o b e s econdary t o w ounding o r f ractures w hich s eem l ikely t o h ave b een a ssociated w ith t he w ay o f l ife. O nly t he m ajor e xamples c an b e r eported i n d etail. T he c ranium o f a w oman a ged 5 0 y ears ( A/72) s hows n ear t he v ertex a n a rea o f e rosion a bout 1 .0cm d iameter w hich i s p robably i nflammatory, p erhaps a ssociated w ith a n i nfected s calp w ound. T he b ase o f t he e roded a rea s eems t o c onsist o f p artially s eparated d ead b one. N ot f ar f rom t he u pper e nd o f t he h umerus f rom a m ale a ged 2 0-25 y ears ( Fig. 5 6) t here i s a d eep l inear d epression w ith a n i rregular b ase o f p artly s clerotic b one. T he m argins a re r aised, i rregularly r o unded a nd p uckered. T hese a re c hanges p roduced b y s uppuration b ut a lmost c ertainly f ollowing t rauma. T he l inear s hape o f t he l esion s uggests a n i ncised w ound o f t he b one, i ts w idth s uggests i njury b y s omething b lunt. R adiographs c onfirm t he s clerosis a nd s uggest a s lowt o-heal l esion o f a t l east a y ear's s tanding. I n a m an a t l east 6 0 y ears o f a ge ( Fig. 5 7), t here i s e vidence o f a s uppurative i nfection t hat h as a ffected t he d istal e nds o f a ll t he s ix r ibs o n t he l eft s ide. T he e nds a re e roded w ith m any n ecrotic a reas r ecognizable b y t heir p ale c olour a nd g ritty s urface; t here a re a lso s ome e xpanded a reas i ndicative o f r eactive b one f ormation . O ne r ib-end i s s harply a ngulated s uggestive o f a n u nderlying t rauma. I t s eems l ikely t hat t he c ause w as a n o pen s uppurating w ound o f t he c hest w all.

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T his m an h ad u nusually m assive b ones w ith s trong m uscle m arkings a nd w as t aller t han m ost ( 5ft i h n) a nd t he s keleton s howed o ther i nteresting d isorders. T he c osto-chondral j unctions o f t he r ibs n ot a ffected a s a bove s how t he i rregular o ssifications i nto t he c artilage d escribed b y I scan e t a l ( 1984) a s c haracteristic o f a dvanced a ge ( p. 5 3 ) . T here i s e vidence t hat, o n t he l eft, t he f irst r ib a nd m anubrium s terni h ad u ndergone b ony u nion . T here i s g ross m arginal l ipping o f t he b odies o f a ll v ertebrae, s lightly l ess m arked i n t he t horacic t han c ervical a nd l umbar r egions; a m arked f eature o f t he v ertebral e nd-plates i s d epressions o f v arious s izes a nd d epths w ith r ounded a nd s ometimes p rojecting m argins ( Schmorl n odes), t ogether w ith p atches o f s clerotic b ones. A t l east o ne o f t he v ertebral b odies s hows s igns o f c ompression f racture. T here i s g ross o steo-arthrosis o f m any a pophyseal j oints e specially i n t he c ervical r egion. T his s keleton i s f rom t he p ost-1800 A D l evel; t he w eight a nd d ensity o f t he b ones c ontrast w ith t he l ight-in-weight o steoporotic o nes o f o ther s keletons, m ale a nd f emale, o f s imilar a ge; f rom t he d entition a nd o ther f eatures, t he a ge a ssessment o f o ver 6 0 y ears i s n ot i n d oubt. S uppuration p layed a p art i n t he e ssentially t rauma-induced u nion o f t he d istal e nds o f t he t ibia a nd f ibula d escribed a nd i llustrated ( Fig. 4 7) i n t he s ection o n i njuries. S uppurative i nfections w ith s uch n on-specific m icro-organisms a s s taphylocci a nd s treptococci c an o ccur i n j oints, i ncluding t hose o f t he s pine e ither b y d irect i nfection f rom p enetrating w ounds o r b y b lood-borne i nfection. A s i n s uppurative i nfection o f b one e lsewhere, t here i s d estruction o f b one, f ormation o f s equestra a nd a t t he p eriphery o f t he l esions t he f ormation o f r eactive b one. S ome o f t he e xamples o f f usions b etween v ertebrae a lready d escribed ( p. 77 ) , o ther t han t hose o f d evelopmental o rigin, m ay h ave b een d ue t o b lood-borne s uppurative i nfections. A part f rom t hose e xamples, t here a re c hanges i n s ome s ingle j oints t hat m ight b e e xplainable o n t he b asis o f l ow-grade i nfections, p erhaps b y o ther t han t he c ommon n on-specific p yogenic s taphylococci a nd s treptococci w hich h ave t he r eputation o f b eing p articularly v irulent a nd r apidly d estructive w hen t hey i nfect j oints. F ifty y ears a nd m ore a go, b efore m orbidity f rom i nfections d iminished i n p opulations i n t he c ountry a s a w hole a s a r esult o f i mproved s ocial c onditions, a nd b efore t he a dvent o f t he a ntibiotics a nd o ther e ffective a ntibacterial a gents, a rthritis f rom b lood-borne i nfections o f v arious k inds w as c ommon. G onococcal a rthritis i s t he b est-known, b ut m eningococcal, p neumococcal, d ysenteric a nd t yphoid a rthritis ( Collins, 1 949) w ere m et w ith a s c omplications o f m eningococcal m eningitis, p neumonia, d ysentery a nd t yphoid r espectively. A ll t ended t o b e l ow-grade i nfections , t o a ffect s ingle l arge j oints, a lthough b y n o m eans a lways, a nd, e xcept f or g onococcal a rthritis, t o o ccur a s l ate c omplications o f w hat w ere u sually i llnesses l asting s everal w eeks o r m onths ( Romanis a nd M itchiner, 1 927). T here i s n othing t o s uggest t hat g onococcal i nfections w ere c ommon b ut r ecords o f t he 1 8th c entury ( e.g. S inclair, 1 791-1799; s ee D iscussion, p . 4 8 e t s eq.) s how t hat a ll t he o ther i nfections m entioned w ere b y n o m eans u ncommon. D ystentery-type d isorders w ere c ertainly c ommon i n t he W estern I sles, e specially i n i nfants, a nd w hat w as c alled t yphus, w hich p robably i ncluded t yphoid

8 8

F ig. 5 7. O steomyelitis o f c hondral j unctions o f r ibs a nd o ther b one d isorders i n m an a ged 6 0 y ears ( D47Y/67A). E vidence o f s uppuration w ith s equestration a nd r esorption a t s everal c ostochondral j unctions, p robably a ssociated w ith a s uppurating w ound o f c hest w all; n ote s harp a ngulation o f a t l east o ne r ib e nd, s uggestive o f t rauma. T he c artilage o f f irst r ibs a re o ssified s o t hat t he r ib e nds a nd s ternal s urfaces a re c ongruent ( compare F ig. 3 5). T wo t horacic v ertebrae ( T11 a nd 1 2) a re d isplayed t o s how e rosions o r S chmorl n odes o f e nd p lates o f t he b odies. T he 5 l umbar v ertebrae s how g ross m arginal l ipping. L 3 s hows s igns o f c ompression f racture.

8 9

f ever, o ccurred. H ence i t i s p ossible t hat s ome o f t he d estructive d isorders o f j oints, p articularly t hose t hat a pparently a ffected o ne j oint o nly w ere d ue t o s uch i nfections . O ne e xample w here a l ow-grade b lood-borne i nfection o f t hat k ind s eems p articularly w orthy o f c ons ideration w ill b e g iven. T he c ervical a nd t horacic s pine o f am an a ged 6 0 y ears ( A 6 5W/66B) s hows o nly a l ittle l ipping o f t he b odies, e xcept o f C 5 a nd C 6 , C 6 b eing s omewhat c ollapsed, a nd h ad a t s ome t ime s ustained a c ompression i njury. T here i s a l ittle g eneral l ipping o f t he a pophyseal a rticular f acets a nd, i n p articular, e vidence o f t he s liding d own o f t he i nferior a rticular p rocesses o f t he l ower c ervical a nd u pper t horacic v ertebrae o n t o t he l aminae o f t he n ext v ertebra b elow ( p.111) t hat i s s o c ommon i n t hese p eople. H owever, t he a rticular s urface o f t he a pophyseal j oint b etween C 2 a nd C 3 o n t he l eft s ide ( Fig. 5 8) s hows g ross c hanges t hat a re q uite u nmatched i n a ny o f t he o ther v ertebrae. T he a rticular s urfaces a re g reatly e nlarged b y t he f ormation a t t he m argins o f i rregular n ew b one o f o steophytic t ype. T he m uch e xtended a rticular s urfaces a re u neven , t he l ower o ne b eing i n g eneral c oncave a nd t he u pper o ne m ore c onvex, r ough a nd p itted. T he c hanges b ear s ome s imilarity t o t hose o f r heumatoid a rthritis b ut t hat i s h ardly l ikely t o h ave a ffected o ne a pophyseal j oint o nly a nd t here i s n othing s uggestive o f t hat t ype o f a rthritis i n t he o ther j oints. I t s eems m uch m ore l ikely t hat t here h ad b een s ome t ype o f i nfection o f t his j oint, b ut w hether i t w as a l ow-grade p yogenic o ne, t he p rimary p ortal o f e ntry b eing s ome l esion s uch a s ac arbuncle o f t he s kin o r e ven a n i nfected w ound o r o ne o f t he o ther b lood-borne i nfections r eferred t o a bove, i t i s i mpossible t o s ay.

9 0

F ig. 5 8. I nferior s urface o f C 2 i n m an a ged 6 0 y ears ( A 6 5W/66B). L eft a pophyseal j oint b etween C 2 a nd C 3 s hows g ross e xpansion o f i ts b oundaries b y o steophytic l ipping, e xtending o n t o t he l amina p osteriorly a nd a nteriorly t o e ncroach o n t he f oramen f or t he v ertebral a rtery a nd t he i ntervertebral c anal ( arrow) a long w hich p asses t he s econd c ervical n erve . T he a rticular s urface i s r ough, i rregular a nd d eeply p itted. T here a re s ome c hanges ( star) a t t he s ynovial l ateral m argin ( joint o f L uschka) o f t he e nd p late o f t he b ody o n t his s ide.

9 1

9 2

T here a re a f ew l esions o f t he e nd-plates o f t he b odies o f v ertebrae t hat p resent f eatures w hich d iffer f rom t hose o f m ost S chmorl n odes a nd w hich s uggest e rosion b y s ome i nfective i nflammatory p rocess. O ne i n t he l umbar v ertebra s hown i n F igure 5 9 i s f rom a y oung p erson , p robably m ale a nd a s y oung a s 1 9 y ears o f a ge. T he l esion c onsists o f a n a rea o f e rosion a bout 1 .0cm i n d iameter w ith r agged m argins; a t t he b ase, t here i s a n e levated a rea o f b one w hich h as p atches o f s clerosis a nd i s s urrounded b y ad eep a nnular g roove. T wo o ther o f t he l umbar v ertebrae p resent s imilar, s maller l esions. D r. P .A . R evell w as k ind e nough t o h ave t hree s lices c ut t hrough t he l esion d epicted. T he c ut s urfaces s how t hat t he c entral e levated a rea i s a s mall m ass o f b one i n p rocess o f s equestration b y a n e rosive p rocess ( Fig. 5 9). T he e rosive p rocess e xtends d eeply i nto t he s ubstance o f t he b ody a nd t here i s a n a pparently s eparate f ocus n ear i ts p osterior s urface. I t m ust b e a ssumed t hat t he s mall m ass o f b one b eing s eparated i s n ecrotic; b ut a s tudy o f t he m icro-anatomy, w hich i s q uite p ossible a fter t he s lices h ave u ndergone f urther p reparative p rocedures, w ould b e n eeded t o d etermine t his a nd o ther f eatures. T he a ppearances r evealed s o f ar c onfirm t hat t his i s a n i nfective i nflammatory l esion a nd a re c ons istent w ith i ts b eing d ue a n on-specific b lood-borne i nfection ; t his i s ac ommon w ay, a nd n ot u nusual s ite, f or s uppurative o steomyelitis t o b egin . O n t he o ther h and, a lthough b one s equestration i s l ess c ommon i n t uberculosis, t his c ould b e at uberculous l esion; t he f ormation o f b ut l ittle r eactive b one i n r esponse t o t he l esion f avours t hat d iagnosis.

F ig. 5 9.

P robable t uberculosis o f s econd l umbar v ertebra o f m ale a ged

1 9 y ears ( D/81D). A bove: U pper s urface a fter a s egment b earing a l esion h ad b een s awn o ut . T he s egment i s d epicted d iagrammatically a nd s hows n ear i ts a nterior m argin a n a rea o f l oss o f c ortex a t b ase o f w hich t here i s a n a rea o f u neven d ensity s urrounded b y a n a nnular g roove. M ore c entrally, i s a s maller a rea w here t he c ortex h as b een l ost, p robably b y p ost-burial d amage. M iddle: S ection t hrough s egment s howing t hat t he l esion c onsists o f ac entral m ass o f b one s urrounded b y a z one o f e rosion . N ear t he p osterior m argin, t here i s a n a rea o f s clerosis . B elow : R adiograph o f s ection s howing w ide e xtent o f t he e rosive p rocess a nd t hat t here a re a t l east t wo l esional f oci. A rrowhead i ndicates t he c entral a rea o f l oss o f c ortex.

9 3

S keletal t uberculosis T here a re s ix i nstances w here t he d iagnosis c an b e c ertain a nd a f ew o ther p ossible e arly l esions.

r egarded

a s

I n am ale a ged 4 0 y ears ( Fig. 6 0), t he h ead o f t he r ight f emur i s a lmost c ompletely d estroyed b y a n e rosive l esion w hich i s a lmost c ertainly t uberculosis r ather t han a s uppurative n on-specific i nfect ion. I t i s o f i nterest b ecause i t p robably r eflects t he d iminished f unction o f t he l imb s econdary t o t he d isease t hat t he a ffected f emur i s n otably s maller i n a ll i ts d imensions t han t he h ealthy l eft o ne; f or i nstance, m easured f rom t he l esser t uberosity, i t i s 1 .3cm s horter a nd i ts m id-shaft c ircumference i s l cm l ess. T he o ther i nstances a re o f t he s pine. F igure 6 1 s hows a n e rosive l esion o f t he a nterior s urface o f t he u pper p art o f t he b ody o f L 5 f rom a m ale a ged 3 5 y ears. T his i s t he t ypical s ite i n a v ertebra f or t uberculosis t o o riginate; f urther, r adiography s hows t hat t here i s b ut l ittle r eactive b one-formation , w hich i s t ypical o f t uberculosis , a lthough t here i s al ittle p eriosteal r eaction o n t he a nterior s urface o f t he b ody a t t he p eriphery o f w here t he a nterior l ongitudinal l igament h ad p robably b een r aised b y t he t hrusting f orward o f c aseous m aterial. T here a re t hree o ther i nstances o f e rosive l esions o f a n u pper a nd l ower s urface o f o ne o r m ore b odies o f v ertebrae t hat c annot b e d iagnosed r eliably b ut w hich c ould b e t uberculosis. O ne h as b een d ealt w ith i n t he p revious s ection ( Fig. 5 9). S uch l esions h ave t o b e d istinguished f rom v arious t ypes o f S chmorl n odes ( see l ater s ection). F igure 6 2, t he s pine o f aw oman a ged 4 5 y ears, s hows w idespread t ypical l esions o f t uberculosis a ffecting t he b odies, m ainly i n t he l ower t horacic a nd l ower l umbar r egion i ncluding t he a nterior s urface o f t he s acrum . T he b ody o f T 10 h as b een r educed t o at hin w edge p artly b y d estruction o f i ts s uperior a nd i nferior s urfaces a nd p artly b y m echanical c ollapse, p roducing a n a ngular k yphosis. T he b ody o f L 5 h as s imilarly b een d estroyed. A s i s c ommon i n t uberculosis r ather t han n on-specific s uppurative i nfections o f t he s pine, t he n eural a rches a nd a pophyseal j oints h ave n ot b een d irectly a ffected; f urthermore t here i s l ittle r eactive b one f ormation. T he s acrum a nd l ower l umbar v ertebrae o f aw oman a ged 4 0 y ears ( Fig. 6 3) s how s ome f eature s imilar t o t he s pine j ust d escribed a lthough t here i s m uch m ore i nvolvement o f t he a pophyseal j oints. T here h as b een t otal d estruction o f t he b ody o f L 4 a nd i ts n eural a rch h as b een f irmly u nited t o t hat o f L 3 b y b ony f usion o f, a nd a round, t he a pophyseal j oints. M uch o f t he i nferior p art o f t he b ody o f L 3 h as b een d estroyed s o t hat i t i s r educed t o aw edge w ith a t hin a nterior e dge. L 3 i s t ilted f orward s o t hat t he e roded i nferior s urface o f i ts b ody r ests o n t he b ody o f L 5 w hich i s g rossly a nd i rregularly c upped o ut b y e rosion . T he a nterior s urface o f t he s acrum i s s imilarly c upped o ut, m ainly t he c entral p arts o f t he b odies o f S i a nd S 2. T he n eural a rch o f L 5 i s f irmly u nited t o t he c orresponding p arts o f S i b y n ew b one f ormation b etween a nd a round t he a pophyseal j oints. T here i s a lso a b ridge o f b one b etween i ts l eft t ransverse p rocess a nd t he l ateral m ass o f t he s acrum .

9 4

6 1

6 0

F ig. 6 0. A nterior v iew o f p roximal e nd o f r ight f emur o f m ale a ged 4 0 y ears ( A 5 0Y/66C), s howing h ead o f t he f emur d estroyed b y a n e rosive l esion w hich i nvolves a lso t he s urface o f t he n eck w ith s light l imiting p roliferative r eaction a t p eriphery o f t he l esion. P robably t uberculosis.

F ig. 6 1. L 5 o f m ale a ged 3 5 y ears ( A 7 7T/67C) s howing e rosive l esion c lose t o a nterior e dge o f u pper s urface o f t he b ody. T he l esion h as b egun t o p enetrate t he r im . T his i s t he t ypical s ite f or t uberculosis t o o riginate. T here i s a l ittle p eriosteal r eaction o n t he a nterior s urface o f t he b ody p roducing s ome r ounded e levations b ut r adiography ( below) s hows e rosion w ith l ittle r eactive b one f ormation t ypical o f t uberculosis.

9 5

F ig. 6 2. W idespread t uberculosis o f t he l ower t horacic a nd l umbar s pine o f w oman a ged 4 0 y ears ( A 5 5U/67D). B elow t he l evel o f T 7, t he c ores o f m any v ertebral b odies h ave b een r educed t o a f ew s truts o f t he o riginal b one. T he b ody o f T 10 i s t otally d estroyed a nd t hose o f T ll a nd L 5 h ave c ollapsed a nd b een r educed t o t hin w edges. T he a nterior s urface o f t he s acrum i s a lso d eeply e xcavated. T here i s l ittle r eactive b one f ormation.

F ig. 6 3. S acrum a nd l umbar v ertebrae o f w oman a ged 4 0 y ears ( D/7 0). A nterior a nd s lightly l ateral v iew . T uberculosis h as d estroyed t he b ody o f L 4 a nd t here h as b een c ollapse, p robably m echanical, o f t he b ody o f L 3 t o aw edge-shape. A nterior s urfaces o f L 2, L 5 a nd s acrum s how e rosive l esions w ith s piky n ew g rowths o f b one a t t he p eripheries, e specially o f L 5. L eft t ransverse p rocess o f L 5 a nd s acrum a re u nited b y a b and o f n ew b one a nd p osteriorly t here i s c omplete f usion o f t he n eural a rch o f L 5 t o t he s acrum. T he s urviving n eural a rch o f L 4 i s s imilarly f used t o t hat o f L 3.

9 6

F ig. 6 4. S acrum a nd l umbar v ertebrae o f w oman a ged 1 8 y ears ( A73Z/66B). T otal d estruction o f b odies o f L 5 a nd L 4 a nd f usion o f t heir n eural a rches w ith e ach o ther a nd w ith s acrum . M uch o f b ody o f L 3 i s d estroyed a nd r emainder h as c ollapsed, w ith f orward t ilt o f a bout 9 0° o n t o s acrum . I nferior s urface o f b ody o f L 2 i s e roded w ith f ormation o f r eactive s piky n ew b one o n i ts a nterior m argin. S everal s pikes p ass u pwards a nd o ne j oins n ew b one o n t he i nferior m argin o f b ody o f L l. C entral p art o f a nterior s urface o f s acrum a s f ar a s c occyx i s c upped o ut b y t he e rosive p rocess.

T he d estruction o f t he b odies h as p roduced a n a ngular k yphosis w ith s ome c ollapse t hrough t he a pophyseal j oints b etween L 5 a nd w hat r emains o f L 4; f or i nstance, t heir s pinous p rocesses a re i n c ontact w ith t he f ormation o f s piky f acets s uggestive o f i nfection r ather t han ap seudo—arthrosis . M ost o f t he e roded s urfaces a re c omposed o f d ense b ut f inely p itted b one, f or e xample t he i nferior s urface o f t he b ody o f L 3 r esembles t hat o f h yperostotic c ancellous b one. T here a re m any s hort s piky p rojections o f n ew b one, e specially a t t he m argins o f t he b odies, n ew b one p robably f ormed i n t he a ttachments o f t he l ongitudinal l igaments. T uberculosis, p erhaps m ore o r l ess u nder c ontrol a nd h ealing, s eems t o b e ar eliable d iagnosis h ere. A n e xample o f t uberculosis i n aw oman a ged 1 8 y ears ( the i liac c rests a re j ust u niting), a ffecting a lso t he l umbar v ertebrae a nd t he s acrum, i s s hown i n F igure 6 4. T here i s t otal d estruction o f t he b odies o f L 4 a nd f usion o f t heir n eural a rches w ith o ne a nother a nd w ith t he l ateral p art o f t he s acrum . T he g reater p art o f t he b ody o f

9 7

L 3 i s a lso d estroyed a nd w hat l ittle o f i t r emains r ests o n t he s acrum s o t hat t here i s a n a bout 9 0° a ngular k yphosis. T here i s a n e ven g reater a mount o f r eactive b one t han i n t he s pecimen j ust d escribed w ith t he f ormation o f m any g rotesque b uttress-like s piky p rojections. T hus, a lthough t he a bsence o f r eactive b one f ormation t ends t o b e c haracteristic o f t uberculosis, t his i s b y n o m eans a lways s o , d epending n o d oubt p artly o n t he v irulence o f t he i nfection. I t s eems l ikely t hat w here t here i s l ittle r eactive b one f ormation, a s i n F igure 6 2, t he d isease p rocess i s v ery r apid.

S keletal s yphilis T here a re t wo i nstances o f s yphilitic p eriostitis. T he f irst i s t he s kull o f a f emale o f e stimated a ge 3 5 y ears f ound o n t he e xposed s urface i n 1 966 ( Fig. 6 5). M ost o f t he e xternal s urface o f t he c alvaria, p articularly t he f rontal r egion e xtending t o j ust b elow t he o rbits, s hows n odular t hickening w ith s ome d epressed s tellate a nd r ounded a reas b etween. I n g eneral, t he n odules a re s mooth a nd t he b one i s s clerotic. A t t he p osterior a nd l ateral p eripheries o f t he a ffected a rea, t here a re a reas n ot o f t hickening f rom f ormation o f n ew b one b ut o f e rosion t hrough t he o uter c ortical p late. T here a re s everal i solated s uch a reas i n t he o ccipital r egion. T hese a re a reas w here i t s eems l ikely t he c hanges w ere a ctive a nd p erhaps b eginning w ithin t he b one r ather t han o n i ts s urface, w hereas i n t he f rontal r egion t he p rocess h ad s ubsided o r w as o f l ow a ctivity. T hese a ppearances a ccord c losely w ith t hose o f g ummatous p eriostitis o f t ertiary a cquired s yphilis. C alvarial e rosion o f t his k ind w as o ne o f t he w ell-recognized a nd d iagnostic s igns i n t he d ays w hen i nadequately t reated s yphilis w as c ommon ( Jaffe, 1 972, p . 9 24); e xamples a re t o b e f ound i n m useums o f p athology, d ating f rom l ast c entury. I t w as u ncommon f or t he i nner t able o f t he c alvaria t o b e p enetrated o r a ffected a nd i n t his s kull t here i s n o e rosion o n t he c erebral s urface o f t he b one. I t m ust b e m entioned, i n v iew o f t he f requency w ith w hich g ummatous p eriostitis a ffected t he p alate, l eading t o a p erforation, t hat t he b ony p alate i n t his s kull w as i ntact. I t w as a n i solated f ind a nd c ould n ot b e a ssociated w ith a ny o ther b ones. I n 1 967, t wo f emora w ere f ound o n t he s urface, c lose t o e ach o ther b ut n ot a ssociable w ith a ny o ther b ones. T heir d imensions a nd d etailed g eneral m orphology c orrespond s o c losely t hat i t i s c ertain t hat t hey c ame f rom t he s ame i ndividual, c ertainly a m ale a nd p robably, f rom t he a bsence o f a rticular c hanges, n o o lder t han 4 0 y ears. T hey a lso a re a p air i n t hat, o n t he m edial s urface o f t he u pper h alf o f e ach s haft, t here i s a s harply-defined f usiform t hickening. T he t exture o f t he n ew b one i s s lightly d ifferent f rom, a nd r ougher t han, t hat o f t he s haft i tself, b ut t he s urface o f n ew b one i s i n g eneral s moothly r ounded a nd d ense. O n t he r ight s ide, h owever, t he l ower p art o f t he s urface i s r ough a nd p itted w ith s ome r agged s hallow e xcavated a reas. T here i s a s imilar s lightly r aised a rea o f r ough n ew b one o n t he a nterior s urface o f t he s haft j ust b elow t he g reat t rochanter. I n r adiographs o f t he b ones ( Fig. 6 6), t he o utlines o f t he o riginal s hafts c an b e s een . T he n ew b one i s o f a bout e qual d ensity t hroughout t o t he b one o f t he s hafts a nd a ppears t o h ave b een d eposited o n t he s urface w ith b ut l ittle c hange i n t he o riginal b one; a z one o f s eparation o f l ess d ensity i s

9 8

F ig. 6 5. F ront a nd v ertex o f s kull o f w oman a ged 3 5 y ears ( C 1 5ii/66A) s hpwing n odular s clerotic t hickening o f t he s urface w ith s ome d epressed, r ounded a nd s tellate a reas. S yphilitic p eriostitis.

9 9

F ig. 6 6. R adiographs o f u pper p arts o f f emora o f a dult m ale ( A 7 3d/67B). T here i s s ymmetrical d eposition o f n ew d ense b one o n t he m edial s urfaces. T he o utline o f t he o riginal b one c an b e d istinguished b ecause a z one o f l ess d ensity s eparates t he o ld f rom t he n ew b one. I n t he f emur o n t he l eft, t here h as p robably b een s ome d eposition o f n ew b one o n t he w alls o f t he m arrow c avity. S yphilitic p eriostitis.

1 00

e vident, e specially i n t he l eft f emur. T here h as p robably b een s ome n ew d ense b one d eposited o n t he c orresponding s urface o f t he c entral m arrow c avity o f t he b one. O ne o f t he f eatures o f s yphilitic p eriostitis i s t hat i t t ends t o a ffect t he s keleton s ymmetrically a s i n t his i nstance; i n o ther r espects a lso , t he a ppearances a ccord w ith t he d escriptions o f t he n ong ummatous o r n on-erosive t ype o f s yphilitis p eriostitis ( Jaffe, 1 972, p . 9 36). I t s eems m uch m ore l ikely t hat t he l esions b oth i n t he s kull a nd f emora a re t he r esult o f a cquired r ather t han c ongenital s yphilis. G ummatous p eriostitis a ffecting t he s kull o f a n i nfant w ould a lmost c ertainly i nvolve t he m ost c ommonly a ffected r egion , t hat o f t he n asal f ossae l eading i n l ater l ife t o a c haracteristic f lattening o f t hat a rea . T his s kull s hows n othing o f t he k ind; n either, i ncidentally , d o t he i ncisor t eeth o r f irst p ermanent m olars s how t he t ype o f e namel h ypoplasia t hat i s c haracteristic o f c ongenital s yphilis. L ikewise t hese f emora a re u nusually l arge a nd r obust. I t i s u nlikely t hat t he o wner s tarted l ife a s a s ickly i nfant b arely s urviving i nto c hildhood. B oth s pecimens w ere f ound a t t he p ost-1800 A D l evel A . I t i s n ot s urprising t o f ind s ome e vidence o f s yphilis i n t he p opulation . P articularly d uring t he 1 9th c entury w hen t ravel b ecame e asier, i t w as c ommon f or m en e ven f rom t he m ore i solated W estern I slands t o s erve i n t he R oyal o r m erchant n avies, b oth i n p eace a nd w artime. Y oung w omen a lso s pent p eriods, m ost i n d omestic s ervice, o n t he m ainland.

D egenerative j oint d isease T he t erm o steo-arthritis f or t he d isabling c hanges i n j oints , o f w hich l ipping o r o steophyte f ormation a t t he m argins o f t he a rticular s urfaces i s t he p redominant f eature, w as e arly c hanged t o o steoa rthrosis t o i ndicate t hat t he p rimary d isorder i s a d egeneration o f t he j oint t issues. F or s ome y ears n ow , i t h as b een r ecognized t hat c hanges i n t he s ynovial j oints o f t he a ppendicular s keleton a nd e lsew here, i ncluding t he a pophyseal i ntervertebral j oints, f orm o ne e ntity, f or w hich t he t erm o steo-arthrosis i s s till e mployed, a nd t he c hanges i n t he n on-synovial s econdary-cartilaginous j oints b etween t he b odies o f t he v ertebrae f orm a nother e ntity, u sually k nown a s d egenerative s pondylosis a lthough i t i s c onvenient t o r etain a n a lternative n eare quivalent o lder t erm s pondylosis d eformans. N ot a ll a uthorities u se t he s ame t erms a nd n ot a ll a gree a bout f ine d istinctions o f m orbid a natomy, a etiology a nd i nterpretation. I h ave f ollowed i n t he m ain t he l arge a nd i mpressive w ork b y R esnick a nd N iwayama ( 1981). A mong t he E nsay m aterial, t here a re m any e xamples o f b oth o steoa rthrosis a nd d egenerative s pondylosis i n t heir s evere f orms s o t hat t he i mpression i s g ained t hat t hese d isorders, i n w hich m echanical s tress p lays a n i mportant p art, a re p articularly c ommon. H owever, o nly a s tatistical a nalysis o f a c omparison w ith t he p revalence o f t hese d isorders i n o ther p opulations c ould e stablish t hat t his i s i ndeed s o, a nd s uch a n a nalysis h as n ot b een p ossible.

1 01

i )

O steo-arthrosis o f s ynovial j oints

S ystemic f actors p lay a r ole i n t his c ondition a nd s ome p eople a re m ore s usceptible t han o thers; c onsequently o ften m ore t han o ne j oint i s a ffected. N evertheless, t he d ominant r ole i s p layed b y l ocal m echanical s tress a nd s o-called w ear a nd t ear o n t he j oint; f or e xample am alunited f racture o f t he f emur w hich m ight p lace a bnormal s tress o n t he k nee a nd h ip j oints i s l ikely a fter s ome y ears t o b e a ssociated w ith o steo-arthrosis o f t hose j oints. T he l arge j oints o f t he l imbs a re t he o nes m ost t ypically a ffected. T he s ynovial a pophyseal j oints b etween t he n eural a rches v ertebrae w ill b e d ealt w ith u nder d egenerative s pondylosis.

o f

t he

F igure 6 7 s hows t he g rossly a ffected r ight k nee-joint o f a w oman a ged 6 5 y ears. T he l ateral c ondyle o f t he f emur a nd t he c orresponding p art o f t he t ibia a re t he m ost s everely a ffected. T he a rticular s urfaces a re c oarsely p itted a nd t wo c orresponding a reas o f l ipping w hich a rticulate a re e burnated a nd p olished. T here i s g ross l ipping o f n ew b one w hich s eems p oured l ike c andle-grease b eyond t he l imits o f t he a rticular s urfaces b ut t he n earby t ibio-fibular j oint i s n ot a ffected. T he r ight k nee-joint s hows c losely s imilar c hanges a nd t here a re a lso t ypical o steo-arthrotic c hanges i n s everal o ther j oints i ncluding o nes o f, i n t he m ain, m uch l ess d egree i n b oth w rist j oints a nd s ome l ipping o f m etacarpo-phalangeal j oints. T he r ight s houlder j oint s hows e vidence o f d isorganization p ossibly f ollowing u nreduced d islocation ( see p . 7 1 ) . T he l eft e lbow-joint ( Fig . 6 8) o f am an a ged 5 5 y ears i s s everely a ffected. E xtension o f t he j oint b eyond a bout 2 0° i s l imited b y t he i mpingement o f o steophytic g rowths o n t he p roximal e nd o f t he u lna o n t he p osterior s urface o f t he h umerus. T he r ight e lbow-joint o f a m an a ged 5 5 y ears ( A 4 3P/67D) s hows c losely s imilar c hanges b ut, a lthough f ull e xtension s eems p ossible, f lexion w ould h ave b een l imited b y a bout 1 0° b y a p rominent u lna o steophyte w hich i mpinges o n t he m iddle o f t he a nterior s urface o f t he h umerus j ust a bove t he a rticular s urface . N either o f t hese i nstances w as a ssociated w ith s imilarly s evere c hanges i n a ny o ther s ynovial j oints. I t s eems l ikely t hat i n b oth i nstances t here h ad b een s ome i njury t o t he j oint t he n ature o f w hich w as o bscured b y t he b ony a rthrotic c hanges. ' T he c hanges i n t he b ones o f t he w rists a nd h ands o f am an a ged 5 0 y ears ( Fig. 6 9) a re t ypical o f o steo-arthrosis. M ost o f t he j oints o f b oth w rists a nd b oth h ands a re a ffected b ut m any t o am uch l ess d egree t han i s d epicted h ere. T he c yst s ituated b eneath t he a rticular s urface o f t he r ight r adius i s a f eature o f o steo-arthrosis a lthough a m ore d iffuse t ype o f o steoporosis i s a lso f ound i n r heumatoid a rthritis . T his m an h ad a n u n-united f racture o f t he n eural a rch o f L 4 ( Fig . 5 4) a s w ell a s h ealed f ractures o f s everal r ibs ( p .68 ) . O steo-arthrotic c hanges i n t he t erminal i nterphalangeal j oints o f t he h and, o f w hich F igure 6 9 d epicts a t ypical e xample, t he l ipping b eing m ost m arked o n t he e xtensor s urface, a re p articularly c ommon i n w omen ( Jaffe, 1 972, p . 7 57), t he o nset u sually b eing s oon a fter t he m enopause. T here a re m any e xamples a mong t he E nsay p eople b oth m en a nd w omen.

1 02

F ig. 6 7. L eft:

R ight k nee j oint f rom w oman a ged 6 5 y ears ( A/83D).

a nterior v iew i n s light f lexion.

R ight: l ateral v iew . S tar i ndicates t he a rea o f a rticulation w ith t he f ibula , u naffected b y a rthrotic c hanges. T he l arge o steophyte b ehind t his a rea o verlapped t he h ead o f t he f ibula a nd i s d eeply g rooved ( arrow) b y t he t endon o f p opliteus w hich a rises f rom t he l ateral a spect o f t he f emoral c ondyle a nd c rosses t he j oint.

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F ig. 6 8. P ostero-lateral v iew o f l eft e lbow j oint o f m an a ged 5 5 y ears ( EV3/82D) i n a lmost f ull e xtension. T here i s g ross l ipping o f m argins o f t he a rticular s urfaces . A rrow i ndicates o steophyte o n h umerus a gainst w hich t he l ipped m argin o f u lna i mpinges, s o l imiting e xtension b y a bout 2 0° . A rrowhead i ndicates o steophyte o n a nterior m argin o f a rticular s urface o f h umerus a gainst w hich h ead o f r adius i mpinges o n f lexion, s o r estricting i t b y a bout 1 0° .

S light e rosion o f t he a rticular e minence o f t he m andibular j oints i n p eople o f m iddle a ge a nd o ver i s c ommon i n t he E nsay s kulls, s omet imes a ssociated w ith a f acet o f e rosion o n t he m andibular c ondyle. P robably t hese a re t he c hanges o f o steo-arthrosis a nd i n t he n ature o f w ear a nd t ear, e specially a s s everal a re a ssociated w ith d isorganisat ion t o t he o cclusion o f t he t eeth f rom t ooth w ear o r t ooth l oss. H owever, a s t he m andibular j oints a re c ommonly a ffected i n r heumatoid a rthritis, s ome o f t he e rosions c ould h ave b een s o c aused. O ne p robable e xample i s d escribed i n t he l ater s ection o n R heumatoid a rthritis ( p. 1 21 ) .

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F ig. 6 9.

A rthrotic w rists a nd h and o f m ale a ged 5 0 y ears ( C2Z/66A).

L eft: A nterior v iew o f r ight u lna a nd r adius, c orresponding l unate a nd s caphoid t urned t o d isplay t heir a rticular s urfaces w ith r adius, r ight t hird m etacarpal ( lateral v iew) a nd m etacarpal a nd p halanges o f t humb. R ight: P osterior v iew o f l eft u lna a nd r adius. G ross o steophyte f ormation a ffected m ost j oints o f t he h and a nd w rist o n b oth s ides w ith m any a reas o f c oarse p itting o n t he a rticular s urfaces. A ffected a reas w ere s clerotic a nd s ome, f or e xample o n s caphoid ( pointer), w ere e burnated. L arge o pening o n s urface o f r ight r adius e nters a n a pproximately s pherical c yst w hich t hinned p rojecting m argins o f t he o pening s uggests h ad b een e xpansile. O penings o n s urface o f l eft r adius ( pointer) l ed d eeply i nto t he b one. N ote b uttresses o f n ew b one w hich a ppear t o s upport t he o steophytic o utgrowth i n t his r egion. E lbow j oints w ere n ot a ffected.

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i i)

D egenerative s pondylosis ( spondylitis d eformans)

I t i s i n g eneral a greed t hat, a lthough t he c haracteristic c hange i s l ipping o f t he m argins o f t he i nter-vertebral s urfaces o f t he b odies o f t he v ertebrae, t he p rimary c hange i s i n t he i nter-vertebral d iscs a nd t heir a ttachments. F or v arious r easons, i ncluding t erminology a nd t he i nterpretations a dopted, i t i s n ecessary t o g ive t he f ollowing s hort a ccount. T he d iscs w hich s eparate t he b odies o f t he v ertebrae ( Fig. 7 0) h ave a s emi-fluid c entre, t he n ucleus p ulposus, w hich i s s urrounded b y a t hick w all o f f ibrous t issue, t he a nulus f ibrosus, i n w hich t he m ajority o f t he f ibres a re c ircumferentially a rranged a round t he c entral n ucleus. T hus, t he d iscs r esemble f lattened t hick-walled r ubber b alls w hich a re w ell a dapted t o a bsorb t he j olts a nd j ars p roduced i n t he v ertebral c olumn b y w alking a nd j umping a bout a nd a lso t he s ustained m ore c ontinuous p ressures s et u p w hen w e l ift o r p ull h eavy w eights. P assing f rom t he e dge o f o ne b ody t o t he o ther a nd, a s i t w ere, h olding t he d iscs i n p lace, b ut n evertheless n ot f irmly a ttached t o t hem , a re t he l ongitudinal i nter-vertebral l igaments f orming a c ontinuous s heath o f l igaments e nclosing t he b odies f rom o ne e nd o f t he v ertebral c olumn t o t he o ther. T he m ost p eripheral f ibres o f t he a nulus, w hich p ass f rom t he r im o f o ne v ertebra t o t hat o f t he n ext, a re p articularly f irmly a nchored. H owever, t he a nulus i s n ot p articularly f irmly a ttached t o t he l ongitudinal l igaments t hat p ass f rom v ertebra t o v ertebra a nd w hich a re f irmly a ttached t o t he s ides o f t he b ody a s light d istance f rom t he r im . ( These f ibres a re s hown w ith s ome e xaggeration i n t he d iagram F ig. 7 0). T he e arliest d egenerative c hange i n t he d isc i s a s ubtle c hemical o ne i n t he c omponents o f t he n ucleus p ulposus i nvolving l oss o f w ater a nd a c hange i n i ts p hysical p roperties. T he f ibrous t issue o f t he n ucleus b ecomes c hanged a nd i ts o rganization l ost. T he d isc b ecomes l ess e lastic a nd l ess r esistant t o c ompressive s tresses; i n c onsequence i t t ends t o b ulge o ut b eyond t he l imits o f t he b odies, e specially a nteriorly, a nd t o b ecome t hinner. V ertical h eight b etween t he b odies i s r educed ( Fig. 7 0). B ulging o f t he d isc p uts a s tretch s tress o n t he a ttachments o f t he l ongitudinal i nter-vertebral l igaments w here t hey a re a ttached j ust b eyond t he m argins o f t he b odies, i n r esponse t o w hich n ew p eriosteal b one i s f ormed w hich u sually d evelops a r ounded s urface. T his i s t he c haracteristic l ipping. L ocal f ormation o f p rominent s pur-like o steophytes i s c ommon a nd s uggests t hat o steoblasts m igrate i nto t he l igament a ttachments. S uch s purs m ay c ome i nto c ontact a nd f use ( Fig. 7 1). I t i s u nusual f or m arked l ipping o r s pur-formation t o o ccur a t t he p osterior m argins o f t he b odies w ithin t he v ertebral c anal b ut s uch c hanges, a nd h erniation o f t he d isc, c an o ccur a nd i mpinge o n t he c ord o r n erve t runks. T he d egenerative c hanges, a t f irst s ubtle c hemical o nes, a lso a ffect t he c artilage c overing o f t he e nd-plates o f t he b odies a nd t here i s a t endency f or d egenerated d isc t issue u nder p ressure t o h erniate t hrough t he c artilage a nd c ortical b one o f t he e nd-plates p roducing s oc alled S chmorl n odes ( see l ater s ection).

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F ig . 7 0. P rogressive s tages o f d egenerative s pondylosis ( spondylosis d eformans). D ense b lack i ndicates c artilage. A bove i s d epicted t he n ormal s tate w ith i ntact n ucleus p ulposus s upported b y c ircumferential f ibrous t issue a nd p eripherally i nvested b y t he a nulus f ibrosus f irmly a ttached t o t he v ertebral r im . A nteriorly, t here i s ac ontinuous l ongitudinal i nter-vertebral l igament w hich i s n ot f irmly a ttached t o t he b odies e xcept b y s trong f ibres i nserted j ust b eyond t he r ims o f t he b odies. M iddle d isc d epicts f irst s tage o f d egeneration l eading t o c hanges i n p hysical p roperties o f n ucleus p ulposus, w hich g ives w ay u nder c odpressive s tresses , a s a lso d oes t he s upportive f ibrous t issue, s o t hat t he d isc b ulges a nteriorly a gainst t he l ongitudinal l igament, p lacing t ension o n i ts f ibrous a ttachment n ear t he r im ; i n r esponse t o t he t ension, n ew b one i s f ormed l eading t o o utwardly p rojecting o steophytes. D egenerative c hanges a lso o ccur i n c artilage o f e nd p lates a nd c ollapse o f t he d isc p laces s tress o n a pophyseal j oints. L owest d isc d epicts m ore a dvanced c hanges w here c ompression o f d egenerated n ucleus p ulposus n ot o nly i ncreases f orward p rotrusion o f t he d isc a nd f urther g rowth o f o steophytes b ut, i n a ssociation w ith d egenerative c hanges i n c artilage, h erniation o ccurs o f d isc s ubstances t hrough t he e nd-plates ( Schmorl n odes). O steo-arthrotic c hanges i n a pophyseal j oints a re b y t hen w ell e stablished. 1 07

p ondy los is .d eformans

F ig. 7 1. P rincipal d ifference b etween o steophytic l ipping o f v ertebral b odies i n d egenerative s pondylosis ( spondylosis d eformans), w here b ony o utgrowths o ccur i n a ttachments o f t he l ongitudinal l igament t o t he b ody a f ew m illimetres f rom t he m argin a nd s omewhat o utwards, a nd i n a nkylosing s pondylitis w here o utgrowths o ccur w ithin t he a nulus f ibrosus o f t he d isc a nd a re a ttached t o t he a ctual m argin o f t he b ody. T hey a re a lso d isposed m ore v ertically. O n t he r ight, t he s tage o f f ormation o f c omplete b ridges i s s hown. ( Derived f rom R esnick a nd N iwayama, 1 981).

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A t f irst, i t i s c haracteristic t hat t he a pophyseal j oints a re u naffected b ut, i n d ue c ourse, p robably a s ar esult o f t he a bnormal m echanical s tresses p laced u pon t hese j oints b y t he l oss o f t he e fficient s upport o f t he d iscs, a nd t he c hanges i n t he r elationships o f t he b odies b ringing t hem c loser t ogether, d egenerative c hanges b egin t o o ccur, f irst i n c artilage o f t he a pophyseal j oints, t hen p roducing e rosion o f t he b ony s urface a nd l ipping o f t he m argins ( Fig . 7 0). D istinctions w hich m ay b e c linically i mportant a re m ade b etween t wo v arieties o f d egenerative s pondylosis, f or e xample b y R esnick a nd N iwayama ( 1981, p . 1 370) w ho d efine a c ondition c alled i nter-vertebral o steochondrosis w here t he m echanism i s m ore o r l ess a s j ust d escribed; t here i s d egeneration o f t he d isc, l oss o f h eight b etween t he b odies a nd c hanges i n t he i nter-vertebral b ony p lates, o ften s clerotic, w ith p eripheral o steophyte f ormation o nly o f s light d egree. T hey d efine a s s pondylosis d eformans a c ondition i n w hich t he d egenerative c hanges a re m ainly, o r a t f irst, i n t he f ibres o f t he a nulus r ather t han i n t he n ucleus p ulposus w hich r etains i ts p roperties s o t hat h eight b etween t he v ertebrae i s n ot l ost; b ut t he n ucleus p ulposus p resses o n t he w eakened d egenerate a nulus s o t hat t he p eripheral o steophyte f ormation , b y e xerting t ension o n t he a ttachment o f t he l ongitudinal l igament t o t he r im , i s t he p redominant b ony c hange. T he d istinctions b etween t hese t wo d isorders m ay b e w ella uthenticated o n h istological a nd r adiographic g rounds; t he d iagnosis o f i ntervertebral o steochondrosis d epend u pon t he r adiographic v isualization o f t he c hanges i n t he p ulposus, l argely p ossible b ecause s lits a nd c avities i n i t t end t o c ontain g as , a nd o n r eactive s clerosis i n b one a djacent t o t he d isc a nd s ometimes i n t he s ubstance o f t he b ody; a lso o n t he p resence o f d isc h erniations o r S chmorl n odes. O bviously, p resence o r a bsence o f l oss o f h eight b etween t he b odies a nd n ature o f c hanges i n t he d iscs c annot b e d etermined i n s keletal m aterial s o t hat d egenerative s pondylosis h as t o b e t reated a s o ne w hole e xcept t hat t he r elative p redominance o f c hanges o n t he v ertebral p late s urfaces, i ncluding S chmorl n odes, i n c omparison w ith t he p eripheral o steophytosis a nd c ertain o ther d etails m ay b e w orth c ommenting o n. K elley ( 1982) h as h ighlighted a s e xamples o f i nververtebral o steochondrosis s ome c rescent-shaped e rosive l esions o f t he a nterior p arts o f t he e nd-plates o f t he l ower t horacic a nd l umbar v ertebrae f ound i n ag roup o f a ncient A merican I ndian s kulls, m ost c ommonly i n m ales. T he l esions c onsisted e ither o f a reas d epressed u p t o 5 mm b elow t he s urface o r o f w rinkled, p itted a reas; t hey w ere u sually i nside t he r ing-like e piphyseal p eripheral z one o f t he e nd-plate b ut s ometimes e xtended i nto t his z one. K elley d oes n ot s eem t o r efer t o t here b eing a ny o steophytic l ipping i n a ssociation w ith t hese l esions. A f ew e xamples o f l esions t hat r esemble t he c rescent-shaped l esions d escribed b y K elley w ere f ound a mong t he E nsay s pines ( Fig . 7 2). H owever, t hey a re a ccompanied b y l ipping o f t he a djacent m argin a nd i n o ther r espects r esemble a n e arly a nd l ocalized f orm o f d egenerative s pondylosis. T hat t hey a re s uch s eems t o b e t he v iew f avoured b y K elley w ho f ound t hese l esions a t t he a ppropriate a ge, 3 0-40 y ears, w hen t hat d isorder t ends

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F ig. 7 2. I nferior s urface o f l ower t horacic v ertebra o f m an a ged 5 5 y ears ( A 5 5Y/67C). I n t he a nterior p art o f t he e nd-plate, t here i s a c rescentic a rea o f l arge d eep p its, m ainly w ithin t he m arginal z one; n ear t he m idline, t his z one i s i nvolved b y t he l esion a nd i s a ssociated w ith s light i rregular o steophytic l ipping. A t t he c entre o f t he l esion, t he s urface p its h ave b ecome c onfluent, p roducing a c urved l inear d epression a bout 0 .2mm d eep. T here a re s imilar l esions i n s everal n earby v ertebrae.

t o c ommence. H e f ound f ew a t m ore a dvanced a ges. T his w ould b e b ecause b y t hen t he c hanges i n t he d iscs, a nd c onsequently i n t he b odies o f v ertebrae, w ould b e m ore s evere a nd w idespread; t hat i s f ew l esions w ould b e i n t he e arly s tages. P itting a nd n odule f ormation i n t he p eripheral z ones o f t he e ndp lates w as c ommon i n t he E nsay s pines i n a ssociation w ith g ross l ipping ( e.g. F igs. 3 9 a nd 5 4C). I n t he s pine s hown i n F igure 7 2, f rom a m ale a ged 5 5 y ears, t he d egree o f l ipping w as m oderate a nd c onfined t o t he v icinity o f t hese l esions, w hich a ffected o nly t hree o f t he l ower t horacic v ertebrae a nd w ere m ore m arked o n t he i nferior e nd-plates. T he u pper t horacic v ertebrae o f t his s pine s howed m arked o steoa rthrotic c hange a nd t he s liding d own o f o ne v ertebra o n t he o ne b elow d escribed l ater ( p.114 , F ig. 7 5); t here w ere a lso s ymmetrical o steoa rthrotic c hanges i n b oth e lbow a nd w rist j oints.

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T he m ajor d escriptions i n t he l iterature o f d egenerative a rthrosis i n a ncient s keletal m aterial ( Ingelmark , 1 959; S teinbock , 1 976; O rtner a nd P utschar, 1 981) d o n ot a ll m ake t he d istinctions r eferred t o h ere o r e ven i nterpret t he m aterial e xactly a s i s a ttempted h ere. T he s pine o f am an a ged 5 0 y ears ( his r ibs a re s hown i n F ig. 3 4) w hose f our l owest t horacic v ertebrae a re d epicted i n F igure 7 3 i llustrate m any o f t he c haracteristics o f t he d egenerative c hanges t hat a re s o c ommon i n t he E nsay s pines. T he c hanges d epicted t here, a part f rom t he b ridging s pur, w ere p resent i n l ess s evere f orm t hroughout t he r est o f t he s pine a nd l ipping w as s evere i n t he c ervical r egion. E xcept i n t he c ervical r egion , t here w ere h ardly a ny c hanges i n t he a pophyseal f acets. H owever, e ven w hen l ipping w as n ot p articularly s evere, t here w ere m arked a nd e xtensive S chmorl-type l esions m ostly s lightly p osterior t o t he c entres o f t he e nd-plates; t hey c ommonly a ffected o pposite s urfaces s ymmetrically a nd c onsisted n ot o nly o f d eep p its o f v arious s izes b ut a lso o f i rregular p rojections o f u nusually d ense a nd e ven e burnated b one. T hese f eatures a re s uggestive o f i ntervertebral o steochondrosis. T he b ridging o steophyte b etween T 10 a nd T 11 i s a ttached t o t he b odies a bout 2 -3mm b eyond t heir r ims a nd t hus s eem t o h ave b een f ormed i n t he s ame w ay a s t he s purs o n t he a djacent v ertebrae w here t here i s a d istinct g utter b etween t he s pur a nd t he r im o f t he e nd-plate. I t i s p ossible t o i nspect t he i nner s urface o f t he b ridge a nd e ven t o m easure i ts t hickness. T he i nner s urface i s d eeply c oncave a nd b owed o ut c orresponding w ith t he c onvex o uter s urface. T he b ridge i s 5 .0mm t hick a t i ts c entre. S ome s imilar b ridges m ay p erhaps b e f ormed b y o ssificat ion i n h aematomas a ssociated w ith a cute i njuries ( p. 7 7 a nd F ig. 5 3). F eatures o f d egenerative s pondylosis a re a lso i llustrated i n m any f igures i n o ther s ections o f t his t ext, i ncluding t he s ection o n t raumatic i njuries o f t he s pine. A f eature o f t he s purs a nd l ipping o f t he v ertebrae i n t his m aterial i s b uttress-like s trands o f b one t hat a rise f rom t he s urface o f t he b ody a nd p ass t o t he p rojecting s urfaces o f t he s purs ( Figs. 5 3, 7 3 a nd o thers). T heir b uttress-like m orphology i nvites t he t hought t hat t hey a re e xamples o f t he w ell-known c apability o f b one t o r espond l ocally t o m echanical s tresses; i n o ther w ords t hat t he s helf-like s purs a re s ubject t o m echanical s trains o r t ensions i n r esponse t o w hich t he p eriosteum p roduces s upportive b uttresses. T o s ome e xtent c ompatible w ith t his i dea , b ut m ore a cceptable, i s t he v iew o f S chmorl a nd J unghanns ( 1971, p . 1 92) t hat t hese s trands o f b one c orrespond t o l igament f ibres e xtending f rom t he a nterior l ongitudinal l igaments t o t he s urface o f t he b ody. S uch b uttress-like s trands o f b one a re s omet imes f ound a t o ther s ites a pparently s upporting o steophytic l ipping ( Fig. 7 4). I n t he l ower c ervical a nd t horacic r egions, t he a rticular f acets o f t he a pophyseal j oints a re m ore o r l ess f lat a nd a re d isposed v ertico-obliquely . E specially i n t he t horacic r egion, i t i s c ommon i n t he f ully a dult E nsay s pine t o f ind e vidence t hat t he l ower f acets h ave, a s i t w ere, s lid d ownwards s o t hat t hey c ome c lose t o, a nd e ven t o r est o n, t he r oots o f t he t ransverse p rocesses b elow ( Fig. 7 5).

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I 1

' Y ' S f r

"

F ig. 7 3. L eft: R ight s ides o f b odies o f T 9-T12 o f m an a ged 5 0 y ears ( D 4 6Z/67A) s howing t ypical l ipping a nd b eak-like s purs i n d egenerative s pondylosis, a nd b ridging s pur b etween T 10 a nd T ll. B roken l ines i ndicate t he m idline a xes. T he b ridge i s a ttached, a s a re f ree s purs, al ittle b eyond t he m argins o f t he e nd-plate . T his p roduces a g utterl ike s pace b etween t he m argin a nd t he s pur. N ote b uttress-like s trands o f n ew b one p assing f rom o uter s urfaces o f b odies t o p rojecting s purs a nd l ipped m argins. R ight: A pposing s urfaces o f b odies o f T ll a nd T 12 s howing l esions n ear t heir c entres t hat c onsist o f r aised a reas o f d ense n ew b one, e burnated i n p laces a nd w ith m any d eep p its.

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T his i s s urfaces s lightly T here i s m argin o f

s hown b y t he e xtension o f t he b oundaries o f t he a rticular w hich u sually c an b e c learly d iscerned e specially a t a l ater s tage w hen t he m arginal l ipping h as b egun t o o ccur. a c orresponding r ounding a nd l ater e version o f t he l ower t he u pper f acet w hen i t r ests o n t he t ransverse p rocess .

F igure 7 5 s hows t he s tages i n w hat s eems t o b e a p rogressive p rocess w hich a ppears t o b e s econdary t o d egenerative c hanges i n t he d iscs b ringing t he v ertebral b odies c loser t ogether. P articularly w hen t he c hange i n t he r elationship o f t he f acets i s m arked, t he a rticular s urfaces a re p itted. S light d egrees o f t he c hange i n r elationship m ay n ot b e a ssociated w ith l ipping o f t he m argins o f t he b odies a nd o ther m anifestations o f d egenerative s pondylosis, w hich a ccords w ith t he v iew t hat t he c hange i n r elationship c onstitutes o ne o f t he e arliest s igns o f d egenerative s pondylosis. T he g ross e xamples o f t he s liding d own o f t he u pper f acets w ere u sually a ssociated w ith g ross d egrees o f s pondylosis. T his p henomenon i s p articularly s een i n t he l ower c ervical a nd u pper t horacic r egions o f t he s pine a nd t he m ost m arked e xamples h ave b een i n w omen. F or e xample, o ne a ged 2 5 y ears ( A 3 1Z/67C), a nother a ged 3 5 y ears ( A 6 5Y/66C) a nd o ne a ged 4 5 y ears ( D 4 1U/67A). I n e ach c ase, t he c hanges a ffect C 5-T4, C 7 a nd T i m ost m arkedly, a nd t here i s b ut l ittle c hange i n t he r est o f t he s pine e xcept i n t he 4 5-year o ld w oman w here d egenerative s pondylosis a ffects t he b odies o f t he l umbar v ertebrae. M uch m ore d etailed s tudy o f a ll t he s pines i s n eeded t o e stablish w hether o r n ot t hese c hanges a re i ndeed m ore m arked i n w omen, b ut t hey c ould b e r elated t o t he f act t hat, i n t he W estern I sles i n g eneral, i t w as t he c ustom f or t he w omen t o d o m ost o f t he c arrying o f h eavy l oads, f or e xample, o f t he s eaweed a nd t he s hell-sand t o t he l azy-beds a nd o f t he p eat f rom t he p eat-beds. T his t hey d id u sing c reels c arried o n t heir b acks s upported b y s traps o ver o r r ound t he s houlders ( Grant, J .S., 1 987, p . 2 00) a nd o ften a lso w ith a s trap r ound t he f orehead ( Cameron , 1 988). T his m ode o f c arrying o n t he s houlder g irdle w ould s eem t o p lace, t hrough t he f irst r ib, t he m aximal p ressure o n T i a nd t o a g radually d iminishing e xtent o n t he v ertebrae b elow t hat l evel. H owever, a s trap r ound t he f orehead w ould, b y b ringing i nto a ction a ll t he m uscles, f or e xample t he s calenes, t o h old t he n eck r igid, t ransmit f orce t hrough t he c ervical v ertebrae w hich w ould b e m aximal o n C 7. A ll t hat c an b e s aid a t p resent i s t hat t his a nalysis a ccords w ith t he f indings i n t he t hree f emale s pines m entioned.

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F ig. 7 4. A ntero-lateral v iew o f l eft a rticular p rocesses o f L 5 o f m an a ged 6 5 y ears ( A 6 5W/66B). S p i ndicates s pinous p rocess a nd T r t ransverse p rocess. T here i s m arked o steophytic l ipping o f m argins o f t he a rticular p rocesses. Ab uttress-like s trand o f b one e xtends f rom t he p edicle t o t he t hick l ipping ( star) o f t he s uperior o ne. A rrow p assed b eneath t he s trand s hows t hat i ts m iddle p art i s f ree o f t he b ody o f t he b one.

F ig. 7 5. L eft: P osterior a spects o f t horacic v ertebrae s howing n ormal r elationship b etween i nferior m argins o f a rticular p rocesses t o t ransverse p rocesses o f t he v ertebrae b elow a nd t wo s tages o f t he c ommon s liding d own o f a rticular p rocesses t o r est u pon t he t ransverse p rocesses, u sually a s a r esult o f l oss o f t hickness o f i nter-vertebral d iscs d ue t o d egenerative c hange. R ight: C orresponding l ower v ertebra w ith u pper o ne r emoved t o e xpose a rticular f acets . A bove: N ormal T 8 a nd T 9 o f m ale a ged 1 9 y ears ( D/81D). M iddle : T 9 a nd T 10 o f f emale a ged 5 0 y ears ( A 2 7/66A). I nferior m argins o f i nferior a rticular p rocesses o f T 9 a re e verted a nd l ipped a nd r est u pon s helf-like e xtensions o f s uperior f acet o f T 10. A lthough ( right) o utlines o f o riginal i nferior b orders o f t he a rticular s urface c an b e f aintly d istinguished, t he s urface i s n ow g reatly e xtended t owards t he t ransverse p rocesses f orming a s helf-like s urface, e specially o n t he r ight s ide. A rticular s urfaces a re f inely p itted. B elow : T 5 a nd T 6 o f m an a ged 5 5 y ears ( A55Y/67C). I nferior a rticular p rocesses o f T 5 a re h ere r esting f ully u pon t he s uperior s urfaces o f t he t ransverse p rocesses o n t o w hich t he a rticular f acets h ave e xtended. P ointer i ndicates i solated e burnated f acet w hich i s a n a rea o f c ontact w ith t he s pinous p rocess o f T 5. A rticular s urfaces a re o f d ense b ut c oarsely p itted b one.

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15

i ii)

S chmorl ( cartilaginous) n odes

T hese a re i rregular d epressions o f v arious d epths o n t he s urface o f t he v ertebral p lates i n t he c entral a rea w ithin t he o uter z one o f t he r im. T hey s ometimes, e specially i n y oung p eople, w hen t hey a re l ikely t o b e o f d evelopmental o rigin, a re o f l inear s hape a nd m ay h ave a s mooth f loor; m ore c ommonly t heir o utline i s i rregular a nd t he f loor a lso i s i rregular a nd e ven a pparently w ithout a l ayer o f c ortical b one. I n l ong-buried s keletalized v ertebrae, i t i s n ot e asy t o d istinguish s uch l esions f rom a reas o f s oil e rosion o r p ost-burial t rauma, n or f rom e arly t uberculous l esions ( p. 9 3 ) . H owever, w hen t he m argins o f t he d epressions a re r ounded o r t hickened s o t hat t he m argin i s r aised, t here i s n o d oubt t hat t hey a re t rue l esions; t he c orrespondence o f t he l esions w ith t he d escriptions o f S chmorl n odes g iven i n S chmorl a nd J unghanns ( 1971, p . 1 58-169) a nd o ther w orks s uch a s C ollins ( 1949), a nd t heir c ommon a ssociation w ith e vidence o f d egenerative s pondylosis ( Figs. 3 9, 5 7 a nd 7 3) e nables t hem t o b e d istinguished f rom t uberculosis. E xamples

o f a ll t he k inds d escribed b y S chmorl a nd J unghanns

a re

a bundant a mong t he E nsay s pines. T he m echanism o f p roduction o f t he s impler v arieties o f S chmorl n odes ( also k nown a s c artilaginous n odes) i s n ot e ntirely c lear. S ome, e specially t hose s ometimes f ound i n a dolescence a nd o nly o ccasionally p roducing p ainful s ymptoms, m ay b e o f d evelopmental o rigin i n t he s ense t hat t hey a re p erhaps d ue t o l ocal p roliferations o f t he c artilage t hat c overs t he e nd-plates w hich b ecome p ressed i nto t he s urface o f t he u nderlying c ortex. A lternatively, t here m ay b e d evelopmental w eaknesses i n t he b ony e nd-plates t hrough w hich s ome s ubstance o f t he d isc o r i ts n ucleus p ulposus m ay b e p ressed b y t he e veryday p ressures o n t he s pine. I n o ther w ords t hese l esions o ccurring i n t he y oung m ay b e a n i ndication, o f w hich t here a re m any o thers, t hat t he h uman s pine h as n ot b ecome f ully a dapted e volutionarily t o m an's u pright p osture. T hus t he s impler n odes a re s ometimes d ismissed s imply a s e vidence o f a d isturbance o f t he d isc-vertebral p late r elationship. S chmorl a nd J unghanns s how t hat m any S chmorl n ode-type l esions c an b e t raced t o s udden t raumatic i ncidents m ore s evere t han o rdinary e veryday s tresses. I t s eems t hat t he c ortex o f t he e nd-plate i s r uptured a nd d isc s ubstance i s f orced t hrough; p erhaps a t f irst a s mall a mount b ut i ncreasing f or a t ime u nless t he s pine i s r ested. I t i s d oubtful w hether s uch l esions e ver h eal i n t he s ense t hat t here i s a r eturn t o n ormal b ut r adiography s hows t hat s ometimes t hey c an b e c onverted t o a n o ssified s car. S chmorl-type l esions a ppear t o a ccumulate i f t he s pine i s s ubjected t o c hronic h eavy s tress a s i n h eavy l abour; t hus t hey a re s aid t o b e m ore c ommon i n l abourers t han i n s edentary w orkers. T he l arger, m ore t ypical c omplex k ind w hich p resent a s i rregular o penings l eading i nto c omplex c avities w ith u ndermined m argins t end t o b e a ssociated w ith d egenerative s pondylosis ( Fig. 6 1 d iagram) o r w ith e vidence o f c ompression i njuries w ith o r w ithout g eneralized o steoporosis. T he m echanism i nvolved i n d egenerative s pondylosis, a s c omplications o f d egenerative c hanges i n t he d isc, h as b een d escribed ( p. 1 06 ) .

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T here a re m any i nstances, s uch a s t hose s hown i n F igures 3 9, 5 7 a nd 7 3, i n w hich t he o penings i n t he b one h ave e levated m argins, s omet imes o f s clerotic b one, w here i t i s e vidence t hat a b one-proliferative p rocess h as f ollowed t he i nitial p rolapse o f d isc t issue. I n a f ew i nstances, a ssociated w ith e vidence o f c ompression c ollapse o f t he b ody o f t he v ertebra, p rotrusion o f m aterial r ather t han p rolapse a ppears t o h ave b een t he p redominant f eature ( Fig. 5 2); i t c an b e p resumed t hat t he f orces o f c ompression h ave b een g reatest w ithin t he s ubstance o f t he b ody r ather t han i n t he d isc a nd t he b ody h as v irtually b urst. T here a re m any i nstances ( Figs. 3 9 a nd 7 3) w here l esions o ccur e xactly o pposite o ne a nother o n o pposing s urfaces o f a djacent v ertebrae. S ometimes a b road d epression i s m atched b y a p rotuberance o f a c orresponding a rea o n t he o pposing v ertebral p lats. S chmorl n odes a ffecting s everal, u sually t horacic v ertebrae, e specially c lose t o t he a nterior m argins o f t he e nd p lates, a nd s omet imes u ndermining t he m argin s o t hat p art o f i t b ecomes s eparated, a re a f eature o f j uvenile k yphosis ( Scheuermann d isease). T he b odies b ecome t hin a nd w edge-shaped a nd t he n atural c urve o f t he s pine b ecomes e xaggerated. I t i s s aid t hat t he c ondition i s p articularly c ommon i n s ub-adults w ho e ngage i n h eavy p hysical l abour, o r s trenuous s ports, b efore t he s pine i s m ature e nough t o b ear t he s train ( Jaffe, 1 972, p . 6 21). I f s o, i t m ight h ave o ccurred a mong t he E nsay p opulation b ut n o c onvincing e xamples w ere f ound.

i v)

D iffuse i diopathic s keletal h yperostotis ( DISH)

D iffuse i diopathic s keletal h yperostotis ( DISH) i s a c ondition t hat a ffects t he s pine p redominantly, i s m ore c ommon i n m en t han w omen i n t he r atio o f a bout 3 :2 a nd i s p erhaps g enetically d etermined; a nd t here i s a t endency f or e xcessive o ssification t o o ccur a t s ites w here t endons a nd l igaments a re a ttached t o b one ( Resnick a nd N awayama , 1 981, p . 1 418). I n i ts m ost t ypical f orm , t here i s o ssification o f t he l ongitudinal l igaments a cross t he b odies o f s everal a djacent v ertebrae w hich a re d istinguishable f rom t he l ipping o f a nkylosing s pondylosis a nd d egenerative s pondylosis b y b eing m ore b ulky, b eing m ore m arked o n t he r ight s ide a nd u nassociated w ith o r d isproportionate t o c hanges a ttributable t o d egeneration o f t he d iscs; f or e xample, r adiog raphically t he d iscs a re o f n ormal t hickness t hough t his c an o nly b e g uessed a t i n s keletal m aterial b y t he a bsence o f t he b ony c hanges o f d egenerative s pondylosis, i ncluding a bsence o f t he s econdary o steoa rthritic c hanges i n t he a pophyseal j oints. A s D ISH t ends t o b egin i n e arly a dult l ife a nd p rogresses s lowly, i t c an b ecome c omplicated b y d egenerative s pondylosis s upervening a nd d iagnosis t hen b ecomes p articularly d ifficult. N everthelers, a ccording t o R evell ( 1986), e vidence o f t he d isorder i s p resent i n a bout 1 0% o f a ll a dult a utopsies. F eatures s uggestive o f D ISH , m ostly c onsisting o f l arge s purs o n b odies o f v ertebrae, o r b ridges a cross t hem a ssociated w ith l ittle e vidence o f d egenerative s pondylosis, w ere f ound i n t hree o f t he E nsay s pines, a ll m ales. O nly o ne c an b e d escribed h ere i n d etail. T here w ere s trap-like o utgrowths o f b one o n t he a nterior s urfaces o f t he b odies o f t he t horacic v ertebrae o f am ale a ged 5 5 y ears ( Fig. 7 6); a lthough n ot a ctually a ttached t o t he a djacent v ertebrae, a t l east s ome

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•

F ig. 7 6. S pine o f m an a ged 5 0 y ears ( D 4 0W/67A) w ith f eatures o f d iffuse i diopathic s keletal h yperostosis ( DISH). L eft: A nterior s urfaces o f b odies o f T 2-T10 d rawn s eparated b y s upposed t hickness o f t he i nter-vertebral d iscs, e xcept T 5 a nd T 6 w hich a re m ore w idely s eparated t o s how t hat t he b ony s pike p rojecting d ownw ards f rom t he b ody o f T 5 i s n ot a ttached t o, b ut o verlaps, T 6. T his a nd o ther b ony o utgrowths i n t he m idline s uggest o ssification i n t he a nterior l ongitudinal l igament. W hite c ard h as b een p laced b ehind a b ridge o f b one a ttached t o b ody o f T 9 a t e ach e nd b ut u nattached a t t he c entre. C entre: L eft l ateral v iew o f s pinous p rocesses o f T 2-T9 s howing d ownwards-projecting s pike-like e xtensions l ikely t o b e o ssification i n t he s upra-spinous l igaments. R ight: A nterior s urfaces o f b odies o f L 1-L4 s howing b eak-like s purs a rising f rom t he m argins. A lthough n one a re f used t o f orm b ridges, s everal, e specially o n t he r ight s ide, r esemble s o-called k issing o steophytes. 1 18

F ig. 7 7. A nterior v iew o f h ead o f r ight h umerus o f m an a ged 5 5 y ears ( D 4 0W/67A, s ee F ig. 7 6). M argins o f t he a rticular s urface a re l ipped a nd s ome o penings ( arrows) l ead i nto m icro-cysts. T hickening a nd o steophyte f ormation a ffect m argins o f t he b icipital g roove b etween t he t uberosities. Ap articularly l arge o steophyte p rojects d ownwards f rom t he f loor o f t he g roove a nd i s i tself g rooved b y b iceps t endon.

o f t hese o ssifications b ridged t he i nter-vertebral d isc a nd o verlaPped t he m argin o f t he v ertebral b ody ( Fig. 7 6, l eft). T he m orphology o f t hese g rowths o f b one s trongly s uggested o ssification o f t he a nterior l ongitudinal l igament w hich i t i s g enerally a greed i s o ne o f t he m ost c haracteristic f eatures o f D ISH ( Resnick a nd N awayama, 1 981). S ome f eatures o f d egenerative s pondylosis w ere a lso p resent, s uch a s m arginal l ipping o f t he b odies a nd S chmorl n odes, p articularly i n t he l umbar r egion ( Fig. 7 6, r ight), b ut t he l ipping a ppeared t o b e d isproportionate a nd s everal a pposing s purs r esembled t he s o-called k issing o steophytes o f D ISH . I n b oth t he t horacic a nd l umbar r egions, t he m arginal l ipping w as m ore m arked o n t he r ight s ide. F eatures s uggestive o f a n o ssifying d iathesis w ere p resent, s uch a s s pike-like b ony e xtensions o f t he s pinous p rocesses o f t he l umbar v ertebrae s uggestive o f o ssification i n t he s upra-spinous l igaments. T here w ere a lso s piky p rojections o f b one f rom t he l ateral m argins o f t he i liac c rests, a p rominent c alcaneal s pur w here t he a chilles t endon i s a ttached a nd o lecranon s purs o n b oth h umeri. P ossibly o f t he s ame n ature i s a l arge d ownwards-projecting s pur o f o steophytic b one a rising f rom t he b icipital g roove o f t he r ight h umerus ( Fig. 7 7); t he s pur i s d eeply g rooved b y t he b iceps t endon . L ipping o f t he a rticular m argin a nd o ther c hanges t ypical o f o steo-arthritis, s uch a s m icro-cysts, a re a lso p resent. T he m orphology h as f eatures i n c ommon w ith t hat o f t hree h umeri d escribed i n t he s ection o n B ony i njuries ( p. 7 5 ) . A lthough t he r elevance t o D ISH i s u ncertain , i t m ust b e m entioned t hat t he d istal r ib e nds s howed s piky o ssifications o nly s lightly l ess m arked t han t he e xaggerated o nes r eferred t o o n p age 5 3 .

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R heumatoid a rthritis R heumatoid a rthritis d iffers f rom o ther t ypes b y p rimarily a ffecti ng t he p eri-articular t issues. " arthermore, t endon-sheaths, f ascia a nd o ther p arts o f t he m usculo-skeletal s ystem a re c ommonly a ffected b y t he s ame i nflammatory p rocess. T he s mall s ynovial j oints o f t he h ands, w rist a nd f eet, a nd t he e lbow a nd m andibular j oints a re t he s ites o f p redilection . T ypically, m any j oints a re a ffected a nd u sually s ymmetrically. T he c ondition u sually b egins i n e arly a dult l ife, 2 5-40 y ears, a nd i s t wo o r t hree t imes m ore c ommon i n w omen . O nly t he c ervical p art o f t he s pine i s p articularly a ffected i n r heumatoid a rthritis, n ot m erely t he a pophyseal j oints b ut a lso t he l ateral p arts o f t he d isco-vertebral j unctions w here t here a re s ome s mall s ynovial j oints ( joints o f L uschka) c lose t o t hose o f t he a pophyseal j oints . T he a pophyseal j oints o f t he r est o f t he s pine a re o ccasionally a ffected. T he f irst c hange i s a n i ntense i nflammation o f t he s ynovia w hich b ecomes c overed w ith a k ind o f v ascularized e xudate, k nown a s p annus , w hich i n d ue c ourse e rodes t he c artilage a nd b one a t t he m argins o f t he a rticular s urfaces. E ventually p annus a nd e rosion i nvolve a ll t he c artilage; f oci o f p annus e nter a nd e xpand i n t he s ubchondral b one p roducing c yst-like s paces. Am ore d iffuse o steoporosis i s a r adiog raphic f eature o f t his i ntermediate f ully-established s tage o f t he d isease. T he c ourse o f t he d isease i s i ntermittent s o t hat p eriods o f r epair o ccur a nd a reas o f r epair a re f ound e ven d uring a ctive p hases. G ross d eformity o f t he m orphology o f t he a rticular s urfaces c an o ccur w hich c an b e d istinguished f rom t hat p roduced b y t he r ounded m arginal l ipping o f o steo-arthrosis. R epair m ay t ake t he f orm o f f ibrous o r e ven b ony a nkylosis o f t he e roded j oint s urfaces. A t al ate s tage, e specially i f t he a cute i nflammation s ubsides, o steo-arthrosis, o r ac ondition i ndistinguishable f rom i t, t ends t o o ccur, e specially i f f unction o f t he j oint c ontinues ( Resnick a nd N iwayama, 1 981, p . 8 69). T hus t he o steoporosis i s r eplaced b y i ncreased b one d ensity, t here i s p roliferation o f s uch a rticular t issue a s r emains, a nd o steophytes f orm a t t he p eripheries o f t he a rticular s urfaces. T he o riginal r heumatoid c haracter o f t he c hanges t hus b ecome o bscured. T he m atter i s c omplicated b y t he f act t hat p eople w ith r heumatoid a rthritis a re p articularly s usceptible t o aw ide v ariety o f s ystemic i nfections. F or t his r eason t he i ncidence i s q uite h igh o f o ne, o r e ven m ore, s uppurative a rthritis i n p eople w ith r heumatoid p olyarthritis ( Resnick a nd N iwayama , 1 981, p . 9 89). T he c ombined e ffect o n as ingle s keletalized j oint o f r heumatoid a rthritis a nd a s uperimposed l ow-grade i nfection c ould n ot p ossibly b e u ntangled e xcept o n ab asis o f s peculation o r p robability. A s r heumatoid a rthritis h as s uch a m arked t endency t o b e p olyarticular, i f t he w hole s keleton, o r a t l east m any r epresentative j oints, c an b e e xamined, t he p ossibility o f d iagnosis i s g reatly i ncreased.

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I t i s, o f c ourse, o nly t he i ntermediate a nd l ate s tages o f r heumatoid a rthritis w hen t he b one h as b een a ffected t hat c an b e r ecognized i n s keletal m aterial, m ainly b y e rosions o f t he a rticular s urfaces e specially a t t heir p eripheries. H owever, m any o f t hese s urface a ppearances a re d oubtful a nd r adiography i s n eeded t o r eveal t he m ore d eep-seated c hanges, i ncluding o steoporosis. T he l ate s tages w here r esolution w ith o steosclerosis a nd o steo-arthrosis o bscure t he o riginal c ondition m ay b e e ven m ore d ifficult t o d ecide u pon. A mong t he E nsay b ones n o u nequivocal e xamples o f r heumatoid a rthritis w ere d etected t hough t here a re p lenty t hat r emained d oubtful, p artly b ecause o nly a f ew c ould b e b rought t o L ondon f or r adiography . F urthermore, i t w as n ot p ossible i n a ll i nstances t o u ndertake t he c areful s ystematic e xamination o f t he s mall b ones o f t he h ands, w rist a nd f eet t hat m ight h ave r evealed c haracteristic e arly e rosive c hanges. I t c an , h owever, b e s tated t hat g ross d eformities a nd b ony a nkyloses o f t he h ands a nd f eet t hat a re t he m ost c haracteristic f eature o f s evere r heumatoid a rthritis w ere n ot a p redominant f eature o f t he E nsay p opulation. E rosions o f t he a rticular s urfaces o f t he m andibular j oint w ere c ommon , b ut w ere m ostly i n p eople o ver t he a ge o f 4 5 y ears a nd w ere t hought t o b e p robably s o-called w ear a nd t ear c hanges, o r o steoa rthrosis, a ssociated w ith w orn d entitions. T here w ere m any e xamples o f c hanges i n t he c ervical s pine w hich r esembled t hose w hich s ome p eople a ttribute t o r heumatoid a rthritis ( Resnick a nd N iwayama , 1 981, p . 8 72) m ainly a ffecting t he a pophyseal j oints a nd c losely r esembling t he c hanges o f o steo-arthrosis b ut a ssociated a lso w ith l ipping o f t he b odies. T here w ere s ome e xamples o f e rosions o f t he o dontoid p rocess w hich , a ccording t o R esnick a nd N iwayama ( p. 9 18) i s ac ommon f eature o f r heumatoid a rthritis. T he p roblem o f d iagnosis i s i llustrated b y t he c osto-vertebral j oints o f aw oman a ged 3 5 y ears d epicted i n F igure 7 8. T he p eripheral f ormation o f o steophytes a ffected a n umber, b ut n ot a ll, o f t he c ostov ertebral j oints a nd v ery s lightly s ome o f t he a pophyseal j oints o f t he t horacic v ertebrae. T hese c hanges a ppeared n ot t o b e s econdary t o d egenerative c hanges i n t he i ntervertebral d iscs b ecause t here w as s light l ipping o f t he m argins o f t he l umbar v ertebrae o nly. T he s ex, a ge a nd t ype o f j oint a ffected s trongly s uggest r heumatoid a rthritis ; i ndeed t here w ere a lso s light e rosions a nd l ipping o f t he j oints o f t he w rist a nd h ands. I t i s s trange t hat t he o riginal a rticular s urfaces o f t he m ost a ffected c osto-vertebral j oints c an s till b e d iscerned ( Fig. 7 8); i n r heumatoid a rthritis o f t his s everity, t hey w ould p robably b e m uch e roded. A nother p ossibility i s f ocal s econdary i nfection f rom a l ow-grade b lood-borne i nfection f rom a p rimary s urface l esion e lsewhere a t a s kin o r m ucosal p ortal o f e ntry. R heumatoid a rthritis i n g eneral i s a d estrucLi - ,e p rocess a ssociated w ith b one a trophy i n c ontrast t o o steo-arthrosis w hich i n g eneral i s a ssociated w ith b one p roliferation. T he m andibular j oints a nd w rist j oint o f aw oman o f 6 0 y ears ( Figs. 7 9 a nd 8 0) s how f eatures o f a trophy w hich a re s trongly s uggestive o f r heumatoid a rthritis a lthough t here a re a lso f eatures t hat a re m ore c haracteristic o f o steoa rthrosis. T he m andibular j oints ( Fig. 7 9) s how a trophic c hanges i n t he a rticular e minences o f t he t emporal b one a nd i n t he m andibular c ondyles. T he e minence o n t he r ight s ide i s c ompletely e roded s o t hat

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F ig. 7 8.

C osto-transverse j oints o f w oman a ged 3 5 y ears ( A 3 2M/67C).

L eft: T 11. T he r ib h as b een r otated s o t hat i ts l ower m argin i s a bove. C osto-transverse a rticular s urfaces a re f ringed b y s piky o verg rowths; o riginal a rticular s urface o n t he v ertebra c an b e d istinguished. R ight: T 9 a nd T 10. C osto-transverse j oints s how c hanges s imilar t o t he a bove, s hared t o s ome e xtent b y j oint b etween h ead o f 1 0th r ib a nd t he b odies o f v ertebrae. T here a re f ew c hanges i n a pophyseal j oints b ut a r ounded f acet a t l ower m argin o f i nferior a rticular p rocess o f T 10 ( arrow) i ndicates a n a bnormal a rticulation w ith t he l amina o f T 11 d ue t o s liding d own o f t he f acets o n o ne a nother.

t he a rticular s urface i s f lat. T he m andibular c ondyle i s a lso f lattened w ith t he f ormation o f a t hin i rregular p erforated s helf o f n ew b one a nteriorly. O n t he l eft, t here h ave b een s imilar c hanges t hough l ess s evere s o t hat t here i s s till a g lenoid c avity b ut t he a rticular e minence i s f lattened. T here w as t otal l oss o f t he u pper d entition; i n t he l ower j aw , o nly t he c anines a nd t wo c arious p remolars h ad s urvived, i n a s tate o f a dvanced p eriodontal d isease. J udging f rom t he a trophic a lveolar p rocesses, m ost o f t he t eeth h ad b een l ost f or m any y ears. T he e dentulousness, a ccompanied p robably w ith v igorous a ttempts t o c hew w ith t he f ew r emaining t eeth a gainst t he a pposing g um w ould l ead t o u nduly m obile m andibular j oints c reating t he s o-called w ear a nd t ear t hought t o b e a n i mportant f actor i n o steo-arthrosis. O n t he o ther h and, t he d estruction o f s o m uch b one a nd d istortion o f t he m orphology i n t hese j oints m akes i t p robable t hat t he c hanges a re t he l ate r esult o f n ow-inactive r heumatoid a rthritis. T his i s m ade m ore l ikely b y t here b eing s everal o ther j oints, i n p articular t he r ight w rist-joint, s imilarly a ffected ( Fig. 8 0). T he s urfaces o f t he s mall b ones o f t he w rist ( scaphoid a nd l unate) w ith w hich t he u lna a nd r adius a rticulated a re s imilalry a trophic a nd e burnated. O n t he o ther h and , t he l eft w rist-joint s hows o nly s light o steo-arthrotic c hanges a nd t he o ther s mall b ones o f t he h ands a nd f eet w hich a re t ypically a ffected i n r heumatoid a rthritis d id n ot s how c hanges s uggestive o f t hat c ondition . H owever, a bout h alf o f t hose s mall b ones w ere n ot r ecovered. A f ew o ther d iseases d isorganize j oints b ut m ost o f t hem a re e ither o f r heumatoid-arthritis t ype a nd e xtremely d ifficult t o d ifferentiate i n s keletal m aterial o r a re s yndromes i n w hich r heumatoid 1 22

z

A

F ig. 7 9. M andibular j oints o f w oman a ged 6 0 y ears ( A 2 9V/66C) s howing g ross a trophic c hanges . T emporal a rticular s urfaces a re d epicted f rom b elow a nd m andibular c ondyles f rom l ateral s ide a nd s lightly a bove. M ast - m astoid. A ud - e xternal a uditory m eatus. F or. o - f oramen o vale. C ar. c - c arotid c anal. Z yg - z ygomatic a rch. A . R ight s ide. A rticular e minence h as b een c ompletely e roded a way a nd a rticular s urface i s f lat; g reater p art, p articularly w here e minence w as , i s t hin a nd f inely p itted; t riangular p it l eads i nto m iddle c ranial f ossa. M andibular c ondyle i s m uch e roded, l eaving i rregular, s lightly r ounded s urface w ith t hin, p erforated e xtension a nteriorly. B . L eft s ide. E arlier s tage o f s imilar c hanges. G lenoid c avity i s m ore o r l ess i ntact b ut s urface o f e minence i s f lattened a nd f inely p itted. A nterior f ace o f c ondyle i s f lattened a nd i rregular.

F ig. 8 0. D istal e nds o f r ight r adius a nd u lna o f w oman o f 6 0 y ears ( A 2 9V/66C) s howing g ross o steo-arthrotic c hanges p robably s uperimposed u pon j oint s urfaces a ffected b y r heumatoid a rthritis. A . P osterior s urface o f r adius t ilted a nd r otated t o d isplay a rticular s urfaces i ncluding m edial c oncave a rticulation w ith u lna. B . U lna d istal h ead r otated t o s how i ts l ateral s urface o f a rticulat ion w ith r adius. A rrow i ndicates a p olished, d ense e burnateds s urface. N ote t he n arrow p art o f s haft, p art o f e vidence o f e arlier r heumatoid a rthritic d estructive p rocess. C . O pposite m edial s urface o f h ead o f u lna. P art o f a trophic o riginal s haft c an b e r ecognized b ut m ost o f t he h ead h as b een d estroyed a nd r eplaced b y t hick o steophytic g rowths. 1 23

a rthritis i s a ssociated w ith v arious n on-articular d isorders , f or e xample o f s kin ( psoriatic a rthritis), o f m ucosas ( Reiter s yndrome) o r o f t he s pleen, o f w hich n o t race c ould r emain a fter s keletalization . A lthough t he i mpression w as g ained t hat r he matoid a rthritis w as n ot c ommon o n E nsay, i t m ust n ot b e t aken a s p ro n . Am ore d etailed s tudy, p articularly o f t he s mall b ones o f t he h and, w rist a nd f eet ( most o f w hich w ere c arefully r ecovered) m ight e stablish t hat i t w as c ommon t hough n ot i n s evere f orms. A f urther s earch f or e vidence o f e arly s tages o f r heumatoid a rthritis a mong t he E nsay p opulation m ight b e r ewarding b ecause, a ccording t o S inclair ( 1825) i n h is a nalysis o f t he S tatistical A ccount o f S cotland ( 1791-1799), r heumatism h ad b ecome m uch m ore p revalent i n S cotland i ncluding t he W estern I sles t han i t h ad b een 7 0 o r 8 0 y ears p reviously. H e d oes n ot d efine r heumatism e xactly b ut i t s eems f rom h is d iscussion o f w hat w ere t hought t o b e i ts c auses t hat h e u sed t he t erm m uch a s w e w ould t oday t o m ean a ttacks o f p ainful m ovement p redominantly i n t he j oints i nvolving m any p arts o f t he b ody. T he t erm w ould n o d oubt h ave e mbraced a lso w hat c an l oosely b e c alled o steoa rthritis o f o lder p eople. F or i nstance h e a ttributed t he i ncrease i n r heumatism t o t he g reater n umber o f p eople l iving i n c old d amp h uts a nd a l ack o f a ppreciation o f t he v alue o f f resh a ir c irculating i n t hem ; a lso t o t he p opularity o f l inen f or s hirts i n p lace o f w ool. I t i s q uite p ossible t hat t he r heumatism S inclair r eferred t o a nd w hich m ight h ave a ffected t he p opulation o f E nsay a ffected j oints a s w ell a s n on-articular t issues, m uscles a nd f ascia , b ut r emained a t a l ow l evel o f a ctivity w ithout p rogressing t o t he s tage o f g ross b one e rosion . T hus a f urther m ore d etailed e xamination o f t he m aterial s hould p articularly e mbrace a c omparison o f t hat o f e arly d ate, 1 5001 600 A D , w ith t hat d ated t o t he 1 8th c entury, i n o rder t o s pan t he p eriod w hen, a ccording t o S inclair, r heumatism b ecame m ore p revalent. I t s hould b e n oted t hat t he m orbid a natomy o f r heumatoid a rthritis w as n ot d escribed u ntil A dams d id s o i n 1 857 a nd w hether t he c ondition e xisted o r w as k nown i n E urope e arlier t han t he l ate 1 7th c entury h as b een a m atter o f d iscussion ( Appelboom e t a l, 1 981). H owever, O rtner a nd P utschar ( 1981) r eferred t o p robable e xamples o f r heumatoid a rthritis i n a n E nglish m edieval b urial a nd i n s everal A laskan E skimos o f u nspecified d ate.

A nkylosing s pondylitis T his i s a c ondition i n w hich t he c hanges t hat o ccur i n t he j oints r esemble t hose o f r heumatoid a rthritis a nd w hich i n o ther w ays a ppear t o h ave s ome c onnection w ith t hat c ondition . H owever, t here a re m ajor d ifferences; f or i nstance a nkylosing s pondylitis i s m ore c ommon, b y a t l east 6 :1, i n m ales. T he a xial s keleton i s p rincipally a f4 . :cted t hough t he a ppendicular s keleton m ay a lso b ecome m uch i nvolved . T he a pophyseal a nd c osto-vertebral j oints a re u sually t he f irst a nd m ost a ffected a nd t hen t he s acro-iliac j oints. A nkylosis o ccurs a t a n e arly s tage. U sually a lso o ssification o ccurs i n t he p eripheral l ayers o f t he a nulus f ibrosus o f t he d isc l eading t o a nkylosis b etween t he b odies o f t he v ertebrae. T his c ondition i s d istinguishable f rom t he l ipping a nd o ccasional a nkylosis o f d egenerative s pondylosis b ecause, i n a nkylosing s pondylitis, t he l ipping o r o ssification a rises f rom t he a ctual m argins o f t he e nd p lates ( Fig. 7 1) w hereas , i n d egenerative

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s pondylosis, i t a rises j ust e xternal t o t he m argin, t hat i s f rom t he m arginal f ace o f t he b ody; t his i s b ecause t he o ssification o ccurs n ot i n t he d isc b ut i n t he l ongitudinal l igaments w hich a t c 4 . : a ttached t here. W hen a nkylosing s pondylitis b egins i n l ate l ife, t here m ay a lready b e d egenerative c hanges i n t he d iscs w ith c onsequencial b ony c hanges, s o t hat d iagnosis b ecomes e xceedingly d ifficult. A t l ater s tages o f a nkylosing s pondylitis, o ther j oints, h ips a nd s houlders a s w ell a s s maller j oints, m ay b e a ffected b ut t he a ctual c hanges a re i ndistinguishable f rom t hose o f r heumatoid a rthritis. N o f ull-fledged u nequivocal e xamples o f a nkylosing s pondylitis w ere f ound a mong E nsay m aterial b ut a s urface f ind o f t hree c ervical a nd t wo t horacic v ertebrae ( Fig. 8 1), a ll u nquestionably f rom t he s ame i ndividual b ut o f s ex a nd a ge i mpossible t o e stimate, s howed f eatures s trongly s uggestive o f t his c ondition. C 5 a nd C 6 a re c ompletely f used a t t he a pophyseal j oints; t here i s a lso a lmost c omplete f usion o f t he b odies, a t l east a t t he p eripheries, i ncluding p osteriorly. C 7, T i a nd T 2 a re s imilarly f used c ompletely a t t he a pophyseal j oints a nd b y b ands o f b one a cross t he a djacent m argins o f t he b odies, b ut n ot p osteriorly. T he a pophyseal j oints b etween C 6 a nd C 7 a re u nfused b ut s how e rosion a nd t he f ormation o f i rregular p eripheral e xtensions o f n ew b one, f orming e nlarged c omplex s urfaces c ongruent w ith e ach o ther. T he s uperior a pophyseal j oint s urfaces o f C 5 a nd t he i nferior o nes o f T 2 s how s imilar c hanges, a s d o t he s urfaces o f t he c osto-vertebral a nd c osto-transverse j oints o f T i a nd T 2. T hese c hanges a re c onsistent w ith t he d iagnosis o f a nkylosing s pondylitis a s, i n p articular, i s a l arge s pike o f b one t hat e xtends f rom t he l ateral s urface o f t he b ody o f C 7. T his s eems t o b e a n o ssification ( enthesis) i nto t he r adiate l igament t hat c overs t he c apsule o f t he c ost-vertebral j oint o f t he f irst r ib. O ssification i n t he a ttachments o f l igaments a nd t endons i s a c ommon f eature o f a nkylosing s pondylitis. I t i s, h owever, t he n ature o f t he l ipping o f t he m argins o f t he b odies i n t his s pecimen o n w hich t he d iagnosis o f a nkylosing s pondylitis m ainly d epends. I t e xtends v ertically f rom t he b ody m argins a nd d oes n ot p roject o utwards, w hereas n early a ll t he l ipping w hich i s s o c ommon i n t he a dult E nsay m aterial a rises f rom t he b ody j ust a bove o r b elow t he m argin o f t he e nd-plate a nd o ften p rojects o utwards a s i s c haracteristic o f d egenerative d isc d isease ( Figs. 7 0 a nd 7 1). R adiographs o f t hese f ive f used v ertebrae s howed a s peckled p attern o f o pacities, m ainly i n t he b odies; t he o pacities a re p robably a reas o f m ineralizing m etastases b y a c arcinoma b ut i t i s n ot l ikely t hat t hey w ere t he c ause o f t he a nkyloses. T hey w ill b e d ealt w ith m ore f ully i n t he s ection o n N eoplasia ( p.132 ) . A nother i solated f ind o f a f used p air o f c ervical v ertebrae ( C3 a nd C 4; A /66A) s hows t he s ame f eatures a s t he f oregoing, e xcept t hat t he s pinous p rocesses a re a lso f used b y aw eb-like b and o f b one. T his c ould b e a nother i nstance o f a nkylosing s pondylitis, t hough l ocalised a ppearances l ike t his c ould a lso b e p roduced b y a s uppurative i nfection o r b y t rauma.

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F ig. 8 1.

V ertebrae ( A/66A) s howing a nkylosing s pondylitis.

R ight. P osterior s urfaces. A pophyseal j oints a nd p arts o f l aminae o f C 5 a nd C 6 a re c ompletely a nkylosed. C 6 a nd C 7 a re n ot u nited b ut p itting a nd g rowth o f n ew b one p eripherally c an b e s een a ffecting a rticular f acets o n C 7. C 7, T i a nd T 2 a re a nkylosed. L eft. A nterior s urfaces. B odies o f C 5 a nd C 6 a re a nkylosed a t t heir p eripheries e xcept i n t he m idline. C hanges i n i nferior a rticular f acets o f C 6 a nd T 2 c an b e s een. B odies o f C 7, T i a nd T 2 a re n ot a nkylosed e xcept b y a s ingle b and o f b one ( arrow-head) b ut m argins o f b odies h ave b een b rought c lose t ogether b y i rregular g rowth o f b one w hich, e xcept f or t he o ne b and o f b one, i s a t t he a ctual m argins a nd n ot p rojecting, u nlike o steophytes i n d egenerative s pondylosis. A rrow i ndicates s piky g rowth o f n ew b one a t s ite o f a ttachment o f l igaments o ver h ead o f f irst r ib, a ttached t o b ody o f T i. A rticular f acets f or r ibs a re p itted a nd o steophytic.

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O ther c auses o f a nkylosis o f v ertebrae A nkylosis o r b ony f usion b etween a djacent v ertebrae m ay i nvolve t he b odies o r t he a pophyseal j oints. T he a cquired v arieties r eferred t o h ere a re n ot a lways e asily d istinguished f rom t hose o f d evelopmental o rigin d escribed o n p . 46. F usion o f t he b odies b y b ridging o steophytes f ormed a t t he p eripheries o f t he e nd p lates a nd a ssociated w ith w idespread o steophytosis a re u sually a ttributable t o d egenerative s pondylosis ( Figs. 7 2 a nd 7 3) t hough s ome m ore l ocalized e xamples o f b ridging o steophytes s eem t o b e t he r esult o f a n a cute t rauma , p resumably o ssification i n ah aematoma f ormed o n t he f ront o r s ides o f t he b odies ( Fig. 5 3). S ome o ther e xamples o f a nkylosis o f b odies a re a lso r eferred t o e lsewhere. T here a re m any e xamples o f f usion o f a pophyseal j oints , s ome u nilateral b ut m ost b ilateral. T his c an r esult f rom t rauma, s uppurative i nfections, s pecific i nfections s uch a s t uberculosis , o r f rom r heumatoid a rthritis. A s t he m orphological e nd-product, d estruct ion o f t he a rticular s urfaces a nd u nion a cross t he s urfaces b y b one, i s b ound t o b e s imilar, i t i s e xtremely d ifficult t o d o m ore t han g uess t he c ause i n a ny p articular c ase u nless t here i s e vidence a part f rom t he a ffected j oints t hemselves. S ome e xamples w ill b e d escribed; o thers a re r eferred t o e lsewhere. T he e xample i n F igure 5 2 i s e vidently d ue t he s ame t rauma t hat p roduced t he c ompression f ractures o f t he b odies. T he j oint s paces a re c ompletely o bliterated b y b one a nd o therwise t here i s b ut l ittle d isturbance b y n ew b one f ormation o f t he m orphology o f t he a rticular p rocesses. P resumably t here w as d amage t o t he a rticular c artilages, h aemorrhage i nto t he j oint s pace w ith v ascularization o f c lot a nd e ventual o ssification o f t he r epair t issue. T he a xis a nd C 3 i n F igure 8 2 a re f rom a m an a ged 6 0 y ears a nd s how b ony a nkylosis t hrough t he a rticular f acets o f t he a pophyseal j oints o n b oth s ides a nd a lso b y w hat s eems t o b e n ew b one f ormed b etween t he p eripheries o f t he e nd p lates o f t he b odies . T he j oint s paces o f t he a pophyseal j oints a ppear t o b e c ompletely o bliterated a nd, o n b oth s ides, t he o riginal c ontours o f t he m argins o f t he a rticular s urfaces, p robably s lightly l ipped b efore f usion, c an b e d iscerned. C ontinuous w ith t he b one o f t he a nkylosis, w eb-like b one f ormations e xtend f or a s hort d istance a cross t he l aminae o f t he t wo v ertebrae. T he b one u niting t he b odies p resents a s mooth s urface p osteriorly b ut l aterally s ome t race o f t he o riginal c ontours o f t he m argins o f t he e nd p lates c an b e d iscerned. A nteriorly t here i s n o u nion a nd a w ide s lit l eads i nto t he d isc s pace. M ost o f t he a pophyseal j oint s urfaces o f t he o ther c ervical v ertebrae, e specially o n t he l eft, s how g ross p itting a nd p eripheral l ipping; t he b odies l ikewise s how g ross c hanges, i rregular l ipping s econdary t o d egenerative c hanges i n t he d iscs.

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T he t races t hat c an b e d iscerned o f t he o riginal c ontours o f t he m argins o f t he a pophyseal a rticular s urfaces, d isturbed b y s ome o steophytosis, p rovide g ood e vidence t hat t his a nkylosis i s a cquired a nd n ot d evelopmental i n o rigin, e specially w hen c ompared w ith t he u nequivocally d evelopmental u nion i n t he s pecimen i n F igure 2 7. I t m ay b e t hat t he a nkylosis i s s imply a f urther s tage o r c omplication o f t he c hanges s imilar t o t he o steo-arthrosis a nd d egenerative c hanges t hat h ave a ffected t he o ther v ertebrae b ut, o n t he w hole, i t s eems m ore l ikely t hat t he a nkylosis f ollowed s ome a cute t rauma t hat c aused h aemorrage i nto t he a pophyseal j oints b etween C 2 a nd C 3 a nd i nto t he p eripheral l igaments b etween t he b odies a nd t hat m ost o f t he d egenerative a nd o steo-arthrotic c hanges i n t he o ther v ertebrae o ccurred l ater. A n i solated f ind o f aC 2 a nd C 3 ( B/66A) w ith f usion b etween t he l eft a pophyseal j oint i s s imilar t o t he f oregoing, i ncluding t he f ormation o f aw eb o f n ew b one b etween t he l aminae, e xcept t hat t he c ondition i s s trictly c onfined t o t he l eft s ide. T he l ateral a spects o f t he j oint a re m uch a dded t o b y t he i rregular f ormation o f n ew b one s uggestive o f a h ealed i njury p robably w ith o rganization o f a h aemorrhage. C onsistent w ith s uch i njury o r p ossibly s econdary t o t he l imitation o f m ovement, t he l eft i nferior a rticular f acet o f C 3 i s b roadened m ainly b y e xtension o n t o t he t ransverse p rocess. T here a re a lso o steo-arthrotic c hanges i n t he n earby l ateral a spect o f t he i nferior s urface o f t he b ody o f C 3 ( joint o f L uschka). T he p ossibility o f a n i nfection p laying a p art i n t his a nkylosis c annot b e e ntirely d iscounted.

E nd-plate o f C 5 s hows i rregular g rowths o f m arginal o steophytes w hich a nteriorly p roject d ownwards b y a bout 0 .9cm t o o verlap C 6 a nd f it i nto h ollows o n i ts s urface. N ote e ncroachment o n t he g rooves f or t he s pinal n erves a nd f oramina i n t he t ransverse p rocesses f or v ertebral a rteries b y n ew b one a t l ateral s ides o f t he s urface o f t he b ody ( arrows); t hese a re t he s ites o f t he s ynovial j oints o f L uschka. N ote a lso e xtension f orwards ( arrowheads) o n t o t he p edicles o f a pophyseal f acets a s ar esult o f p ressure d ownwards a gainst t he a rticu : Lar p rocesses o f C 6, c ontributing t o n arrowing o f t he i ntervertebral c anal. C . S uperior s urface o f T i s howing g ross e nlargement o f a pophyseal j oint f acets b y p eripheral g rowth o f o steophytes a nd e xtension o f t he a rticular s urfaces o n t o t he l aminae a s ar esult o f t he c ollapse o f t he i ntervertebral d isc. T he r ounded m argins i ndicated b y a rrowheads, b ecause t he s urfaces h ave s lid d own o n o ne a nother, a rticulate w ith t he p edicles a nd t ransverse p rocesses o f t he v ertebra a bove ( compare i nferior s urfaces o f C 5 i n B .)

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F ig. 8 2. C ervical a nd f irst t horacic v ertebrae o f am an a ged 6 0 y ears ( D 4 7Y/67A). A . L eft a ntero-lateral v iew o f C 2, C 3 a nd C 4 . C 2 a nd C 3 a re u nited t hrough t he a pophyseal j oint ( arrowhead) a nd, e xcept n ear t he m idline, b y b ands o f b one b etween t he m argins o f t he b odies. A pophyseal a rticular f acets o f C 3 a nd C 4 a re e nlarged a nd t hickened b y p eripheral a dditions o f b one; s uperior f acet o f C 4 h as a n i rregularly-rolled e verted m argin ( arrow) w hich, b ecause t he v ertebra i s d isplaced u pwards, p resses o n t he i nferior s urface o f l ateral p rocess o f C 3. S tar i ndicates p itted e nlarged i nferior a rticular f acets o f C 4. N ote c onstriction b y o steophytic g rowths o f i ntervertebal f oramen b etween C 3 a nd C 4 ( white s tar) c ompared w ith t he n ormal-sized o ne a bove b etween C 2 a nd C 3. N ote b uttresses o f n ew b one o n s urface o f t he b ody o f C 4 a ppearing t o s upport t he o steophytic m arginal e xtensions. B . A pposing s uperior s urface o f C 6 ( above) a nd i nferior s urface o f C 5 ( below). E nd-plate o f C 6 i s c oarsely p itted a nd a t t he c entre t here i s as mall S chmorl n ode. A nteriorly t he m argin i s d eeply c upped o ut w ith t ransverse h ollows i nto w hich f it c orresponding d ownward-projecting i rregularities o f m argin o f i nferior s urface o f C 5. A rticular f acets a re p itted, e nlarged b y m arginal e xtensions a nd h ave e ncroached o n t he l aminae. N ote n arrowing o f g roove f or t he s pinal n erves o n l eft s ide ( arrowhead) b y o steophytic g rowth. [ continued o n f acing p age] 1 29

N eoplasia a nd s imilar l esions T here w ere o nly a f ew e xamples o f n eoplasms. T he m ost s imple i s a d ome-shaped o steoma o f i vory-like d ensity a bout 1 .4cm i n d iameter o n t he o uter s urface o f t he f rontal b one n ear t he c entre o f t he f orehead o f aw oman a ged 5 5 y ears ( A 7 i/66A). A d epression a bout 1 .5cm d iameter n ear t he m iddle o f t he l eft f rontal b one o f am an a ged 3 5 y ears ( E 3 U/82D) i s s uggestive o f a d epressed f racture o f t he o uter t able o f t he b one; t here i s n o c orresponding e levation o f t he e ndocranial s urface. H owever, b ecause o f i ts s trictly h emispherical s hape, a bsence o f ar aised m argin a nd t he s moothness o f i ts l ining c ortical b one, i t w as m ore l ikely t o b e a d epression p roduced b y t he c ontinuous l ong-standing p ressure o f a s ebaceous c yst i n t he o verlying t issues. T he i nferior p art o f t he s ternum o f am an a ged 5 0 y ears ( Fig . 8 3), w hich o n t he l eft s ide s hows o ssification i nto t he c artilages o f t he f irst a nd s eventh r ibs, i s d istorted b y a r ounded l esional m ass. T he l esion m ainly i nvolves t he x yphoid p rocess, w hich i s f used t o t he b ody o f t he s ternum , a nd e xtends s lightly i nto t he o ssified r egion o f t he s eventh r ib. O nly t he p osterior p late o f t he x yphoid p rocess r emains; i t h as b een c urved b ackwards a nd p erforated b y t he l esion . T he a nterior b one h as b een d estroyed b y t he l esion . T he l esional s urface o f t he b one i s d ense a nd i rregularly s mooth s uggesting t hat t he l esion w as a b enign n eoplasm , p erhaps a c hondroma, r ather t han a n a bscess. T he l eft f emur o f a 1 7-year-old, p robably m ale m ainly b ecause o f t he l arge s ize o f t he s kull, j aws a nd t eeth , h as a l esion w ithin t he g reat t rochanter w hich i s p robably a c hondroblastoma . O f t he f our f emoral e piphyses, o nly t he p roximal h ead w as u niting. T he o nly d isturbance o f t he e xternal m orphology o f t he b one i s s light e xpansion o f t he m edial f ace o f t he t rochanter e piphysis a nd a n o pening a t i ts c entre w hich l eads i nto a l arge c avity c ompletely h ollowing o ut t he e piphysis, l eaving a w all a bout 0 .3cm t hick ( Fig. 8 4). T he c avity e xtends i nto t he s haft a s f ar a s t he l evel o f t he l ower m argin o f t he l esser t rochanter. T he l ining o f t he c avity i s p artly s mooth b ut m uch o f i t s hows t he p attern o f t he t rabeculae o f t he o riginal b one s uggesti ng t hat t he i nvasive l esion w as s preading i nto t he m arrow s paces l eaving m ajor t rabeculae i ntact. Am ajor b uttress o f b one t hat s urvived t he i nvasive p rocess c an b e s een w ithin t he c avity e xtending f rom t he s haft i nto t he n eck o f t he f emur, a nd i n r adiographs ( Fig . 8 4). T he t rochanter i s a f avoured s ite f or t uberculosis b ut t he s urface o f t he c avity i s n ot t hat p roduced b y a n i nflammatory p rocess a nd t he r adiographic a ppearances d o n ot s uggest t uberculosis ( Dr. D .J . S toker). T he l esion i s m uch m ore l ikely t o b e an eoplasm w ith l ocallyi nvasive c haracteristics. T he s ite o f o rigin c ould h ave b een o n e ither s ide o f t he e piphyseal p late w hich w as t hen p enetrated o r t he l esion m ay h ave a risen i n t he e piphyseal c artilage i tself w hich s uggests, t aking a ccount o f t he a ge o f t he s ubject , ac hondroblastoma . A mong t he s cattered b ones d issociated w ith a ny p articular i nterment w as t he p osterior e nd o f ar ib ( Fig. 8 5) e xpanded t o a bout t hree t imes i ts n ormal s ize a nd s o d istorted t hat f ew n ormal m orphol ogical f eatures a re r ecognizable e xcept b oth a rticular f acets.

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F ig. 8 3. A nterior a spect o f s ternum o f m an a ged 5 0 y ears ( D 4 6Z/67A). O n l eft s ide, t here a re e xtensions ( arrowheads) o f n ew b one o n t o s urfaces o f f irst a nd s eventh c ostal c artilages. R egion o f x yphoid p rocess h as b een d istorted b y ar ounded l esional m ass. O nly t he b ackward c urving a nd p erforated p osterior p late o f b one r emains.

F ig. 8 4. L eft f emur o f m ale a ged 1 7 y ears ( A41F/67D). E piphysis o f g reater t rochanter h as b een r emoved, a nd i ts u nder s urface d isplayed, t o s how l esional c avity e xtending i nto s haft o f f emur. S tar i ndicates b uttress o f o riginal b one e xtending i nto t he n eck o f f emur. I n w all o f d eeper p art o f t he c avity, t rabecular s tructure o f o riginal b one s tands o ut i n r elief. T he c avity s urface i n t he e piphysis i s m ore s mooth. A rrow p assed t hrough s urface o pening o n m edial f ace o f t he e piphysis s hows c ommunication w ith c avity. I n t he r adiograph, u n—united e piphysis o f t he t rochanter h as b een p laced i n p osition. T he l esion i nvolves b oth s haft a nd e piphysis a nd m ust h ave d estroyed o r p enetrated t he c artilaginous e piphyseal p late. P robably a c hondroblastoma o riginating i n c artilage. 1 31

O n t he u pper s urface, t he t hinned c ortex i s b roken t hrough i n s everal p laces r evealing t hat t here a re a ngular s paces w ithin , n ot g lobular o r c ystic. R adiography s hows t hat s ome m ain b ony t rabeculae c ross t he m ass w ith s ome f iner t rabeculae b etween. T he o penings i n t he c ortex d o n ot h ave t he r ounded m argins c haracteristic o f d ischarging s inuses; t his i s u nlikely t o b e a n i nfective l esion. I t i s m ore l ikely t o b e a t umour o r t umour-like l esion s uch a s f ibrous o steo-dysplasia. T he p roximal e nd o f t he h umerus o f a c hild a ged o ne y ear ( Fig. 8 6) i s g reatly d istorted a nd e xpanded b y a l esion w hich h as p roduced a c avity o f c omplex r ounded o utline w ith m ore o r l ess s mooth w alls. T he l esion h as p enetrated t he s urface i n m any p laces, t he l argest o pening b eing m edially. T he m argins o f t he o penings a re m ostly t hin a nd r agged b ut i n p laces a re r ounded w ith t he f ormation o f a n ew c ortex. O ne o f t he l argest o penings i s o n t he e piphyseal s urface. T he e piphysis i tself w as n ot r ecovered a nd t he a rticular s urface o f t he s capula i s s oil-eroded s o t hat, a lthough i t d oes n ot s eem t o h ave b een e roded b y t he l esion, i t i s i mpossible t o b e q uite s ure. T he i nner s urface o f t he c avity i s m ore l ike t hat p roduced b y a t umour-like l esion t han a n i nfective p rocess s uch a s t uberculosis . I t s eems l ikely t hat t he l esion w as a n a neurysmal b one c yst w hich i s k nown t o o ccur i n i nfancy b ut l esions s uch a s m onostotic f ibrous d ysplasia c annot b e e xcluded. O nly p arts o f t he s kull a nd a f ew o ther b ones w ere r ecovered. I n t wo i nstances, r adiographs o f t he s pine s how e vidence o f m etastatic c arcinoma. O ne i s t he o steoporotic s pine o f aw oman o f 6 5 y ears ( Fig. 3 7) w hich s hows m any a reas o f r adio-opacity t hroughout t he t horacic a nd l umbar v ertebrae. T hese a re a lmost c ertainly m etastases o f a m alignant n eoplasm ; t hat i s o f a n eoplasm t hat t ends t o i nduce a l ocalized m ineralizing r eaction i n b one. T he m ost l ikely c ause i n a w oman i s a c arcinoma o f b reast. S imilar s mall n ot s harply-defined a reas, w ere p resent i n r adiog raphs o f t he g roup o f f ive a nkylosed v ertebrae ( p.125 , F ig. 8 1). T he a ppearances a ccord c losely w ith t hose o f m ineralizing m etastases. I f f emale, t he m ost l ikely w ould b e a b reast c arcinoma a s i n t he p revious e xample; i f m ale, a p rostatic c arcinoma. P art o f t he r ight h umerus ( M3/71B) o f a n a dult, p robably m ale, c onsisting o f t he h ead a nd u pper t hird o f t he s haft, s hows e vidence o f h aving b een s eparated f rom t he r est o f t he b one b y a n eoplasm , a lmost c ertainly a m etastasis. T he s urface o f s eparation i s i rregular a nd s hows t he s calloped s urface i ndicative o f o steoclastic r esorption; t here i s n one o f t he p eriosteal t hickening t hat w ould b e e xpected i n a n i nflammatory o r i nfective p rocess. T here a re t wo l arge r Tenings i n t he c ortex, b ounded a lso b y s calloped r esorbed m argins s uggesting t hat t he n eoplastic p rocess w ithin t he b one h ad b roken t hrough t he c ortex. T his w as a s urface f ind d issociated f rom a ny i nterment.

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F ig. 8 5. U pper s urface o f i rregularly e xpanded p osterior e nd o f r ight r ib ( A8/66A). I rregular o penings e xtend i nto a ngular s paces p artitioned b y b ony t rabeculae. R adiograph o f t ilted s pecimen s hows t he c oarse t rabeculation o f t he l esional b one, f iner i n p laces.

F ig. 8 6. D iaphysis o f r ight h umerus a nd s capula o f c hild a ged o ne y ear ( D/79D). T he p roximal h umerus i s e xpanded a nd c ontains a c omplex r ounded c avity w ith s everal o penings o n t o t he s urface; a p ointer h as b een p assed t hrough t he o pening o n t he e piphyseal s urface. P robably a n a neurysmal b one c yst. 1 33

M iscellaneous l esions T he o nly d evelopmental a nomaly o bserved, a part f rom t hose a ffecting v ertebrae, i s a n a bnormal l eft r ib i n aw oman a ged 5 0 y ears. T he d istal o ne-third o f w hat i s p robably t he t hird r ib i s o f a bout t wice n ormal w idth a nd e nds i n t wo s eparate c osto-chondral j unctions ( Fig . 8 7) s o t hat t he c hondral e nd i n c ontact w ith t he s ternum m ust h ave b een d uplicated. T hat t here i s a s upernumerary e lement r ather t han f usion o f a p air o f n ormal r ib e lements i s s hown b y t here b eing a f ull c omplement o f 1 2 r ibs o n e ach s ide. F rom t he a rticular r ecesses o n t he s ternum a nd a ssuming t hat t he a bnormal r ib w as t he t hird, t he c hondral e nds o f t he r ibs w ould h ave b een a s d epicted d iagrammatically b ecause t here a ppeared t o b e as upernumerary r ib a rticular r ecess o n t he x yphoid p rocess w hich i s f used t o t he b ody o f t he s ternum . A ll t he b ones o f ac hild a ged o ne y ear ( Fig. 8 8) f rom t he d entition, e xcept t hose o f t he s kull, a re g reatly t hickened a nd m any, e specially t he f irst r ibs, a re g rossly d istorted i n s hape. T he b ones o f t he s kull a re o f n ormal s ize a nd t hickness, a lthough t here m ay b e a l ittle t hickening o f t he b ody o f t he m andible; t he l ong b ones a re s hort a s w ell a s t hick . A r adiograph o f t he s capula s hows t hat i ts u nusual s hape i s d ue t o p eriosteal b one d eposition b ecause t he o utline o f t he o riginal b one c an b e d iscerned w ithin t he e xternal o utline o f n ew b one. T he s hape o f t he o ther b ones c ould a lso b e e xplained o n t he b asis o f d eposition o f n ew b one o n t he s urface; e ven t he d istortion i n s hape o f t he f irst a nd s ome o ther r ibs c ould b e d ue t o u neven d eposition o f n ew b one. T oo m any b ones a re a ffected f or t hese t hickening o f t he b ones t o b e d ue t o l ocalized i nfections o r o steomyelitis. W idespread s ubp eriosteal t hickening i n i nfancy c an b e d ue t o c ongenital s yphilis ; h owever, t he s kull i s n ot l ikely t o e scape. O n t he o ther h and, t hickening o f t he p ost-cranial b ones i n i nfancy c losely r esembling t his i s o ne o f t he c haracteristics o f i nfantile c ortical h yperostotis ( Caffey's d isease); t he m andible i s u sually a ffected b ut t ypically t he b ones o f t he c alvarium a re n ot a ffected ( Wynne-Davies a nd F airbank , 1 976). I nfantile c ortical h yperostotis i s ar are d isorder t hat w as n ot f ully r ecognized u ntil a bout 1 945. O nset i s u sually i n t he f irst y ear. T here i s f irst a d iffuse s welling o f t he s oft p arts a ssociated w ith t enderness o f o ne o r m ore b ones, t he m andible o r o ther b ones o f t he f ace, t he s capulae, l ong b ones o r t hose o f t he c hest. T he h ands, f eet , s pine a nd c alvaria a re n ot a ffected. A fter a bout 1 2 m onths o f i llness , r ecovery i s u sual; t he b ones g radually r eturn t o t heir n ormal c ontours . T he f acial s keleton o f am an a ged 4 0 y ears ( Fig. 8 9) s hows m arked a symmetry d ue t o h yperplasia o f t he l eft c ondyle o f t he m andible. T he p rojective v ertical h eight ( Miles, 1 973) o f t he a rticular s urface f rom t he m andibular b aseline o n t hat s ide i s 7 .8cm c ompared w ith 5 .5cm o n t he o pposite, n ormal s ide. T he a ffected c ondyle i s m uch l arger b ut o f m ore o r l ess n ormal m orphology , a lthough t he j oint s urfaces a re s lightly d istorted b y a rthritic c hanges.

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F ig. 8 7. B ody o f s ternum a nd l eft t hird r ib o f w oman o f 5 0 y ears ( D36X/67A) w hich h as a d ouble c osto-chondral j unction i nvolving a s upernumerary c hondral e lement. P robable r elationships o f t he r ibs a re d epicted, d educed f rom p resence o f e ight i nstead o f n ormal s even a rticular r ecesses o n l eft s ternum , o ne b eing o n t he x yphoid p rocess w hich i s o sified a nd f used t o t he b ody. R ibs a re n umbers, 3 + i ndicati ng t he s upernumerary r ib e lement.

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F ig. 8 8. P art o f s keleton o f c hild a ged o ne y ear ( D31Y/67B). B ones m arked w ith a sterisks a re h umerus a nd u lna f rom a n ormal o ne-year o ld c hild f or c omparison. T he b ones a re s tunted, t hickened a nd m isshapen. N ote c urved f ibula w ith i ts t ibia l ower l eft. T he s capulae a re p articularly t hickened ( right o ne b elow i s d amaged). L eft c lavicle a nd f irst r ibs a re p articularly m isshapen.

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F ig. 8 9. F acial a symmetry i n m ale a ged 4 0 y ears ( E/80D), d ue t o o verg rowth o f l eft m andibular c ondyle . T he f ace f rom b elow o rbits i s l onger o n t he l eft, t he o cclusal p lane i s n ot h orizontal; t here i s c rowding o f t he t eeth w ith g eneralized m alocclusion p rincipally b ecause t he l ower t ooth a rch i s l arger t han t he u pper. N ote g ross d eposits o f c alculus o n t he t ooth c rowns. T here i s am etopic s uture. T he l eft m andibular c ondyle p rojects w ell a bove t he l evel o f t he c oronoid p rocess a nd i s m uch w ider t han t he r ight. T he b ulk o f t he c ondyle a ppears t o h ave b een i ncreased b y n ew b one f ormation o n i ts a rticular s urface w hich i s p robably a rthritic. T he c orresponding g lenoid s urface s hows a rthritic c hanges w ith e rosion a nd f lattening o f t he a rticular e minence.

T he c artilage o f t he m andibular c ondyle p lays a n i mportant p art i n g rowth o f t he m andible a nd f acial s keleton a s aw hole; i n u nilateral b enign h yperplasia o f t he c ondyle ( Gorlin a nd G oldman, 1 970), t here i s c ompensatory g rowth o f t he m axilla a nd o ther b ones o n t he a ffected s ide, e specially i f o cclusion b etween t he t eeth i s m aintained o n t hat s ide, a s w as t he c ase h ere, l eading t o f acial a symmetry.

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T here w ere a f ew e xamples o f m isplaced t eeth t oo t rivial t o d eserve d etailed d escription b ut, i n t he l eft u pper j aw o f am an a ged 3 0 y ears ( Fig. 9 0), t he p ermanent c anine a nd p remolars a re a lmost c ompletely u nerupted. T he s pace i n t he t ooth a rch t hey w ould h ave e rupted i nto i s p artially c losed b y m ovement o f t he a djacent t eeth i nto i t. T his c losure o f t he s pace w ould h ave b een s econdary t o t he f ailure o f t he e ruptive p rocess a nd n ot t he c ause o f i t. R adiographs s how a s mall c onical s upernumerary t ooth c ompletely b uried i n t he b one i n a n i nverted p osition l ingual t o t he r oots o f t he i ncisors. T he c ommonest c ause o f n on-eruption o f ' t hese t eeth i s r etention o f t heir d eciduous p redecessors b eyond t heir n ormal t ime b ut t here w as n ot s ign o f a ny s uch r etention. T he p resence o f t he s upernumerary t ooth w ould n ot a ccount f or t he n on-eruption a nd i t i s h ard t o t hink o f p ossible c auses. I t i s p ossible t hat t here h ad b een a b enign s oft t issue t umour, s uch a s a f ibroma o f t he g um t hat h ad f illed t he s pace i n t he d ental a rch a nd p revented t he e ruption o f t he t eeth. T he f ormation o f t ooth e namel c an b e a ffected b y s evere n utritional d isturbances s uch a s r ickets a nd a lso m ore s pecifically b y t he e xanthematous f evers, s uch a s m easles a nd s carlet f ever ( Sarnat a nd S chour, 1 941). I f t he i llness i s o f s hort d uration o nly, a z one o f e namel m ay b e a ffected, p roducing t he s o-called r ing e namel h ypoplasia . O nly t hree e xamples w ere f ound, w hich i s p artly t he b asis f or s aying e lsewhere h ere t hat t here i s n o e vidence t hat r ickets a nd s evere n utritional d eficiencies i n c hildhood w ere c ommon o n E nsay. T he e xample o f e namel h ypoplasia o f t he f irst p ermanent m olars ( M1) i n a m ale a ged 3 5 y ears i n F igure 9 1 i s t ypical o f t he k ind w hich h as b een a ttributed t o m easles o r s carlet f ever o r t o s evere n utritional d isturbances t hat m ay b e a ssociated w ith p rolonged g astro-intestinal i nfections o r e ven t o w hooping c ough i n i nfancy. A t b irth , t he t ips o f t he c usps o f M 1 a re j ust f ormed b ut s till s eparate. T he a ffected e namel i n t hese M 1 s eems t o b e t hat f ormed b etween b irth a nd a bout n ine m onths o f a ge; t here s eems t hen t o h ave b een a r apid r eturn t o n ormal e namel f ormation . T his s uggests s imply a s ickly i nfant, p erhaps p remature, b arely s urviving f or s everal m onths. C ongenital s yphilis a ffects t he e namel d uring p recisely t hat p eriod a nd t ypically d iminishes t he s ize o f t he d ooth f ormed, h ence t he c ontracted n otched H utchinsonian i ncisor t hat i s c haracteristic o f s yphilis. E namel h ypoplasia a nd c ontraction o f t he o cclusal s urface o f t he M 1 i s s aid t o b e a ssociated w ith t he n otched i ncisors a nd i s n otoriously d ifficult t o d istinguish f rom t he o ther f orms o f e namel h ypoplasia . T he p ossibility o f s yphilis h as t o b e c onsidered i n t his i nstance b ecause t he o cclusal s urfaces p articularly o f t he u pper f irst m olars s eems c ontracted. T he m orphology o f t he e dges o f t he i ncisors w ere d estroyed b y w ear; o n t he w hole i t s eems l ikely t hat t he a pparent c ontraction o f t he o cclusal s urface i s s imply d ue t o t he e namel b eing t hinner t han n ormal. T he r ecovery o f as ickly s yphilitic i nfant e ventually t o b ecome a n a dult w ith a n u nusually r obust s keleton l ong b efore a ny s pecific t herapy w as a vailable ( interment w as i n l evel A , p robably p re-1850) i s h ighly u nlikely. t hickness t ooth i s e vidence.

A l ongitudinal s ection o f t hese m olars c ould r eveal t he o f t he e namel a nd w hether t he u nderlying d entine p artof t he c ontracted b ut w ould n ot b e l ikely t o r eveal c onclusive

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F ig. 9 0. U pper l eft j aw o f m an a ged 3 0 y ears ( E7S/82D). C anine a nd p remolars a re i n t heir p re-eruptive p ositions. T he s pace t hey s hould o ccupy i n t he a rch i s d iminished b y b ackward m ovement o f t he i ncisor a nd f orward m ovement o f m olars. T here i s n othing t o s uggest r etention o f d eciduous p redecessors. P ositions o f t he r oots a nd o f a n i nverted s upernumerary t ooth, a s s een i n r adiographs, i s i ndicated.

F ig. 9 1. M olar d entition o f m an a ged 3 5 y ears ( D 3 6Y/67A) s howing r ing e namel h ypoplasia o f f irst m olars. O cclusal v iew o f u pper m olars s hows t hat o cclusal e namel o f t he f irst m olars i s w rinkled a nd t he o gclusal s urface i s r educed i n s ize; i t s hould b e l arger t han t hat o f M '. L eft M1 h as a n e xtensive c arious g avity a nd t here i s c aries a lso o f e namel o f t he a djacent s urface o f M '. C aries h as a lso d estroyed t he c rown o f r ight Ml ; a n o pening i n t he b one l eads t o a bscess c avity a round i ts r oots a nd t he w hole t ooth h as b een p artly e xtruded. T here i s a lso c aries o f b uccal s urfaces o f l eft M2 a nd r ight Ml . A l ittle a bove t he e namel m argins o f t he l ower t eeth, a r im o f c alculus i ndicates w here t he g ingival m argin w as. T he d istance f rom t hat i s g reater t han n ormal ( 0.3mm o n r ight; a bout 0 .4mm o n l eft) s o t hat t here w ere p eriodontal p ockets o f e ven d epth a round t he t eeth, a l ittle d eeper i nterdentally, p roduced b y s ome d estruction o f b one o f a lveolar c rests. A rrow i ndicates l ocalized d estruction o f b one i nterdentally m esial t o M2 o n t he l eft ( a s hallow i ntrabony p ocket). T he b ony c ortex e lsewhere i s i ntact, e xcept b etween r oots o f a bscessed Ml . E specially o n t he l eft, t here i s as helf-like p rojection o f r eactive b one a l ittle b elow t he a lveolar c rest.

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Suprag i ngiva I calculus P l aque F ig. 9 2. D iagrammatic r epresentation o f r elation o f p laque, s ubgingival c alculus ( black) a nd s upragingival c alculus t o t he t ooth s urface a nd g ingival m argin i n e arly p eriodontal d isease.

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4 611 0 4 Bone

P eriodontal d isease P eriodontal d isease, o r m ore s trictly c hronic i nflammatory p eriodontal d isease t o d istinguish f rom o ther f orms, s tarts a s a n i nflammation o f t he g um m argin w hich l eads t o p rogressive d estruction o f t he c rests o f t he b ony a lveoli a nd t o t he f ormation o f p ockets b etween t ooth a nd g um . T he b eginnings o f p eriodontal d isease, l ike d ental c aries w hich i s y et t o b e d ealt w ith, l ie i n t he f ormation o n t he t ooth s urface o f a n a dherent f ilm k nown a s b acterial d ental p laque ( Fig. 9 2). F ollowing a m eal, a l ayer o f s aliva c ontaining f ood s ubstance a nd a s ample o f t he m icrobial f lora o f t he m outh i s l eft, n ot o nly o n a ll t he s urfaces o f t he c rowns o f t he t eeth b ut e xtends o ver t he g ingival m argin a nd p articularly i nto t he g ingival c revices b etween t he g ingival m argin a nd t he t ooth s urface. T his p laque m ay b ecome d etached a fter a s hort t ime b y t he m ovement o f t he l ips a nd t ongue b ut, i f t he f oods i nclude f ermentable s ubstances, s uch a s f ermentable c arbohydrate, m icroo rganisms a mong t he l arge v ariety p resent i n t he p laque, o r t heir e nzymes, a re l ikely t o p roduce s ticky h igh-polymer s ubstances w hich m ay b e s o r esistant t o d islodgment t hat t he p laque b ecomes a m ore o r l ess p ermanent f eature o f c ertain p arts o f t he t ooth. T hese i nclude p its a nd f issures o n t he o cclusal s urfaces, c ontact a reas b etween a djacent t eeth a nd t he g ingival c revices. D ental p laque p rovides am icro-environment t o a l arge e xtent s eparate a nd d ifferent f rom t he e nvironment i n t he m outh a t l arge. I t h as a s pecial m icrobial f lora, m aintained b y s ubstances t hat s eep i nto

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t he p laque f rom c onstantly r enewed l ayers o f s aliva m ixed w ith f ood s ubstances t hat a re d eposited o n i ts s urface. T here i s a g reat d eal o f e vidence t hat t he f lora o f p laque w ithin a nd a round t he g ingival c revice ( gingival p laque) i s s ignificantly d ifferent f rom t he f lora i n p laque o n t he t ooth c rown ( coronal p laque). O n t he o cclusal s urfaces o f t he t eeth, t here i s t oo m uch i ntert ooth a ctivity f or t he p laque t o r emain a nd t his m ay b e s o a lso f or t he e xposed s ides o f t he t eeth , d epending o n t he n ature o f t he d iet. I f t he d iet c ontains a l ot o f r oughage, t he p laque m ay b e r ubbed o ff a s i t w ould b e b y v igorous t ooth-brushing. H owever, i n c ertain a reas, p laque m ay r emain l ong e nough f or d estructive o r i rritant s ubstances t o b e f ormed w ithin i t. W ithin c oronal p laque, t he n ature o f t he m icrobial f lora t ends t o b e s uch t hat a cids a re f ormed a nd d ental c aries m ay c ommence ( see p .147 ) . W ithin g ingival p laque, t he s ubstances f ormed t end n ot t o b e t ooth d estructive, b ecause c aries v ery r arely o ccurs b elow t he g ingival m argin , b ut t hey a re i rritant, o r e ven d estructive t o t he s oft t issues o f t he g ingiva. S welling o f t he g ingiva i s a f eature o f t he c hronic i nflammation t hat a ccompanies t he p ersistence o f g ingival p laque. T his a lone i ncreases t he d epth o f t he g ingival c revice a nd c onsequently s tagnation w ithin t he p laque. M icro-organisms t hat p roduce t oxic s ubstances t hat a re p articularly h armful t o c ells, s uch a s C apnocytophaga a nd A ctinobacillus a ctinomycetemcomitans, h ave b een a mply d emonstrated i n g ingival p laque. T hus i t i s e asy t o u nderstand h ow t he l ining e pithelium o f t he c revice m ay b e p artially d estroyed s o t hat m icrou lcers o ccur a nd s erum a nd i nflammatory c ells, l iving a nd d ead, i n o ther w ords p us, e xude i nto t he c revice. T he n ature o f t he g ingival p laque h as n ow c hanged a nd i ts d ifference f rom c oronal p laque i s m uch g reater. T he c hronic s tate o f a ffairs t hat h as a risen c an e xist f or a l ong t ime, p erhaps s everal y ears, w ithout t he c ondition b eing n oticea bly p rogressive. I n d ue c ourse, h owever, t he c ondition m ay s pread b eyond t he g ingival m argin a nd t he b one a t t he c rest o f t he t ooth s ockets i s r esorbed, m ost c ommonly i nterdentally f irst, a nd t he g ingival c revice b ecomes d eeper. G ingival, o r p eriodontal, p ockets a ppear. V arious d egrees o f a trophy o f t he g ingival m argin o ccur s o t hat, i nstead o f t he p ockets d eepening, t he g ingival m argin i n p laces r ecedes. P eriodontitis c an n ow b e r egarded a s f ull-fledged a nd, u sually s lowly, m ore a nd m ore o f t he p eriodontium i s d estroyed u ntil t he t eeth b ecome l oose. I f t he p rocess c ontinues u nhindered, i n d ue c ourse t he t eeth a re e xfoliated. T he h ost r esponse t hat h as o nly b riefly b een r eferred t o i n t he a bove a ccount i s h ighly i mportant a nd v ariable a nd m uch o f t he a dvance o f k nowledge o f h uman p eriodontal d isease i n r ecent y ears c onsists i n e lucidation o f t he c omplex h umoral a nd t issue-immune r esponses t hat o ccur; d ifferences b etween i ndividuals p robably a ccount f or t he d ifferent r ates o f p rogress a nd f orms o f t he d isease. R esistance o f t he t issues i n p eriodontal d isease a lso v aries a t d ifferent t imes; p eriods o f a ctive p rogression w ith p erhaps a cute s uppurative e pisodes m ay i nterrupt l ong p eriods o f s eeming i nactivity. T he m aintenance o f a n e ffective h ost r esponse d epends o n a c omplex o f f actors, i ncluding t he q uality o f t he d iet a nd a b alanced i ntake o f v itamins, a nd i s d iminished f or e xample b y p assing s ystemic i nfections. T here a re s ome f orms i n w hich n early t otal a bsence o f r esponse m akes i t s eem a s i f t he i nitial b reakdown o f t he p eriodontium o ccurs f rom w ithin; l ocal i nflammatory s igns m cy b e s light a nd a pparently s econdary.

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P laque s ituated i n t he g ingival c revice o r w ithin a g ingival p ocket i s k nown a s s ubgingival p laque; p laque o n t he t ooth s urface j ust o utside t he c revice i s k nown a s s upragingival p laque ( Fig. 9 2). M ineralization o f e ither s ubgingival o r s upragingival p laque, o r b oth, o ften o ccurs p roducing a h ard m aterial, d ental c alculus o r t artar, a dherent t o t he t ooth s urface. B oth s ubgingival a nd s upragingival c alculus a ggravate t he i nflammatory p rocess ; i n p articular, t he r ough s urface o f s ubgingival c alculus r ubs a gainst t he g ingival w all o f t he p ocket a nd h elps t o m aintain t he c hronic i nflammation a nd m ay f rom t ime t o t ime i nduce a cute s uppurative e pisodes. T here i s s upragingival f ood d ebris, ( Figs. 2 5 a nd t heir o cclusal

n o l imit t o t he c ontinuous o r i ntermittent a ccretion o f c alculus a nd s ometimes, i f t here i s g ross s tagnation o f m asses o f c alculus m ay b uilt u p o n t he t ooth s urface 9 3) a nd, i f t eeth a re n ot i n o cclusion, m ay e ncroach o n s urfaces .

S upragingival c alculus i s am anifestation o f s tagnation o f f ood d ebris o n t he t ooth s urface a nd, a part f rom b eing a n i ndication o f a bsence o f ar egime o f o ral h ygiene w ith t ooth b rush o r r ubbing t he t eeth w ith t he f inger d ipped i n s alt, s oap o r a sh ( met w ith i n s ome p eoples, e specially i n a ncient t imes), i t i s a n i ndication o f a d iet t hat l acks r oughage a nd i s o therwise n ot o f ac onsistency t hat t ends t o l eave t he t ooth s urface c lean o r e ven t o c leanse t he t eeth o f t he d ebris l eft b y t he p revious m eal. W hen t he s upragingival c alculus i s m ore o r l ess c onfined t o t he l abial a spects o f t he a nterior t eeth ( Fig. 2 5), i t i s r egarded a s ar eliable i ndicator o f m outh-breathing w hich i s a ssociated w ith a bsence o f l ip m ovement o ver t he t ooth s urfaces a nd d rying o f d ebris l eft o n t he t eeth. S upragingival c alculus w ould t end t o b e a bsent w here t he d iet c onsisted l argely o f m eat o r f ish , e specially c onsumed r aw o r r oasted, f resh v egetables a nd f ruit. O n t he o ther h and , i t w ould b e m ost l ikely t o a ccumulate i f w hatever m eat o r f ish w as i n t he d iet w as s tewed o r t he d iet c onsisted l argely o f o atmeal p orridge o r b read. I n a ssessing p eriodontal d isease, i t i s d esirable t o d istinguish t wo t hings: ( a) t he e xtent o r s tage o f a dvancement a nd ( b) t he s everity o r s peed o f d estruction . B oth o f t hese h ave t o b e a ssessed i n r elation t o a ge b ecause o bviously f inding a n e arly s tage w ith e vidence o f a ctive r apid b one d estruction a t t he a ge o f 1 8 y ears w ould b e m ore n oteworthy t han f inding a dvanced d estruction , s uch a s l oss o f m ost o f t he a lveolar b one, a t t he a ge o f 6 0 y ears, w hich w ould h ave b een t he e ffect o f p rogressive l oss o f t issue o ver 3 0 y ears. T he s tage o f a dvancement m ust b e j udged f rom t he r elationship o f t he a lveolar c rest a nd t he p utative g ingival m argin f rom t he c rowns o f t he t eeth . T he p osition o f t he g ingival m argin c an o ften b e d educed f rom t he c alculus o n t he t ooth s urface ( Figs. 9 1, 9 3 a nd 9 4). T he c alculus t hat w as s ubgingival c an b e d istinguished f rom t he s uprag ingival b ecause s ubgingival c alculus i s d arker i n c olour, o ften b lack , b ecause i t c ontains a ltered b lood f rom g ingival m icro-haemorrhages. F urthermore , s upragingival c alculus w hich i s t ypically p ale y ellow , j uts o ut, o ften q uite s harply, b eyond t he s ubgingival ( Figs. 9 3 a nd 9 4).

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T he s everity o r s peed o f d estruction a nd w hat s ort o f r esponse t he t issues h ave m ade t o t he d isease p rocess c an b e d educed f rom d etails o f t he b one s urface, q uite a part f rom t he a mount t hat h as b een d estroyed. W hether t he i nflammatory p rocess i s a ctive o r p roceeding s lowly a nd w hether t he t issues a re p roducing a r epair-like r esponse c an b e d educed. I f t he b one s urface i s s mooth a nd e vidently c overed w ith a m ore o r l ess s ound l ayer o f c ompact b one, a nd e specially i f t here i s n ew b one f ormation p roducing l ipping ( Figs. 9 1, 9 3 a nd 9 4) t he r esistance b y t he t issues i s g ood a nd t he d isease p rocess c an b e a ssumed t o b e p rogressing b ut s lowly o r m ay b e s tatic. T he p rocess i s k nown t o b e p hasic w ith s hort ( weeks) o r l ong ( years) o f a ctivity i nterspersed w ith s imilar p eriods o f l ess a ctivity. F urthermore t he r ate b e u niform t hroughout t he m an s hown i n F igure 9 1, t here s eems t o h ave b een

o f p rogress a nd r eactive c hanges t end n ot t o d entition. I n t he d entition o f a 3 5-year-old t he d isease i s a t a n e arly s tage. B ecause a v igorous b ony r eaction, i t m ay b e i nferred

t hat t he d isease i s o nly s lowly p rogressive b ut t here a re m any o ther p ossible r easons w hy t he d isease p rocess w as n ot p articularly a ggressive. N evertheless i n o ne l ocalized a rea i nterdentally t he a lveolar c rest s hows t he p itting o f a ctive e rosion a nd t here i s a n i ntra-bony p ocket. T he t erm i ntra- o r i nfra-bony p ocket r efers t o t he g ap b etween t he c rest a nd t ooth-root p roduced w hen t here i s d estruction o f b one o n t he t ooth s ide o f t he c rest ( Manson, 1 986). I n t he e xample i n F igure 9 3 f rom a n o lder m an o f 4 5 y ears, w hich i s n otable f or t he a mount o f s upra-gingival c alculus, t he e ffects o f p eriodontal d isease h ave b een m ost s evere i n t he m olar r egion, e specially w here t he r oot b ifurcations h ave b een r eached. N everthel ess, t he m argins o f t he a lveolar c rests a re r ounded a nd t hickened, w hich a re s igns o f a f avourable r esponse. F igure 9 4 s hows t he d entition o f a w oman a ged 5 5 y ears i n w hich t here h as b een m uch d estruction o f t he a lveolar c rests, i n p laces w ith t he r e-formation o f a b ony c ortex a nd t hickening. H owever, i n o ther s ituations t here a re s igns o f l ocalized d estruction, i ncluding i ntra-bony p ockets a nd t he a bsence i nterdentally o f a b ony c ortex. T he d entition i s a lso n otable f or t he c aries t hat h as a ttacked t he s urfaces o f t hese r oots e xposed b y t he p eriodontal d estruction. T he a ssessment o f t he p resence a nd e xtent o f p eriodontal d isease i n ' s keletal m aterial c an b e e ntirely s ubjective a nd c ategorized w ith a s imple r anking s ystem , b ut i s p referably c ategorized i n a ccord w ith a s ystem b ased o n t he m easurement o f t he a mount o f a lveolar b one t hat h as b een d estroyed, e .g. o f t he d istance o f t he c rest f rom t he c ervical m argins o f t he t ooth c rowns. A s i t i s c haracteristic o f p eriodontal d isease t hat n ot a ll p arts o f t he t ooth a rch o r i ndeed n ot a ll p arts o f i ndividual t eeth a re e qually a ffected, a f ully s ophisticated s ystem i nvolves l arge n umbers o f d ifficult m easurements. A ccount m ust a lso b e t aken o f a ge-related r ecession o f t he a lveolar m argin f or t he e xistence o f w hich t here i s m uch e vidence a lthough t here i s a lso e vidence t hat t his r ecession i s l argely k ept p ace w ith b y c ontinuing e ruption o f t he t eeth s o t hat, i n t he a bsence o f p eriodontal i nflammatory d isease, t he d istance f rom t he a lveolar c rest t o t he o cclusal s urface r emains m ore o r l ess c onstant ( Levers a nd D arling, 1 983; W hittaker e t a l 1 985).

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F ig. 9 3. P art o f d entition o f m an a ged 4 5 y ears ( C 1 4 i i/66A). U pper c anine w as l ost p 9st m ortem . T here a re d efects i n t he b one e xposing r oots o f 12 a nd M ' ( asterisks) w hich a re p robably d ehiscences n ot i nduced b y p eriodontal d isease. S helf-like m argins o f t he s upragingival c alculus i ndicate p osition o f t he g ingival m argin, w hich v aries b etween 2 .5 a nd 5 .0mm f rom t he a lveolar c rest. M orphology o f t he c rests d iffers a g reat d eal i n d ifferent a reas. S ome l arge p erforations a re s een i n t he b one c ortex i nterdentally; t here i s p articular l oss o f b one b etween t he r oots o f t he m olars a nd p erforations o f t he c rest o ver t he u pper m olars w hich a re d isease i nduced. A rrowheads i ndicate a reas o f t hickening o f t he a lveolar c rests; a rrow i ndicates w here t he c rest p resents a k nife-like e verted m argin. T here i s a n i ntra-bony p ocket o n t he m esial a spect o f M2 e xtending o n t o i ts b uccal s urface. M3 w as l ost a nte m ortem p robably f rom t he d isease p rocess; M3 i s i n c onsequence b ut l ittle w orn a nd h as o ver-erupted.

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C osta ( 1982) a nd p articularly C larke e t a l ( 1986), i n r ecording p eriodontal d isease i n s keletal m aterial, h ave a ttached m ore i mportance t han o ther w orkers t o t he s ubjective a ssessment, u sing a r anking s ystem , o f t he d egree o f a ctivity o f t he d isease p rocess, i ts a ggressive o r n on-aggressive c haracter a nd t he b ony r esponse t o i t. F or e xample, f eatures t hat w ould b e r egarded a s i ndications o f a n a ggressive, a dvancing d isease p rocess, a re c upping-out o f t he a pproximal a lveolar c rests, p erforation o r l oss o f t he c ortical b one a nd i ntra-bony p ockets ( Figs. 9 3 a nd 9 4). O n t he o ther h and, r eformat ion o f a n i ntact c ortex o r t hickening o f t he o uter m argin o f t he a lveolar c rest b y t he f ormation o f n ew b one w ould b e r egarded a s e vidence o f r esistance t o t he d isease p rocess o r a t l east o f a q uiescent p eriod i n t he c ourse o f t he d isease. T o t ake a ccount o f t he s everity o f t he a ctual d isease p rocess d uring t he t erminal p eriod o f t he l ife o f e ach i ndividual i nvolves t he e xtremely d etailed r ecording o f t he s tate o f t he a lveolar c rests i n a ll r egions o f t he t ooth a rches, a ided p referably b y r adiography. T he a bove o utline o f h ow s keletal m aterial c an b e s tudied s upposes t hat t he c alculus o n t he t ooth s urfaces h as b een p reserved i ntact a nd t hat t he a lveolar c rests h ave n ot b een a ffected b y t he s oil e rosion t hat t ends t o b e a ssociated w ith p rolonged b urial. I n f act, o ften o ne o f t he m ain p roblems i s t o d istinguish t he e ffects o f d isease f rom t hose o f s oil e rosion . T his i s p robably o ne o f t he r easons t hat i nvestigations o n t he l ines o utlined a bove a ppear n ot t o h ave b een u ndertaken t hough s ome, s uch a s t hose q uoted a bove, p rovided v aluable m odels o n w hich s uch a n i nvestigation c ould b e d esigned. T he E nsay m aterial i s r emarkably i ntact i n a ll t hese d etails a nd t herefore e xceptionally s uitable f or a d iscriminatory, s earching o r r efined s tudy o f t he p eriodontal d isease. H owever, a s t he m aterial i s s tored o n t he i sland t he d ifficulties h ave b een t oo g reat f or s uch a s tudy t o b e y et u ndertaken . I n a ny c ase t he a ssistance o f s omeone w ith s pecial e xperience i n t he f ield o f p eriodontal d isease i s n eeded. S uch a s tudy c ould b e s cientifically h ighly r ewarding a nd c ould p rovide a m ore s ound b asis f or t hinking a bout t he d iet o f t he p eople o f E nsay. M y h ypothesis ( p. 3 5 )t hat t he s upragingival c alculus w hich i s p resent s o f requently o n t he a nterior t eeth i s a ssociated w ith m outh b reathing d uring m oderately l ong p eriods ( several w eeks) o f f ebrile t erminal i llness c ould p erhaps b e t ested b y a s tudy o f t he i nternal s tructure o f t he c alculus w hich m ight g ive a n i ndication o f t he s peed w ith w hich i t w as d eposited. A s c alculus f ormation i s a n a ccretion p rocess, c alculus t ends t o s how a p atterns o f g rowth l ines f rom w hich a d ifference m ight b e d etected b etween t he r ates o f d eposition o f t he s urface l ayers a nd t he d eeper o nes. I t i s o nly p ossible t o s ay, o n t he b asis o f t he r outine f ield n otes o nly, t hat a dvanced p eriodontal d isease w as v ery c ommon i ndeed i n s kulls f rom a ll t he f our l evels a nd w as a ssociated w ith u nusually m arked d eposition o f c alculus. Q uite c ommonly e very t ooth w as s urrounded b y a t ide-mark-like r ing o f s ubgingival a nd s upragingival c alculus ( Figs. 9 1, 9 3 a nd 9 4). M ost o f t he y oung s kulls, t hat i s u p t o 3 0 y ears o f a ge, s howed t hin r ings o f c alculus t hough w ithout g ross c hanges i n t he b one o f t he a lveolar c rest. T his i ndicates a c hronic

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F ig. 9 4. D entition o f w oman a ged 5 5 y ears ( D 3 2Z/67B). P eriodontal d isease h as d estroyed m uch a lveolar b one e xposing a bout h alf t he l ength o f t he r oots o f t he t eeth ; m ore i n u pper m olar r egion. A lveolar c rests i nterdentally a re i n g eneral f lat a nd c overed w ith s ound c ortical b one b ut a rrows i ndicate i ntra-bony p ockets; a p articularly e xtensive o ne i s p resent b etween u pper s econd a nd t hird m olars. A r ing o f s ubgingival c alculus i ndicates a pproximate p osition o f t he g ingival m argin a bout 3 .0mm f rom t he a lveolar c rests. I n m any p laces, e xposed r oot s urfaces a re c arious. A lthough c aries h as d estroyed s ome c ervical e namel, i t s eems l ikely t hat t his h ad s pread f rom r oot-surface c aries. P ulp c avities o f b oth u pper p remolars h ave b een e xposed, l eading t o ac hronic a bscess o ver r oot o f t he f irst p remolar. T here i s aw indow-like d efect ( dehiscence) o f t he b one o ver t he r oot o f u pper c anine.

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g ingivitis o f a s everity w hich w ould b e u nusual i n c ontemporary y oung p eople. B y t he p resumptive a ge o f 3 5 y ears, m ost s kulls s howed a t l east l ocalized l oss o f a lveolar c restal b one m ostly b etween s ome c heek t eeth a nd g ross s upragingival c alculus w as c ommon ( Fig . 9 1). B y 4 5 y ears o f a ge, l oss o f c restal b one w as m uch m ore s evere, l ocalized a reas a mong t he c heek t eeth w here m ore t han h alf t he l ength o f t he r oots w ere e xposed w ere c ommon a nd l oss o f t eeth w as c ommon ( Fig. 9 3). U nless a dvanced d ental c aries w as a lso p resent, t his l oss o f t eeth c ould r eliably p resumed t o b e d ue t o p eriodontal d isease. T he f ield n otes m ade o n e ach s kull i ncluded a d escription o f t he p eriodontal s tate w hich n oted f or e ach q uadrant o f t he d entition m any o f t he f eatures u sed b y C larke e t a l ( 1986) r eferred t o a bove a nd c ategorized t he s tage a s o ne o f n o d isease, m ild, m oderate o r s evere p eriodontal d isease. O n t he b asis o f t hese f ield n otes, s upplemented b y t he e xamination o f as ample o f 3 0 s kulls ( not a r andom c ross-section b ecause m ost w ere o ver 4 0 y ears o f a ge) u sing t he c riteria o f C larke e t a l m ore p recisely, i t i s p ossible t o s ay t hat a dvanced p eriodontal d isease w as e xceptionally h igh c ompared w ith c ontemporary p opulations. H ow i t c ompares w ith m ainland B ritish o r S cottish p opulations o f 1 500-1850 i s n ot p ossible t o s ay b ecause n o s uch S cottish m aterial a ppears t o h ave b een r eported o n.

D ental C aries A s a lready e xplained ( p.140), f ollowing a m eal, b acterial d ental p laque i s f ormed o n t he s urfaces o f t he c rowns o f t eeth . I n s tagnation a reas, s uch a s t he p its a nd f issures b etween t he c usps a nd r idges o f t he o cclusal s urfaces, a nd a t c ontact a reas b etween t he t eeth , p laque m ay p ersist a s am ore o r l ess p ermanent f eature. T ooth-destructive s ubstances, n otably a cids, f ormed w ithin p laque m ay r emain i n c ontact w ith t he t ooth s urface l ong e nough t o b egin a p rocess o f d issolving o r d estroying i t; c aries t hus b egins. I n i ts c ommonest f orm a bout w hich s o m uch h as b een w ritten, d ental c aries a ttacks t he e namel p rimarily a nd o nly a ttacks d entine w hen t he e namel h as b een p enetrated; i t t hen c haracteristically s preads o ut a nd t he e namel i s u ndermined a nd a ttacked f rom b elow . . I n c ontemporary l iving p eople, i t i s a d isease p redominantly o f c hildren a nd a dolescents; t he d eciduous d entition i s f requently a ffected. T he p revalence o f p rimary e namel c aries d iminishes d uring f ull a dult l ife, p artly b ecause t he p articularly s usceptible t eeth , s uch a s t he d eciduous t eeth a nd f irst p ermanent m olars h ave b een l ost b ut a lso b ecause t he e namel b ecomes m ore r esistant t o a ttack b y c aries. H owever, t here i s a nother f orm i n w hich t he d entine o r c ementum i s a ttacked f irst, p redominantly t he c ementum-covered d entine e xposed b y p eriodontal d isease ( Hazen, C hilton a nd M umma , 1 973; K atz e t a l, 1 982; K atz, 1 984). I t i s t herefore k nown a s r oot-surface c aries a lthough s ometimes i t a ttacks c rown d entine e xposed b y w ear o r b ecause a pproximal e namel t hinned b y w ear h as b roken a way ( Fig . 9 5, M iles, 1 969).

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F ig. 9 5. D iagrammatic r epresentation o f c aries a ssociated w ith w ear. A : w orn o cclusal s urfaces, t he s hading b eing e xposed d entine; w ear h as f lattened t he a pproximal s urfaces a nd t hinned t he a pproximal e namel w hich, n ow w eakened, i s l iable t o f racture l eaving e xposed d entine w hich m ay b e a ttacked b y c aries. B : b uccal v iew ; a lveolar c rests h ave r eceded a nd c aries i s d epicted o n e xposed r oot s urfaces s tarting e ither i nterdentally o r b uccally.

T hus r oot-surface c aries i s f ound v irtually o nly i n a dults w hen p eriodontal d isease h as p rogressed s ufficiently t o e xpose t he r oot s urface ; i ts p revalence i ncreases a s p eriodontal d isease a dvances a nd b ecomes m ore c ommon. I t i s d esirable i n s tudies o f e pidemiology b oth i n l iving p eople a nd s keletalized a ncient m aterial t o d istinguish p rimary e namel c aries f rom r oot-surface c aries a nd t o s core t hem s eparately b ecause, w hereas m ost d ental c aries i n c ontemporary p eople i s e namel c aries a nd r oots urface c aries i s n ot n early s o c ommon , i n g eneral i n a ncient p eoples r oot-surface c aries i s m uch m ore c ommon . A s b oth t ypes o f c aries a re p rogressive a nd a ge-related a lthough i n d ifferent w ays, i t i s e ssential t o r elate t heir p revalences i n a ncient m aterial t o a ge, e specially i f c omparison i s t o b e m ade w ith c ontemporary o r r ecent c aries p revalences . I t s eems a lso i mportant i n r ecording d ental c aries i n a rchaeological m aterial t o u se a s f ar a s p ossible t he s ame m ethodology a nd c riteria a s a re u sed i n c ontemporary d ental e pidemiology.

1 48

T he E nsay d entitions w ere e xamined i n a g ood l ight; a r ight-angled s harp s tandard p robe w as u sed t o d etect c aries i n e namel o cclusal f issures a nd p its, a nd t o d etect l oss o f e namel s ubstance e lsewhere. C aries w as r ecorded i f t he p robe s tuck a nd w as r esistant t o w ithdrawal o n b eing p ressed i nto a f issure; t his i s a cknowledged t o b e e vidence o f c avitation o r a t l east a t r oughness o f t he s ides o f t he f issure. S taining o f t he f issure a lone w as n ot r egarded a s e vidence o f c aries. I n o ther w ords, t he p rinciple f ollowed w as t hat o f t he b est d ental e pidemiologists, " When i n d oubt d o n ot s core a s c aries". S imilarly, a reas o f s taining o f o pacity o f t he e namel o n a pproximal a nd o ther s mooth s urfaces o f t he c rowns w ere o nly s cored a s c aries i f t here w as s ome e vidence, s uch a s p itting o r r oughness, o f a ctual d estruction o f e namel. M any s uch a reas o f o pacity o r s tain m ight b e e arly s tages o f c aries b ut i t i s i mpossible t o b e s ure t hat t hey w ould p rogress. T here w ere m any i nstances w here s o m uch o f t he t ooth h ad b een d estroyed t hat i t w as i mpossible t o b e s ure w hether t he c aries h ad s tarted i n e namel o r o n an earby s urface o f t he r oot; f or e xample, w here t he c aries h ad d estroyed t he w hole a pproximal p art o f t he t ooth , i ncluding s ome o f t he o cclusal s urface a s w ell a s s ome o f t he r oot s urface a pproximally . H owever, i n m ost d entitions a ffected b y c aries, t here w ere m ultiple l esions a nd, i f r oot e xposure b y p eriodontal d isease w as p resent a nd e xamples o f e arly c aries a ttacking e xposed r oot s urfaces w ere a lso p resent , e specially i nterdentally, t he i nference w as d rawn t hat t he g rosser l esions w ere r oot-surface c aries a s w ell, u nless t here w as e vidence t o t he c ontrary. T o s core t hus o n t he b asis o f p robabilities w as c onsidered t o b e j ustified, e specially a s i t w as d esirable t o o btain a s m uch i nformation a s p ossible, e ven t hough i t m ight b e t entative, f rom a s mall n umber o f s kulls. I t w as c lear t hat t he n umber o f s kulls a vailable w as t oo s mall t o m ake i t w orthwhile t o r eproduce h ere m ore t han t he s imple r ecord o f c arious t eeth a t t he d ifferent l evels. T he m ore c omplete d ata w ill o nly b e s hown i n r espect o f t he 5 8 s kulls f rom l evel D ( 1500-1600 A D), b ecause t hat g roup c an b e c ompared w ith S cottish m aterial o f s imilar d ate ( Kerr, B ruce a nd C ross, 1 988). L evel D h appens t o b e t he l argest a nd m ost a ccurately-dated g roup . A lthough i t s eems n atural t o g roup s ubjects i n d ecades f rom b irth, w hich h as t he a dvantage t hat i t p roduces a b reak b etween a dolescence a nd a dulthood a t 2 0 y ears, a nd t his i s f avoured b y m any c ontemporary e pidemiologists, m ost r ecent w orkers o n d ental c aries i n a ncient p eoples h ave d ivided i nto d ecades f rom t he a ge o f 1 6 y ears. T o f acilitate c omparison w ith t hese w orkers' f indings t his g rouping h as b een a dopted h ere f or t he d etailed a nalysis o f t he l evel D g roup . I n p resenting t he d ata, v arious o ther d ecisions h ave t o b e m ade. I t i s n ecessary t o a ssume t hat o riginally t he w hole o f e ach d entition w as p resent a nd t hat s uch t eeth a s a re m issing h ave e ither b een l ost d uring l ife o r h ave f allen f rom t he j aws a fter d eath. I t i s u sually e asy t o r ecognize t ooth s ockets f rom w hich t eeth h ave f allen o ut a nd s ometimes, w hen t he s ocket i s s hallow a nd i ts m argins a re r ounded, a h ealing t ooth s ocket c an b e d istinguished, t he t ooth h aving b een l ost w eeks o r m onths b efore d eath .

1 49

I t i s q uite c ommon p ractice t o e xpress t he c aries p revalence a s t he n umber o f t eeth c arious a s a p ercentage o f t he t eeth p resent i n t he s kulls, b ut t here a re s ound a rguments ( Whittaker e t a l 1 981) f or p resenting t he d ata a s a p ercentage o f w hat i s e stimated t o h ave b een t he t otal n umber o f t eeth a t r isk; t hat i s t he t eeth p resent p lus t hose l ost b oth a nte-mortem a nd p ost-mortem . W hittaker e t a l ( 1981) h ave d iscussed t his a nd o ther r elevant m atters a nd r ecommend s ensibly t hat i t i s b est t o p resent d ata i n a s m any a lternative w ays a s p ossible. T hat p olicy w ill b e a dopted h ere. T eeth w ith s ingle a nd o ften c onical r oots, s uch a s t he i ncisors a nd c anines, a re a lways m ore c ommonly l ost f rom s kulls t han t he m ultir ooted p osterior ( post-canine) t eeth. T his w as s o i n t he E nsay m aterial; i n t he l evel D s kulls, t here w as p ost-mortem l ost o f 1% o f t he a nterior t eeth a nd 4 % o f t he p osterior t eeth. I t w as n oticeable t hat m ost o f t he c aries w as a mong t he p osterior t eeth; e ven w hen t he s ystematic e xamination h ad b een c arried o ut, n o c aries a t a ll w as f ound a mong t he a nterior t eeth. A lthough i t i s n ecessary f or c omparison w ith o ther s tudies, i ncluding e pidemiological s tudies o f l iving p eople, t o e xpress t he c aries p ercentages i n r elation t o t he w hole d entitions, t hat i s t o i ndividuals, i n T able 1 7 t he d ata w ill a lso b e e xpressed i n t erms o f t ooth s urfaces a ffected. T here b eing n o c aries o f t he a nterior t eeth, t his T able r efers t o t he p osterior t eeth o nly. T able 1 1 s hows t he t otal n umber o f a dult s kulls a vailable f or a nalysis a t e ach l evel, t ogether w ith t heir e stimated a ge. B ecause t he d ata h ad i nitially b een s o p repared, t he c omparison b etween t he d ifferent l evels i s p resent i n 1 0-year a ge g roups f rom t he c onvenient a ge o f 2 1 y ears. I n s kulls b elow t he a ge o f s ix y ears, n o c aries a t a ll w as n oted. A mong t he 3 8 E nsay s kulls i n t he 6 -20 y ear o ld g roup ( 13 f rom l evel D ), i nvolving 2 50 d eciduous t eeth a nd 4 13 p ermanent t eeth a t r isk, t here w ere o nly s even c arious t eeth; f our w ere i n d eciduous t eeth a nd a ll w ere e xamples o f r oot-surface c aries ( three o f t hem i n t he s ame n iney ear o ld c hild a nd a ll a ssociated w ith t he e xposure o f r oot s urface c onnected w ith s hedding o f d eciduous m olars) a nd t hree w ere p rimary e namel c aries a ffecting t he b uccal c ervical e na l Pel o f a 1 7-year o ld c hild. H ence t he s tatistical a nalysis h as b een c onfined t o t he a dult s kulls. T he f ollowing T ables 1 2, 1 3 a nd 1 4 s how t he m ean n umber o f t eeth m issing, c arious, a nd b oth, p er s kull f or e ach l evel. I n e ach c ase, a c omparison i s m ade w ith c orresponding d ata d erived f rom t he 1 972 S cottish A dult N ational D ental S urvey ( Todd a nd W hitworth , 1 974). T he f igures i n t he T ables d o l ittle m ore t han s how t hat, a t a ll f our l evels, t he p revalence o f c aries i s s ignificantly l ess t han i n t he S cottish 1 972 p opulation. S tatistical a nalysis s erved t o e mphasize t hat, w ith t he p ossible e xception o f t he l evel D g roup, t he n umbers i n t he g roups a re n ot l arge e nough t o r eveal a nything b ut g ross d ifferences a nd t hat t hese d id n ot e xist. N othing s uggests t hat t here w ere a ny l arge d ifferences i n t he p revalence o f c aries b etween t he f our

1 50

T able 1 1.

N umbers o f a dult s kulls f rom e ach l evel.

A ge g roup i n y ears

A

2 1-30

1 2

3 1-40

6

4 1-50

1 2

L evel B C 4

3

8

1 6

3 3

4

5

1 6

3 7

1 5

3 8

5

7

6 1 a nd o ver

2

0

T able 1 2.

3 7

T otal

4

5 1-60

T otal

D

1 8

1 1 2 9

5

6 5 8

2 5

9 1 42

M issing t eeth .

A ge g roup i n y ears

L evel C

B

2 1-30

0 .8

1 .8

0 .0

0 .0

1 0 .5

3 1-40

0 .2

4 .0

0 .6

1 .0

1 7.0

4 1-50

4 .3

5 .0

3 .4

2 .4

2 3.3

5 1-60

4 .0

8 .0

6 .4

6 .7

2 7.5

1.5

-

1 4 .0

8 .8

3 1.0

2 .8

5 .3

3 .7

3 .6

6 1 a nd o ver T otal

D

T otal

S cotland 1 972

A

3 .6

M issing t eeth r efers t o t hose l ost a nte-mortem a nd t hose l ost p ostm ortem c ombined, e xcept i n r espect o f S cotland 1 972 w hich r efer t o l iving p eople w ith , o f c ourse, n o p ost-mortem l oss.

1 51

T able 1 3 .

C arious t eeth .

A ge g roup i n y ears

A

L evel B C

D

Total

S cotland 1 972

2 1-30

1 .8

3 .3

0 .3

0 .0

9 .3

3 1-40

4 .3

3 .3

1 .8

3 .6

7 .0

4 1-50

3 .0

0 .3

4 .4

2 .9

4 .0

5 1-60

5 .4

5 .3

3 .5

2 .7

2 .0

6 1 a nd o ver

0 .5

-

2 .0

1 .2

1 .0

T otal

3 .0

3 .4

2 .7

2 .6

T able 1 4 .

A ge g roup i n y ears

2 .8

C arious a nd m issing t eeth

A

L evel B C

D

Total

S cotland 1 972

2 1-30

2 .6

5 .0

0 .3

0 .0

1 9.8

3 1-40

4 .5

7 .3

2 .4

4 .6

2 4.0

4 1-50

7 .3

5 .3

7 .8

5 .3

2 7.3

5 1-60

9 .4 1 3.3

9 .8

9 .3

2 9.5

6 1 a nd o ver

2 .0

-

1 6 .0 1 0.0

3 2.0

T otal

5 .8

8 .7

6 .3

6 .2

S ee f ootnote t o T able 1 2.

1 52

6 .4

l evels . A lthough t he d etailed d ata w ill n ot b e s hown, a nalysis s howed t hat a t a ll l evels r oot-surface c aries p redominated o ver e namel c aries i n t he r atio o f a bout 8 :1, a s w ill b e s hown i n g reater d etail i n r espect o f t he l evel D g roup. T he g eneral p attern o f o verall c aries p revalence, w ith p redominance o f r oot-surface c aries, i s s imilar i n t he s kulls f rom t he o ther t hree l evels s o t hat t here i s n othing t o s uggest a ny s ignificant c hange i n t he n ature o r p revalence o f c aries, a nd p erhaps o f p eriodontal d isease a lso , f rom 1 500 A D u p t o t he t ime o f t he l ast b urials o n t he i sland, w hich s hould p erhaps b e c ounted a s t he m iddle o f t he l ast c entury.

T he L evel D g roup T able 1 5 s hows t he n umbers o f s kulls, n umbers o f t eeth p resent, m issing a nte m ortem a nd p ost m ortem a nd t he t otals o f t eeth a t r isk ; t hat i s, c ombining t he t eeth p resent w ith t hose m issing, s o f orming a n e stimate o f t he n umber i nitially p resent w hich w ould h ave b een a t r isk o f t he d isease p rocess . F or c ompleteness, b ecause e pidemiologists a re m ostly c oncerned w ith i ndividuals, t he p roportions o f s kulls a ffected b y c aries a re a lso g iven. B ecause t here w as n o c aries a t a ll a mong t he a nterior t eeth ( incisors a nd c anines) w hereas, e specially i n t he o lder a ge g roups, t here w as m uch c aries a mong t he p osterior ( post-canine) t eeth, T able 1 6 p resents t he a nterior a nd p osterior t eeth s eparately. I t a lso g ives s eparately t he n umbers o f t eeth w ith c aries o f t he e namel o f t he c rowns a nd t hose w ith c aries o f t he r oot s urfaces. T able 1 7 a nalyses t he p osterior t eeth a ffected b y c aries i n m ore d etail; i t n ot o nly d istinguishes e namel f rom r oot-surface c aries b ut i ncludes w hich o f av ariety o f t ooth-surface s ites a re a ffected. U nlike i n T ables 1 5 a nd 1 6, t he p roportions o f s urfaces a ffected a re o nly c onsidered i n t erms o f t he t otal n umbers o f s urfaces o f t he t eeth p resent ( cf. W hittaker e t a l, 1 981 a nd K err e t a l, 1 988). I t s eemed i nappropriate t o i nclude t he m issing t eeth i n t his c onsideration . T eeth o f w hich t he c rowns h ad b een a lmost t otally d estroyed b y c aries w ere c ounted b ut a n u nknown n umber w ould h ave g one b eyond t hat s tage; t he r oots w ould h ave b een e xfoliated b y w hat c an b e c alled a bscess f ormation . F or p ractical p urposes, t he o nly o ther c ause o f a nte-mortem t ooth l oss, a part f rom t rauma , i s p eriodontal d isease. I t i s w orthwhile t o t ry t o e stimate t he r atio b etween l oss f rom t hese t hree c auses. A nte-mortem t ooth l oss i n t he a nterior t eeth i n t he o ver 4 6 y ear g roups w as 2 3% . A s n o c aries w as f ound a mong t he a nterior t eeth b ut p eriodontal d isease w as c ommon, i t m ust b e a ssumed t hat t he t ooth l oss w as m ainly d ue t o p eriodontal d isease. S ome t eeth w ould h ave b een l ost f rom i njury; i f f or c onvenience i t b e a ssumed t hat l oss f rom i njury w as 5 % , i t f ollows t hat t ooth l oss f rom p eriodontal d isease w as a bout 1 8% . A s p eriodontal d isease w as a t l east a s r ampant a nd d estructive a mong

1 53

0

6 -15

9

1 1.0

1 66 ( 78)

0

1 2 ( 7)

1 78

1 6-25

8

1 2.4

2 29

1

4

2 34

2 6-35

7

4 2.9

1 97

1

3 3 (3 ) 3

3

%o f t eeth a t r isk c arious

0

Z

%o f t eeth p resent c arious

o f h ypothetically c arious t eeth * *

c ; .

o f c arious t eeth

•

o f t eeth a t r isk *

y ears

o f t eeth m issing p ost-m .

i n

%w ith c aries

g roups

o f s kulls

A ge

t eeth m issing a nte-m .

C aries p revalence i n L evel D s kulls.

t eeth p resent

T able 1 5.

1 .8

1 .7

1 .7

1 .3

1 .3

1 .3

1 7

2 15

1 2

1 2

6 .1

5 .6

5 .6

3 6-45

1 9

7 3.7

4 83

3 4

2 7

5 44

7 6

7 9

1 5 .7

1 4.0

1 4 .5

4 6-55

1 9

6 8 .4

3 67

7 5

4 6

4 88

4 2

4 9

1 1.4

8 .6

1 0 .0

6 6 .7

1 61

9 7

1 3

2 71

2 7

3 6

1 6 .7

1 0 .0

1 3 .3

1 603 2 08

19

1 930 1 63 1 82

1 0 .2

8 .4

9 .4

5 6 +

T otals

9

7 1

5 3 .5

T eeth a t r isk = t eeth p resent + t eeth m issing a nte-mortem +t eeth m issing p ost-mortem * *

H ypothetically c arious t eeth = c arious t eeth + 9 % o f t eeth m issing a nte-mortem c alculated t o h ave b een l ost f rom c aries ( see t ext). T he f igures i n b rackets i n t he 6 -15 y ear c olumns i ndicate n umbers o f d eciduous t eeth.

1 54

T eeth p resent a nd m issing i n a nterior a nd p osterior ( postc anine) p arts o f t he d entitions a nd t ypes o f c aries ( enamel o r r oot-surface) o f p osterior t eeth . T here w as n o c aries o f a nterior t eeth .

A nterior t eeth

a

e

. 2 U l • ) 1 I 1

4 i c d

• z

z

• • o o z z

1 00 ( 58)

0

0

9 6

1 36

1

1

1 38

1

8 3

1 26

0

6

1 32

y ears

6 -15

9

6 6 ( 20)

0

1 6-25

8

9 3

0

2 6-35

7

7 1

1

1 2 7 8 (7 ) 3

1 00

%w . r oot-surfaces c aries

a ) g i

0

r oot-surface c aries

0 0

e namel c aries

i n

4 C W M

e namel c aries.

g roups

o f s kulls

A ge

c rown d estroyed*

P osterior ( post-canine) t eeth

N o. o f t eeth c arious

T able 1 6 .

3

0

0

3 0

0

0

3

3 .0

0

4

2 .9

0

0

1 2

0

5 3 .8

7

5 .3

z z

( 3) 3

3 6-45

1 9

1 88

1 1

1 7

2 16

2 95

2 3 1 0

3 28

7 6

7 8

2 .4

6 4

1 9.5

4 6:55

1 9

1 40

3 0

2 5

1 95

2 27

4 5 2 1

2 93

4 2

1 4

1 .4

4 1

1 4.0

6 4

3 1

1

1 06

9 7

6 6

1 65

2 7 1 4

1 0 .6

1 3

7 .9

6 22

7 3

7 9

7 74

1 .9 1 28

1.1

5 6+ .

9

T otals 7 1

2

8 81 1 35 4 0 156 1 63 2 2 2 2

.T he f igures i n b rackets i n t he 6 -15 y ear c olumns i ndicate d eciduous t eeth. *T he n umbers o f t eeth w ith c rowns d estroyed b y c aries a re i ncorporated i n t he t otals o f c arious t eeth.

1 55

O cclusal

B uccal

A pproximal

m u r n

m

( . 1 4 4

U )

4 1 0

0 e r1 4 C O U

1 1

Z

E -

u m

4 1 4

4 1 0

0 • , — i 4 C d U

z

Z

Z

Z

Z

U )

C , ) o . H C l ) w

C l )

0

• r i

0

4 C d U

1 4

U )

C O

y ears

4 , 0 • 0 C

m

A pproximal

T otal n o. o f l esions

U m

4 4 4

B uccal

N o . c arious

i n

R oot—surface c aries

N o. o f s urfaces

g roups

C rown s urface ( enamel) c aries

N o . c arious

A ge

T ypes ( enamel a nd r oot—surface) a nd s ites o f c aries a ffect— i ng t he p osterior t eeth a nd p ercentages a ffected o f t eeth p resent.

N o. o f s urfaces

T able 1 7 .

6 -15

1 00

0

1 00

0

2 00

0

0

1 00

0

2 00

3

3

1 5-25

1 36

1

1 36

3

2 72

0

4

1 36

0

2 72

0

0

2 6-35

1 26

2

1 26

0

2 52

3

5

1 26

5

2 52

4

9

3 6-45

2 95

3

2 95

2

5 90

3

8

2 95

3 4

5 90

4 6

8 0

4 6-55

2 27

2

2 27

1

4 54

1

4

2 27

1 4

4 54

2 9

4 3

9 7

0

9 7

1

1 94

0

1

9 7

1 94

1 4

2 2

5 5+

1 56

8

t he p osterior t eeth , i t a lso f ollows t hat a bout 1 8% o f t he 2 7% o verall t ooth l oss i n t hat r egion i n t he o ver 4 6-year g roup w as d ue t o p eriodontal d isease , l eaving i t t o b e a ssumed t hat a bout 9 % w as d ue t o c aries. T ooth l oss f rom i njury w ould b e m uch l ess l ikely t han a mong t he a nterior t eeth . A mong t he 7 1 l evel-D s kulls, t here w as n o c aries a mong t he a nterior t eeth a nd, a mong t he p osterior t eeth, n one u ntil t he 2 6-35 a ge g roup w hen a bout 3 % o f p ost-canine t ooth s urfaces w ere a ffected, w ith a bout a 3 :1 p redominance o f r oot-surface l esions o ver c oronal e namel l esions ( Fig. 1 7). O ver t he a ge o f 3 6 y ears, h owever, r oot-surface c aries i ncreased t o a bout 8 % o f s urfaces w hereas c oronal e namel l esions, w hich i n t he 2 6-35 y ear g roup h ad a ffected 1 .0% o f s urfaces, f ell t o 0 .5% . hat w ere E xpressed a s p ercentages o f p osterior t eeth a t r isk t aries i s a ffected b y c aries ( Table 1 6), t he i ncidence o f e namel c elow 1 % i n h ighest ( 3.8%) i n t he 2 6-35 y ear c ategory a nd d iminishes t o b 6-35 y ear t he o lder c ategories. R oot-surface c aries i s 5 .3% i n t he 2 nd i n t he g roup, r ises s ubstantially i n t he 3 6-45 y ear g roup t o 1 9.5% a s ubsequent y ears i s a bout 1 2%. O ut o f a t otal i n a ll t he a ge g roups o f 1 50 c arious t eeth w here i t w as r ecorded w hether i t w as e namel o r r oot-surface c aries, 8 5.3% o f t he l esions w ere r oot-surface c aries a nd 1 4 .7% w ere e namel c aries ( Table 1 6), a r atio o f a bout 6 :1. T he e stimate o f 9 % o f a nte-mortem l oss b eing d ue t o c aries h as b een a pplied i n T able 1 5 b y a dding t hat p ercentage t o t he n umber o f c arious t eeth t o c reate a c olumn c alled ' number o f h ypothetically c arious t eeth '. T his w as d one m ainly t o s ee h ow m uch d ifference w as m ade t o t he p ercentages. T he d ifferences a re m inute b ut n aturally i ncrease i n t he o ver-36 y ear a ge g roups w here t here i s m uch c aries a nd m uch a nte-mortem t ooth l oss. T he p rinciple m ight h ave s ome v alue i n a w ider c ontext o f ac omparison o f t he E nsay d ata w ith t hose f or o ther p opulations. B ecause o f t he i mportance a ttached t o t he d istinction, w hich i s b ecoming i ncreasingly r ecognized i n c ontemporary d ental e pidemiology , b etween t he a etiology o f p rimary e namel c aries a nd t hat o f r oot-surface c aries w hich t ends t o a rgue f or t hem t o b e t reated a s d ifferent d iseases, t he c ategories u sed h ere d o n ot c orrespond e xactly w ith t hose u sed b y W hittaker e t a l ( 1981) a nd K err, B ruce a nd C ross ( 1988) w ho h ave i n g eneral a dopted t he c ategories u sed b y M oore a nd C orbett ( 1971). I n t heir m ethodology, a n a ttempt i s m ade t o i dentify t he s ite o f o rigin o f t he c aries b ut t he, f rom t he p oint o f v iew o f r oot-surface c aries, c ritical c ervical r egion o f t he t ooth, t he e namel-root j unction ( enamel-cementum j unction) i s t reated a s a s ingle e ntity. K err e t a l e xpress t he c ategory a s " at o r n ear t he e namel-cementum j unction", d istinguishing , o f c ourse, b etween a pproximal a nd b uccal/lingual a spects o f t he t ooth . B ecause o f d ifferences o f d efinition o f c aries t ypes a nd o f s ites, a nd d ifferences b etween o ur a ge g roupings ( the o ldest g roup o f K err e t a l i s c ategorized a s 3 5-45+ y ears), i t i s n ot p ossible t o m ake m ore t han a b road c omparison w ith t he f indings o f K err e t a l. H owever, t hey

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a lso f ound a t otal a bsence o f c aries f rom t he a nterior t eeth . I n t he 1 6-25 y ear g roup, 7 .1% o f t he p osterior t eeth w ere c arious; t his i ncreased t o 8 .6% a nd 8 .0% r espectively i n t he 2 6-35 a nd o ver 3 6 y ear a ge g roups ( no a ge g roup a bove 4 5 y ears w as d istinguished). S imilarly a lso , e namel c aries, a s s pecified b y c aries i n o cclusal f issures a nd a t t he c ontact a reas b etween t eeth , w as o nly o f t he o rder o f 2 % w ith a f all i n t he o ver 3 6-year g roup. L esions a t o r n ear t he e namel-cementum j unction , p articularly a pproximally r ather t han b uccally o r l ingually, p redominated, e specially i n t he o ldest g roup . A s i n t he c ase o f t he E nsay m aterial, t he n umbers o f d entitions a re s mall s o t hat w hen t he l esions a re d ivided i nto a n umber o f c ategories t he f igures a re d isconcertingly s mall. F or e xample i t s eems t hat o nly n ine l esions a t t he e namel-dentine j unction w ere c onfined t o t he r oot s urface, c ompared w ith f ive c onfined t o t he e namel a nd n ine i n w hich b oth r oot a nd e namel w ere i nvolved. H owever, K err e t a l c oncluded t hat t heir m aterial s howed a p redisposition t o r oot c aries a s a r esult o f e arly r oot e xposure c onsequent o n f ood s tagnation i n t he a pproximal e mbrasures. T hey w ere u nconvinced, h owever, t hat t he g ingival r ecession w as a m anifestation o f p eriodontal d isease. T here s eems t o h ave b een m uch l ess r oot-caries ( less t han 4 .0% o ver a ll) o f t he c heek t eeth i n t heir m aterial t han i n t he E nsay s kulls ( 19.5% i n 3 6-45 y ear g roup). K err e t a l h ave n ot y et r eported o n t he p revalence o f p eriodontal d isease a nd a ll I c an s ay a bout t he E nsay m aterial i s t hat, i n s ubjects o ver t he a ge o f 4 0 y ears, a dvanced p eriodontal d isease w as e xtremely c ommon. T he r oot-caries, w hen p resent, i s a lways a ssociated w ith e vidence o f p eriodontal d isease. I t s eems p ossible t hat t here i s l ess p eriodontal d isease i n t he A berdeen s kulls o r i t i s o f l ess s everity; t his c ould a ccount f or t he a pparent l ower p revalence o f r oot-surface c aries. T he a pparent h igher p revalence o f r oot-surface c aries i n t he E nsay p opulation t han i n t he A berdeen o nes c an p robably i n p art b e a ttributed t o t he m ore i nferential b asis o f m y d iagnosis o f t he s ite o f o rigin o f t he c aries, w hether o n t he e namel o r o n r oot s urface. H owever , t he p revalence o f c aries, i ndependent o f s ite o r t ype, i s h igher ( 13 .1% o f t eeth p resent i n o ver 4 6 y ear g roup) i n t he E nsay m aterial c ompared w ith t he A berdeen s kulls ( 5.3% o f t eeth p resent i n o ver-36 y ear g roup). . I n t he R omano-British s kulls e xamined b y W hittaker e t a l ( 1981), 7 .7% o f t eeth i n t he 3 5-46 y ear g roup h ad l esions " at t he n eck o f t he t ooth o r r oot s urface". A mong c ontemporary l iving p eople, d entitions t hat s how g ross p eriodontal d isease w ith m ore o r l ess c ontinuous r ings o f s ubgingival c alculus a s w ell a s m uch s upragingival c alculus a nd, a s i n t he E nsay p opulation , a ssociated w ith g ross r oot s urface c aries, a re u ncommon . S uch d entitions h ave, h owever, b een d escribed a nd i llustrated f rom p rimitive p eoples. F or i nstances, S chamschula, K eyes a nd H ornabrook ( 1972) a nd S chamschula e t a l ( 1974) f ound t hat i n g eneral t he t eeth o f t he p eople o f ar emote r egion o f N ew G uinea w ere c overed u p t o t he o cclusal s urfaces w ith c opious a ccumulations o f a dherent s oft, w hitish p laque. G ingivitis a nd p eriodontal d isease o f v arious d egrees, r elated t o t he p utative a ge o f t he s ubjects, w as p resent b eneath t he p laque a nd

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c aries c ommonly a ffected t he e xposed r oot s urfaces. T he c arious l esions w ere m ostly s hallow , a pparently t ending t o s pread c ircumferentially b ut i n m any i nstances a dvancing d eeply i nto t he s ubstance o f t he t eeth, e xposing t he p ulps a nd s ometimes u ndermining t he c rowns s o t hat t hey b roke o ff. A lthough t here w as b rown s taining o f e namel i n s tagnation a reas, t here w as b ut l ittle i nvasive e namel c aries b eneath t he p laque; h ence S chamschula e t a l ( 1972) c oncluded t hat, a lthough t he b acteria o f t he p laque s eemed n ot t o i nduce i nvasive c aries o f e namel, i t d id i nduce d estructive i nflammation i n t he g ingiva a nd, w hen r oot s urface b ecame a vailable, w as c onducive t o a n a ctive d estructive t ype o f c aries o f c ementum a nd d entine. T he s taple d iet o f t hese p eople c onsisted o f p reparations o f c arbohydrate-rich y am , b anana, s weet p otato a nd s ago r oot.

D ISCUSSION T his c ommunication h as t wo m ain p urposes. F irstly t o d erive a s m uch i nformation a s p ossible f rom t he r emains d iscovered o f t he p ast i nhabitants o f t his i sland; s econdly, t o p ublicize t he e xistence o f t he c hapel w hich m ust b e a n i mportant f ind b ecause, w hatever i ts e xact a ge, a part f rom b eing r oofless a nd t he d eterioration o f t he u pper p arts o f i ts w alls t hat h as o ccurred i n t he p ast f ew y ears, i t i s i n a n early i ntact s tate a s i t w as w hen i t b ecame b uried b y s and b low i n w hat i t i s a rgued h ere w as a bout A D 1 500 .

T he c hapel I t i s c onvenient t o d iscuss t he c hapel f irst. I n o rder t o d istinguish i t f rom t he c hapel b y E nsay H ouse, t he n ewly d iscovered c hapel w ill b e r eferred t o a s M anish c hapel a fter t he n ame o f t he n earby s trand. T he M anish c hapel i s u nlikely t o b e o f e arlier d ate t han t he s econd p eriod o f C hristianity d uring t he p eriod o f N orse c olonization o f t he H ebrides. S impson ( 1961) h as p ointed o ut t hat i n t he 1 3th c entury, t he N orwegian e mpire, w hich i ncluded t he W estern I sles, w as s table, h ighly o rganised a nd w isely a nd h umanely g overned; i t w as a p eriod w hen b eautiful c athedrals, t he e quivalent o f t hose o f F rance a nd E ngland, w ere b eing b uilt i n N orway i tself. E ven i n t he p eripheral p arts o f t he e mpire, s uch a s G reenland, C hristianity h ad t aken a t l east s hallow r oot a s e arly a s t he b eginning o f t he 1 2th c entury. A ccording t o N 8rlund a nd R ousell ( 1929), t he N orse c athedral a t G ardar i n G reenland w as e rected i n t he l atter h alf o f t he 1 2th o r e arly i n t he 1 3th c entury. S impson a rgued t hat s ome o f t he c hurches a nd c hapels i n t he N orthern a nd W estern I sles o f S cotland c an r easona bly b e a ttributed t o t his N orse p eriod b efore t hose t erritories w ere c eded t o S cotland f ollowing t he b attle o f L args i n 1 263; f or e xample, h e g ave a m id-12th c entury d ate f or t he b uilding o f t he S t. M agnus C athedral i n K irkwall i n t he O rkneys a nd a ttributed T eampull M holuichh i n L ewis t o a bout t he e nd o f t he 1 2th c entury w hereas t hat c hurch w as " tentatively a ssigned t o t he 1 4th c entury" b y t he R oyal C ommission o n A ncient M onuments o f S cotland ( 1928). S impson a lso a ssigned T eampull T rionaid i n N orth U ist t o a bout 1 200 A D , w hereas t he R oyal C ommission a scribed i t t o t he 1 6th c entury. T hese t wo c hapels, l ike m any o thers i n t he W estern I sles, m ost o f w hich a ppear t o h ave n o d ate a ssigned t o t hem , a re c onstructed o n v ery s imple l ines, l ike t he E nsay c hapel.

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F ig. 9 6. C lose-up v iew o f f ractured s urface o f s hell-sand m ortar f ound o n o uter s urface o f t he c hapel w all. Q uite l arge f ragments o f s hell ( up t o a bout l cm d iameter) c an b e i dentified b y t heir c urved e dges a nd b y t he p atterns o f g rowth l ines. T he f ragments c an b e s cratched w ith a s harp i nstrument i ndicating c alcination b y h eat. x 2 .

M any a re a bout t he s ame s ize a nd s ome a ppear t o h ave b een, a t l east i n p art, b uilt o f d ry s tone, t hough T eampull M holuichh a nd T eampull T rionaid j ust m entioned a ppear t o b e c onstructed b y l aying t he s tone s labs i n m ortar. T he m ortar ( shell-lime o r s hell-mortar) o f M anish c hapel w as h ard a nd d ifficult t o d etach f rom t he s urfaces o f t he s tones ( Figs. 8 a nd 9 6). P resumably t he w hole s urface o f t he d rystone w alls h ad b een r endered s mooth w ith t he m ortar; i ndeed p art o f t he o uter s urface o f t he n orth w all w as e xcavated t o a d epth o f a bout 1 .5m a nd a t t hat d epth t he s urface w as m ore o r l ess c overed w ith m ortar. T here i s n o l imestone o n t he i sland s o i t m ust b e p resumed t hat t he m ortar w as p repared b y h eating s hell g athered f rom m iddens o r t he b each o r b y h eating s hell s and. A n i mpressively l arge a mount o f e ffort w ould b e n eeded t o p roduce e nough m ortar t o r ender t he s urfaces o f t he c hapel w hich s eems u nlikely t o h ave b een d one a t t he t ime t he c hapel w as b uilt, o therwise s tones w ould h ave b een l aid i n m ortar. P robably t he r endering w as d one a t s ome l ater d ate. I f t he r endering h as b een l ost f rom t he u pper h alf o nly o f t he o uter f aces o f t he c hapel, a s s eems p ossible f rom f inding a m ore o r l ess i ntact m ortar r endering a t t he 1 .5m l evel o n t he n orth f ace, t his w ould s uggest t hat t he s and b lows a t f irst h ave o nly b uried t he c hapel t o t hat l evel f or m any y ears l eaving t he u pper p art t o b e g radually d estroyed b y t he e lements. A t l east s ix d istinct s trata w ere f ound i n t he s and o n t he n orth s ide ( p . 2 1 ) , t hat i s f ive t hin d ark l ayers i ndicative o f v egetation-growing s oil, b etween

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l ayers o f p ale s and a bout 0 .5m d eep. T hus t here h ad b een s everal s andb lows w ith i ntervals o f s everal s easons o f s tability d uring w hich a g rass c over d eveloped. A ccording t o t he R oyal C ommission R eport ( 1928), t he c hurch a t N orth R ona, a lthough d rystone, s hows e vidence o f h aving b een p ointed i nternally w ith c lay a nd s and a nd a t s ome s ubsequent t ime w ith r ough l ime m ortar o ver t he o riginal p ointing ( see a lso N isbet a nd G alley, 1 960). T here i s s ome e vidence ( I. F isher, p ersonal c ommunication) t hat l aying t he s labs o n c lay o r a s and-clay m ixture a nd r endering t he s urface s mooth w ith s uch a m ixture w as a w idespread p henomenon ( see a lso R oyal C ommission o n A ncient a nd H istorical M onuments o f S cotland, 1 984, p . 2 7). H ad E nsay c hapel b een b uilt i n t his w ay, t he m ortar b eing s tuck t o t he s urface e dges o f t he s tones a nd n ot e xtending b etween t hem w ould b e a ccounted f or. A ny c lay a nd s and b etween t he s tones c ould h ave w eathered a way o nce t he l ime-mortar c overing w as l ost. E xamination o f t he d eeper u ndisturbed w alls s hould d etermine w hether t his i s s o. I t i s i nteresting t hat S inclair ( 1794 , 1 0 : 3 51) s aid t hat E nsay i s o ne o f t he f ew p laces i n t he W estern I sles w here t here i s s ome c layey a rable s oil. C lay b ands u p t o a bout .1 0cm t hick c an b e s een t oday a t v arious p laces o n E nsay a t l evels a l ittle a bove t he b each i n t he l and e xposed b y f alls f ollowing s ea e rosion. H ow s hell-sand m ortar ( Fig. 9 6) w as m ade i s n ot r ecorded. S ome f orm o f l ime w ould h ave b een n eeded a nd t he m ost l ikely s ource w ould h ave b een s ea-shell o r t he s hell-sand i tself. J udging f rom t he e ase w ith w hich t he f ragments o f s hell i n t he s hell-sand m ortar c an b e s cratched a nd c onverted t o a p owder o n c rushing, t he s hell h ad b een c alcined b y h eat. I t s eems l ikely , t herefore, t hat t he m ortar w as m ade e ither b y c alcining b y h eat t he s hell-sand i tself o r m ixing t he s and w ith s hell, b roken a nd c rushed t o ac oarse p owder a fter h eating . I t i s r ecorded ( Herman, 1 954; H ughes, 1 988) t hat t he f irst s ettlers i n A ustralia t owards t he e nd o f t he 1 8th c entury o btained t he l ime f or m aking m ortar b y h eating i n ak iln s hell f rom t he s hell-middens o f t he a borigines. H owever, Ia m b ound t o s ay t hat a s imple e xperiment i n w hich b roken s hell w as h eated t o r edness i n a t in i n a d omestic f ire a nd t hen c rushed t o ap owder d id n ot, w hen m ixed w ith s hell-sand a nd w ater, p roduce a m ortar t hat s et h ard. T he l ime h as t o b e i n t he h ydrated f orm f or t he s etting r eaction t o t ake p lace a nd p erhaps h ydration r equires e ither a p eriod o f t ime o r s ome s imple s pecial c onditions. A lthough t he p re-Christian d uns a nd b rochs i n t he H ebrides a re c haracteristically d rystone, i t i s n ot p ossible t o a rgue t hat d rystone b uildings a re o f g reater a ntiquity t han t hose w here t he s tones a re l aid i n m ortar; d rystone f or s imple d wellings h as c ontinued w ithout i nterruption u ntil r ecent t imes a nd i s l ikely t o h ave b een u sed a lso f or s imple c hapels i n t he s mall i sland c ommunities l ike E nsay 's, l iving o n t heir o wn r esources. S ome o f t he e arly s mall c hapels i n t he H ebrides a re r ecorded a s b eing a t l east p artly d rystone, f or i nstance t he c hapels o n N orth R ona ( Darling , 1 939), o n t he F lannain I sles a nd o n O ronsay, a lthough t he m ajority a re d escribed a s b eing c onstructed o f " stone a nd l ime" o r " stone a nd m ortar" ( Roy. C omm. A nc. M onuments o f S cotland, 1 928).

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I n s ummary, I a m n ot c ompetent t o j udge w hen t he c hapel m ay h ave b een b uilt b ut i n s ize a nd o ther f eatures i t r esembles s ome o f t he s maller e arly c hapels i n t he S cottish i slands, m ost o f t hem r educed t o r uins, t hat h ave b een a ttributed t o t he 1 3th o r 1 4th c enturies, o r e ven e arlier ( Muir, 1 861, 1 885). T he M anish c hapel i s u nusual i n t hat i t i s m ore o r l ess i ntact, a part f rom b eing r oofless; i t d eserves t o r eceive t he a ttention o f t hose w ith t he e xpert k nowledge t o e xcavate a nd i nterpret i t.

T he p ebbles T he p ebbles o n t he e ast w indow s ill a re o f i nterest b ecause t hey s eem t o h ave b een p laced t here a nd t wo w ere a ttractive p ebbles o f w hite q uartz. B ord a nd B ord ( 1978) g ave m any e xamples o f w ater-worn o void o r s pherical s tones b eing f ound i n p rehistoric s ituations a nd i n h istoric t imes b eing u sed a s c harms a nd h aving a ttributed t o t hem m agical h eali ng p roperties m ainly i n I reland b ut a lso i n t he W estern I sles a nd m ainland o f S cotland. B ord a nd B ord a lso m entioned s everal i nstances o f q uartz, w hether a s w ater-worn p ebbles, s ometimes b earing i ncised p atterns, o r a s c rystal m asses o r i rregular b locks, b eing f ound i n p rehistoric s ites a nd g raves a nd s uggested t hat w hite q uartz h ad m ystical a ttraction i n a ncient t imes.

T he i nvesting w all T he c ircle o n t he O rdnance S urvey m ap, s ix i nches t o t he m ile, o f 1 882 a nd l ater m ust i ndicate t he c ircular n ature o f t he w all s urroundi ng t he b urial g round b ecause t he b urial g rounds o n P abbay a nd B erneray m aps a re i ndicated b y a n o val a nd a r ound-cornered r ectangle r espectively. T he b ase o f t he s urrounding w all i s a pproximately l evel w ith t he t ops o f t he g ables o f t he c hapel ( Fig. 1 0). A s t he w all i s o nly 1 5m f rom t he c hapel, t he c hapel w ould b e l ying i n av ery d eep h ollow i f w e e nvisage i t a nd w all b eing o f s imilar d ate. H ence, t he l evel o f t he b ase o f t he w all c an o nly m ean t hat i t w as b uilt a fter t he c hapel h ad b een b uried i n t he s and, p robably w hile a t l east t he t ops o f t he g ables w ere s till t o b e s een o r w hile t he p osition o f t h2 c hapel c ould b e r ecalled b y t he b uilders o f t he w all. T he w all i s a pproximately c ircular i n p lan w ith t he c hapel n ear i ts c entre ( Fig. 9 ). A lmost c ertainly t herefore t he w all w as b uilt d eliberately t o e nclose t he c hapel a nd i ts i mmediate s urroundings a s c onsecrated g round t hat c ould b e u sed a s a c emetery . P ossibly t he i nterments c lose t o t he e ast g able w all a re a mong t he f irst i n t his m ore r ecent i nterment p eriod. I t i s t o b e a ssumed t hat t here i s a nother l evel o f i nterments i n t he c hapel a rea b elow t he l evel o f t he c hapel f oundations, i nterments a ssociated w ith u se o f t he c hapel f or w orship. T hese w ould b e m ost l ikely t o b e o n t he s outh s ide, p ossibly r elated t o ap ath l eading t o t he d oor.

A ccording t o T homas ( 1971), t he e nclosure o f c emeteries b y a n o val o r c ircular w all, r ather t han a r ectangular o ne, i s a n e arly C hristian c haracteristic a nd m ay b e a n e xpression o f t he p rehistoric e mphasis o n t he c ircle, e .g. c ircular s acred p laces w hich s eparate t he s acred f rom t he p rofane, a nd, i n t he c ase o f b urial p laces, t he d ead f rom t he l iving. T his i s n ot t o s uggest t hat t he E nsay w all i s e arly C hristian b ut t hat t here c ould h ave b een t he p ersistence i n t hese r emote i slands o f s uch i deas l ong a fter t hey h ad b een d isplaced e lsewhere. T he p ossibility c annot b e d iscounted t hat t he w all w as b uilt i n t his w ay b ecause t here w as t he h anding d own b y w ord o f m outh o f t he e xistence o f a c ircular w all s urrounding t he c hapel o riginally. I t w ould b e w orth s earching f or s uch a n i nvesting w all a t a d eeper l evel, w hen f ull e xcavation o f t he c hapel i s u ndertaken.

T he c hapel s ite W hether o r n ot t he l egend i s b elieved t hat a t o ne t ime t he S t. K ilda g roup o f i slands w as j oined t o H arris, t here i s ag reat d eal o f e vidence t hat a t o ne t ime t he O uter H ebrides e xtended m uch m ore t o t he w est a nd t hat c hanges o f t he l evel o f t he s ea o r s inking o f t he l and, w ith o ccasional v iolent s torms p laying a l esser p art, h ave b rought a bout m ore o r l ess c ontinuous e rosion o f t heir w estern c oasts s ince p rehistoric t imes ( Jehu a nd C raig, 1 926; 1 928); i ndeed t here h as b een m uch l oss i n t he p ast f ew h undred y ears ( Moisley, 1 961). M acGregor ( 1969) d ocumented t he e vidence f or s ea-encroachments o n t he w est c oast o f N orth U ist i n 1 540 a nd 1 542 a nd a gain i n 1 717 a nd 1 721 w hen, a ccording t o c ontemporary a ccounts, " The s ea o verflow 's s everal p arts o f t he c ountry b reaking d own m any h ouses." S inclair ( 1794 , 1 0 : 3 73) w rote, " On P abbay t here a re a t t imes o f s pring e bbs l arge t runks o f t rees v isible w ith r oots f ixed i n b lack m oss. T he s ame i s o bservable a long t he l engths o f t he L ong I sland ( Outer H ebrides), p roof t hat a w ide e xtent o f t he w estern c oast, o nce t he h abitation o f m en , h as , e ither t hrough s ome v iolent c oncussion , o r ag radual p rocess o f n ature, b ecome t he b ed o f p arts o f t he A tlantic." T he M anish c hapel i s a t p resent o nly a bout 2 00m f rom t he s ea. I ts f oundations a re a bout 1 2m a bove s ea l evel a nd a ppear t o r est o n s and o r s andy s oil w hich m ay b e t he o riginal m achair n ow d eep u nder s and d unes. W ind e rosion o ver t he p ast 1 2 y ears h as b rought t o l ight, a mong t he d unes i n t he v icinity o f t he b urial g round, a n umber o f d rystone w alls, a pparently e nclosing q uite l arge a reas o f l and, a nd f oundations o f b uildings a t a bout t he s ame l evel a s t he c hapel. T hese w alls r esemble t he p erimeter w all o f t he b urial g round i n b eing c omposed m ainly o f r ounded b oulders a nd n ot w ell-fitted s labs. T he M anish c hapel i s a bout 4 00m e ast o f t he s ite o f ab ronze a ge c ist e xcavated b y D r. D erek S impson i n 1 967. T he a ctual s ite h as n ow b een d estroyed b y e ncroachment b y t he s ea . D r. S impson o n av isit t o E nsay i n 1 981 d emonstrated b y f inding f ragments o f b ronze a ge p ottery e tc. t hat, b eneath t he s and d unes i n t his a rea a nd a t al evel a bout 3 m b elow t hat t he f oundations o f t he c hapel, t here i s e vidence o f a n e xtensive b ronze a ge o ccupation s ite . M anish c hapel s tands w ithin t his a rea.

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I t i s p ossible t hat t he g rave r eferred t o b y M artin M artin ( 1703) a s h aving b een d iscovered o n t he i sland i n a bout 1 695 a nd " in w hich w as f ound a p air o f s cales m ade o f b rass, a nd a l ittle h ammer, b oth o f w hich w ere f inely p olished" w as a lso w ithin t his g eneral a rea. T he g rave s eems l ikely t o h ave b een a b ronze a ge o ne. T he p resent c onditions s o c lose t o t he s hore a nd a t t he s eaward m argin o f m achair, t he i nstability o f w hich i s l ikely t o h ave b een k nown i n a ncient t imes, a re s o u nsuitable a s ite f or a c hapel t hat i t m ust b e i nferred t hat t he c onditions w ere q uite d ifferent w hen t he c hapel w as b uilt. I t i s r easonable t o v isualize t hat t he s ea w as m uch f urther a way; i t w ould s eem q uite p ossible t hat t he M anish c hapel w as b uilt, w hether i n t he 1 3th c entury o r t he 1 5th , o n m achair l and w hich a t t he t ime e xtended a k ilometer o r p erhaps m uch m ore f urther t o t he n orth t han t he p resent s ea—line a nd w ith a t l east o ne b lackhouse, b ut p ossibly a s mall c ommunity o f o thers n earby . T he c haracter o f t he w est p arts o f t he O uter H ebrides h as b een c hanged o ver t he y ears b y a nother p henomenon t o s ome e xtent a ssociated w ith t he e ncroachment b y t he s ea a lready r eferred t o, n amely t he d rift— i ng i nland o f s and f rom t he w estern s hell—sand b eaches b rought b y t he p revailing, a nd i n w inter, n early c onstant s outh—westerly w inds. I ndeed t he g reatly v alued f ertile m achair i s t he p roduct o f t he g radual a ddition o f s uch w ind—blown s and r ich i n l ime t o t he p eat, r ich i n o rganic m atter b ut a cid. H owever, a t t imes t he a mount o f s and b lown i s f ar t oo m uch t o b e b eneficial a nd a rable o r g razing l and h as b ecome l ost u nder a d eep l ayer o f s and t ogether w ith h ouses a nd c hurches . L amb ( 1967) c ollected e nough e vidence f rom v arious s ources t o s how t he p attern o f w eather i n B ritain s ince e arly h istorical t imes. T here w as a w arm p eriod b etween 1 000 a nd 1 300 A D w hen t he a verage t emperatures w ere a bout 1°C h igher i n E urope a nd p erhaps 2 -4 °C h igher i n t he A rctic t han n ow . T his w as t he p eriod w hen t he V ikings c olonized G reenland, I celand a nd t he N orthern a nd W estern I sles o f S cotland a nd m ay h ave v isited N orth A merica . A fter 1 300 , i t t ended t o b ecome c older; t he t emperature o f t he A tlantic f ell b y 2°C b etween 1 300 a nd 1 600 a nd t he w inter i ce e xtended m uch f urther s outh , s ometimes a s f ar a s t he F aroes. W ind r ecords s uggest y ears w hen t he d ominance o f S W w inds w as p articularly g reat, e .g. 1 350 , 1 530 a nd 1 730 A D. O ther w ritten r ecords ( Lamb , 1 964, 1 965) s how t hat t here w as a n e xtraordinary s uccession o f s evere s easons i n U lster a nd S cotland i n t he y ears 1 432 — 1 436 c ulminating i n a t l east o ne s erious h arvest f ailure w hen a P apal v isitor t o S cotland f ound t he c ountry d esolate a nd t he H ighlanders " living o n t he b ark o f t rees." A n a ccount i n M acFarlane's G eographical C ollections ( Mitchell, 1 907) r ecords t he l oss o f m uch a rable l and i n t he w estern p art o f U ist b y b eing b uried, t ogether w ith d wellings a nd c hurches, b y h eavy d rifts o f s and f ollowed b y a n e ncroachment o f t he s ea s o t hat a t l ow t ide t he r emains o f c hurches c ould b e s een. I t s eems t hat t he c ause w as a p articularly v iolent s torm t hat w as o nly r emembered b y t he o ldest m en

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o n t he i sland. I t i s g enerally a ccepted t hat t his a ccount i s b ased o n t he f ield n otes o f T imothy P ont, t he c artographer. T here i s g ood r eason t o b elieve t hat P ont 's s urvey w as u ndertaken b etween 1 584 a nd 1 596 ( Megaw , 1 969) w hich t herefore c an b e r egarded a s t he d ate o f t he f ield-note a ccount. I f i t o ccurred i n t he c hildhood o f t he o ldest m en, t he t ime o f t he s torm w ould s eem t o b e t he e arly y ears o f t he 1 6th c entury. H owever, i t s eems p ossible t hat t he m en k new a bout i t b y d irect h earsay, i n w hich c ase t he d ate m ight h ave b een 5 0 y ears o r s o e arlier. C rawford a nd S witsur ( 1977) r eferred t o a s andstorm i n t he S ound o f H arris i n 1 697 w hich w as v ery d estructive o f a rable l and a nd l ed t o a s evere e conomic d ecline i n t he r egion w hich p rogressed f or m any y ears. S inclair ( 1794, 1 0 : 3 44 , 3 73) m entioned i nstances o f t his d estruction o f a rable l and h aving o ccurred i n t he e arly 1 8th c entury. P abbay, h e r ecords, o nce k nown a s t he g ranary o f H arris, l ost a g reat p art o f i ts f ertility b y e ncroachment o f s and d rifts a nd " exhibits a m ost d esolate a ppearance." O f t he w estern s hores m ore g enerally, h e a dded ( 10 : 3 73) " by p erpetual d rifting o f t he s and a nd e ncroachment o f t he s ea, l ands p loughed w ithin l iving m emory a re n o m ore." T hat t his w as o ccurring i n t he e arly 1 8th c entury i s b orne o ut b y W alker ( McKay, 1 980 , p . 5 4). I t i s l ikely t hat s torms o f s ufficient i ntensity t o c reate s andb lows w ould b e w idespread e nough t o a ffect a ll t he s usceptible a reas o n t he w estern s eaboards o f t he O uter H ebrides i ncluding t he E nsay s eaboard.

D ate o f t he e ngulfment o f t he c hapel b y s andblows M artin ( 1703, p . 1 24) r eferred t o t here b eing a n o ld c hapel o n E nsay i n 1 695, " for t he u se o f t he n atives". I t s eems u nlikely t hat h e o verlooked t hat t here w as a nother o ne ( he v isited E nsay t wice; t he s econd t ime o n h is j ourney o f 1 697 t o S t. K ilda); i ndeed h is e nquiries w ere s ufficiently s earching t o m ake i t l ikely t hat h e w ould h ave b een t old i f a nother w as k nown t o h ave b een l ost u nder t he s and, a nd t o h ave r ecorded i t. H e r ecorded w hat h e w as t old a s w ell a s w hat h e s aw . F or i nstance, h e m ust h ave b een t old o f t he g rave o n t he i sland w here a p air o f s cales o f b rass w as f ound ( p.164); i t i s r easonable t o s uppose t hat h ad t he e xistence o f a s econd c hapel r ecently b uried u nder t he s and b een k nown h e w ould h ave b een t old o f t hat t oo. M artin ( 1703 , p . 1 22) d id m ention t hat t here w ere t wo c hapels o n B erneray a nd P abbay, s mall i slands i n t he v icinity o f E nsay, a nd t wo c hapels a lso o n T aransay o ff t he w est c oast o f H arris. M artin m ade n o m ention o f t he w alled b urial g round o n E nsay a nd m ade b ut l ittle m ention o f b urial p laces i n t he r eport o f h is t ravels t hroughout t he H ebrides, p erhaps b ecause t hey w ere s ufficiently c ommonp lace t o b e t aken f or g ranted.

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T he c hapel o n t he e ast s ide o f t he i sland c lose t o E nsay H ouse h as a l ong c ontinuous h istory; i t i s s aid t o h ave b een u sed t o s table h orses e arly l ast c entury a nd w as n ot r estored u ntil a bout 1 900. I n 1 960 i t w as r e-roofed. I t i s r eputed t o d ate f rom t he 1 6th c entury, a nd t o h ave b een b uilt o n a n e arlier s ite s aid t o h ave b een o ccupied b y o ne o f S t. C olumba 's m onks w ho c hose t he s pot b ecause o f t he p resence o f a s pring. W ater i s n ow p iped i nto t he h ouse f rom a s pring i n t he g eneral d irection o f t he c hapel; t he e xact s ite o f t he s pring c annot n ow b e i dentified. A ccording t o A .R. D ufty o f t he R oyal C ommission o f A ncient M onuments i n E ngland a nd W ales, w ho e xamined t he c hapel i n 1 973, " the w est w all o f t he c hapel s hows d efinite s igns o f a s pecial c orner b ond o f a lternate s mall a nd l arge s labs w hich c an o nly b e p re1th c entury w ork . U p t o a bout 6 ft f rom t he g round l evel o f t hat p art o f t he c hapel d ates f rom t hat p eriod a nd h as b een i ncorporated i nto a l ater b uilding ." O ur f irst w orking h ypothesis w hen t he M anish c hapel w as d iscovered w as t hat t he c hapel r eferred t o b y M artin ( 1703) w as t he o ne b y E nsay H ouse a nd t hat, a t t he t ime o f h is v isit i n 1 695, t he M anish c hapel w as n ot o nly c ompletely e ngulfed b y t he s and b ut t hat e vent w as n ot r ecent; o therwise h e w ould h ave b een e xpected t o b e t old a bout i t a s h e w as a bout t he a ncient g rave. F urthermore, a s i t w ould t ake a f ew g enerat ions, s ay a bout 1 00 y ears, f or l ocal f olk-memory o f t he e xistence o f a s econd c hapel t o f ade, w e a rrive a t a bout 1 600 A D a s a w orking h ypothesis f or t he l atest d ate f or t he e ngulfment a nd l oss o f t he M anish c hapel w ith t he p ossibility t hat i t c ould h ave b een e arlier. T he r anges o f a ge c overed b y t he c arbon-dating o f t he t wo i nterments a gainst t he e ast f ace o f t he c hapel a nd o f t he i nterment d isturbed b y t he b uilding o f t he p erimeter w all o verlap s o t hat i n s trict s tatistical t erms t hey a re i ndistinguishable. T heir d ates, h owever, a re, t o s ay t he l east, c onsistent w ith t hat s uggested b y t he h istorical e vidence o utlined a bove a nd w ith t he m ore w eighty e vidence o f t he c oin w hich , h aving b een m inted d uring t he r eign o f J ames I V , 1 488-1513, a nd, f rom i ts w orn s tate h aving b een i n c irculation f or a c onsiderable p art o f i ts p otential l ife, t hat i s, f or w hat m ight b e e stimated a s 5 0 y ears, s uggests a d ate o f a bout 1 500-1550 A D . O f P ot I a nd t he b uckle i t c an o nly b e s aid t hat t heir e stimated a ges a re n ot i nconsistent w ith t his d ate. T he d ate r ange a ccorded t o t he i nterment u nder t he p erimeter w all ( HAR6414) e xtends t o a n e arlier d ate t han t he o thers a nd, a part f rom b eing i n a ccord w ith t he w all h aving b een b uilt a fter t he i nitial e ngulfment o f t he c hapel, m erely p rovides e vidence t hat t he a rea w as i n u se a s ab urial g round a t t he t ime t he p erimeter w all w as b uilt . T hat t he w all w as b uilt a fter t he e ngulfment o f t he c hapel w as w ell a dvanced r ests o n t he r elation o f t he l evel o f t he f oundations o f t he w all t o t he t ops o f t he g ables o f t he c hapel ( p. 1 3 ) .

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T he e nclosure o f t he a rea w ith t he c hapel a t i ts c entre s uggests t hat t he p erimeter w all w as b uilt a t t he t ime w hen e ither t he g ables w ere s till v isible o r t he p resence a nd p osition o f t he c hapel w ere r emembered. A ssuming t hat b urials w ere m ade i n t he v icinity o f t he c hapel d uring t he p eriod i t w as i n u se, t he b uilding o f t he w all w ould i ndicate a d ecision t o c ontinue t hat u se. N one o f t his, o f c ourse, t hrows a ny l ight o n t he d ate o f b uilding o f t he c hapel, e xcept t hat i t m ust h ave b een p re-1500 A D.

t he

T he c oin , p ot, b uckle a nd C -dated i nterments w ere a ll m ore o r l ess a t t he s ame l evel, t hat i s t he l evel o f t he u pper p art o f t he c hapel. T o b e m ore p recise, t he i nterments w ere f ound a bout 1 .5 m etres b elow t he l evel o f t he t op o f t he g able a nd, u nless t hey h ad b een p laced i n u nusually d eep g raves, i t m ay b e i nferred t hat t he t op o f t he g able w as s till e xposed a t t he t ime o f t he b urials . H ence t he d ate 1 500-1550 A D, p rovided m ainly b y t he c oin b ut s upported b y t he c arbon-dating o f t he i nterments, r efers t o t he c omplete, o r n early c omplete, e ngulfment o f t he c hapel. T he b eginning o f t his p rocess o f e ngulfment a nd c onsequent a bandonment o f t he c hapel w ould h ave b een e arlier. T he b uild-up o f s and i s l ikely t o h ave b een i ntermittent, i ndeed t he s tratification o f t he s and b y a t l east t hree d istinct d ark l ayers w as n oted w hen p art o f t he o uter s urface o f t he n orth w all w as e xplored t o ad epth o f 1 .5m ( P. ) , s howing t hat t he b uild-up o f s and w as p eriodic w ith i ntervals p robably l ong e nough f or t he s and s urface t o b ecome g rass-grown. T he i ntermittent b uild-up w ould h ave b een p redominantly o n t he s eaward s ide. O n t he s outhern s ide, i t w ould h ave b een m uch l ess a nd a t f irst e fforts w ould h ave b een m ade t o k eep t he d oor c lear a nd t he c hapel i n u se u ntil e ventually t here w as a l arger s andblow o r i t w as f elt t hat i t w as n o l onger w orthwhile t o b attle w ith t he e lements. S and d rifts c an , l ike s now d rifts, b uild u p q uite r apidly. S and d unes t end t o b e u nstable a nd p eriods o f a ccretion a re l ikely t o b e i nterrupted b y p eriods o f e rosion. R anwell ( 1972), i n a n i mportant r eview o f t he m echanisms c oncerned, c oncluded t hat c ycles o f a bout 8 0 y ears a re c ommon. H e p ointed o ut t hat s and d unes c ommence t o g row f rom a n ucleus a gainst w hich t he s and d rifts a nd s uch n uclei m ay b e s mall, s uch a s t idal l itter o r t ufts o f m arram g rass, o r l arge. T he M anish c hapel w ould b e a n e xample o f l arge-scale n ucleus c omparable w ith a v ehicle R anwell m entioned t hat w as a bandoned c lose t o t he N orfolk s hore a nd i n 2 0 y ears b ecame e mbedded i n a s and d une 6 m h igh ; t hat i s s everal m etres h igher t han t he o riginal n ucleus. I n o ther w ords, o nce t he m echanism o f d une f ormation i s s et i n m otion , t he a ccretion p rocess i s a pt t o c ontinue a nd t he u ltimate h eight o f t he d une i s l imited b y v arious f actors o ther t han t he h eight o f t he o riginal n ucleus . S ome d irect e vidence o f t he a ctual r ates o f a ccretion a nd e rosion o n E nsay i s a vailable. W e h ave s een s and b uild u p i n t hree y ears t o t he t op o f am etre-high d ry s tone w all a bout 4 00 m etres i nland o f t he M anish s hore; w e h ave s een a d epth o f a bout e ight m etres o f s and b lown

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a way f rom a bove a nd a round t he c hapel i n t he p ast 2 0 y ears. W alker ( McKay, 1 980 , p . 7 4), w riting p robably i n 1 765, s aid t hat i n S outh U ist, " it w as i ndeed M elancholy, l ast A ugust, a fter a T ract o f h igh W inds, t o s ee s ome e xcellent F ields o f B ear ( barley), t urned i n a f ew D ays i nto F ields o f S and, i n s ome p laces a y ard d eep". N o d oubt s ome s uch s and b low , o r o ne e ven m ore s evere, b egan t he p rocess o f e ngulfm ent o f t he M anish c hapel, w ith o thers f ollowing a t i ntervals. B earing i n m ind t he s tratification i n t he s and o n t he n orth s ide ( p.21 ) , w hich i ndicates a t l east f ive p eriods, a m inimal p eriod o f 5 0 y ears f or t he p rocess o f e ngulfment s eems r easonable. I t c ould, o f c ourse, h ave t aken m uch l onger. H ence w e a rrive a t at entatively e stimated d ate r ange o f 1 450-1500 A D f or t he i nitial s and b low . E nsay w ould u ndoubtedly h ave s hared s ome o f t he d amage c aused b y t he v iolent s torm , a lready r eferred t o, r ecorded b y P ont a s h aving l ed t o t he l oss o f m uch a rable l and o n t he w estern s ide o f N orth U ist. E specially i f t he e arliest e stimated d ate f or t hat s torm o r s tormy p eriod i s c onsidered, n amely t he l atter h alf o f t he 1 5th c entury, i t c ould b e r elated t o t he i nitial s and b low t hat l ed t o t he e ngulfment o f t he M anish c hapel. T he s uccession o f s evere s easons i n U lster a nd S cotland i n 1 432-1436 r eferred t o b y L amb ( 1964, 1 965) c ould b e i mplicated i f, a s s eems t o b e i mplied, t hese w ere p eriods o f w inter s torms a s w ell a s c old s ummers. H owever, a s H urst ( 1967) h as p ointed o ut, s andblows h ave a lways b een a p erennial h azard i n t he m achair a reas o f t he O uter H ebrides. T he s uggestion t hat t he M anish c hapel h ad c eased t o f unction b y t he b eginning o f t he 1 6th c entury f its q uite w ell t he s tory o f t he E nsay H ouse c hapel b eing b uilt d uring t he 1 6th c entury, w hether o r n ot i ncorporating t he r emains o f a n e arlier b uilding; t he l oss o f t he M anish c hapel c ould h ave b een t he i ncentive f or a n ew b uilding. A n i nterval o f 5 0, o r e ven m ore, y ears w hen t here m ight h ave b een n o f unctional c hapel o n t he i sland i s n o h indrance t o t his i dea . I t i s w orth r emarking t hat t he 1 6th c entury w as a p eriod o f r eligious u nrest a ssociated w ith t he R eformation . H owever, i t m ay b e s upposed t hat t he s maller i slands i n t he O uter H ebrides w ould h ave b een b ut l ittle a ffected b y t he m ainland a gitation . T he p ossibility m ust b e c onsidered t hat t he E nsay H ouse c hapel a nd t he M anish c hapel w ere, b efore t he l oss o f t he l atter, b oth f unctional a t t he s ame t ime. A t f irst s ight, E nsay s eems t oo s mall a n i sland, w ith a p opulation o f n ot m ore t han 2 5 f amilies ( see l ater), f or t his t o b e l ikely. M artin ( 1703, p . 1 23) m entioned t wo c hapels o n i slands o f t he s ame o rder o f s ize a s E nsay, b ut w e c annot b e s ure t hat h e m eant t hat t hey w ere b oth i n u se; h e w as r arely a s s pecific a s h e w as a bout E nsay c hapel, " for t he u se o f t he n atives". N evertheless i n r espect o f t he t wo c hapels o n T aransay ( an i sland w ith a bout f our t imes m ore a rable a nd g razing l and t han E nsay), h e m entioned t hat t here w as a t radition t hat m en m ust b e b uried a t o ne a nd w omen a t t he o ther, s o t hat i t i s e vident t hat t hese t wo c hapels w ere i n u se a t t he s ame t ime . I t i s p ossible t hat s mall c hapels w ere b uilt m ore a s a n e xpression o f p iety t han t o m eet a n eed f or a c overed p lace f or w orship. A ll t he i nterments s o f ar e xposed b y w ind e rosion , o r e xcavated i n a nticipation o f s uch e xposure, b elong t o t he p eriod a fter t he

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e ngulfment o f t he c hapel. I t i s f airly c ertain t hat e rosion h as e xposed l evels A , B a nd C o ver t he w hole o f t he w alled a rea s o t hat n o i nterments r emain b elonging t o w hat i s e stimated t o b e t he p ost-1600 A D p eriod. T he e rosion t hat h as c ontinued a t a s lower r ate o ver t he p ast t hree y ears h as e xposed f ew a dditional b urials o f t he l evel D p eriod; h ence i t i s b y n o m eans c ertain t hat m ore d o n ot r emain . W hether t here a re i nterments a t am uch l ower l evel, b elow t he l evel c orresponding t o w hen t he c hapel w as f unctional a nd w orshippers w ere e ntering b y t he d oor i n t he s outh w all, i s am atter o f s peculation. I t s eems l ikely t hat t here a re s uch i nterments b ecause t here i s n othing s uggestive o f i nterments i n t he v icinity o f t he E nsay H ouse c hapel; i ndeed s olid r ock i s t here, a s i n s o m any p arts o f t he i sland, t oo n ear t he s urface f or a nything b ut t he m ost s hallow o f g raves. I t i s p ossible t hat t he M anish s ite i n t he m achair l and w here i nterment w ould b e e asy, w as c hosen f or a b urial g round a t a n e arly d ate, p erhaps w hen t he E nsay H ouse c hapel w as i n i ts C olumban p eriod, a nd t hat l ater t he M anish c hapel w as b uilt i n a ssociation w ith t he i sland's b urial g round. T hus t here m ay b e, a t a l evel s everal m etres b elow t he p resent o ne, a nother p opulation o f i nterments i n t he a rea a round t he c hapel. T hese o ne d ay m ay c ome t o l ight b y s oil e rosion o r e xcavation a nd t hus t hrow l ight o n am uch e arlier p eriod o f t he i sland 's p eople.

P opulation o f E nsay E nsay h appens t o b e o ne o f t he f ew i slands o r a reas o f l and i n r espect o f w hich s ufficient i nformation c an b e d educed f rom t he L andlord's ( MacLeod o f H arris) r ecords t o p rovide e xamples o f t he s ize p ennylands c ould b e, a nd w hat p roduce c ould b e o btained f rom t hem i n t he l ate 1 7th c entury ( Macdonald D ., 1 978) t hough i t i s e vident f rom S inclair's S tatistical A ccount ( 1794) o f a bout 1 00 y ears l ater t hat e ither p roductivity h ad g reatly i ncreased o r t here w as g reat v ariability. A ccording t o S haw ( 1980, p . 5 5), t he 1 680 r ental r ecords a mong t he M acLeod P apers s how t hat J ohn C ampbell h eld 2 p ennylands o f E nsay a nd 1 j oint t enants h eld t he " other 2 p ennylands". T he 1 684 r ecords ( F .J . S haw , p ersonal c ommunication) s how t hat t here w ere t hen 1 3 j oint t enants. A p ennyland i s a r ough m easure o f a n a rea o f l and, n ot b ased o n l inear m easurement b ut o n w hat c ould b e g rown o n i t o r w hat s tock i t w ould m aintain . I t m ight s upport s even o r e ight c attle a nd p roduce a c onsiderable q uantity o f c rops. E ach j oint t enant r eferred t o c an b e r egarded a s r epresenting a f amily. J ohn C ampbell w as t he m inister o n H arris a nd t herefore e ither s ublet h is h alf o f E nsay o r m ust h ave e mployed s everal f amilies t o w ork i t f or h im . W e m ay p erhaps e nvisage a s m any a s 2 5 f amilies l iving o n E nsay. A f amily u nit i s l ikely t o h ave c onsisted o f a bout f ive p ersons o f v arious a ges r anging f rom a b aby t o a g randparent, f rom w hich w e d erive a t otal o f 1 25 p ersons l iving o n E nsay a t t he e nd o f t he 1 7th c entury. M artin ( 1703, p . 3 50) r eferred t o f amilies o f f our t o f ive p ersons a t l east a nd W alker ( McKay, 1 980) i n 1 764 g ave f ive t o s ix a s t he a verage f amily s ize i n t he P arish o f S mall I sles ( Eigg, R um , M uck , C anna) w ith a r ange f rom t wo t o e leven. T his

e stimate o f 1 25 p ersons i s a r easonable f igure

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f or

E nsay 's

4 40 a cres i f w e t ake a ccount o f w hat i s r ecorded o f t he p opulation o f s ome o ther i slands o f s imilar s ize. M acGregor ( 1933), o n t he b asis o f f inding t he w alls o f a s m any a s 3 0 h omesteads o f P abbay ( 1745 a cres o f a rable a nd g razing) a nd o n a 1 595 A D r ecord w hich s ays t hat P abbay c ontributed 4 0 m en a t a rms, e stimated t he p opulation t o h ave b een a t l east 2 00 p eople; i n 1 764, t he p opulation w as 1 86 p eople ( Walker , 1 808, p . 2 3). S imilarly, t he M onach I slands ( 600 a cres) i n 1 595 w ere a ble t o r aise 2 0 m en a t a rms, s uggesting a p opulation o f a bout 1 00 ( Thompson , 1 968); W alker ( 1808, p . 2 3) i n 1 764 r ecorded a p opulation o f 7 0 f or H eyskir ( Monach I slands). T he e stimates o f a reas g iven a bove r efer t o E nglish o r I mperial a cres. T he S cots m ile a nd a cre, u sed u ntil e arly l ast c entury, w ere l arger t han t he I mperial e quivalents b y a bout 5 :4. U nlike s ome e arly w riters, W alker ( McKay , 1 980, p p. 2 03 a nd 2 23) t o s ome e xtent a nd J . M acdonald ( 1811) m ore p recisely s pecified w hen t hey c orrected t o I mperial m easurements, a s d id t he R ev. J . M acleod, t he M inister o f t he P arish o f H arris, w ho p rovided t he a ccount i n S inclair ( 1794, 1 0: 3 43). I t i s n ot a lways s pecified i n o ther p arts o f S inclair's S tatistical A ccount w hether t he m easurements a re S cots o r I mperial. W hether o r n ot t here w ere a s m any a s 1 25 p eople l iving o n E nsay i n 1 680, b y 1 710 i t s eems t hat t he p opulation m ust h ave f allen b ecause i t i s r ecorded ( Thompson, 1 968, p . 1 69) t hat i n t hat y ear a R oderick C ampbell o f N orth U ist w as p aid 3 13 m erks b y t he C hief's a gents t o s ettle o n E nsay w hich w as " like t o b ecome w east ( waste)". I n 1 710, t he 2 2nd C hief w as o nly f our y ears o f a ge a nd M acLeod e states w ere b eing m anaged p rincipally b y J ohn M acLeod o f C ontullich, o ne o f t he B erneray M acLeods, a ided b y h is s on a nd h eir, R oderick M acLeod. T he s ource o f t he i nformation a bout R oderick C ampbell a nd E nsay i s t he C ontullich A ccounts, 1 706-1720, p reserved i n D unvegan C astle b ut r eproduced b y M orrison ( 1966), w hich a re t he r ecord o f h is s tewardship k ept b y M acLeod o f C ontullich . I .F . G rant ( 1959) r ecounted t hree i ncidents c oncerning C ampbells o f E nsay. I n o ne, N orman M acLeod, t he 2 2nd C hief, w as t ouring t he c oasts o f H arris i n 1 736 w ith S ir A lexander M acDonald, h is n eighbour o n S kye, a s p art o f a n e ffort t o s ettle a d ispute c onc erning t he o wnership o f l ands i n t he a rea. I n t he c ourse o f t his v oyage t hey d ined w ith C ampbell o f E nsay. T he p arty e nded t he d ay b y a v isit, v ery d runk, t o t he M inister o f L uskintyre. I t i s o bvious t hat t he C ampbell r eferred t o c ould h ave b een t he R oderick C ampbell o f 2 6 y ears b efore, o r h is s on. I t i s n oted t hat, a ccording t o W alker ( 1808), i n 1 764, a fter t his i ncident, 6 0 p eople w ere l iving o n E nsay.

2 8

y ears

G rant ( p. 5 06) a lso m entioned t hat, i n 1 777, C ampbell o f E nsay a s w ell a s C ampbells o f S calpay a nd S tron w ere a mong t he a ncient a dherents o f t he C hief w ho o ffered t o p ay i ncreased r ents i n o rder t o p reserve h is a ncient l ands i ntact. T he t hird m ention o f C ampbell o f E nsay ( Grant, p . 5 41) i s i n t he u npublished a utobiography o f J ohn N orman M acLeod w ho s ucceeded w hen t he C hief, h is e lder b rother, w as k illed i n a n aval d isaster i n 1 799. H e r ecalled t hat i n t hat y ear c ertain M acLeod l ands w ere s old t o C ampbell o f E nsay . I t

m ust

b e a ssumed t hat t hese l ater m entions o f

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a

C ampbell

o f

E nsay a re t o d escendants o f t he o riginal R oderick C ampbell o f 1 710 a nd, i n v iew o f t heir a pparent i ntimacy w ith t he M acLeods, t hey m ay h ave b een e xtensions o f t he f amily o f C ampbells o f S calpay, o ff t he e ast c oast o f H arris, w ho s ince a ncient t imes h ad b een t he h ereditary f oresters t o t he M acLeod C hiefs a nd w ho , a ccording t o G rant ( p. 4 89), i n c irca 1 755, s till h eld t hat r ank a nd w ere s till l iving o n S calpay. I t s eems f rom I .F . G rant ( 1959) t hat t he s ource o f t hese i tems o f i nformation i s M acLeod d ocuments h eld a t D unvegan C astle. T hese p apers a re l ikely t o b e t he s ource o f t he s tatement t hat, i n 1 720, " Roderick M acLeod, B aylie o f H arris, h ad E nsay", w hich M acGregor ( 1972, p . 7 3) i nterpreted a s m eaning M acLeod l ived t here b ut i s m ore l ikely t o m ean h ad m anaging o r t acksman 's r esponsibility f or. T he C ontullich A ccounts ( Morrison , 1 966) d o c ontain a n umber o f s light d irect r eferences t o E nsay b ut t hey m erely i ndicate t hat r ents f rom t he i sland w ere r eceived a nd t hat a b ereaved M ary M acQueen w as r eceiving s ome p ayments f rom t he e state. H owever, f or 1 713 ( Morrison , p . 3 33), t here i s ap uzzling r eference t o t he p ayment o f 4 20 m erks t o a R ory M acLeod o f E nsay f ormerly ' designed i n N orthtoun ' ( designated a s o f N orthton) w hich M orrison ( p. 3 48) a ppears t o i nterpret a s r eferring t o R oderick M acLeod t he s on o f J ohn M acLeod o f C ontullich . I t c annot b e e xpected t hat a ll t he q uestions t hat a rise i n c onnection w ith E nsay a nd i ts a ssociations w ill e ver b e a nswered. E nsay s eems t o h ave h ad a ssociations o ut o f p roportion t o i ts s mall s ize; t he a djacent i sland o f K illigray i s n ot m entioned n early s o m uch i n t he s tory o f t he M acLeod c lan ( Grant, 1 959) o r i n t he C ontullich A ccounts. A c ontemporary a ccount o f 1 774 ( Grant, 1 959, p . 5 51) s ays o f t he l east-landed t enants o f t he M acLeod l ands, w hich w ould h ave i ncluded E nsay, t hat t he g rain g rown o n t heir s mall p lots w as g enerally a ll c onsumed b efore J une o r J uly w hen t heir p otatoes w ere n ot r ipe a nd t hey w ere o bliged t o l ive o n m ilk , f ish a nd s hell-fish . P otatoes w ere i ntroduced i n t he W estern I sles a bout 1 730-1740 . A ccording t o W alker ( 1808) o f a bout f orty y ears e arlier, e mployment o f t he i nhabitants d epredations o f w ild g eese. N o

w riting o f h is e xperiences o n t he U ists f rom J uly 1 t o O ctober, t he p rincipal w as t o d efend t heir c rops a gainst t he d oubt t his w as s o o n E nsay a lso.

T he l ast y ears o f t he 1 7th c entury w ere o nes o f d earth a nd f amine d uring w hich t here w as a g eneral f all i n p opulation i n S cotland, i ncluding t he W estern I sles. H owever, d etailed p opulation s tatistics f or t he W estern I sles a re n ot a vailable f or e arlier t han 1 755 w hen t he R ev . A lexander W ebster o f E dinburgh g athered a n e numeration o f t he i nhabitants o f e ach p arish f rom h is f ellow m inisters t hroughout t he w hole o f S cotland. H is d ata s till r emain i n m anuscript b ut a re n ow a vailable i n K yd ( 1952) a nd i n B arclay a nd D arling ( 1955). B etween 1 764 a nd 1 771, t he R ev. J ohn W alker, w ho l ater a s P rofessor o f N atural H istory i n E dinburgh b ecame a n e xtremely a ctive a nd d istinguished s cientist , m ade a s eries o f j ourneys i n t he H ebrides a nd c ollected d ata o n t he p opulation o f t he v arious i slands, a s w ell a s o n t he w ay o f l ife i n m any a spects. W alker's R eport t o H is M ajesty's C ommissioners o f A nnexed E states w hich, w ith t he G eneral A ssembly o f t he C hurch o f

1 71

S cotland, c ommissioned h is j ourneys, w as n ot p ublished d uring h is l ifet ime b ut e xists a s am anuscript a t t he B ritish L ibrary i n L ondon ( King 's M S 1 05). T he R eport f orms t he b asis o f h is " Economical H istory o f t he H ebrides a nd H ighlands" p ublished i n 1 808 , f our y ears a fter h is d eath . T he m anuscript c ontains m uch a dditional d ata , t hough w ith s ome i nconsistencies. F or m any y ears o nly t wo p arts w ere p ublished ( Mackenzie, K .S., 1 901; M acdonald, R ., 1 912), b ut t he w hole o f t he m anuscript h as n ow b een e dited a nd p ublished b y M cKay ( 1980). W alker 's s urvey i s a p articularly v aluable s ource o f p opulation f igures a nd a creages o f a rable a nd g razing o n t he v arious i slands o f t he H ebrides b ut a ppears t o b e an eglected s ource. H is p opulation f igures, w hich a re i ndependent o f W ebster 's s lightly e arlier o nes, t hough q uite s imilar, a re n ot f or i nstance i ncluded i n t he c omprehens ive T ables p rovided b y B arclay a nd D arling ( 1955) p art o f o ne o f w hich i s r eproduced h ere ( Table 1 8). W alker's p opulation r ecords w ere b ased o n d ata c ollected b y m inisters a nd t heir r epresentatives ( catechists) i n t he v arious p arishes a nd a ppear t o b e m ore c omprehensive t han W ebster's o f 1 755 ( Kyd, 1 952). P arish r ecords o f p opulations t ended t o i nclude o nly t hose o ld e nough t o b e e xamined i n t he p rinciples o f r eligion a nd s o t ended t o e xclude c hildren y ounger t han a bout e ight y ears o f a ge a nd i n s ome c ases c hildren b elow t en y ears. W alker ( 1808, p . 3 8) t ook s teps t o h ave c hildren i ncluded a nd, w hen t hey w ere n ot, t o a pply a c orrection f actor w hich a dded o ne-quarter f or c hildren u nder e ight y ears o f a ge. I t c an b e a ssumed t hat h is f igure o f 6 0 f or t he p opulation o f E nsay a lready q uoted ( p.170) w as s o a djusted. B ecause E nsay i s s o o ften c ommented o n a s a p articularly f ertile i sland, i t i s o f i nterest t hat t he p opulation o f t he n earby i sland o f K illigray, w hich i s o f a bout t he s ame s ize, w as 4 8. T hese f igures d erive f rom a T able ( Walker, 1 808 , p . 2 2) w hich g ives t he p opulations o f o ver 9 0 o f t he i slands o f t he H ebrides i n 1 764. T here i s n o f urther d irect i nformation a bout t he p opulation o f E nsay u ntil o ver 7 0 y ears l ater. T he f irst c ensus r ecords t o i nclude E nsay w ere i n 1 841 ( Table 1 ) w hen t he p opulation w as o nly 1 6. T here i s a g reat d eal o f e vidence t hat, i n t he l atter h alf o f t he 1 8th c entury, t here w as a c onsiderable s teady i ncrease i n t he p opulat ion o f t he H ighlands a nd I slands o f S cotland a ssociated w ith t he g reater s tability i n S cotland t hat f ollowed t he d efeat o f t he s upporters o f t he S tuarts a t C ulloden i n 1 746 , t o a d ecline i n s mallpox ( p.18 1 )a nd t o t he i ntroduction o f t he p otato . T here w as a lso g reater p rosperity a nd, f or a s hort t ime b efore t he C learances, a n i mprovement i n t he l ot o f t he c ommon p eople. I n t he O uter H ebrides, p rosperity i ncreased f rom a bout 1 770 a s ar esult o f t he d evelopment o f t he k elp i ndustry w hich d epended o n t he h igh p rice p aid f or t he b urned s eaweed n eeded a s a s ource o f p otash u sed i n t he m anufacture o f s oap a nd g lass. T his i ndustry f lourished d uring t he N apoleonic w ars b ut w ent i nto a s harp d ecline w hen t he e nd o f t he w ar, a nd f inally t he r epeal o f t he s alt t axes i n 1 822, r emoved r estrictions o n t he i mportation o f c heap p otash f rom S outh A merica.

s uch a ble t hat

T here a re n o d irect r ecords s howing w hether t he s maller i slands, a s E nsay, s hared t his i ncrease i n p opulation b ut i t i s a r easona ssumption t hat t hey d id. M ercer ( 1974) h as a ssembled e vidence t he C ara, G igha, C olonsay, J ura g roup o f i slands o f t he I nner

1 72

T able 1 8.

S howing r ise i n p opulation i n H arris a nd N orth U ist o nly t o 1 841, c ompared w ith c ontinuous r ise i n L ewis e ver s ince 1 755.

D ate

H arris

N orth U ist

L ewis

1 755

1 ,969

1 ,909

6 ,386

* 1764

1 ,993

2 ,584

7 ,312

1 790

2 ,536

3 ,218

1 801

2 ,996

3 ,010

1 811

3 ,569

3 ,863

1 821

3 ,909

4 ,971

1 831

3 ,900

4 ,603**

1 841

4 ,429

4 ,428

1 851

4 ,250

3 ,918

1 861

4 ,178

3 ,910

1 871

4 ,095

4 ,107

1 881

4 ,784

4 ,264

1 891

4 ,980

4 ,187

1 901

5 ,249

3 ,891

D ecline s ince 1 931 t o 3 ,977 i n 1 951

9 ,168

1 2,231

1 7,037

2 1,056

2 5,487

2 8 ,948

C ontinuous d ecline t o 2 ,220, i n 1 951

T he T able i s b ased u pon t hat o f B arclay a nd D arling ( 1955) D ata o f W alker ( McKay, **

1 980)

I n 1 828, 6 00 h ad l eft f or C anada ( Gordon,

1 73

1 845; p .

1 65)

H ebrides d id e xperience a p opulation i ncrease f rom 1 755-1841 b efore a d ecline s et i n. H owever, t he p roximity o f t hese i slands t o t he A rgyle m ainland l imits a ny a nalogy w ith i slands i n t he S ound o f H arris. I n H arris a nd N orth U ist, t he l arge i slands i n p roximity t o E nsay, t here w as a p rogressive i ncrease i n p opulation u ntil a bout 1 841 ( Table 1 8) w hereas i n L ewis, n o d oubt b ecause o f t he c ontribution m ade b y S tornoway's d eep-sea r elationships, t he p opulation i ncrease c ontinued t o t he e nd o f t he c entury. I t s eems t hat, w hereas t he d epopulation o f t he S cottish H ighlands o f w hich t he C learances w ere s uch a n otorious f eature, w ere w ell u nder w ay b y t he e nd o f t he 1 8th c entury, t his i s at ime w hen t he p opulation i n t he O uter H ebrides w as r ising; i t c ontinued t o r ise u ntil n ear t he m iddle o f t he 1 9th c entury ( Table 1 8). E migration a nd c learance o f t he p opulation t o f acilitate s heep-farming i n t he O uter H ebrides w as d elayed t o s ome e xtent b ecause t he p rosperity o f t he k elp i ndustry p rovided l andowners w ith a n a lternative t o s heep f arming a s a s ource o f i ncome. H owever, w ith t he f all i n t he p rice o f k elp, p overty i n t he O uter H ebrides b ecame w idespread a nd w as p articularly a cute i n t he y ears 1 846 a nd 1 847 b ecause o f t he f ailure o f t he p otato c rop . L ife f or t he p easants b ecame s o w retched t hat e migration w as w elcomed. E migration t o t he m ainland a nd N orth A merica b rought a bout s harp l ocal d eclines i n p opulation, p articularly o f t he s maller i slands, a nd a g radual d epopulation o f t he W estern I sles a s aw hole w hich c ontinues t o t he p resent t ime. T he q uestion a rises w hether t he n umber o f i nterments, n amely 4 16 f ound a nd e stimated t o d erive f rom t he p eriod s ince 1 500 A D , i s i n a ccord w ith w hat h as b een s aid a bout t he n umbers o f p eople l iving o n E nsay o ver t hat p eriod a nd w ith w hat w ill b e s aid a bout t he p robable e xpectation o f l ife. I t i s o nly p ossible t o d iscuss t his i n t erms o f l oose a pproximations b ut t he a rgument s eems t o r un a s f ollows: T he e xpectation o f l ife a t b irth o f t he p eople i s c alculated ( p.177 ) t o h ave b een 2 3 y ears. A pplied t o a p opulation o f 1 25, t his w ould m ean t hat t here w ould h ave b een a bout f ive d eaths e very y ear. A ssuming t hat t hey w ere a ll b uried o n E nsay, t he t otal o f 4 16 i nterments r evealed s o f ar w ould h ave b een r eached i n l ess t han 1 00 y ears. T his d oes n ot d iscount e ntirely t he p ossibility t hat t he p opulation w as a s h igh a s 1 25 a t l east f or t he e arliest p eriod, s ay 1 500-1600 A D , b ecause a s m entioned ( p. 1 69 ) , a lthough t he l evels A , B a nd C o f t he b urial g round, t hat i s d own t o t he e stimated 1 600 A D l evel, a re v irtually c ompletely e roded, i t i s q uite p ossible t hat m any i nterments b elonging t o t he p eriod 1 500-1600 A D r emain a s y et u ndisturbed. I t h as a lready b een m entioned ( p. 2 6 )t hat t here i s ap ossibility t hat i n e arly t imes, a s i n t he k nown r ecent p eriod, s ome p eople w ho d ied o n H arris w ere b uried o n E nsay. A s earch o f t he D eath R ecords o f t he P arish o f H arris f rom 1 855 t o 1 886, t he o nly y ears i t h as s o f ar b een p ossible t o e xamine, h as r evealed s ix e ntries ( Table 1 9) w hich r efer t o t he d eceased h aving d ied o n E nsay o r b een b uried t here . F our o f t hese u p t o 1 859 a re r ecorded a s b uried o n E nsay b ut h aving d ied e lsewhere; t he t wo a fter 1 860 a re r ecorded a s h aving d ied o n E nsay b ut i t i s n ot s tated t hey t hey w ere b uried t here. O ne o f t hese, A rchibald S tewart, i s t hought t o h ave b een b uried i n L uskentyre ( p. 4 ) .

1 74

T able 1 9 .

R ecorded b urials o n E nsay f rom t he R egisters o f t he o f H arris.

P arish

1 855.

N ov. 3 :

A ngus M cAskill a ged 1 y ear, d ied a t O ab ( now L everb urgh) o f E ffy M cAskill, g eneral s ervant. A n E ffy M cCaskill, a ged 1 5, a ppears i n t he 1 841 C ensus. A llowing f or v agaries o f s pelling s urnames, t his m ight h ave b een h er c hild b orn o ut o f w edlock. A f amily o f M cCaskill's i s l isted i n t he 1 851 C ensus b ut n ot E ffy .)

1 856 .

J an.

K enneth M cKinnon B erneray.

1 9:

a ged

7 9 .

D ied

a t

R isgary,

M cLennan ( no o ther p articulars).

1 858.

F eb.

2 0 :

J ohn M acDonald a ged 6 9. C helsea p ensioner. a t K entulivig ( near L everburgh .)

D ied

1 859 .

J uly 2 :

D orothy M cLennan a ged 9 8. D ied a t F insbay ( on e ast c oast o f H arris, n orth o f R odel.)

1 873 .

D ec.

1 0 :

J ohn M cDonald a ged 4 8.

1 880 .

A ug.

2 1:

A rchibald S tewart a ged 9 2. D ied a t E nsay.

D ied a t E nsay .

P roprietor

o f

E nsay.

U ncoffined b urials A t a c ertain l evel a bout 2 5m b elow t he s urface o f t he c entral h ummock, t here w as a c hange f rom i nterments w ith t races o f c offin a bove t hat l evel t o i nterments w ith n o t race o f c offin b elow t he l evel. T his l evel o f c hange i s a pproximately t hat o f g roup C i nterments, g iven t he t entative a ge p eriod 1 600-1700 A D . U ntil t he l atter h alf o f t he 1 7th c entury, i t w as t he c ommon p ractice i n m ainland S cotland ( Andrews 1 899), a nd i n E ngland a lso ( Andrews 1 891), t o b ury t he d ead u ncoffined. C offins w ere u sed o nly f or p eople o f r ank o r w ealth. N aturally t herefore t he c ustom o f u ncoffined b urial c ontinued a mong t he p oor f or m uch l onger; i t c an b e a ssumed t hat, f or v arious r easons, i ncluding d ependence o n d rift-wood f or a l ocal s upply o f w ood, u ncoffined b urial w ould h ave p ersisted i n r emote p arts o f t he l argely t reeless H ebridean i slands, s uch a s E nsay , f or m uch l onger t han e lsewhere, a nd c ertainly i t i s e asy t o e nvisage i t h aving p ersisted u ntil t he e nd o f t he 1 7th c entury o r e ven l ater. T he c hange t o b urial i n c offins , m anufactured f rom i mported p lanks, m ight

1 75

w ell h ave o ccurred d uring t he p eriod o f i ncreased p rosperity i n t he W estern I sles a ttributed t o t he l ate 1 8th a nd e arly 1 9th c enturies. H ence t he l evel a t w hich i t s eemed t here w as a c hange f rom u ncoffined t o c offined b urials w as a ssigned t entatively t o c . 1 750 a nd t his c ont ributed t o t he b asis o n w hich t he d istinction b etween g roup A a nd g roup B i nterments w as m ade. T here a re g ood r ecords o f t he u se i n S cotland, i n t he 1 6th c entury a nd l ater, o f ac ombined b ier a nd c offin w ith a h inged s ide, a nd o f w hat w as c alled a d eath h amper m ade o f t wisted r ushes ( Puckle, 1 926), t o c onvey t he s hrouded c orpse t o t he b urial g round w here t he c orpse w as r emoved a nd l owered i nto t he g rave. A ccording t o S wire ( 1966), p eople w ere a live o n L ewis i n 1 900 w ho r emembered w hen , b ecause n o w ood f or c offins w as t o b e h ad, t he c orpse w as c arried t o t he g rave o n a s oc alled d eath-bed a nd i nterred w rapped i n p laid o r w inding s heet. A ndrews ( 1891), r eferred t o t he c ustom o f u ncoffined b urial h aving p ersisted i n W exford, I reland, u ntil 1 818. N ot a g reat d eal c an b e s aid a bout t he s ingle i nterment f ound w ith t he h ead t o t he e ast i n t he r everse o f t he c ustomary C hristian o rientation , t hat o f am ale o f e stimated a ge o f 2 5-30 y ears, a g roup C 1 600-1700 A D i nterment. I t i s h ard t o t hink o f a ny c onvincing r eason f or b urying i n t his w ay d eliberately. I t m ay h ave b een a s imple e rror; t here w as n o t race o f c offin a nd p erhaps t his w as a s hrouded c orpse b uried i n ah urry w hen t he w eather w as v ery s tormy. I t m ust b e a dded t hat m y f riend t he l ate G avin F erguson t old m e t hat h e h ad h eard t hat t he c ustom h ad e xisted i n p arts o f t he H ebrides o f b urying t he k irk m inister i n t his r eversed f ashion w ith t he i dea t hat h e w ould t hus b e r eady t o f ace h is f lock o n j udgement d ay a nd g uide t heir e ntrance i nto t heir c elestial l ife. Ih ave n ot b een a ble t o f ind a ny r eference i n t he l iterature t o s uch a c ustom b ut w ill m ention a nother c ustom b ecause i t c ould b e r elevant t o t he i nterments f ound c lose t o t he e ast w all o f t he c hapel. A ccording t o T yack ( 1898), m ore i n r eference t o E ngland t han S cotland, t he p arish p riest w as s omet imes b uried i mmediately w ithout t he e ast w all a s n ear a s p ossible t o t he a ltar h e s erved d uring l ife. F our o f t he i nterments w ithout t he e ast w all o f t he M anish c hapel w ere m ales o f e stimated a ges 3 5 t o 6 5 y ears. H owever, t hese w ere b urials a fter t he c hapel w as e ngulfed i n s and a nd s o, i f b y a ny c hance a ny o f t hem w ere t he m inisters , t hey c ould n ot h ave s erved a t t hat p articular a ltar. T he f act t hat t here w ere m any o ther b urials i n t hat s ituation , m ost o f t hem f emales, s eems t o m ake i t u nlikely i n a ny c ase t hat t hese b urials w ithout t he e ast w all h ad a ny s pecial s ignificance.

T he a ge-at-death d istribution o f t he i nterments T he g eneral a ge d istribution i n t he m aterial f rom t he f our g roups w as s imilar; j uveniles ( 0-20 y ears) a nd a dults w ere p resent i n a bout e qual n umbers a s s hown b y t he s maller p ie d iagram i n F igure 2 2 a nd a mong t he a dults t he s exes w ere a bout e qual. P resentation o f t he d etails o f t he m aterial i n t erms o f t he f our g roups o r p eriods w ould o ccupy m uch s pace a nd, i n v iew o f t he s ize o f t he g roups a nd a bsence o f c raniometric d ifferences ( p. 3 6 ) , i s u njustified. H ence t he a ge a nd s ex s tructure o f t he p ooled p opulation

1 76

o f 4 16 i ndividuals i s d epicted i n F igure 2 2 f or c omparison w ith t he a ge-at-death d istribution o f ah ypothetical p resent-day p opulation o f t he s ame s ize. Am uch s horter l ife s pan i n t he E nsay p opulation i s i ndicated b y t he c lustering o f d eaths i n t he 3 0-50 y ear p eriod i n c omparison w ith t he p eak i n t he 1 960 p opulation a t 7 5-80 y ears. T he E nsay d ata c ould b e p resented a s a l ife t able o n t he p rinciples o utlined b y B oddington ( 1987) w ho p resented s uch a t able f or a n A nglo-Saxon p opulation o f 3 28 b urials. T he m aximum a ge w as e stimated t o b e 6 0 y ears. B oddington c alculated t hat t he o verall e xpectation o f l ife a t b irth w as a bout 2 3 y ears a nd a t a ge 1 7 y ears w as a bout 3 5 y ears. T o c alculate t he l ife e xpectancy f rom b irth f or t he t otal E nsay b urial-ground p opulation o f 4 16, i ncluding t he v ery l arge n umber o f n eonates d oes n ot s eem a ltogether r ealistic b ut g ives a lso a n e stimate o f 2 3 y ears . I t s eems m ore r ealistic t o c alculate t he e xpectation o f l ife, a s r ecommended b y B oddington , o nce t here h ad b een s urvival o f t he h azards o f i nfancy a nd c hildhood. H e s elected t he a ge o f 1 7 y ears b ut, f or t he E nsay m aterial, i t h as b een m ore c onvenient t o s elect 2 0 y ears. T he e xpectation o f l ife f or t he E nsay p opulation a t t hat a ge w as c alculated t o b e a bout 4 5 y ears. I n g iving s uch e stimates a nd i n t he p reparation o f l ife t ables, t he a ssumption i s m ade t hat o ver t he p eriod s panned t he t otal p opulat ion a nd i ts a ge s tructure w as s table; t hat i s, i f t here w as e migration, i t w as a bout e qualled b y i mmigration a nd t he r ates o f f ertility d id n ot c hange. T his s eems t o b e ar easonable a ssumption t o al imited e xtent f or t he E nsay p opulation o ver t he p eriod 1 600-1800 A D a lthough r eference h as a lready b een m ade ( p.172) t o a p robable g eneral i ncrease i n t he p opulation o ver t hat p eriod a nd l ater i t w ill b e s hown ( p . 1 81 ) t hat a r eduction i n c hildhood d eaths f rom s mallpox m ay h ave o ccurred a t t he l atter e nd o f t hat p eriod. I t h as b een a lready i ndicated ( pp .55 , 6 6 a nd e lsewhere) t hat t here c ould h ave b een a c onsiderable u nder-estimation o f t he a ges o f t he E nsay s kulls t hat h ave b een p laced i n t he 5 0-65 y ear g roups. M artin ( 1703), W ebster ( 1755; a vailable i n K ydd, 1 952) a nd S inclair ( 1791-1799) a ll r ecorded p eople o ver t he a ge o f 8 0 y ears i n t he H ebrides . T he f ullest a nd m ost c onvincing a ge d istribution r ecords w ere p rovided b y W alker ( McKay , 1 980; p . 2 25) f or 1 764. H e r ecorded f ive p eople o ver t he a ge o f 8 0 y ears, i ncluding w omen o f 9 2 a nd 9 7 y ears, a mong t he 3 04 i nhabitants o f R um . T able 2 0 r eproduces t he a ge d istribution g iven b y t he R ev. J ohn M acleod ( 1792) o f t he p opulation i n h is p arish o f H arris, w hich a t t hat t ime i ncluded E nsay a nd t he o ther i slands i n t he S ound o f H arris . T he r eliability o f t he s tatement t hat 1 .8 p er c ent w ere o ver 8 0 y ears o f a ge m ay b e o pen t o q uestion. S inclair ( 1825, p . 1 10) a rgued, w ith t he s upport o f w hat m ust b e s ome v ery e arly T ables o f M ortality a nd o f L ife E xpectancy, t hat o nce t he p articularly h azardous p eriods o f i nfancy a nd c hildhood w ere p assed, t he H ighlands a nd W estern I sles w ere n otable f or l ongevity. C omparisons b etween t he l ife e xpectancy e stimated f rom s keletal p opulations o f t wo A nglo-Saxon c emeteries w ith h istorically a ttested a ges o f t he p opulations s uggests t hat t here i s a t endency t o u ndere stimate s keletal a ge, a t l east o f t he c ategory o f o ldest, b y 1 0-13 y ears o r e ven m ore ( reviewed b y B oddington [ 1987], t ogether w ith o ther a spects o f t he c onstruction o f a rchaeological l ife t ables).

1 77

T able 2 0

A ge d istribution o f t he p opulation o f t he p arish o f H arris, i ncluding E nsay, i n 1 792 ( Data g iven b y M acleod i n S inclair, 1 794 , 1 0 : 3 83).

I nfants u nder 1 y ear

5 1

( 2.0%)

U nder 7 y ears

3 63

( 15.3%)

7 -14 y ears

3 68

( 15.3%)

1 481

( 58.4%)

1 4-50 y ears O ver 5 0 y ears

2 28

( 9.0%)

O ver 8 0 y ears

4 5

( 1.8%)

2 536

( 1136 m ales,

1 400 f emales)

I n t he E nsay m aterial, t he g eneral p attern o f d eaths s hown i n F igure 2 2 a nd t he c alculations t herefrom r eferred t o w ould n ot h ave b een v ery d ifferent i f t hose e stimated t o b e 6 5 y ears o f a ge w ere i n f act 1 0 y ears o r m ore o lder. Ac alculation b ased o n t he a ssumption t hat o ne-half o f t hose i n t he 6 0-65 y ear c ategory w ere i n f act 8 0 y ears o f a ge o nly m arginally r aised t he e stimates o f e xpectation o f l ife a t b irth a nd a t 2 0 y ears b y l ess t han o ne y ear . W hat i s v ery s triking i s t he e normous n umber o f d eaths i n t he 0 -5 y ear p eriod, t he c ategory u sed t o e xpress c hild m ortality. T he l arge p ie d iagram w ithin F igure 2 2 a nalyses t he c hild d eaths f urther, a nd s hows i ncidentally t he p roportion o f i nfants l abelled f etal d eemed, f rom t he s tate o f t heir t ooth d evelopment a nd d imensions o f b ones, t o b e l ess t han f ull-term p regnancies. I n t his g roup w ere o nes e stimated t o b e p regnancies o f a bout 6 -8 m onths. T hese a nd t he f ull-term g roup w ould b e b abies ( apart f rom s till-births) w hich h ad d ied i n t he n eonatal p eriod. T he p ie d iagram s hows t hat o ver o ne-half o f t he d eaths i n t he 0 -5 y ear p eriod t ook p lace b efore t he e nd o f t he f irst y ear. T he f irst y ear i s t he p eriod u sed t o e xpress i nfant m ortality r ates a nd t he r ate c alculated f rom t hese E nsay f igures i s 2 81 p er t housand b irths c ompared w ith a p resent-day . England a nd W ales i nfant m ortality r ate o f a bout 2 0 p er t housand. T he p ie d iagrams d epicting t he c hild d eaths i n t he f ive E nsay g roups ( Fig. 2 3) s uggest t hat t he i nfant m ortality w as h igh i n a ll t he p eriods. T he c alculated E nsay c hild m ortality r ate i s 4 18 p er t housand b irths c ompared w ith a p resent-day E ngland a nd W ales r ate o f a bout 3 6 p er t housand.

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I t m ust b e p ointed o ut t hat t hese E nsay m ortality r ates m ay b e u nduly h igh b ecause w e d o n ot k now h ow m any o f t he p remature ( fetal) a nd f ull-term b irths w ere s till-births. I n t he l ikely e vent o f a t l east a ll t he p remature o nes b eing s till-births, t he i nfant m ortality r ate b ecomes 2 42 a nd t he c hild m ortality r ate 3 80 p er t housand. I t i s n ecessary t o c omment o n t he p eak o f d eaths b etween 3 0-40 y ears t hat a ppears i n t he E nsay h istogram ( Fig. 2 2) a lthough t he p roportions o f t he h istogram t end t o e xaggerate t he p eak; i n o ther w ords, t he n umbers o f s ubjects w ithin t he g roups a re t oo s mall t o a ttach g reat w eight t o i t. T here i s a p reponderance o f f emales i n t he 2 0-30 y ear d eaths ( 18 f emales; 9 m ales) w hich c an b e a ttributed t o t he h azards o f c hildbirth . T he s exes a re a bout e qual i n t he 3 0-40 y ear g roups. I t i s e asy t o i magine, h owever, t hat t his p eriod, w hen b oth s exes w ere a t t he p eak o f t heir p hysical p owers, c ould b e o ne w hen s ome o f t he h azards o f t heir w ay o f l ife m ight b e m aximal; i n t he w omen, t hose o f c hildbirth w ould c ontinue o r e ven i ncrease; i n t he m ales, e specially i f f ishing a nd j ourneying b y b oats w ere m uch e ngaged i n, d eath f rom d rowning c ould h ave b een a f eature o f t heir l ives. A p ossible s pecial e ffect o f w arfare o n t he m ale p opulation c an h ardly b e i nvoked; s ome y oung m ales w ould d oubtless h ave b een d rawn a way f rom t he i sland b ut t he b urial g round w ould o nly b ear e vidence o f t he s upposedly f ew w ho m ight h ave r eturned t o d ie o f t heir w ounds l ater; i t i s p ossible t hat t he a mputated t ibia o f am an a ged 2 5 y ears f rom l evel A ( p. 6 6 )o riginated i n t hat w ay.

S tatures T he d ifferences i n s tature o f t he a dults i n t he f our p eriod c ategories d o n ot w arrant p resenting t hem s eparately, a nd t hey a re d epicted i n F igure 2 4 f or t he t otal p opulation o f a dults f or w hom s tature c ould b e c alculated. T hese i ncluded n ot o nly t hose m ore o r l ess c omplete r emains o f i ndividuals w here a t l east t he f emurs w ere a vailable b ut 2 5 f emurs s elected f rom t he l arge q uantity o f s cattered i solated b ones w ith w hich t he s ite a bounded. O nly l eft f emurs a nd o nes w hich c ould b e r eliably s exed w ere u sed f or t hese c alculations o f s tature. B y s electing o nly f emurs o f t he l eft s ide, t he c hance o f i ncluding t he s ame i ndividual t wice w as d iminished t hough t he p ossibility r emains t hat a f ew o f t he i solated o nes c ame f rom s emic omplete e xamples o f t he m ain g roup o f i nterments. T he m ean h eight o f t he a dult m ales w as 1 66cm ( 5'5I -") a nd o f t he f emales w as 1 55cm ( 5'1"). T he s tatures s how t he a mount o f s ex d ifference t hat i s f ound i n m ost p opulations. T here i s n o e vidence t hat t he E nsay p opulation w as u nusually t all. T here w as o nly o ne m ale a s t all a s 1 83cm ( 6'0") a nd n o f emales t aller t han 1 70cm ( 5'7"). T he w idespread i dea t hat t he H ebrideans a nd H ighlanders w ere t all g ains n o s upport f rom t he E nsay m easurements; a nd i ndeed n one f rom s ome 1 8th c entury r ecords. T he h eights a re r ecorded o f 3 29 S cottish m ale p risoners a waiting t ransportation i n 1 746 f ollowing t he b attle o f C ull den ( Seton a nd A rnot, 1 928). T he p roportion o f w hat w ould b e a ccepted a s H ighlanders i s n ot k nown a nd o nly a f ew w ere f rom t he H ebrides. T heir a verage h eight w as 1 63cm ( 5'4"), t he t allest w as 1 78cm ( 5'10"), a nd e ight w ere 1 52.5cm ( 5') o r l ess i n h eight. H owever, a mong t he 1 68 l ess w ell-documented c aptured g arrison o f C arlisle, n ine w ere p ut i nto a ' 6 f eet' c ategory. I t i s f urthermore r ecorded t hat i n 1 794 t he E arl o f S eaforth, i n o rder t o r ecruit a b attalion o f L ewis m en h ad t o l ower t he m inimum h eight f rom 1 63cm ( 5'4") t o 1 60cm ( 5'3") ( Davidson

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1 901, P . 1 3). T he n earest c omparison t hat c an b e m ade w ith t he E nsay m aterial i s w ith t he a dult m ales i n t he 1 700-1800 A D g roup , t he m ean h eight o f w hich w as 1 63cm . I t i s w ell k nown t hat s tatures h ave i ncreased i n t he p ast 1 00 y ears o r s o; f or i nstance, i n 1 939 , t he m ean h eight o f g roups o f L ewis b oys a nd g irls a ged 1 5-16 y ears w as a lready 1 65cm ( Cathcart, M urray a nd B everidge, 1 940). T he b oys a t l east w ould h ave b een c onsiderably t aller t han t his, p erhaps b y a n a dditional 1 0cm , w hen t hey b ecome a dult. I n 1 979-80 t he m ean h eight o f 1 4-year o ld s choolchildren i n S tornoway ( personal c ommunication , D r. M . A midi) w as b oys 1 67cm a nd g irls 1 61cm .

C auses o f m orbidity a nd d eath T he i nfant a nd c hild m ortality r ates, 2 81 a nd 4 18 p er t housand b irths r espectively , a re s o r emarkably h igh t hat t heir v alidity d eserves t o b e q uestioned. T hey m ean t hat b y t he e nd o f t he f irst y ear o ne o ut o f e very f our i nfants b orn w ould b e d ead. B y t he e nd o f t he f ifth y ear p eriod o nly t wo o ut o f t he f our w ould h ave s urvived. H owever, t hey a re s imilar t o t hose r ecorded f or o ther s ocieties w here l ife w as h ard, i nfant d isease r ampant a nd l ittle o r n o m edical t reatm ent a vailable. T he i nfant m ortality r ate f or t he b lack p opulation i n t he U SA i n 1 900 w as 2 53 p er t housand a nd b y c ontrast t hat f or t he w hite p opulation w as 1 33 p er t housand ( Dublin , L otka a nd S piegelman , 1 949). O ver t he p eriod 1 885-1894, t he i nfant m ortality r ate i n L ancashire a s a w hole w as 1 70 p er t housand b ut i n t he m ill-town B urnley w as a s h igh a s 2 20 ( Newsholme, 1 899) a nd c orresponding c hild m ortality r ates w ere o f t he o rder o f 3 50 p er t housand. J udged f rom t he m ainly a necdotal i nformation a vailable ( MacGregor, 1 969), t he i nfant m ortality r ate o n S t. K ilda d uring t he l ast c entury w as a t l east a s h igh a s t hat i nferred f or E nsay. T he p redominant c ause o f n eonatal d eaths o n S t. K ilda w as t he s o-called e ight-day s ickness . T he i nfant o ften s eemed t o t hrive u ntil a bout t he s ixth d ay a nd w ould o ften b e d ead w ithin 4 8 h ours. I t i s g enerally a ccepted t hat t he c ause w as t etanus f rom i nfection o f t he c ut u mbilical c ord w ith t he t etanus b acillus a s ar esult o f t he c ustom o f a nnointing i t w ith a m ixture o f f ulmar o il a nd s heep d ung. T here i s e vidence t o s uggest t hat t he e ight-day s ickness o ccurred i n t he C ater H ebrides a lso ( Sinclair, 1 797, 1 9: 2 81) s o t hat i t i s l ikely t o h ave a ccounted f or s ome o f t he i nfant m ortality o n E nsay. O f h is v isit t o t he I sle o f L ewis i n 1 695, M artin ( 1703 , p . 9 3) w rote, " The c hin-cough a ffects c hildren ; a nd t he f ever, d iarrhoea a nd d ysentery a re a ll p revalent." C hin-cough i s w hooping c ough a s i s m ade c lear b y ( Watt, 1 813); t he t erm m ay d erive f rom t he D utch " kinckin" m eaning " to p ant". A g ood d eal o f r egional i nformation a bout t he d iseases t hat w ere p revalent a mong t he H ighland a nd I sland c hildren i s a vailable i s S inclair 's S tatistical A ccount o f S cotland ( 1791-1799) a nd i n h is l ater A nalysis ( 1825) o f t hat A ccount. C roup , w hich w ould h ave m eant p redominantly d iphtheria , a nd c hinc ough a re m entioned a nd a re l ikely t o h ave h ad a h igh m ortality w hen i nfants w ere a ffected.

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T uberculosis b oth i n t he f orm o f c onsumption a nd s crofula a nd m esenteric ( abdominal) t uberculosis w ere c ommon a ll o ver N orthern E ngland a nd S outhern S cotland ( Sinclair 1 794, 1 0 : 5 94). T he H ebrides, a lthough n ot s pecifically m entioned, w ould h ave s hared i n t his. A nother d isease t hat c an b e i dentified a s ac ommon c ause o f d eath i n a dults a part f rom t uberculosis i s p neumonia. S inclair ( 1794, 1 0 : 3 85) i n r espect o f H arris r eferred t o " a p estilential f ever w hich a ffected n early e veryone a nd k illed m any o ld," a r eference p erhaps t o a n i nfluenza-type o f e pidemic. S mallpox m ust h ave b een t he c ause o f m any d eaths o n E nsay, e specially o f j uveniles, a lthough o utbreaks i n t he v arious i slands o f t he H ebrides a ppear t o h ave b een s poradic . I t c ould s uddenly s weep a way w hole f amilies a nd d epopulate t he s maller i slands. S inclair ( 1825, p . 1 27) r eferred t o t he d readful r avage w hen c hin-cough p revailed a t t he s ame t ime. I n h is a ccount o f t he P arish o f H arris i n S inclair ( 1794, 1 0 : 3 85) w hich i ncludes E nsay a nd t he o ther i slands i n t he S ound o f H arris, t he m inister, t he R ev . J ohn M acleod, s ays t hat c oughs a nd r heumatism w ere t he m ost p revalent d iseases a nd t hat, i n 1 792, " There w as a b ad k ind o f s mall p ox , w hich c arried o ff a n umber o f t he c hildren, a lmost a ll i noculated b y t heir p arents w ithout m edical a ssistance, a p lan w hich w as f ound t o h ave a nswered, a t f ormer p eriods, w ithout a ny f atal c onsequence; b esides w hich e very s oul i n a f amily o nce i nfected w as l aid u p a nd i t g enerally p roved f atal t o o ld p eople." I noculation b y t heir p arents r efers h ere t o t he p ractice o f d eliberately i nducing w hat w as h oped w ould b e m ild a ttacks o f s mallpox i n c hildren, b ased o n t he o bservations t hat t hose w ho r ecovered w ere i mmune t o s ubsequent a ttacks. I n t he i nstance M acleod m entioned, o f i noculation d uring a b ad s mallpox e pidemic, a n umber o f c hildren h ad d ied; w hether b ecause o f s uch i noculation o r i n s pite o f i t i s u nclear. I n t he S cottish H ighlands, a nd e vidently a lso i n t he W estern I sles, a s i n m any u nsophisticated s ocieties i n m any p arts o f t he w orld ( Razzell, 1 977), t here h ad b een a l ong-standing f olk p ractice o f i noculation, e ither b y b ringing c hildren i nto c lose c ontact w ith c hildren s uffering f rom t he d isease, p referably a m ild a ttack , o r b y a pplying m atter f rom p ustules t o t he s kin . T he p ractice o f i noculation t hrough s kin s cratches b ecame w idespread i n E ngland a fter L ady M ary W ortley M ontagu , w ho h ad s een i noculation p erformed i n T urkey, m ade i t f ashionable i n 1 721. T he p ractice r eached S cotland b y t he m iddle o f t he c entury a nd q uickly b ecame a c ommon p ractice i n p rincipal u rban a reas s uch a s E dinburgh ; t he d etails o f t he p ractice a nd t he c hange f rom s imple a pplication o f p ustular m atter t o t he s kin s urface t o v arious t ypes o f s kin s cratches o r i ncisions i s w ell d ocumented b y A . M onro ( 1765). I t i s e vident f rom S inclair ( 1794) t hat a t l east t he s impler f orms o f i noculation w ere c ommon o n H arris; t hey w ere d oubtless p art o f t he w ay o f l ife o n E nsay a lso . A s a lready m entioned ( p .172 ) , t he d ramatic d ecline i n d eaths f rom s mallpox t hat a ccompanied t he s pread o f i noculation c ontributed g reatly t o t he i ncrease i n t he p opulation o f t he H ighlands a nd I slands d uring t he l atter h alf o f t he 1 8th c entury.

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A t t he e nd o f t he c entury , i noculation w as g radually r eplaced b y v accination, t hat i s, i noculation n ot w ith s mallpox i tself b ut w ith c owpox, w hich w as s afer a nd g ave s imilar i mmunity t o s mallpox. V accination r apidly g ained p opularity i n G lasgow f rom 1 801 o nwards ( Cleland, 1 832) a nd p robably r eached t he W estern I sles w ithin a f ew y ears. M easles i s b ut l ittle m entioned i n t he S tatistical A ccounts b ut t here i s o ther e vidence t hat i t w as n ot o nly a c ommon d isease i n S cotland i n t he 1 8th a nd 1 9th c enturies b ut w as a m ore l ethal d isease t han i n r ecent t imes. A ccording t o S inclair ( 1825), a s s mallpox b egan t o d ecline i n t he l atter h alf o f t he 1 8th c entury t here w as a n i ncrease i n d eaths f rom m easles. H e q uoted ( p. 1 30) t he f indings o f D r. R obert W att i n r espect o f t he C ity o f G lasgow w hich s uggested t hat, i n t he y ears f ollowing t he i ntroduction o f v accination t here i n 1 801 ( Cleland, 1 832), t here w as a s teady f all i n t he n umber o f d eaths o f c hildren f rom s mallpox t o a bout o ne-third o f w hat t hey h ad b een i n p revious y ears, b ut d eaths f rom m easles i ncreased o ver e ight t imes d uring t he p ostv accination p eriod. T his r efers t o v accination , t hat i s i noculation w ith c owpox. T he a ccount b y W att ( 1813 A ppendix) i s e xtremely r ecord o f t he c ommon c auses o f d eath i n c hildren u p t o y ears. I t p rovides d etailed T ables o f d eath f rom A lthough t hey r efer s trictly t o G lasgow , t hey m ust h ave t o o ther p arts o f S cotland, i ncluding t he H ebrides.

v aluable a s a t he a ges o f 1 0 1 783 t o 1 812. s ome r elevance

I t m ust b e p ointed o ut t hat W att's s tatistics r elate t o p roportions o f t otal d eaths a nd n ot t o n umbers o f t he l iving p opulation w hich i n G lasgow a t t hat p articular t ime m ust h ave b een i ncreasing, p robably r apidly w ith a h igh b irth r ate. C ensus i nformation w as n ot a vailable, h owever, s o W att d id t he b est h e c ould. H e w as a ware t hat h is f indings w ould b e m ade u se o f b y t he a nti-vaccinationists , a s i ndeed t hey w ere, b ut h is v iew w as t hat a n e nthusiasm f or v accination , w hich h e s hared, s hould n ot b lind p eople t o t he f acts. I t i s i nappropriate t o a ttempt a ny f urther d iscussion h ere o f h is f indings b ut, l ooking a t h is d ata , i t s eems t hat, w hereas v accination p roduced a s teady r eduction i n d eaths f rom s mallpox, i n t he y ears 1 802, 1 808 , 1 811 a nd 1 812 t here w ere e pidemics o f m easles a nd , i ncidentally, i n 1 809 a nd 1 810 o f w hooping-cough . W att's T ables i nclude s ome c ategories o f c auses o f d eath t hat a re h ard t o i nterpret a nd a re o nly m entioned h ere b ecause t hey t hrow a l ittle l ight o n d isorders t hat t he c hildren o n E nsay m ay h ave s uffered.. T he c ategory ' fevers ', s econd t o s mallpox a s t he m ain c ause o f d eath b efore 1 801, h e p ointed o ut m ust h ave i ncluded s carlatina a nd t yphus; ' bowelhives', a bout t he f ourth c ommon c ause o f d eath , c hin-cough b eing t he t hird, h e w as d oubtful a bout b ut s uggested t hat i t r eferred t o av ariety o f c onditions i n w hich t here i s a n a cute b owel d isorder a ssociated w ith a s kin e ruption ( hives). A ccording t o t he O xford E nglish D ictionary ( 1933), b owel-hives w as t he p opular n ame f or i nfantile e nteritis a nd s imilar a ffections. ' Stopping ', w hich W att s eemed t o a ssume w ould b e u niversally u nderstood, p erhaps r efers t o c onditions i n w hich c onstipation w as t he p redominant f eature b ut m ight a lternatively r efer t o s udden d eath o f u nknown c ause. ' Water o n t he h ead ' m ay r efer t o m eningitis, p erhaps t uberculous, b ecause h e d id n ot o therwise r efer t o t uberculosis. T he a nnual n umber o f d eaths u nder t his h eading d uring 1 783-1812 w as v ery v ariable, f rom s ix t o 6 3 , w hich

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s uggests t hat t here m ight h ave b een i n a ddition o utbreaks o f s ome i nfectious d isorders s uch a s m eningococcal m eningitis. I t i s e xtremely h ard t o d ivine w hat m ay b e m eant b y w ater o n t he h ead b ecause, a ccordi ng t o J ames 's d ictionary o f 1 743-5, a lthough i nternal h ydrocephalus c onnoted w hat i t d oes t oday, a n e xternal f orm w as d efined i n w hich t he c ollection o f f luid w as b etween s kin a nd c ranium . T he w ritings o f t he S cottish p hysician , W illiam C ullen , o f t he l atter h alf o f t he 1 8th c entury ( Thomson, 1 828) a re a v aluable s ource o f i nformation a bout t he s tate o f m edical k nowledge a t t hat p eriod. F inally , i t m ust n ot b e a ssumed t hat W att's m ortality r ecords, d erived f rom t hose o f i ndividual b urial g rounds, r epresent t he b est r eflective d iagnoses o f t he m edical p ractitioners o f t he p eriod. J udged f rom w hat i s k nown o f t he r ecording p rocedures i n L ondon o f t hat p eriod ( Forbes, 1 976), m any c ould r epresent t he o pinions o f t he f amilies o r t hose r esponsible f or l aying-out t he b ody. T yphus, w hich u ntil w ell i nto t he 1 9th c entury c ould n ot b e c learly d istinguished f rom t yphoid ( James, 1 743-1745; C reighton, 1 894, p . 1 83), w as c ommon o n m ainland S cotland i n t he 1 7th a nd 1 8th c enturies ( Pennie, 1 958) b ut b ecame r are b y t he e arly 1 9th c entury ( Gordon , 1 845, 1 4 : 1 64). T yphus a ppears t o h ave r eached t he W estern I sles b ecause i t i s s aid o f N orth U ist ( Gordon , 1 845) t hat t yphus, f ormerly t he c ause o f m any d eaths, h ad b ecome r are. I t i s p ossible t hat t yphus o r t yphoid w ere a mong t he f evers t o w hich t here a re m any r eferences i n S inclair ( 1791-1799). T he e arly o utbreaks o f p lague i n B ritain s eem o nly t o h ave a ffected t he s outhern a nd e astern p arts o f m ainland S cotland a nd t he g reat E nglish p lague o f 1 665 d id n ot r each S cotland a t a ll ( Pennie, 1 958). T here a re n o i dentifiable r eferences t o c holera i n t he m ain s ources o f i nformation a bout t he h istory o f t he W estern I sles a nd i t i s u nlikely t o h ave o ccurred t here, a lthough t he u rban a reas a nd p orts o f S cotland s hared i n t he v arious o utbreaks i n B ritain t hat o ccurred u p t o t he m iddle o f t he l ast c entury, a nd t here w as a w idespread o utbreak o f c holera i n 1 832 t hat a ffected m any r ural a reas o f S cotland ( Creighton , 1 894 , p . 8 14). A ccording t o S inclair ( 1825, p . 1 31), r heumatism , a ttributed t o t he v ividly d escribed c old a nd d ampness o f H ighland a nd I sland h omes, a nd t o l ack o f c are i n c lothing t hemselves p roperly, w as r ife. S o a lso w a§ a gue i n t he s pring a nd a utumn , t o t he e xtent t hat i t w as a dvisable t o o rder s ix l abourers i nstead o f f our t o u ndertake a p articular t ask i n t he e xpectation t hat s everal w ould f all s ick. P ennie ( 1958) c onfirmed t hat t he a gue r eferred t o w as m alaria a nd, a lthough t he H ebrides a re n ot s pecifically m entioned, t he S hetland I slands w ere a ffected a s w ell a s m ost p arts o f S cotland. T he N ew S tatistical A ccount o f S cotland ( Gordon , 1 845) c ontains f ar l ess o n t he d iseases a nd c auses o f d eath t han t he e arlier A ccount. T he a ccount f or H arris ( 1845, 1 4: 1 55) c ontains n othing b ut t hat f or N orth U ist ( p. 1 59) m entions t hat t yphus, f ormerly t he c ause o f m any d eaths, w as a lmost u nknown. T his w as a ttributed t o t he i mprovement o f l iving c onditions, i n p articular w ell-spaced c ottages f or e ach t enant i n p lace o f s everal h ouseholds c rowded t ogether. R eferences t o i mprovements i n h ealth a ppear t hroughout t he 1 5 v olumes, m any b eing

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r elated t o t he d raining o f m arshland. T he d ata f or t he N ew S tatistical A ccount w ere c ollected i n a bout 1 837 a nd t he i mprovements r efer t o t he p eriod s ince t he o bservations c ollected b y S inclair a bout 4 5 y ears e arlier. T he a ccount o f t he P arish o f K ilmuir, S kye ( 1845, 1 4: 2 44) cute r heumatism , m entioned t hat t he m ost c ommon d isorders t here w ere ”a a sthma, d yspepsia , p leuritic d isorders, t yphus f evers, p neumonia, I t i s i nteresting e rysipelas a nd d isease o f t he l ymphatic s ystem ." 1 14), p repared i n t hat i n t he a ccount o f L ewis ( 1845, 1 4, p art 2 : r i nfant l ock-jaw 1 833, i t i s m entioned t hat t he e ight-day s ickness o w as s till c ommon i n t he o utlying d istricts. S urprisingly, d eath i n c hild-bed i s n ot r eferred t o i n t he S tatistical A ccounts ( Sinclair, 1 791-1799, 1 825; G ordon , 1 845), p erhaps b ecause i n e arly t imes , i ncluding t he 1 8th a nd e arly 1 9th c enturies , i t w as t aken f or g ranted. A s o nly a s mall p roportion o f d iseases, a nd o nly t uberculosis a nd j oint r heumatism o f t hose j ust m entioned, l eave d iagnostic c hanges i n t he b ones, t he s keletal f indings c an g ive n o c lue t o t he m ajor c auses o f d eath o n E nsay. T here w ere a f ew i nstances o f s keletal d isease a mong t he j uveniles, a f ew c ysts, a n e xample o f i nfantile c ortical h yperostosis, b ut n ot i n n oteworthy n umbers. R ickets w ould h ave l eft e vidence i n t he b ones, b ut t here w as n one, a nd i n a n e nvironment w here f ish a nd o ther s ea-food m ust h ave b een c ommon i tems o f d iet, a d eficiency o f v itamin D w ould n ot b e l ikely e ven i f t he g eneral l evel o f n utrition w as l ow . I t i s a ppropriate t o m ention a lso t hat, a ccordi ng t o S inclair ( 1794, 1 0 : 3 58), t he m any i slands i n t he S ound o f H arris t oo s mall t o b e h abitable f or m an, f or i nstance, t hose b etween E nsay a nd H arris, a bounded w ith r abbits, s o t hat w hen c rops f ailed, w hich w as p robably f requently ( Macdonald, D . 1 978), o ther s ources o f f ood w ere a vailable; t he e xtent t o w hich t hey w ere u sed i s n ot r ecorded. T here w as m uch m ore e vidence o f d isease a mong t he a dult m aterial. N evertheless, s ystematic c onsideration o f t he p revalence o f t he v arious d isorders c ould n ot b e u ndertaken p artly b ecause c omparable d ata f or o ther p opulations a re n ot a vailable . H owever, t he f ive i nstances o f s keletal t uberculosis a nd s everal o ther p robable o nes, i n a p opulation o f a bout 2 00 a dults i s a h igh p roportion; t he i nstances w ere d istributed a bout e qually b etween t he f our l evels, a lthough o nly d oubtful o nes w ere f ound i n l evel A . I n E ngland a nd W ales i n 1 913, w hen t uberculosis w as r egarded a s r ife, n on-pulmonary t uberculosis, o f w hich a bout h alf m ay h ave b een s keletal t uberculosis, w as n otified a t a bout t he r ate o f o nly 0 .12 c ases p er h undred o f t he p opulation . T he a mount o f s keletal t uberculosis o n E nsay w ould a ccord w ith a h igh p revalence o f p ulmonary t uberculosis. L ikewise s even e xamples o f f ractured v ertebrae i s a r emarkably h igh p roportion b ut, i f t he p resumption i s c orrect t hat t hey a rose f rom v iolent m uscular a ction, t he f requency a ccords w ith t he l ife t he p eople o f E nsay m ust h ave l ed, t he h ard t oil t o e xtract a l ivelihood f rom s uch a n u ngentle e nvironment. T he e vidence o f t he l abour t hat w as n ecessary t o r emain a live r emains t o t his d ay i n t he l azy-beds w ith w hich t he i sland a bounds, n ow b landly r ounded b ut, w hen g rowing c rops, n eeding a nnual r emaking w ith s ea-weed a nd s hell-sand b rought u p f rom t he s hore, f ollowed b y c onstant a ttention a nd p rotection f rom g razing a nimals

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d uring t he g rowing s eason . T he m any e xamples o f c hronic s keletal i njury, f or e xample, t o j oints ( p. 7 3 )a nd c ompression f ractures o f v ertebral b odies ( p . 75 ) , a ccord w ith a l ife o f h ard t oil, a s d o t he m any s triking e xamples o f d egenerative s pondylosis ( p. 1 11 ) . H owever, a s i ndicated e arlier ( p . 1 01), a c areful c omparison o n a s tatistical b asis w ith c ontemporary a nd p erhaps o ther a ncient p opulations w ould b e n eeded t o e stablish w hether t he p revalence o f d egenerative j oint d isease w as p articularly h igh o n E nsay . T he n eed f or e xtensive f urther s tudy o f t he b ones t o a nswer q uestion w hether t he p opulation e xperienced r heumatoid a rthritis b een r eferred t o ( p .124 ) .

t he h as

I nstances w ere f ound o f g eneralized o steoporosis, t hought t o b e o f t he s enile a nd p ost-menopausal v arieties. A s i ndicated e arlier ( p . 5 6 ) , a s ystematic e xamination , u sing a v ariety o f m icrot echniques, o f b ones f rom a p roportion o f t he i ndividuals s elected b y i nitial c onventional r adiography, w ould t hrow a g reat d eal o f l ight o n t he s tate o f h ealth o f t he p eople a nd o n s uch t hings a s t heir s usceptibility t o b ony i njuries, f or e xample o f t he s pine t o s tress. A s m alnutrition i n e arly l ife c an l eave w hat c an b e c alled s cars i n t he b asic s tructure o f t he b one, s uch a s tudy c ould p rovide i nformation a bout t he n utrition o f i ndividuals t hroughout t heir l ife-spans. T he f inding o f af ew e xamples o f m ineralization o f b lood-vessel w alls b y n o m eans s uggests t hat d egenerative c ardiovascular d isorders w ere c ommon. I t m erely e mphasises t he f ortunate c ircumstances o f b urial i n s and w hich w as n ot d estructive t o m ineralized t issues a nd w hich g reatly f acilitated t he r ecovery o f t he r emains w ith m inimal d amage a nd l oss. P eriodontal d isease i n t he E nsay p opulation h as n ot y et b een f ully s tudied b ut i t w as e stablished t hat d ental c aries w as r ife i n t he o lder a ge g roups, p robably b ecause i t w as s econdary t o p eriodontal d isease. S ome q uestions c oncerning d ental c aries c annot b e a nswered u ntil t he p eriodontal d isease h as b een f urther s tudied.

F uture o f t he s ite M uch r emains t o b e d one. T he i mmediate p roblem i s t he p revention o f f urther d eterioration o f t he c hapel w hich, e ven t hough i ts d ate r emains u ndetermined, i s a n u nusually w ell-preserved a nd u nrestored o ne o f e arly d ate. A l onger t erm a im i s t o e xcavate t he c hapel i n o rder t o e stablish i ts d ate; i t i s n ot t oo m uch t o h ope t hat s ome o f i ts r oof t imbers, w hich c ould e ither b e c arbon-dated o r d ated b y t ree-ring c hronology, l ie b eneath t he s and t hat h as p rotected t hem f or 3 00 y ears. T his a im i s p ut s econd b ecause, u nless t he c hapel c an b e q uickly p rotected a gainst f urther d eterioration, t here c ould b e l ittle t o b ase a d ate o n . T he l evel s urrounding t he c hapel p rior t o t he s andblows c ould b e p rofitably e xplored e specially o n t he s outh s ide w here i nterments c ontemporary w ith t he u se o f t he c hapel c an b e p redicted. T he r eport i s p reliminary i n t he s ense t hat f urther s tudy o f b ones a lready r escued w ill t hrow m ore l ight o n t he l ife o f i slanders.

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t he t he

A PPENDIX A Iw as p rivileged t o s pend a m orning ( August 1 987) w ith, a s f ar a s i s k nown , t he l ast o f t he S tewarts t o h ave l ived o n t he i sland, M rs. M ary R obinson ( nee F raser) a ged 9 5 y ears, n ow l iving n ear W inchester, H ants. F igure 9 7 i s a p artial f amily t ree o f A rchibald S tewart a nd o f S tewart o wners o f t he i slands, d erived m ainly f rom i nformation p rovided b y M rs. M ary R obinson a nd h er n iece M rs. B ridget K ellas o f A rdnamurchan . A s a c hild a nd y oung w oman , M ary R obinson s tayed o n t he i sland f requently. H er g randfather w as J ohn S tewart, n ephew o f A rchibald . O n h is d eath i n 1 899, t he p roperty p assed t o h is s on W illiam , e ldest o f h is f amily o f t wo s ons a nd t hree d aughters. W illiam w as a b achelor a nd o n h is d eath i n 1 906 h e l eft t he i sland t o h is n ephew W illiam F raser, s on o f h is s ister I sabel. M ary R obinson i s ad aughter o f I sabel a nd t herefore s ister o f W illiam F raser. H e c hanged h is n ame t o S tewart w hen h e s ucceeded t o t he p roperty. H e s pent m uch t ime t here a nd m ust h ave b een r esponsible f or f arming i t. M acGregor ( 1933) r ecorded v isiting t he i sland a nd o bserving f ive g rey-lag g eese a pparently s wimming o ut e xcitedly t o m eet t he b oat. L ater h e s aw t hese g eese t amely b eing h and f ed b y W illiam S tewart a t t he w ater's e dge ( there i s ap hotograph o f t his h anging i n E nsay H ouse). T he s tory o f t hese g eese i s t hat W illiam S tewart t ook f ive e ggs f rom a n est o n t he i sland o f G roay, f ive m iles d istant, a nd p laced t hem u nder a b roody h en o n E nsay. Aw eek l ater, f ive g rey-lag g oslings w ere h atched. F or a bout s ix w eeks t hey r emained w ith t he h en, f ollowing h er e verywhere, b ut l ater t he g oslings t ended t o g o o ff a nd l ead t he h en a d ance b ecause m aternal i nstinct o bliged h er t o d o h er b est t o f ollow h er b rood e verywhere a nd i n a ll w eathers t hrough w et g rass a nd r ain . S he b ecame a b edraggled p itiable o bject. A fter a w hile, t he h en g ave u p a nd f or a bout t wo m onths t he g oslings f ed a t t he e dge o f t he s ea u ntil, a pparently b y a ccident, t hey d iscovered t hat t hey c ould w ade o ut a nd s wim ( Macgregor, 1 933, p . 1 01 e t s eq.). A ccording t o M acGregor ( 1972, p . 7 1), W illiam S tewart o wned P abbay a nd s old i t i n 1 934. M rs. M ary R obinson w as u nable t o r ecount m uch a bout t he D onald S tewart o f t he r ailed g rave b eyond c onfirming w hat a ppears i n t he m ain t ext. H e w as w ell k nown t o h er a nd w as t he f avourite u ncle o f h er m aiden a unt J essie w ho b rought h er ( Mary) u p f rom t he a ge o f 1 3 y ears a fter h er m other I sabel d ied i n 1 904 . M ary v ividly r ecalled t hat i n 1 920 , a t t he a ge o f 2 9 y ears, s he a ccompanied h er a unt, t hen a ged 6 0 y ears, t o E nsay t o d eliver t he g ranite n ame s lab t o D onald S tewart t hat h er a unt h ad h ad m ade. M ary d id n ot s ee t he g rave a t t hat v isit b ut t hinks t he r ailed p art w as a lready t here. T here i s a n e ntry i n t he S cottish R egister o f D eaths o f a D onald S tewart, f armer, s ingle, w ho d ied i n D unoon ( at R oyal C rescent) a ged 7 1 y ears o n D ecember 4 th , 1 887. H is p arents w ere D onald a nd I sabella ( nee M acrae) S tewart. I n v iew o f t he l apse o f 3 2 y ears b efore t he n ame s lab w as m ade, i t s eems p ossible t hat t he a unt m isremembered t he d ate s o t hat i t w as r ecorded o n t he g ranite s lab a s 1 888. T he m ystery o f D onald's p lace o f d eath i s c onsistent w ith i ts h aving b een m ade a nd

1 86

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r IC O

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t ransported f rom G lasgow . A ssuming t hat D onald S tewart w ho d ied i n D unoon w as t he o ne b uried o n E nsay , t he n ame o f o ne o f A rchibald's b rothers ( Fig. 9 7) w as D onald a nd h is w ife w as I sabella . A lthough M rs. M ary R obinson d oes n ot r ecall h earing o f a D onald A lexander S tewart, h is s ister, t he M ary S tewart o f t he 1 891 C ensus ( Table 2 ), m ust h ave b een h er g reat-aunt M ary a fter w hom s he w as n amed M ary b ecause h er g reat-aunt h ad d ied a t a bout t he t ime o f h er b irth i n 1 892. S he w as u ncertain a bout t he r elationship o f t his b rother a nd s ister t o J ohn a nd D onald S tewart. T he n ames D onald A lexander a nd D onald s uggest t o m e t hat t hey w ere c ousins r ather t han b rothers a nd t hey a re t herefore s o r ecorded i n t he f amily t ree ( Fig. 9 7).

A PPENDIX B A w ritten v ersion o f t he G aelic b allad c omposed b y " a b ard f rom P abbay" i n p raise o f E nsay H ouse, r ecorded b y S imon M ackenzie, t ogether w ith h is E nglish t ranslation o f t he G aelic. I t i s p ossible t hat t he b ard w as N eil M orrison w ho i s m entioned b y M acGregor ( 1972, p . 7 2) a s b eing t he a uthor o f m any G aelic s ongs a nd p oems. H e s pent m ost o f h is l ife h erding c attle a nd s hepherding . H e w as b orn i n 1 812 a nd w as t herefore p robably a live a t t he t ime o f t he b uilding o f E nsay H ouse.

M OLADH N A L ÜCHAIRT 1 .

' Sann l ä n a b liadhn ' u ire c hunnaic m i l e m ' s huilean A n a itreabh t ha m i'n d ull c hoisinn c liü a n T aobh T uath; ' Nuair n ochd m i s toigh d o 'n l üchairt, ' s a s heall m i a ir g ach t aobh d hiom , C ha m hör n ach t ug m o s huilean m o t hür u ile b huam .

2 .

L eis n a g habh m i d h 'iongnadh d e 'n c hlachaireachd ' s d e' n t -saorsnachd, C iamar b 'urrainn d aoine g ach a on d hiu c hur s uas; P iöban u mha ' s a irgid t oirt u isg ' o c harraig a ilbhinn T re g hlasan t ha n eo-chearbach ' s d hearbhas b hith b uan

3 .

F hir a c hosg n a c iädan r i t alla n an c lach s giamhach, C haneil a l eithid l ionmhör a n i ar a ir n a c aoil; F aileasach a ir f airge ' s g un e f ad ' o g harbhlach , ' S g ur p ailt a m b radan t arra gheal g a m harbhadh ' ra t haobh .

4 .

G e b 'fhear m i ab hiodh e olach ' o R ubha n a C irc a n L eödhas G u r uigeadh R ubha n a h -Ordaig c ha b 'eöl d homh ah -aon ; U inneagan a s heömair a m harbhaiste n a r oin a nn G un c harachadh b ho 'n b hörd l e f ear l eönaidh n a s muid.

1 88

5 .

' Nuair l asadh t u d o c hoinnlean s hios

es s huas a n s taidhre B hiodh s eöldairean n a h -oidhche l än a oibhneis ' s s unnd; A ig deu inneagan aeb oillsgeadh l e d eärrs m ar s holas H eisgeir,

' S i omadh f ear a ' f oighneachd:

" Cö r inn ' n t -inneal ü r?"

6 .

R i t reöireachadh n an ä nrach a b hios a n c unnart b äthaidh C an t oirt g u c aladh s äbhailt l e d ealradh d o r am ; I ad a ' r uith n a c örsa t roimh s hruth C haolais Strömaidh C u B un-an-t-sruth , f ar ' n c oir d haibh a n r öp c hur a n g runnd.

7 .

Bee s ud a n t -eilean f iachail,

g ur p ailt a c hinneas f eur a nn, C ha c hualas g ainne r iamh a nn g u b iadh d haoine es b hruid; A d h ea indheoin g eur a n F haoillich b idh s ai l a ir m art sc aor a nn ' S c ha c hluinnear g uth a ir c aoil a ir a h -aon d hiu t ighinn d luth. 1

8 .

G e bef hear a d heänamh d än m i n eo s nas a c hur a ir b ärdachd, N ach bef hea f r d homh f uireach s ämhach n a c äch er ädh r ium C u b heil e t ur r o ' d hän d homh b ruidhinn a ir a n f härdaich N ach d eän m i c all n as f heärr n a c ur b ärr b un-os-cionn .

I N P RAISE O F E NSAY H OUSE 1 .

I t w as u pon N ew Y ear's d ay t hat I s aw w ith m y o wn e yes t he m ansion t hat w on f ame i n t he n orth ; w hen I e ntered t he d welling a nd l ooked a ll a round m e I m arvelled a t w hat m y e yes b eheld.

2 .

S o g reat w as m y a mazement a t t he s tonework a nd w oodwork -Im arvel a t w hat m an c an a chieve; l ead a nd s ilver p ipes d rawing w ater f rom t he f linty s tone - a s ource ( of w ater) t hat w ill p rove t o b e e verlasting.

3 .

H e w ho s pent t he h undreds u pon t he h all o f t he b eautiful s tone w hose l ike i s u nparalleled t o t he w est o f t he s eac hannels; s ituated b y t he r ocky s easide a nd r eflected u pon t he s ea-waters - p lentiful i s t he s ilvery s almon c aught b y i ts s hores.

4 .

I f Iw as f amiliar w ith a ll t he l and b etween C hicken H ead i n L ewis a nd T oe H ead ( in H arris) I d oubt i f y ou c ould f ind a f iner h ouse ; f rom i ts w indows, y ou c an h unt t he s eals w ithout r ising f rom t he t able w ith a g un .

5 .

W hen y ou l ight t he c andles u pstairs a nd d ownstairs, t he m ariners o f t he n ight w ill b e f ull o f g ladness a nd j oy; t he s hining l ights i n y our w indows l ike t he g reat l ight(house) o f H eisgeir a nd a ll m arvelling a t t he s ight a nd w ondering " Who c reated t his n ew m arvel?"

6 .

B ecause o f t he r adiance o f y our r ooms, s torm-tossed s trangers w ho a re i n d anger o f d rowning a re g uided t o s afety a s t hey p ly t heir c ourse t hrough t he K yles o f S tromaidh a nd B un-an-t-struth .

7 .

T he i sland i tself i s m ost v aluable; l uxurious t he g rowth o f g rass; s tarvation f or e ither m an o r b east i s u nheard o f a nd, d espite t he b itter b ite o f J anuary, s heep a nd c attle r etain t heir f at. N ot a w ord o f d eprivation o r a ffliction:

8 .

Iw ish t hat I w as t ruly a b ard w ho c ould e legantly c ompose. M aybe i t's b etter t o r emain s ilent t han f or o thers t o a ccuse m e o f i mpertinence i n m y e ffort t o p raise t he g reat d welling.

1 90

A CKNOWLEDGEMENTS I a m i ndebted i n p articular t o M r. J ohn M ackenzie o f L everburgh, a nd t o h is f ather M r. S imon M ackenzie, n ow d eceased, f or p ermission t o w ork o n h is l and a nd f or m any k indnesses t hat f acilitated t he w ork, t he l ate D r. J ohn D avid o f G hana, a nd m ore r ecently t o h is n iece a nd n ephews, f or t he h ospitality o f E nsay H ouse, a nd t o t he R ev. J . S mith o f t he P resbytery, L ochmaddy, f or h is p ermission t o r escue a nd s tudy t hese h uman r emains. Ia m a lso i ndebted t o M r. D on B rothwell o f t he A rchaeological I nstitute, U niversity o f L ondon, w ho g ave v aluable a dvice a nd p hysical a ssistance a t t he s ite i n 1 967, a nd t o t he v arious m embers o f m any w orking p arties f or t heir a ssistance a t t he s ite. Ia m g rateful t o D rs. M .J. S tenhouse, A .J. W alker a nd R .L . O tlet w ho, a s a ttributed i n t he t ext, t ook s o m uch t rouble w ith t he c arbon-dating o f t he b ones. Ia m a lso g rateful t o t he t rustees o f t he G roves B equest o f t he R oyal C ollege o f S urgeons o f E ngland f or f inancing t he c arbon d ating. W ithin t he t ext, Ih ave a cknowledged t he h elp o f a n umber o f e xperts, i n a ddition, i n r espect o f t he s keletal p athology, I w as g enerously h elped b y d iscussions w ith D r. D ennis J . S toker, D irector o f R adiological S tudies, I nstitute o f O rthopaedics, L ondon, a nd w ith D r. P eter A . R evell, o f t he B one a nd J oint R esearch u nit, T he L ondon H ospital M edical C ollege. M y p resentation o f t he d ata o n c ranial m orphology a nd t he a ssociated s tatistical a nalysis, a nd o n d ental c aries, w ould h ave b een i mpossible w ithout t he g enerous a nd p atient h elp I r eceived f rom D r. J ohn S . B ulman o f t he D epartment o f C ommunity D ental H ealth, I nstitute o f D ental S urgery, L ondon.

A :E .W . M iles O dontological M useum R oyal C ollege o f S urgeons o f E ngland 3 5/43 L incoln 's I nn F ields L ondon W C2A 3 PN

1 91

S UMMARY T he r emains o f 4 16 i ndividuals w ere r escued f rom t he w ind-eroded b urial g round i n r elation t o f our s trata r anging f rom a bout 1 500 t o 1 850 A D. O ver o ne-half w ere j uvenile a nd a bout o ne-quarter w ere b elow t he a ge o f f ive y ears. P ossible c auses o f t he h igh c hild m ortality a nd o f a dult d eaths a re d iscussed, r anging f rom n eonatal t etanus, s mallpox a nd s keletal t uberculosis. S even a dults s howed s pinal i njuries p robably c aused b y h eavy w ork . T he a rduous l ife o f t he i slanders p robably c ontributed t o t he o steo-arthrosis a nd s pondylosis w hich a re d escribed i n d etail, a s i s av ariety o f, m ostly s ingle, e xamples o f s keletal d isease. E xamples w ere f ound o f m ineralized s oft t issue l esions i ncluding f our o f m ineralized a rtery w alls. R oot-surface c aries w as a n otable f eature o f t he d entitions o f t hose o ver t he a ge o f 3 5 y ears a nd i s r egarded a s s econdary t o p eriodontal d isease. T he m ean s tatures d erived m ostly f rom f emur l engths w ere s ubstantially l ess t han t hose o f c ontemporary p eople b ut s imilar t o s ome r ecorded f or 1 8th c entury m ales. I n 1 971 a c hapel, b uilt o f d rystone t hough w ith s ome s hell-lime m ortar f acing, t entatively r egarded a s a bout 1 3th c entury, b ecame e xposed a t t he c entre o f t he s ite. C arbon-dating o f t wo i nterments c lose a gainst t he o uter f ace o f t he e ast w all, a nd a t hird f ound i n t he f oundations o f t he w all t hat e ncircles t he b urial a rea, t ogether w ith a c oin o f 1 488-1513 A D a nd t he r emains o f a n e arthenware p ot, s uggest 1 500-1550 a s t he p robable d ate f or t he e ngulfment o f t he c hapel b y s andblows, a d ate s upported b y h istorical a rgument. A s t he m ain p urpose o f t he s tudy o f t he b ones w as t o l earn a bout t he w ay o f l ife o f t he p eople, a s m uch a s p ossible o f t he h istory o f t he i sland s ince t he 1 5th c entury w as c ulled f rom t he l iterature. T he a ccount i ncludes t he r ecollection o f o ne w ho, a s a c hild a nd y oung w oman, k new t he i sland w ell i n t he e arly y ears o f t his c entury.

1 92

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