122 • Jerome C. Rose and Philip Hartnady 



be noted that we combined age groups 

 11-19 and 20-29 years to facilitate 

 comparison by producing a sample size 

 (9) approximately equal to the other age 

 groupings. Table 2 shows that both the 

 prematures and neonates (grouped to- 

 gether as aged at birth) have a high fre- 

 quency of systemic proliferative le- 

 sions. Virtually every component of the 

 skeleton is impacted: cranium, ribs, 

 bones of the arm, pelvis, and bones of 

 the leg. Of particular interest is the high 

 rate of endocranial involvement (38%). 

 The fact that these lesions are so exten- 

 sive, even on those individuals aged 

 younger than birth, strongly suggests 

 that the infectious agent was contracted 

 in utero. The patterning of lesions (i.e., 

 distribution among the bones of the 

 skeleton) remains relatively stable be- 

 tween birth and 10 months, but then, 

 with the exception of the cranium and 

 clavicle, the frequency of infected 

 bones declines. The fact that no healed 

 cranial lesions are found on individuals 

 of any age (Table 3) indicates that few 

 or none of those neonates and children 

 with cranial infections survived. For 

 example, examination of infections of 

 the calvarium (Figure 1) shows a de- 

 cline with age and only two healed le- 

 sions among those aged between 40 and 

 49 years. This pattern is roughly similar 

 for all bones of the skull. 



The postcranial skeleton shows a 

 slightly different pattern. Active le- 

 sions of the arm bones drop steadily 

 from birth through 5 years and reoccur 

 at sporadic low levels between 1 1 and 

 39 years. This pattern can best be illus- 

 trated by lesions of the radius (Figure 

 2). The few healed infections of the arm 

 can best be attributed to late-occurring 

 infections and not to survivorship of the 

 infected infants. The arm lesions sug- 

 gest a bimodal pattern of origin with the 

 first peak of active infections occurring 

 before and at birth and the second oc- 

 curring between 1 1 and 39 years. 



In contrast, the infectious lesions of 

 the leg, especially the lower leg, show a 

 trimodal distribution. Like the arm 

 bones, the active lesions of the leg arc 

 highest at birth, drop significantly be- 

 tween birth and 10 months, exhibit a 



CEDAR GROVE CALVARIUM INFECTIONS 



Birth 



Figure 1. 



c 

 o 



£ 



c 



c 

 o 

 u 



w 



o 



a. 



100 - 

 90 . 

 80 

 70 - 

 60 



50 H 

 40 

 30 



20 H 

 10 

 



Birth 



P^ Active 

 I I Healed 



II 



2/8 



0'/05 °VlO 'V29 3%9 



Age of Death 



"0/49 



60 • 



CEDAR GROVE RADIUS INFECTIONS 



t^^ Active 



! 1 Healed 



J 



XL 



AH 



JIL 



2/8 



'Vos 



06/10 



y29 



3%9 



"%< 



50- 



Age of Death 



Figure 2. 



second peak between one and five years 

 (actually a modal age of 18 months), 

 followed by a third consisting of an 

 age-cumulative increase of healed le- 

 sions. This pattern is best illustrated by 

 the fibula (Figure 3). 



The ribs have been singled out for 

 special attention because in one respect 

 they are similar to the arm bones in dis- 

 tribution, but different in that they are 

 often not associated with lesions on 

 other bones (Figure 4). Like the arm 

 bones, active periostitis of the ribs 

 drops between birth and five years and 

 occurs at relatively low levels in adult- 



hood, with only one healed lesion in the 

 entire sample. The majority of the early 

 lesions can be attributed to systemic in- 

 fection, but two children (one at 13 

 months and the other at 20 months) dis- 

 play no other infectious lesion. The 

 three adults (one male and two females) 

 with active rib infections also show no 

 other active lesion. This distribution 

 suggests that a separate pathological 

 process is responsible. The fact that 

 there is only one healed rib lesion pres- 

 ent in the sample suggests that rib le- 

 sions might be etiologically related to 

 causes of death. 



Zagreb Paieopathotogy Symp- 1 98ft 



