Paleopathological study on infectious diseases in Japan • 131 



Figure 2. Schematic representation of 

 moderate "plaquelike" periostitis and a 

 case from Jomon site (Tsukumo siiell- 

 mound). 



Figure 3. Schematic representation of ad- 

 vanced chronic osteomyelitis with seques- 

 trum, involucrum, and cloaca formation 

 (MacCallum 1920). 



Zaf;reb Paleopathology Symp. 1988 



Figure 4. Sclerosing osteomyelitis of Garre from modem Japanese skeletal mate- 

 rial: a. pathological (right) and nonnal (left) bone specimen; b. x-ray film. 



ordinary inflammatory reaction represented mainly by peri- 

 ostitis with plaquelike bone deposition and, in the advanced 

 case, by osteomyelitis. On the other hand, specific inflam- 

 mation can be characterized by a peculiar granulomatous 

 lesion even in the dry bones which may be detectable in gross 

 examination. Actually, in the typical/advanced cases of tu- 

 berculosis and syphilis, their inflammatory changes can be 

 diagnosed by characteristic morphology and peculiar dis- 

 tribution of the lesion in the skeleton. In some cases, of 

 course, geographical and epidemiological information 

 should be considered in order to evaluate the bone lesion and 

 differentiate between possible diseases which affect the skel- 

 eton in a similar fashion (Buikstra 1976). 



However, in the case showing slight inflammatory bone 

 change or even in the advanced changes with ordinal perios- 

 teal reaction, it is not always possible to difterentiate these 

 two categories with certainty. Only typical and demonstrable 

 cases showing peculiar morphology caused by specific infec- 

 tion can be diagnosed in the dry-bone specimens. In other 

 words, it is quite natural that overlapping between non- 

 specific and specific inflammatory change, particularly in 

 the early stage of bone infection, would occur in archeologi- 

 cal specimens. Therefore, the etiology of periostitis, which is 

 very common in archeological specimens, cannot always be 

 identified. This is one of the reasons why periostitis has often 

 been treated as an independent entity in paleopathology. On 

 this problem, Ortner and Putschar (1 98 i : 1 3 1) stated the fol- 

 lowing: 



