figure 6 Left calcaneum and talus showing disruption of the articular surfaces

Robusticity/new bone formation/ossification
Very prominent muscle markings are visible on most bones of this skeleton supporting a male sex estimation (for example see Figure 7). The obturator foramina of both innominates and the iliac crests (Figure 8), anterior patellae, linea asperae, trochanters and fovea of the femurs, and the achilles tendon attachment on the calcanei all have bone formation on them, suggesting a robust person or a pathological condition. Ossification of costal and thyroid cartilages are also seen. The right tibia has lamellar bone formation along its shaft length.

figure 7 Robust scapulae

figure 8 Innominates showing new bone formation in obturator foramina, superior acetabular rims and iliac crests

Trauma and infection
The left tibia displayed an abnormality in the distal half of the shaft (Figures 9 and 10). A healed oblique fracture was evident with a healed cloaca (sinus or hole) present on the posterior surface of the fracture. New lamellar (i.e. longstanding) bone formation is present on the medial side of the fracture. The fibula has also suffered an oblique fracture in the proximal half of the shaft which is also healed and displays longstanding lamellar bone formation. The radiograph (Figure 11) showed overlap of the fracture fragments which is supported by the 14mm loss of length compared to the right tibia. However, no deformity was evident on healing, suggesting possible care and treatment. New bone formation was also seen on the distal end of the shafts of the tibia and fibula at the site of attachment for the tibio-fibular ligament, and on the medial and posterior sides. These changes suggest a fracture with subsequent infection of the medullary cavity (osteomyelitis). The left foot bones (Figures 5 and 6) may have suffered in the same traumatic event that led to the tibial and fibular fractures; osteophytes are visible on many of the articular surfaces of the tarsals and metatarsals.

figure 9 Fractures to distal tibia and proximal fibula (anterior view)

figure 10 Fractures to distal tibia and proximal fibula (posterior view, showing osteomyelitic sinus)

figure 11 Radiograph showing anterior view of fractures with obvious oblique fracture line and sinus

Metabolic disease
Radiographs of the left tibia displayed Harris lines of arrested growth (dense horizontal opaque lines), and the orbits of the skull showed holes in their anterior aspects; these latter are interpreted as cribra orbitalia, a condition associated with iron deficiency anaemia (Stuart-Macadam and Kent, 1992). Both conditions indicate some stress during growth which may be the result of a nutritional deficiency, childhood disease or other less specific cause (Goodman et al. 1988).

Conclusions
The analysis of this skeleton suggested a robust mature adult male aged approximately 40-60 years at death and 1.82m in height. He suffered from a number of health problems during his life. "This commenced in his growing years of childhood when he suffered stress which is indicated by cribra orbitalia in the eye sockets and Harris lines of arrested growth seen on radiographs of the tibiae. The iron deficiency cause for cribra orbitalia may be the result of a number offactors within that person's life which could include an iron deficient diet, high pathogen (infection) load, and excessive loss of blood; there were no postcranial changes suggesting sickle cell anaemia or thalassaemia. The dentition showed antemortem tooth loss (?cause), an abscess (probably as a result of the extreme occlusal attrition on the affected tooth), and calculus, the latter suggesting an alkaline based oral cavity and lack of dental care. Developmental (congenital anomalies) were seen in the form of an open sacrum at levels 4 and 5 and an extra lumbar vertebra, both not having any implications for the person's well being. Extensive joint disease (including osteoarthritis) was seen through the spine, including Schmorls Nodes in a number of vertebrae; these changes suggest advancing age and/or trauma to the spine. The fusion of the cervical vertebrae on one side suggests, by its asymmetrical nature, an underlying traumatic cause predisposing to joint change. The bones of the skeleton are very robust with prominent muscle, tendon and ligament markings; these are, again, consistent with advancing age but may also be an indicator of the early stages of Diffuse Idiopathic Skeletal Hyperostosis (Rogers and Waldron, 1995), although the spinal changes of ossification of the anterior longitudinal ligament are absent. The left tibia and fibula have healed longstanding fractures, and the former shows evidence of infection. Overall, the skeleton suffered a number of health problems but all were contracted well before the person's death, suggesting that his immune status was such that he was able to survive the conditions and develop and display the healed chronic changes (Wood et al., 1992).