UCL INSTITUTE OF ARCHAEOLOGY ARCLMG143: MORPHOLOGY AND PALAEOPATHOLOGY OF THE HUMAN SKELETON

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UCL INSTITUTE OF ARCHAEOLOGY
ARCLMG143: MORPHOLOGY AND PALAEOPATHOLOGY
OF THE HUMAN SKELETON
2013 – 2014
15/30 Credits
Co-ordinator: PROFESSOR TONY WALDRON
[email protected]
Room 312, telephone 020 7679 4784
ARCLMG143 MORPHOLOGY AND PALAEOPATHOLOGY OF THE HUMAN SKELETON 2013-20014 PAGE 1
1. OVERVIEW
Short description
This course is confined almost entirely to the postcranial skeleton (the skull is covered in detail in ARCLMG144). It is intended
to introduce the anatomy of the bones, the ways in which they vary in size and shape, the information that this yields about the
age and sex of the individual, and some of the diseases that can be diagnosed from them.
Week-by-week summary
All lectures will be given by Professor Waldron. Practical sessions will be taken by Professor Waldron and Dr Carolyn Rando.
The weekly timetable is shown below:
Week
Lectures and seminars
2
The structure and function of the skeleton
3
4
5
Growth and development of the skeleton
Bone metabolism
Basic pathological mechanisms
6
Joint disease 1: morphology and patterns of
osteoarthritis
Reading week No Teaching
Joint disease 2: the erosive and sero-negative
arthropathies
Fractures: recognition of types, sequelae and
treatment
Infectious disease: recognizing evidence for
infection in the skeleton and assigning to most
probable cause
7
8
9
10
Practicals (weeks 2 - 5 only)*
Lectures and seminars from week 6 onwards
The arm and shoulder girdle – scapula, humerus, radius
and ulna
The leg – femur, tibia, fibula and patella
The axial skeleton – pelvis, vertebrae, ribs and sternum
The hands and feet – carpals and tarsals, metapodials
and phalanges
Osteoarthritis
Erosive, sero-negative and other arthropathies
Trauma: fractures, dislocations and intentional injury
Osteomyelitis, tuberculosis, syphilis
ARCLMG143 MORPHOLOGY AND PALAEOPATHOLOGY OF THE HUMAN SKELETON 2013-20014 PAGE 2
11
12
Neoplasms: classification of primary and secondary
tumours of bone
Multiple choice examination
Metabolic diseases
*Informal pathology tutorials will take place on Wednesday afternoon from 4.00 – 6.00 pm in room 308 beginning on week 8.
Basic texts
Note: From the list below, either Bass or Brothwell is essential. They each have their strong points and the latest editions of
both can usually be bought second hand from a web-site such as Abebooks. Although very old now, the best anatomy of bones
by far is Frazer; it can sometimes be bought from Abebooks otherwise any version of Gray’s Anatomy is more than adequate.
There are few good textbooks on palaeopathology and modern textbooks on bone pathology are not very helpful as they tend to
concentrate almost exclusively on cellular pathology. The best illustrations of pathological lesions are usually to be found in old
books, written prior to the development of disease modifying drugs when the lesions became chronic (as in the remote past).
Two of the more interesting are Greig and Jones cited below; they may appear on the list of second-hand book sellers.
Aufderheide, A.C. & Rodriguez-Martin, C. (1998). The Cambridge Encyclopedia of Human Paleopathology. Cambridge:
Cambridge University Press. Institute of Archaeology Library JF Qto AUF
Bass, W.M., (1979). Human osteology, a laboratory and field manual of the human skeleton.
Columbia : Missouri
Archaeological Society. Institute of Archaeology Library BB 2 BAS
Brothwell, D.R., (1981). Digging up bones.
London & Oxford : British Museum & Oxford University Press. Institute of
Archaeology Library BB2 BRO
Buikstra, J.E. and Ubelaker, D.H., Ed. (1994). Standards for data collection from human skeletal remains. Arkansas
Archeological Survey Research Series No 44. Fayetteville : Arkansas Archeological Survey. pages 40-44.
Frazer, J.E., The anatomy of the human skeleton, London, Churchill, 1914 (and subsequent editions)
Gray’s Anatomy. Available in room 308, or various parts of the UCL library
Greig, D.M., Clinical observations on the surgical pathology of bone, Edinburgh, Oliver & Boyd, 1931
Jones T., Diseases of the bones, London, Smith Elder & Co., 1887.
Larsen, C.S. (1997). Bioarchaeology. Cambridge Studies in Biological Anthropology. Cambridge: Cambridge University Press.
Muscolino, J.E. Musculoskeletal anatomy coloring book. Missouri: Mosby, 2004.
ARCLMG143 MORPHOLOGY AND PALAEOPATHOLOGY OF THE HUMAN SKELETON 2013-20014 PAGE 3
Ortner, D.J. (2003). Identification of pathological conditions in human skeletal remains. 2nd Edition.
Amsterdam, London:
Academic Press. Institute of Archaeology Library JF ORT
Roberts, C. & Manchester, K. (1996 & 2005). The archaeology of disease. 2nd & 3rd Edition.
Stroud: Sutton Publishing.
Institute of Archaeology Library JF ROB
Scheuer, L. & Black, S. (2000). Developmental juvenile osteology. London: Academic Press.
Steele D.G. and Bramblett, G.A. (1988). The anatomy and biology of the human skeleton. College Station, Texas : Texas A &
M University Press. Available in room 308, or Institute of Archaeology Library BB 2 STE
Waldron, T. (2007). Palaeoepidemiology. The measure of disease in the human past. Walnut Creek, Left Coast Press.
Waldron, T. (2009). Palaeopathology, Cambridge, CUP.
White, T.D. (2000). Human osteology. London: Academic Press. Anthropology
I have made no attempt to provide an exhaustive list of references. It is assumed that at the very least each student will have
referred to the essential books in the list above, all of which contain references to further reading. The following short list is
mainly to alert students to modern developments in bone biology and metabolism. Given the speed at which the subject is
developing it is inevitable that the list will be out of date and students who wish to keep abreast of research should consult data
banks such as Google Scholar or PubMed.
M Zaidi, Skeletal remodelling in health and disease, Nature Medicine, 2007, 13, 791 – 801.
HK Datta, WF Ng, JA Walker and SS Varanasi, The cell biology of bone metabolism, Journal of Clinical Pathology, 2008, 61,
577 – 587.
H Takayanagi, Osteoimmunology: shared mechanism and crosstalk between the immune and bone systemns, Nature Reviews
Immunology, 2007, 7, 292 – 304.
F Elefteriou, Regulation of bone remodelling by the central and peripheral nervous systems, Archives of Biochemistry and
Biophysics, 2008, 473, 231 – 236.
D Taylor, JG Hazenburg and TC Lee, Living with cracks; damage and repair in human bones, Nature Materials, 2007, 6, 262 –
268.
X Feng and JM McDonald, Disorders of bone remodelling, Annual Review of Pathology: Mechanisms of Disease, 2011, 6, 121 –
145.
PCJ Donoghue and IJ Sansom, Origin and early evolution of vertebrae skeletonization, Micrsocopy Research and Technique,
2002, 59, 353 – 372.
ARCLMG143 MORPHOLOGY AND PALAEOPATHOLOGY OF THE HUMAN SKELETON 2013-20014 PAGE 4
MM Cohen, The new bone biology. Pathologic, molecular and clinical correlated, American Journal of Medical Genetics, 2006,
140A, 2646 – 2706.
AJ Buckwaller and RR Cooper, Bone structure and function, Instructions Course Lectures, 1987, 36, 27 – 48.
A Prentic, I Schoenmakers, MA Laskey, S de Bone, F Ginty and GR Gilbert, Nutrition and bone growth and development,
Proceedings of the Nutrition Society, 2006, 65, 348 – 360.
D Evered and S Harnett (eds), Cell and Molecular Biology of Vertebrate Hard Tissue. Ciba Foundation Symposium 136,
London, Ciba Foundation, 1988.
Methods of assessment
This course is assessed by means of:
(a) one essay of 2500 words (± 5%); the essay counts for 60% of the final mark awarded for the course.
(b) a multiple choice examination of one hour; this examination counts for 40% of the final mark awarded for the course.
Teaching methods
The course is taught through lectures and practicals. For the first four weeks only there are lectures on Mondays that deal with
the basics of bone structure and function, metabolism, and pathological mechanisms. The lectures are followed later in the week
by a practical session which will deal with regions of the skeleton. It is expected that students will have studied the anatomy of
the particular region that is the subject of the practical on their own prior to the practical session. Most lectures are based
around PowerPoint presentations and these are available through online teaching resources that you will be able to access at
any time on a password controlled UCL website. Details of how to do this will be given during the first week of the course.
Practicals are to teach students how to identify individual anatomical elements and how to allocate them to the correct side; how
to determine age and sex; how to take essential measurements; and how to recognise normal variants. Following reading week
a series of informal pathology tutorials will take place in room 308 on Wednesday afternoons from 4.00 – 6.00 pm (starting in
week 8). The topics will be based on the lectures the previous week and students are strongly advised to prepare for the tutorial
in advance. Attendance at these tutorials is voluntary. Students will be assigned to practical sessions and will be notified of the
group to which they have been allocated. All practical sessions will take place at the Royal College of Surgeons in Lincolns Inn
Fields (see map at end of handbook)
Workload
There will be 10 hours of seminars/lectures and 15 hours of practical sessions for this course. Students will be expected to
undertake around 75 hours of reading, plus 50 hours of independent practical work combined with preparation of the assessed
ARCLMG143 MORPHOLOGY AND PALAEOPATHOLOGY OF THE HUMAN SKELETON 2013-20014 PAGE 5
work. In addition, about 15 hours revision is needed for the class test. This adds up to a total workload of 150 hours for the
course.
2. AIMS, OBJECTIVES AND ASSESSMENT
Aims
The aims of the course are to provide students with a comprehensive knowledge of the anatomy and function of the skeleton
including an understanding of its metabolism, growth and development; recognition of normal variants; basic pathological
mechanisms as they affect bone, and the ability to recognise the common diseases that affect the skeleton.
Objectives
On successful completion of this course, students would be expected to:
• have a good knowledge of the basic structure of bones, their growth, development and metabolism;
• be able to identify confidently all the bones of the postcranial human skeleton in both adult and juvenile remains;
• be able to label the main features and landmarks of individual bones;
• have an understanding of variation in size and shape, and its interpretation in terms of sexual dimorphism, growth and
development;
• be able to take the most commonly used postcranial bone measurements;
• have an understanding of the methods used for estimating sex and age at death from the skeleton, and their limitations;
and
• have a knowledge of basic pathological mechanisms and be able to identify and record the most common types of
pathological lesions and developmental anomalies seen in the skeleton, and understand the ways in which they may be
interpreted.
Learning outcomes
On successful completion of the course students should be able to demonstrate general skills of observation and inference,
critical reflection and application of acquired knowledge.
Coursework
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Assessment tasks
The course is assessed by means of an essay and a multiple choice examination. The title of the essay is at the student’s
discretion, based on the content of the course or any particular interest in skeletal anatomy or pathology that the student may
have. The title of the essay, however, must be agreed by the course co-ordinator before any writing begins. The essay must be
handed in by mid-day on 17 January 2014.
The multiple choice examination will take place on the last morning of the course at the Royal College of Surgeons and all
students must attend at 10 am for the test. The examination consists of twenty questions, each with five possible answers.
There may be more than one correct answer to each question and marks will be deducted for incorrect answers. The questions
will cover all aspects of the course – anatomy, metabolism, and pathology.
If students are unclear about the nature of either of these assessments, they should discuss this with the course co-ordinator.
Students are not permitted to re-write or re-submit essays in order to better their marks. They may, however, submit a brief
outline of their essay for comment prior to submission. The course co-ordinator is happy to discuss an outline of an essay,
providing this is planned suitably in advance of the deadline for submission. Advice on completing the multiple choice
examination will be given during the term and the course co-ordinator will be happy to discuss the exam further for those who
may still have difficulties in understanding the task.
Word-length for essays
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Strict new regulations with regard to word-length were introduced UCL-wide with effect from the 2010-2011 session. If your work
is found to be between 10 and 20% longer than the official limit, your mark will be reduced by 10%, subject to a mark equivalent
to a bare pass, assuming that the work merited a pass. If your work is more than 20% over-length, it will be given a zero mark.
The following should not be included in the word-length: bibliography, appendices, and tables and graphs and their captions.
Submission procedure for essays
Students are required to submit a hard copy of the essay to the course co-ordinator’s pigeon hole via the Red Essay Box st
Reception by the deadline noted above. The course work must be stapled to a completed coversheet (available via the web,
from outside room 411A, or from the library).
With effect from 2012-2013 students should put their Candidate Number, not their name on all coursework. They should also
put the Candidate Number and course code on each page of their work.
Please note that stringent penalties for late submission are being introduced UCL-wide from 2012-2013. Late submission will be
penalised in accordance with the regulations unless permission for late submission has been granted and an Extension Request
Form (ERF) completed.
Date-stamping will be via Turnitin (see below), so in addition to submitting hard copy, students must also submit their work to
Turnitin no later than midnight of the day before the deadline.
Students who encounter technical difficulties submitting their work to Turnitin should e-mail the nature of this problem to [email protected] in advance of the deadline in order that the Turnitin advisers can notify the course co-ordinator that it may be
appropriate to waive the late submission penalty.
If there is any other unexpected crisis on the submission day, students should telephone or e-mail the course co-ordinator and
follow this up with an ERF.
Please see the Coursework Guidelines on the IoA website (or your degree handbook) for further details of penalties
(http://www.ucl.ac.uk/archaeology/administration/students/handbook/turnitin)..
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Note that hard copy will no longer be date stamped.
The Turnitin Class ID is 611660 and the Class Enrolment Password is IoA1314. Further information is given on the IoA website.
Turnitin advisers will be available to help you via e-mail ([email protected]) if needed.
UCL-WIDE PENALTIES FOR LATE SUBMISSION OF COURSEWORK
• The full allocated mark should be reduced by 5% for the first working day after the deadline for submission of the
coursework.
• The mark will be reduced by a further 10% if the coursework is submitted during the following six calendar days.
• Providing the coursework is submitted before a date during term 3 defined in advance by the relevant Master’s Board of
Examiners, but had not been submitted within seven days of the original deadline for submission, a mark of zero will be
recorded but the assessment would be considered to be complete.
• Where there are extenuating circumstances that have been recognised by the Board of Examiners or its representative,
these penalties will not apply until the agreed extension period has been exceeded.
Timescale for return of marked coursework to students
You can expect to receive your marked work within four calendar weeks of the submission date. If you do not receive your work
within this period, or a written explanation from your marker, you should notify the Institute’s Academic Administrator, Judy
Medrington. You must return your marked copy to the marker within two weeks of receiving it.
Keeping copies
Please note that it is an Institute requirement that you retain a copy (either a hard or an electronic copy) of all submitted
coursework submitted.
Citing of sources
Coursework must be expressed in the student’s own words giving the precise source of any ideas, information, diagrams etc
that are taken from the work of others. Any direct quotations from the work of others must be indicated as such by being placed
within inverted commas. Plagiarism is regarded as a very serious irregularity which can carry very heavy penalties. It is
your responsibility to read and abide by the requirements for presentation, referencing and the avoidance of plagiarism to be
found in the IoA coursework guidelines on the IoA website (http://ucl.ac.uk/archaeology/administration/students/handbook)
ARCLMG143 MORPHOLOGY AND PALAEOPATHOLOGY OF THE HUMAN SKELETON 2013-20014 PAGE 9
Strict new penalties for plagiarism are being introduced from the 2012-2013 session. You will receive details separately.
3. SCHEDULE AND SYLLABUS
Teaching schedule
Anatomy lectures will be held from 1:00 – 2:00 pm on Mondays, in room 612 during weeks 2 – 5 only. The palaeopathology
lectures will be held from 10 am on Thursday mornings at the Royal College of Surgeons from weeks 6 - 11 excepting reading
week. (See map at back of handbook for location of RCS.) Both the anatomy and pathology lectures will be given by Professor
Waldron.
Tutorial groups and practicals
Anatomy practical sessions will take place on Thursday mornings from weeks 2 – 5 inclusive at the Royal College of Surgeons..
As the class is large, you will be split into two groups for practical classes. Group 1 will attend at the RCS from 10.00-11.30 am
and Group 2 from 11.30 am -1.00 pm. Thereafter both groups will attend the RCS at 10.00 am for the palaeopathology lectures.
Voluntary pathology tutorials will be held in room 308 on Wednesday afternoons from 4 – 6 pm starting in week 8. Professor
Waldron will deliver all the lectures and will supervise practical sessions with Dr Carolyn Rando.
Please note that photography is not permitted in the Royal College of Surgeons without express permission. Students must
undertake to abide by this regulation and any others that the RCS has in force. Failure to do so will result in the student’s
expulsion from the RCS.
Syllabus
Lectures all to be given by Professor Waldron:
Week 2. Monday morning. The structure and function of the skeleton. Basic functions – locomotion, protection, storage of some
essential elements, detoxification of some elements (especially lead).
Week 3. Monday morning. Growth and development of the skeleton. Primary and secondary ossification centres, growth plates.
Cartilage and membrane derived bones. Timing of sutural closure.
Week 4. Monday morning. Bone metabolism. Function of the major bone cells – osteoblast, osteoclast and osteocyte.
Remodelling and factors necessary for normal metabolism – cytokines, vitamins, hormones.
ARCLMG143 MORPHOLOGY AND PALAEOPATHOLOGY OF THE HUMAN SKELETON 2013-20014 PAGE 10
Week 5. Monday morning. Basic pathological mechanisms. Pathology as the result of the decoupling of normal bone
remodelling. Lesions caused by infection, trauma, metabolic defects, joint diseases and malignant disease. Role of cytokines in
pathological mechanisms. The importance of the inflammatory process in skeletal pathology.
Weeks 6 and 8. Thursday morning. Joint diseases. Classification of joint disease into proliferative and erosive forms.
Osteoarthritis as the model of a proliferative arthropathy. Means of diagnosing joint disease in the skeleton including the use of
operational definitions. The sero-negative arthropathies as types of erosive joint disease, including rheumatoid arthritis,
ankylosing spondylitis, psoriatic arthropathy and reactive arthropathy. Erosive arthropathy as an example that spans the two
major types.
Week 9. Thursday morning. Trauma. Intentional and accidental trauma. Fractures, dislocations and subluxations, their causes,
complications and recovery. Wounding and other intentional traumas.
Week 10. Thursday morning. Infectious diseases. Primary infections of bone, including osteomyelitis, tuberculosis, treponemal
diseases, and leprosy. Polio. Differentiation between types
Week 11. Thursday morning. Neoplastic disease. Primary and secondary tumours, benign and malignant. Major types of
primary tumours, including osteoma, osteochondroma and osteosarcoma. Secondary tumours including those originating in the
breast, lung, and prostate; malignant myeloma.
And Metabolic disease. Osteoporosis and its diagnosis in the skeleton; Paget’s disease of bone, rickets and scurvy.
Week 12. Thursday morning. Multiple choice examination.
For the lectures on bone metabolism students should refer to the list of supplementary references given above. For the
pathology lectures students are strongly advised to read the appropriate chapter(s) in Waldron’s Palaeopathology.
4. ONLINE RESOURCES
The full text of the UCL Institute of Archaeology handbook
http//ucl.ac.uk/archaeology/administration/students/handbook.
on
coursework
guidelines
can
be
found
at:
Online reference sources
Up to date references to bone metabolism, and clinical reference to bone disease can best be found using search engines such
as Google Scholar or PubMed. If students have any problems with either source, the course co-ordinator will be very happy to
advise them.
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Moodle
The access code to Moodle for this course is ARCLMG143.
5. ADDITIONAL INFORMATION
Libraries and other resources
In addition to the Library of the Institute, other libraries in UCL may be helpful, including the science and medical libraries.
Libraries at King’s College and Senate House may also be useful. The British Library is usually able to obtain copies of almost
anything (but for a fee). The British Medical Association and the Royal Society of Medicine have extensive runs of medical
journals, and the RSM is an excellent source for historical material. (TW is a member of both organisations and will obtain
copies of articles if requested to do so – within reason). The Wellcome Library in Euston Road is an unparalleled source of
material relating to medical history.
Attendance
A register will be taken at each class. If you are unable to attend a session, please let the course co-ordinator know by e-mail.
Departments are required to report each student’s attendance to the UCL Registry at frequent intervals throughout the term.
Dyslexia
If you have dyslexia or any other disability, please make your course co-ordinator aware of this. Please discuss with him if there
is any way in which he can help you. Students with dyslexia are reminded to indicate this on each piece of coursework.
Feedback
In trying to make this course as effective as possible, we welcome feedback from students during the course of the year. All
students will be asked to give their views on the course in an anonymous questionnaire which will be circulated towards the end
of the term. These questionnaires are taken seriously and help the course co-ordinator to develop the course. Summarised
responses are considered by the Institute’s Staff-Student Consultative Committee, the Teaching Committee, and by the Faculty
Teaching Committee.
If there are any aspects of the course which students feel they cannot raise with the course co-ordinator they should consult
their personal tutor, the academic administrator (Judy Medrington), or the Chair of the Teaching Committee, Dr Karen Wright.
ARCLMG143 MORPHOLOGY AND PALAEOPATHOLOGY OF THE HUMAN SKELETON 2013-20014 PAGE 12
Health and Safety
The Institute has a Health and Safety Policy and a Code of Practice relating to work in the laboratories. This is revised annually
and a revised edition will be issued in due course. All work undertaken in the laboratories is governed by these guidelines and
students have a duty to be aware of them and to adhere to them at all times. It should be noted that eating and drinking is not
allowed in room 308 at any time.
ARCLMG143 MORPHOLOGY AND PALAEOPATHOLOGY OF THE HUMAN SKELETON 2013-20014 PAGE 13
marks:
Institute of Archaeology
and
Royal College of Surgeons
35-43 Lincoln's Inn Fields,
London, WC2A 3PE
Tel: 020 7405 3474
(Ask for Jane Hughes)
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