Brucellosis at Herculaneum (79 AD )

The author describes vertebral lesions observed in the skeletons of 16 adults who fled to the ancient beach at Herculaneum during the eruption of Mount Vesuvius, where they were buried alive. In all cases the lesions present as the osteolysis of the superior vertebral angle. Though it is true that this region is generally affected by osteolytic activity in all the haematogenous vertebral osteomyelitises, because of the particular arterial circulation patterns of the vertebrae, several distinctive features of these lesions indicate they were caused by brucellosis. Of particular significance are the strong, frequent sclerotic reactions below the osteolytic areas and the non‐involvement of the small posterior intervertebral articulations. The sclerotic reactions are primarily due to endosteal activation, with thickening of the trabecular network produced by both an increase in the volume of the trabeculae and an increase in their number, which results in a consequent reduction of the marrow spaces. There is also periosteal activation due to the involvement of the periosteum; the anterior faces of the vertebrae struck by chronic phlogosis. Finally, there are ossifications at the centres of the anterior faces of the affected vertebral bodies that form as a result of the osseous metaplasia of the anterior longitudinal vertebral ligament, which is also involved in the progression of the disease. The bone neoformations attributable to these varying pathogenetic origins (endosteal, periosteal and metaplastic) combine to produce a sclerotic hemi‐ring, known as the brucellar sclerotic vertebral hemi‐ring, which can be quite dense, and surrounds the area of the osteolysis of the antero‐superior somatic angle from below and behind. The vertebral lesions are also restricted to characteristic sections of the spinal column (the dorso‐lumbar traict), the vertebrae (the antero‐superior angle) and the upper plate (the region below the impression of the anulus fibrosus ) . In 68.7% of the cases the vertebral lesions are associated with rib alterations that are likely attributable to the micronodular brucellar pleurisy that commonly strikes brucellosis victims. Vertebral lesions that correlate with melitococcic spondylitis were found in 16 subjects (about 17.4% of the adults) and are more common in men than in women (M/F ratio=3:1). The high frequency of the disease is supported by historic evidence; indeed, written sources mention that the Romans made considerable use of milk from sheep and goats. It was consumed directly, without cooking or other forms of treatment, and also as milk derivatives, including ovine‐milk yogurt and an impressive variety of fresh cheeses. The important role of ovine milk in the Roman diet could be behind the great frequency of brucellosis at the time. The data from the Herculaneum population provide the first concrete evidence in favour of a milk‐related source for the disease. Copyright © 1999 John Wiley & Sons, Ltd.