Contents lists available at ScienceDirect International Journal of Paleopathology journal homepage: www.elsevier.com/locate/ijpp Research article Is differential diagnosis attainable in disarticulated pathological bone remains? A case-study from a late 19th/early 20th century necropolis from Juncal (Porto de Mós, Portugal) Sandra Assis a,b, ⁎ , Charlotte Yvette Henderson c , Sílvia Casimiro a,b , Francisca Alves Cardoso a,b a LABOH – Laboratório de Antropologia Biológica e Osteologia Humana, CRIA/FCSH, Universidade Nova de Lisboa, Portugal b CRIA – Centro em Rede de Investigação em Antropologia, Faculdade de Ciências Sociais e Humanas, FCSH, Universidade Nova de Lisboa, 1069-061 Lisboa, Portugal c CIAS – Research Centre for Anthropology and Health, Department of Life Sciences, University of Coimbra, 3001-401 Coimbra, Portugal ARTICLE INFO Keywords: Palaeopathology Trauma Periosteal reactions Joint changes Amputation Entheseal changes ABSTRACT Differential diagnosis is a fundamental step in every palaeopathological study. It is a challenging exercise since many intrinsic and extrinsic factors may negatively impact the accurate interpretation of bone changes in human skeletal remains. Among these, the completeness and preservation of skeletal elements plays a significant role. This study aims to explore the limits of differential diagnosis in the analysis of disarticulated, fragmented bones. The sample consists of twelve adult bone fragments with noticeable changes. The remains were identified in a dis-articulated skeletal assemblage from the former necropolis of Juncal (Porto de Mós, Portugal), which probably closed in the late 19th century/early 20th century. They were analysed visually and with X-radio- graphy, and the changes carefully described prior to differential diagnosis. Six bones presented signs of healed bone trauma and one showed features compatible with leg amputation. Periosteal reactions were observed in several bones, one of them resembling changes consistent with an overlying skin ulcer. Two bone fragments were identified as belonging to the same individual due to the matching bone changes. Despite the incomplete re- mains, a broader diagnosis was possible for most cases, which facilitated a discussion of health, medical and social care among the inhabitants of the region. 1. Introduction Differential diagnosis occupies a central role in the challenging task of understanding disease in past human populations (Larsen, 2006). In palaeopathology, differential diagnosis is a process of ongoing im- provement, as new imaging, genetic and biochemical techniques are slowly unveiling the complex co-evolutionary interactions of host-pa- thogens, as well as the impact of environmental changes in past disease expression (Grauer, 2012). More often, diagnostic criteria for dry bone rely on the detailed observation and description of the bone changes “coupled with a logic-driven problem-solving framework” (Klaus, 2015: 13), and using clinical imaging data from living patients as comparative sources (Mays, 2012). Even so, a considerable number of factors are described in the palaeopathological literature as impacting our ability to assess the aetiology of bone changes. These factors may be associated with the object of analysis, i.e., skeletonised human remains, the lim- ited bone tissue response to disease and injury, and the fragmentary and/or commingled nature of some skeletal assemblages. Commingling of human skeletal remains can occur at any stage of burial, in association with certain funerary practices, as a result of ex- cavation and storage of skeletal assemblages, and even after it (Fox and Marklein, 2014). The study of commingled remains, defined by Osterholtz et al. (2014) as human and/or faunal remains that have become de-individualized due to the mixing of elements, either in- tentionally or unintentionally, is not a straightforward exercise espe- cially if it aims to reconstruct past population’s health, behaviour and cultural practices. The presence of fragmentary remains, often occur- ring in association with commingled assemblages also increases the interpretative difficulties (Osterholtz et al., 2014). Regarding these problems, several publications focussing on theoretical and new methodological approaches in the study and interpretation of com- mingled, disarticulated, or disturbed skeletal remains in bioarchaeolo- gical and forensic contexts have been published (for a review see Adams and Byrd, 2008 and Osterholtz et al., 2014, and authors herein. See also Adams and Byrd, 2006; Tuller and Ðurić, 2006; Silva et al., 2009; Cabo et al., 2012; Varas and Leiva, 2012; Gregoricka, 2014; Finlayson et al., https://doi.org/10.1016/j.ijpp.2017.10.007 Received 20 September 2016; Received in revised form 18 October 2017; Accepted 27 October 2017 ⁎ Corresponding author. Present address: CRIA – Centro em Rede de Investigação em Antropologia, Faculdade de Ciências Sociais e Humanas, Universidade Nova de Lisboa, Edifício ID, Av. Berna, 26, sala 3.09, 1069-061 Lisboa, Portugal. E-mail addresses: sandraassis78@gmail.com (S. Assis), c.y.henderson@uc.pt (C.Y. Henderson), scasimiro@fcsh.unl.pt (S. Casimiro), francicard@fcsh.unl.pt (F. Alves Cardoso). International Journal of Paleopathology 20 (2018) 26–37 1879-9817/ © 2017 Elsevier Inc. All rights reserved. T