Endemic congenital iodine deficiency syndrome from a 19th to 20th century poorhouse cemetery in Riggisberg, Switzerland.

OBJECTIVE

To identify and describe skeletal remains showing features consistent with congenital iodine deficiency syndrome (CIDS), also known as "cretinism" and to explore whether this condition may have been underdiagnosed or if it is underrepresented in archaeological skeletal assemblages.

MATERIALS: 121 adult skeletons from the 19th/20th century former Riggisberg poorhouse cemetery.

METHODS

The remains were studied macroscopically using standard osteological methods for the estimation of age, sex and stature.

RESULTS

Features typical of CIDS were detected in four individuals, and for another six, we consider it a highly consistent diagnosis. The review of palaeopathological data from a comparative sample of 2314 archaeological skeletons revealed an underrepresentation of individuals with CIDS but also clues that previously undiagnosed cases may exist.

CONCLUSIONS

We suggest that an underrepresentation in the archaeological record of endemic regions may be due to increased childhood mortality of affected individuals, difficulties in diagnosing this condition in immature skeletal remains, and - at least in the modern period - frequent institutionalization and burial in specific cemeteries belonging the institutions.

SIGNIFICANCE: Several new cases of CIDS increase the small body of known affected remains and add to the knowledge about its skeletal manifestations. This study contributes to the differential diagnosis of a nearly eradicated disease and to its assessment in past populations.

LIMITATIONS: Incompletely preserved skeletons limited the assessment and diagnosis.

SUGGESTIONS FOR FURTHER RESEARCH: Further intensive review and precise assessment of skeletons is advised to explain archaeological underrepresentation of diseases.