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Abstract
A probable case of scurvy is identified in a child skeleton from England, dating to 2200–1970 BC. Lesions were mainly restricted to the ectocranium, but some endocranial lesions were also seen. This appears to be the earliest reported example of scurvy from Britain, and adds to the very few palaeopathological case descriptions available for the disease in infants and young children from Europe. Copyright © 2007 John Wiley & Sons, Ltd.
... The diffuse microporosity of facial elements such as the maxillae, mandible, temporal bone and palate is likely to be the result of a hyper-vascular response to an inflammatory process which caused capillary proliferation and subsequent porosity, and is therefore suggestive of a systemic metabolic disease affecting numerous skeletal regions and producing a widespread pathological pattern (70,71). In particular, patterns of micropores around the infraorbital foramen of the maxilla, on the palatal elements and around the mandibular lingula are among the features strongly suggestive of scurvy, which could have caused diffuse micro-hemorrhages in the facial area (72,73). Other etiologies may be traumatic or infectious, although in this case they seem rather unlikely due to the lack of diffuse subperiosteal bone production, which would be expected in such cases. ...
... Consequently, abnormal porosity (< 1mm) forms at muscular insertions as capillaries proliferate due to the inflammatory response to bleeding (66,71). The diagnostic features reported in the literature are microporotic lesions in the facial bones (orbital walls, maxillae, palatines, medial surface of the mandible, (78) greater wing of the sphenoid, temporal bone, zygomatic bones) and in the post-cranial skeleton (scapular fossae and long bone metaphysis), and deposition of new bone upon the underlying cortex, especially on the long bones (66,68,(71)(72)(73). Regarding the endocranial lesions, several studies have reported that, when found in conjunction with other scurvy-specific features, they could be indicative of intra-cranial hemorrhage, causing bone resorption due to proliferation of capillaries on the endocranial surface (71,73). ...
... The diagnostic features reported in the literature are microporotic lesions in the facial bones (orbital walls, maxillae, palatines, medial surface of the mandible, (78) greater wing of the sphenoid, temporal bone, zygomatic bones) and in the post-cranial skeleton (scapular fossae and long bone metaphysis), and deposition of new bone upon the underlying cortex, especially on the long bones (66,68,(71)(72)(73). Regarding the endocranial lesions, several studies have reported that, when found in conjunction with other scurvy-specific features, they could be indicative of intra-cranial hemorrhage, causing bone resorption due to proliferation of capillaries on the endocranial surface (71,73). Rickets and osteomalacia result from inadequate osteoid mineralization due to a deficiency in vitamins D 2 and D 3 (69). ...
... 4.1). The amount of vitamin C in food may be reduced by prolonged storage or exposure to high cooking temperatures (Mays, 2008). As a result, the occurrence of scurvy is commonly associated with winter months, when fresh fruits and vegetables are not available (Brickley and Ives, 2008). ...
... With time, the number of diagnostic traits increased, starting with the juvenile cranium (Ortner and Ericksen, 1997), and culminating with a summary of macroscopic, radiological and histological diagnostic criteria, on both juveniles and adults (Brickley and Ives, 2008). More recently, the focus of studies has changed to establishing new cases of scurvy in geographic regions and periods Ives, 2006, 2008;Brown and Ortner, 2011;Halcrow et al., 2014;Mays, 2008;Ortner et al., 2001;van der Merwe et al., 2010). Scurvy has also found its place in population studies, where various pathological conditions are used to analyze historical events (Geber and Murphy, 2012;Lewis, 2010). ...
... Compared to other sites, this is an unusually high occurrence of scurvy. The occurrence of scurvy in archaeological sites is generally low, rarely exceeding 10% of the sample (e.g., Bourbou, 2014;Brown and Ortner, 2011;Halcrow et al., 2014;Klaus, 2014;Lewis, 2010;Mays, 2008). A higher occurrence of scurvy has been observed in at least three skeletal samples. ...
In this study, we examine the scurvy associated skeletal lesions among juveniles from the late Medieval site Uzdolje-Grablje in Croatia. The study aims to establish a demographic pattern of scurvy using existing diagnostic criteria. The sample consists of 16 well-preserved and fairly complete juveniles, excavated from a cemetery dating to 1420-1920. Skeletal remains were analyzed macroscopically for signs of porosity and new bone formation. Scurvy is diagnosed using the "Ortner criteria" of cranial and postcranial lesions. Depending on the location of the lesions, individuals were diagnosed with either scurvy or possible scurvy. Half of the individuals in our sample are diagnosed with scurvy, with additional 25% being diagnosed with possible scurvy. Along with porotic lesions, all individuals diagnosed with scurvy/possible scurvy showed new bone formation on at least one skeletal element. The occurrence of lesions associated with scurvy in our sample is unusually high. Instead of focusing solely on diet and insufficient intake of the vitamin C, a more likely explanation lies in the synergy between diet, exposure to infections, and the environment.
... The degree and localization of the lesions in the NEQ individual suggest a pathological etiology rather than normal growth or pseudopathology (Table 2) Ortner, 2003; Table 1 Sites of abnormal porosity, new bone formation, and vascular impressions in the Nag el-Qarmila individual with possible etiology(compiled from Gray (1973) and McMinn and Hutchings (1985)). Ortner et al., 2001;Mays, 2008). Although rickets and scurvy do co-occur (Castilla et al., 2014;Schattmann, 2014), there are no diagnostic rachitic lesions (e.g., bowing of the lower limbs, craniotabes) ( Table 2). ...
... Porotic hyperostosis and cribra orbitalia h , porotic and osteolytic lesions along the humeral and femoral necks, and along the vertebral bodies, appearing lattice-like, with variable periosteal new bone i . a Ortner et al., 2001;Mays, 2008). b (Ortner, 2003). ...
... b (Ortner, 2003). c (Brickley and Ives, 2008;Mays, 2008;Ortner, 2003;Ortner and Mays, 1998). d (Caffey and Silverman, 1945;Ghom and Ghom, 2014;Jaffe, 1972;Ortner, 2003;Rana et al., 2009;Resnick and Niwayama, 1995). ...
To date there has been a lack of palaeopathological evidence for the presence of scurvy in ancient Egypt. In this paper we describe one of, if not the first, differentially diagnosed bioarchaeological cases of subadult scurvy in the region in the skeleton of a 1-year +/− 4-month old infant recovered from the Predynastic site of Nag el-Qarmila (c. 3800–3600 BCE) in Aswan, Egypt. Bony change was observed on the left maxilla and greater wing of the sphenoid bone, left and right mandibular rami, orbits, and zygomatic bones, as well as on the humeri, radii, and femora, all of which appear to be suggestive of scurvy. While the cause of this infant's probable scorbutic state is unknown, various circumstances such as diet and cultural behaviors may have contributed to the condition. Given the current lack of evidence of scurvy from ancient Egyptian contexts, this case study informs on the antiquity of ascorbic acid deficiency in the Old World.
... Ortner and colleagues (Ortner et al., 2001; Ortner and Ericksen, 1997; Ortner et al., 1999) have described the pathological features of scurvy in skeletal remains as including new bone formation and abnormal porosity on specific areas of the skull. These criteria have found acceptance in the literature, having been used, and expanded, by other bioarchaeologists investigating scurvy (Brickley and Ives, 2006; Brown and Ortner, 2011; Mays, 2008). Abnormal porosity on the external surfaces of the greater wings of the sphenoid is considered to be pathognomonic of scurvy (Ortner et al., 2001; Ortner and Ericksen, 1997; Ortner et al., 1999). ...
... Although the greater wings of the sphenoid will normally have some pitting of the cortical bone, these pits tends to be large in size and low in number, penetrating the cortex at an oblique angle (Mays, 2008). In contrast, Mays (2008) describes abnormal pitting as smaller in size but greater in number and entering the cortical bone at a vertical angle. ...
... Although the greater wings of the sphenoid will normally have some pitting of the cortical bone, these pits tends to be large in size and low in number, penetrating the cortex at an oblique angle (Mays, 2008). In contrast, Mays (2008) describes abnormal pitting as smaller in size but greater in number and entering the cortical bone at a vertical angle. Abnormal porosity in the skeleton is the result of chronic bleeding at sites where blood vessels are close to the surface of the skin and muscle activity causes stress (Jaffe, 1972). ...
... Data on skeletal manifestations of inadequate vitamin intake provide important clues to our understanding of past diet and nutrition, even though it is difficult to establish clear criteria for recognising osteological signs of dietary deficiencies in the skeletal remains (Ortner et al., 2001). This is also true for scurvy, metabolic bone disease resulting from prolonged deficiency of vitamin C-ascorbic acid-which results in defective connective tissue and blood vessels (Aufderheide & Rodríguez-Martín, 1998;Weinstein et al., 2001;Brickley & Ives, 2008;Mays, 2008). Humans are unable to synthesise and store vitamin C, so they require exogenous sources, mainly fresh fruits and vegetables (Stone, 1966;Aufderheide & Rodríguez-Martín, 1998;Ortner & Theobald, 2000;Waldron, 2009). ...
... Humans are unable to synthesise and store vitamin C, so they require exogenous sources, mainly fresh fruits and vegetables (Stone, 1966;Aufderheide & Rodríguez-Martín, 1998;Ortner & Theobald, 2000;Waldron, 2009). Vitamin C serves as a cofactor for prolyl and lysyl hydroxylases in the biosynthesis of collagen, a major structural component of connective tissues, including bone (WHO, 1999;Mays, 2008), while tissue and capillary vulnerability in scorbutic patients is attributed specifically to a defect in the proline hydroxylation step of collagen formation (Pimentel, 2003). ...
... Vitamin C is a relatively unstable compound, especially in neutral and alkaline environments and when exposed to oxygen/air, heavy metals, light and heat. Also, processing methods applied to foods, such as cooking, drying, pickling, salting and prolonged storage, considerably lower the vitamin C content (WHO, 1999;Fain, 2005;Roberts & Manchester, 2005;Brickley & Ives, 2008;Mays, 2008). Thus, the prevalence of scurvy in a given population not only reflects dietary deficiency of vitamin C but also reflects food processing and preservation methods. ...
Late and post-medieval writings report that scurvy was a widespread condition in medieval and early historical Poland. Archaeological and historical data indicate that the diet of children was based on foods poor in vitamin C and contained small amounts of raw plant products. Also, historians emphasize that in medieval and post-medieval Poland there were seasonal fluctuations in food availability, frequently accompanied by poor harvests. Both resulted in long periods of poor nutrition, which affected children most severely. The aim of this study was to investigate skeletal manifestations of scurvy in subadult remains from medieval and post-medieval Poland. Following standards described by Ortner et al. (1999, 2001) anatomical sites pathognomonic of scurvy in subadults (<17 years) were assessed for abnormal porosity and hypertrophic bone among skeletons excavated from three sites: Ostrów Lednicki (dated to the 11th-14th centuries AD), Cedynia (10th-14th centuries AD), and Słaboszewo (14th-17th centuries AD). In total 3.6% of all examined children were found to bear traces of vitamin C deficiency. The prevalence of scorbutic lesions was 4.5% for Cedynia, 2.6% for Ostrów Lednicki, and 3.6% for Słaboszewo. The majority of affected children were less than 7 years of age. Scurvy was likely more widespread in the living populations than it appears from the calculation of skeletal markers, because some individuals might have recovered or died before obvious traces became apparent. Also, in some children scurvy might not have reached an advanced stage, identifiable in the skeletal material. The prevalence of scurvy reflects not only dietary patterns but also food storage and preparation techniques adopted in the Polish territories during the Middle Ages, which contributed to low intakes of vitamin C. This article is protected by copyright. All rights reserved.
... Unfortunately, neither a description nor differential diagnoses were presented for this case. More recently, Mays (2008) reported a case of scurvy in a sub-adult individual from the Bronze Age in Wiltshire, England, which was the earliest reported example of scurvy in the British Isles. ...
... This lesion is manifested bilaterally and it is more developed on the left side. The porosity does not extend beyond the mandibular foramen, so, once again, it cannot be attributed to the normal growth process (Mays, 2008). ...
... On the other hand, the bilateral abnormal porosity in some skull regions, the mandible, the maxilla, the hard palate and the greater wing of the sphenoid bones are not typical lesions of rickets (see Ortner, 2003). Instead, this specific distribution pattern of abnormal porosity fits much better with the lesions of scurvy (Ortner & Ericksen, 1997;Ortner et al., 2001;Mays, 2008). ...
A case of what are most likely metabolic diseases is identified in a child buried during Chalcolithic times in the El Portalón site (Sierra de Atapuerca, Burgos, Spain). The skeleton has been directly dated by C14 to between 5030 to 5020 Cal BP. Macroscopic analysis and a CT scan reveal a set of lesions both in the skull and the long bones, which indicate that this individual probably suffered from rickets and scurvy at different stages of his/her life. The lesions are bilateral and are characterized by abnormal porosity, new bone formation and deformation of long bones. The presence of non-specific stress indicators, such as enamel hypoplasias and Harris lines, allow us to establish two times of stress associated with these pathologies: one crisis during infancy (1-3 yrs) and subsequently a second crisis at the beginning of childhood (3-5 yrs). The etiology of both metabolic diseases could be associated with abnormal feeding during these stages of life and/or the living conditions of these populations, e.g., the preparation of food and/ or the existence of infections caused by the transmission of pathogens and unhealthy hygiene. Evidence of metabolic diseases during the recent European Prehistory is rather unknown and very few cases have been reported. Thus, the child from El Portalón can add relevant information about the life and health conditions of these prehistoric populations.
... One further metabolic disease that could have produced such conditions is caused by a lack of vitamin C. Its prolonged absence in humans interferes with the synthesis of collagen in bone, impairs wound healing and results in abnormal bleeding due to connective tissue defects in the blood vessels and particularly the fragile capillaries. In scorbutic individuals, bleeding may occur in response to minor trauma or just any intrinsic mechanical stress, such as that sustained by the weight-bearing portions of the legs (Maat, 2004:79;Mays, 2008aMays, , 2008bvan der Merwe et al., 2010b). In this process, the periosteum, which tightly encapsulates the compact bone in a healthy organism, is impaired by the defective collagen, leading to subperiosteal haemorrhages. ...
... The scorbutic aetiology of these kinds of lesions in adults is still under debate (Ortner, 2003;Maat, 2004). The majority of scurvy cases are reported in subadults, in which lesions are usually more dramatic and easier to detect (Ortner & Ericksen, 1997;Ortner et al., 1999;Ortner, 2003;Maat, 2004;Brickley and Ives, 2006;Mays, 2008a), whereas they are less frequent and more varied in adults, making their identification difficult (Mays, 2008a:184). ...
... Historically speaking, scurvy is a well-known metabolic disease caused by a long-term lack of vitamin C intake (De Luna et al., 2003;Maat, 2004;Mays, 2008a;Geber & Murphy, 2012). In fact, it caused some 80% of all deaths during 16th century and 17th century long sea voyages (Baron, 2009). ...
This article explores the living conditions and specifically the possible etiologies of subperiosteal reactions among those seafarers who did not survive Christopher Columbus' second voyage to the Americas and died at La Isabela, the first permanent European settlement in the New World, which is located in present-day Dominican Republic. The town was founded in 1494 by Christopher Columbus (1451-1506) and occupied for only four years. This study analyzes the macroscopic and histological evidence of the skeletal series excavated from this contact cemetery, which is presently curated at the Museo del Hombre Dominicano. Twenty of the 27 systematically scored individuals reveal subperiosteal bone accretions and in at least 15 individuals, these accretions appear bilaterally. The morphology, distribution and healing stages of the majority of these lesions provide new, direct evidence suggesting severe adult scurvy, a condition caused by sustained vitamin C deprivation, which was common among seafarers before the 18th century. The historical context surrounding the individuals' death at the European contact settlement and the conditions and duration of Christopher Columbus' second transatlantic voyage to the New World, represent key elements in the interpretation of these lesions. In this case, the evidence also corroborates the known failure of Columbus' crew to exploit the locally available foods rich in vitamin C. Scurvy probably contributed significantly to the outbreak of sickness and collective death within the first months of La Isabela's settlement, an aspect that inflects the current discussion about the degree of virulence of New World infections that decimated the European newcomers, who we conclude to have been already debilitated and exhausted by scurvy and general malnutrition. This article is protected by copyright. All rights reserved.
... There is a growing body of bioarchaeological literature on scurvy (vitamin C deficiency) (e.g., Brickley and Ives, 2006;Brown and Ortner, 2011;Buckley, 2000;Carli-Thiele, 1995;Ferreira, 2002;Geber and Murphy, 2012;Lewis, 2010;Maat, 1982Maat, , 2004Mays, 2008;Melikian and Waldron, 2003;Ortner, 1984;Ortner et al., 1999Ortner et al., , 2001Ortner et al., , 2007Ortner and Ericksen, 1997). However, few contributions to this research consider individuals from tropical environments, excepting Buckley (2000), Ortner et al. (2001), Saul (1972) and White et al. (2006). ...
... Ortner et al. (1999Ortner et al. ( , 2001 and Ortner and Ericksen (1997) have described the pathological features of scurvy in skeletal remains as including new bone formation and abnormal porosity on specific areas of the skull. These criteria have been widely accepted and elaborated in other bioarchaeological investigations of scurvy (Brickley and Ives, 2006;Brown and Ortner, 2011;Geber and Murphy, 2012;Mays, 2008). Abnormal porosity on the external surfaces of the greater wings of the sphenoid bone is considered virtually pathognomonic of scurvy (Ortner et al., 1999(Ortner et al., , 2001Ortner and Ericksen, 1997). ...
... Abnormal porosity on the external surfaces of the greater wings of the sphenoid bone is considered virtually pathognomonic of scurvy (Ortner et al., 1999(Ortner et al., , 2001Ortner and Ericksen, 1997). Although the greater wings of the sphenoid bone will display a range of normal vascular foramina visible on its cortical surface, these tend to be large in size and few in number, and they penetrate the cortex at an oblique angle (Mays, 2008). Mays (2008) distinguishes such foramina from abnormal porosity, which involve foramina smaller in size and greater in number that enter the cortical bone perpendicular to the surface. ...
This paper presents the first bioarchaeological evidence of probable scurvy in Southeast Asia from a six-year-old child at the historic-era site of Phnom Khnang Peung (15–17th centuries A.D.) in the Cardamom Mountains, Cambodia. Examination of skeletal material shows evidence consistent with scurvy – specifically, abnormal porosity on the greater wings of the sphenoid bone and hard palate, and vascular impressions on the ectocranial surface of the frontal bone and maxillary alveolar bone. In addition, this individual has evidence of cribra orbitalia indicative of anemia. Although a nutritionally linked etiology is the most common cause of scurvy, a number of other factors influencing ascorbic acid levels need to be considered in an environment with sufficient vitamin C potentially available in the diet. Assessing the environmental evidence, the possibility of a number of interrelated factors contributing to the development of scurvy in this individual seems the most plausible explanation. Factors affecting vitamin C levels may have included social aspects of food allocation or choice of food, genetic predisposition, anemia, pathogens, and nutrient malabsorption.
... 4.1). The amount of vitamin C in food may be reduced by prolonged storage or exposure to high cooking temperatures (Mays, 2008). As a result, the occurrence of scurvy is commonly associated with winter months, when fresh fruits and vegetables are not available (Brickley and Ives, 2008). ...
... With time, the number of diagnostic traits increased, starting with the juvenile cranium (Ortner and Ericksen, 1997), and culminating with a summary of macroscopic, radiological and histological diagnostic criteria, on both juveniles and adults (Brickley and Ives, 2008). More recently, the focus of studies has changed to establishing new cases of scurvy in geographic regions and periods Ives, 2006, 2008;Brown and Ortner, 2011;Halcrow et al., 2014;Mays, 2008;Ortner et al., 2001;van der Merwe et al., 2010). Scurvy has also found its place in population studies, where various pathological conditions are used to analyze historical events (Geber and Murphy, 2012;Lewis, 2010). ...
... Compared to other sites, this is an unusually high occurrence of scurvy. The occurrence of scurvy in archaeological sites is generally low, rarely exceeding 10% of the sample (e.g., Bourbou, 2014;Brown and Ortner, 2011;Halcrow et al., 2014;Klaus, 2014;Lewis, 2010;Mays, 2008). A higher occurrence of scurvy has been observed in at least three skeletal samples. ...
... Although porosity was noted on the remains of individual BF10, scurvy is unlikely, as porosity does not follow soft tissue structures and is not found in pathognomonic locations such as the greater wing of the sphenoid and temporal bone (Ortner et al., 2001;Mays, 2008). Furthermore, scurvy does not cause bowing and angulation of skeletal elements. ...
... Porosity and/or new bone deposition on the skull (greater wings of the sphenoid, temporal bones, orbits, zygomatic bones, maxillae), scapulae, and long bone metaphyses and diaphyses. Fracture and flaring of the ribs (Halcrow et al., 2014;Ortner et al., 2001;Mays, 2008). ...
Objective:
To evaluate pathological lesions suggesting the presence of rickets and to place the diagnosis into bioarchaeological and historical context.
Materials:
The remains of a 3-year ± 12-month-old child discovered during a rescue excavation in Heuvelton, New York.
Methods:
We examined the individual macroscopically and conducted a differential diagnosis following established protocols in the palaeopathological literature.
Results:
Bony change on the orbits, mandible, ribs, clavicles, left scapula, humerii, radii, ulnae, femora, tibiae, fibulae (e.g., porosity, diaphyseal thickening, flaring, bowing), and dental lesions were recorded.
Conclusions:
We demonstrate that the child likely presented with vitamin D deficiency rickets during crawling and as they learned to walk.
Significance:
This example offers an important contribution to the bioarchaeological literature, as few cases of rickets have been recorded in rural North America using updated diagnostic criteria and little is known of the health and lifeways of early settlers in 19th-century upstate New York.
Limitations:
It is not possible to ascertain the precise aetiology of this child's rachitic state and to compare this individual with others in the population.
Suggestions for further research:
Examination (and re-assessment) of other North and South American skeletal assemblages for signs of vitamin D deficiency rickets following current bioarchaeological standards.
... Differential diagnosis for vitamin C deficiency was performed according to the "Ortner criteria" (Brown & Ortner, 2011;Ortner, 2003;Ortner et al., 1999Ortner et al., , 2001Ortner & Ericksen, 1997) and guidelines by other authors (Armelagos et al., 2014;Brickley & Ives, 2008;Buckley et al., 2014;Crandall & Klaus, 2014;Geber & Murphy, 2012;Mays, 2008;Moore & Koon, 2017;Snoddy et al., 2017;Stark, 2014). Vitamin D deficiency was differentially diagnosed following the criteria outlined by Ortner andMays (1998), Ortner (2003), Ives (2006, 2008), and Mays et al. (2006). ...
... Consequently, abnormal porosity (<1 mm) forms at entheseal sites as capillaries proliferate due to the inflammatory response to bleeding (Ortner, 2003;Ortner et al., 2001). Pregnant and breastfeeding women are at high risk for scurvy due to increased requirements for vitamin C, and it has been demonstrated that babies of deficient mothers may also suffer from scurvy (Burns, 1963; & Ives, 2008;Brown & Ortner, 2011;Buckley et al., 2014;Geber & Murphy, 2012;Klaus, 2014;Mays, 2008;Moore & Koon, 2017;Ortner, 2003;Ortner & Ericksen, 1997;Ortner et al., 1999;Ortner et al., 2001;Snoddy et al., 2017;Snoddy et al., 2018 T A B L E 4 (Continued) & Ives, 2008;Ives, 2018;Lewis, 2007Lewis, , 20102018a;Ortner, 2003;Ortner & Mays, 1998 Anemia & Ives, 2008;Lewis, 2012;Ortner, 2003;Oxenham & Cavill, 2010;Walker et al., 2009 Congenital syphilis Alessandri et al., 1995;Cantey et al., 2013;Ortner, 2003;Satti et al., 2010 (Continues) Hershkovitz et al., 2002;Jankauskas, 1999;Jankauskas & Schultz, 1995;Lewis, 2004;Lewis, 2018a;Ortner, 2003;Matos & Santos, 2006;Roberts & Buikstra, 2003;Santos & Roberts, 2001 Rubella Kaplan et al., 2005aKaplan et al., , 2005bSillence et al., 1979;Spranger et al., 2018Hirschmann & Raugi, 1999. The majority of the lesions observed in this sample (Table 4) are compatible with this metabolic disorder, which has been seldom considered in the paleopathological literature related to perinates (Buckley et al., 2014;Geber & Murphy, 2012;Lewis, 2007Lewis, , 2018aSnoddy et al., 2017). ...
This paper reports a case study of 43 fetuses and perinates from four mass graves and two double burials from the cemetery of St Jacob in Tartu (SE Estonia). The burials were dated to the 13th‐15th centuries AD and located outside the cemetery walls, and likely can be linked to historically‐recorded episodes of famine and epidemic in medieval Livonia. All individuals belonged to the fetal and perinatal age categories, meaning they were either aborted or died around the time of birth. Ten perinates of these 43 individuals displayed skeletal evidence for systemic metabolic disease. The results of the bioarchaeological investigation provide insights into the effects upheavals of the time had on the weakest members of the society, especially the vulnerability of pregnant and lactating mothers to undernutrition and infections, and shed light on how the prematurely deceased were treated in this urban community. This may potentially explain the burial location. This work is the first detailed paleopathological study of non‐adults in medieval Estonia and the Baltic region, opening the way for further research on similar material in this geographical area.
... Stable isotope analysis of human bone collagen recovered from Neolithic archaeological sites on the Chinese Central Plains has demonstrated that millets dominated the human diet and were an overwhelmingly preponderant source of calories during the middle and late Neolithic (Lanehart et al., 2011;Dong et al., 2017;Pechenkina, 2018). Archeobotanical studies report no evidence of fruit trees and only the limited presence of leafy vegetables (Crawford et al., 2005), suggesting that human diet would have been severely deficient in vitamin C. Snoddy et al., 2018Ortner et al., 2001Brown and Ortner, 2011;Snoddy et al., 2017Snoddy et al., , 2018Briekley and Ives, 2008;Mays, 2008 iron deficiency anemia Paine andBrenton, 2007 L. Sun, et al. International Journal of Paleopathology 26 (2019) xxx-xxx Scurvy, caused by vitamin C deficiency, leads to aberrant production of collagen, compromising the integrity of connective tissue and also manifests as frequent hemorrhages, particularly around alveoli and in areas surrounding entheses, where muscle contraction exerts pressure on the blood vessels. ...
... At the same time, she observed that the child skeletons excavated from Christ Church Spitalfields in industrial London, which generally offered evidence of a high rate of deficiency diseases, showed a much lower than expected frequency of these endocranial lesions. Slight endocranial lesions were noted in association with an apparent Bronze Age case of scurvy in Britain (Mays, 2008). A juvenile cranium from Phnom Khnang Peung (15-17th centuries A.D.), Cambodia, displayed capillary lytic lesion on the endocranial aspect of the frontal bone (Halcrow et al., 2014). ...
Endocranial lesions were recognized on eight out of the 31 juveniles (25.8%) that were recovered from three Neolithic archaeological sites in Henan province. The remains of juveniles were recovered from urn burials at the Jiazhuang site (2200–2030 BCE) and graves at the Pingliangtai (2300–2100 BCE) and Haojiatai sites (2448–1700 BCE). The presence of endocranial lesions on all eight of these juvenile skulls was associated with a
range of lesions on other bones, including areas of abnormal porosity and subperiosteal new bone deposition on either the sphenoid, maxilla, mandibular ramus, or orbit, as well as subperiosteal lesions on the postcranial bones.
Several plausible explanations for the formation of these endocranial lesions in our eight cases include scurvy, shaken baby syndrome, and intrathoracic disease (such as tuberculosis or pulmonary infection). We show that the presence of endocranial lesions had a strong correspondence with skeletal markers of dietary deficiency, i.e. scurvy, and in one case, anemia. Millet was a key component of the Longshan subsistence in the area, while paleobotanical evidence of fruit and leafy vegetables appears to be limited, likely resulting in a nutrient deficient diet. The coupling of endocranial lesions with skeletal signs of dietary deficiency can be direct, as scurvy favors hemorrhaging, or mediated by physiological or sociocultural factors, and thereby represents comorbidity.
... These pores are characteristically ,1 mm diameter and fully penetrate the outer cortex (Brown and Ortner, 2011). In addition, deposits of new bone may show small branching channels indicating capillary proliferation, and such "branched lysis" may also be seen on the normal cortical surface (Mays, 2008b;Brown and Ortner, 2011). Although lesions may take the form of subperiosteal new bone formation and/or porosity of existing cortex, the latter is more frequent (Ortner et al., 2001;Krenz-Niedbała, 2016). ...
... 20%) of subadults showing lesions suggestive of scurvy were associated with famine or other historic events that disrupted normal food supply (Mays, 2014). p0255 A Bronze Age round barrow at Barrow Clump (Mays, 2008b) provides an early case of scurvy from England. The remains date from 2200 to 1970 BC and are of a child aged about 2 years. ...
... This proliferation of research began with the identification by Donald Ortner and colleagues of a suite of dry bone lesions which the authors argue can be intuitively linked to the unique pathophysiology of this disease (Ortner, Butler, Cafarella, & Milligan, 2001;Ortner & Ericksen, 1997;Ortner, Kimmerle, & Diez, 1999). Subsequent researchers have expanded on this work, both by extending Ortner's logical process of lesion identification to osseous changes at other sites in the skeleton and by integration of clinical radiographic and histological features of scurvy (Brickley & Ives, 2008;Geber & Murphy, 2012;Maat, 2004;Mays, 2008;Moore & Koon, 2017;Stark, 2014). ...
... This feature has been noted in a number of archaeological individuals who exhibit other features diagnostic of scurvy (Brown & Ortner, 2011;Mays, 2008;Snoddy et al., 2017). ...
The past two decades have seen a proliferation in bioarchaeological literature on the identification of scurvy, a disease caused by chronic vitamin C deficiency, in ancient human remains. This condition is one of the few nutritional deficiencies that can result in diagnostic osseous lesions. Scurvy is associated with low dietary diversity and its identification in human skeletal remains can provide important contextual information on subsistence strategy, resource allocation, and human‐environmental interactions in past populations. A large and robust methodological body of work on the paleopathology of scurvy exists. However, the diagnostic criteria for this disease employed by bioarchaeologists have not always been uniform. Here we draw from previous research on the skeletal manifestations of scurvy in adult and juvenile human skeletal remains and propose a weighted diagnostic system for its identification that takes into account the pathophysiology of the disease, soft tissue anatomy, and clinical research. Using a sample of individuals from the prehistoric Atacama Desert in Northern Chile, we also provide a practical example of how diagnostic value might be assigned to skeletal lesions of the disease that have not been previously described in the literature.
... Reports on north-western European human skeletal remains dated to the Bronze Age provided indications for general health as well as specific indications for nutritional deficiencies (Bennike, 1985;Smits and Maat, 1993;Hermanussen and Kühl, 2006;Mays, 2008;Mount, 2012;Tornberg, 2013;Veselka, 2015). ...
... However, it must be kept in mind that anaemia can also be the result of the body's defence against pathogens, so it can signify infection rather than iron deficiency as well. Evidence for both conditions are found in the Early Bronze Age, although they seem rare (Mays, 2008;Mount, 2012). ...
Wild plant gathering and consumption has previously been described as being unimportant during the Bronze Age in the western Netherlands. It was believed that the people were full-time farmers and that the food produced on the settlement was enough for people to be self-sufficient. However, the analysis performed here to re-evaluate this statement has shown that wild plants were also essential to life in the Bronze Age. The combined information obtained from ethnography, ethnobotany, archaeology, ecology, nutritional studies, and physical anthropology has indeed indicated that wild plants, and especially their vegetative parts, would have had to have been gathered yearround in order for people to remain healthy.
... As detailed by Brickley and Ives (2006) and Ortner (2003), a degree of non-pathological porosity accompanies rapidly growing bones of young infants, but can be distinguished from abnormal porosity if it penetrates the outer cortex by pores less than 1 mm in diameter. The abnormal porosity reflects a vascular response to inflammation caused by extravasated blood [also see Mays (2008a) for a description of normal versus abnormal porosity of infant bones]. Normal growth masquerading as a disease condition in these young infants is unlikely. ...
... The skeletal lesions of vitamin D deficiency are largely those of defective osteoid mineralisation laid down during bone growth (Mays, 2008b). This lack of mineralisation leaves the bone surface spiculated with larger pores representing 'voids' in the bone structures, which would have been filled with osteoid in life (known as strut-slit morphology) (Ortner and Mays, 1998;Mays, 2008a). The only Teouma infant with rickets-like lesions is Burial 30 (infant) with strut-slit changes in the ribs and ulnae, although this infant also had abnormal porosity of the greater wing of the sphenoid bone. ...
The Neolithic colonisation of the Pacific islands was one of the most challenging migration events in human history. The regions east of the Solomon Islands were colonised relatively recently by a people known as the Lapita. The Lapita brought with them a ‘transported landscape’ of domesticated plants and animals that had to be established upon arrival for the survival of these fledgling communities. Colonisation of these previously uninhabited islands was potentially perilous, and could leave colonisers vulnerable to periods of resource stress. The largest cemetery sample of Lapita people from the site of Teouma in Vanuatu offers a unique opportunity to assess the impact of colonisation on the health of pioneering populations. This paper explores the possibility that Teouma people experienced vitamin C deficiency as one of the consequences of the agricultural subsistence practices during the initial phases of island colonisation. Skeletal lesions in infants and adults indicative of scurvy suggest that initial colonisation phases in the Pacific islands involved precarious times involving deficiencies of key nutrients. Colonisation of the Pacific islands may share similar frameworks and problems as periods of subsistence transition in other parts of the world.
... All the bones were observed in detail, with a naked eye and a magnifying lens, and posteriorly radiographed (conventional and CT). Bibliography used for differential diagnosis (e.g., Ortner et al. 2001;Resnick and Kransdorf 2005;Matos and Santos 2006;Mays 2008;Mariotti et al. 2015;Klaus 2017;Snoddy et al. 2017Snoddy et al. , 2018Lewis 2018; Buikstra 2019;Vlok et al. 2023). ...
... This grading enables the analysis to avoid a binary system of 'present' or 'absent', which has traditionally been employed (e.g. Mays, 2008;Ortner et al. 2001;Ribot and Roberts, 1996;Simonit et al. 2023). In these cases, the subjectivity and accuracy of these interpretations must be accepted, with little known about the specifics as to how pathological SPNB is being defined and when it is/is not being recorded. ...
Objectives: This research aims to determine the aetiology of porosity and subperiosteal new bone formation on the inferior surface of the pars basilaris. Materials: A total of 199 non-adult individuals aged 36 weeks gestation to 3.5 years, from a total of 12 archaeological sites throughout the UK, including Iron Age (n=43), Roman (n=12), and post-medieval (n=145) sites, with a preserved pars basilaris. Methods: The pars basilaris was divided into six segments, with porosity (micro and macro) and subperiosteal new bone formation recorded on the inferior surface in scorbutic and non-scorbutic individuals. Scurvy was diagnosed using criteria from the palaeopathological literature that was developed using a biological approach. Results: There was no statistically significant difference in microporosity between scorbutic and non-scorbutic individuals in four out of the six segments analysed. There was a significant negative correlation between age and microporosity in non-scorbutic and scorbutic individuals. A significant difference in subperiosteal new bone formation was observed between scorbutic and non-scorbutic individuals. Conclusions: Microporosity on the inferior pars basilaris should not be considered among the suite of lesions included in the macroscopic assessment of scurvy in non-adult skeletal remains (less than 3.5 years). Significance: This study highlights the risk of over diagnosing scurvy in past populations. Limitations: It is difficult to distinguish between physiological (normal) and pathological (abnormal) bone changes in the skeleton of individuals less than one year of age. Suggestions for further research: Future research should focus on the analysis of individuals over 3.5 years of age.
... To make sure that it was skeletal tuberculosis, a differential diagnosis was made. Disorders that leave similar or the same changes on the endocranial surface are the following: scurvy, syphilis, meningitis, anaemia, and tuberculosis (Hershkovitz et al. 2002;Lewis 2004;Mays 2008;Lei et al. 2019). ...
This paper presents the results of a bioanthropological analysis of human skeletal
remains from grave no. 34 from the site of Đurine Ćelije on Rudnik. The remains of
a small late medieval monastery, from the beginning of the 15th century until the end of
the 17th century, were discovered and systematically researched. The monastery was destroyed
and rebuilt in the time of the Turks and later abandoned. The burial of a deceased
in grave no. 34 was performed in the second half of the 16th or during the 17th century. The
deceased most likely belonged to the brotherhood of this monastery. A specific disease
caused by the bacillus Mycobacterium tuberculosis was detected in the skeletal remains
of this man. Pathological changes coexisting with this disease were present on the endocranial
surface of the skull, and the thoracic vertebrae, and destructive lesions were
detected on the ribs, shoulder joints, and sacroiliac joint.
... Ðèñóíîê 5. Ïîðîç íèaeíåé ÷åëþñòè ó ðåáåíêà èç ïîãðåáåíèÿ 9 ðàñêîïà 1 ìîãèëüíèêà Ìàÿ÷íûé Áóãîð 2 Figure 5. Porosity of the mandible, a child from the burial 9 excavation site 1 of the burial ground Mayachny Bugor 2 Waldron, 2003]; Ã. Ìààò [Maat, 2004]; Ì. Áðèêëåé è Ð. Èâñ [Brickley, Ives, 2006]; Ñ. Ìàéñ [Mays, 2008]; Ñ. Ñèííîòò [Sinnott, 2013] è ìíîãèõ äðóãèõ ó÷åíûõ ïåðå-÷åíü ïðèçíàêîâ è çîí ïðîÿâëåíèÿ ïîðîçà íà êîñòÿõ ñêåëåòà áûë çíà÷èòåëüíî ðàñøèðåí. Ïîýòîìó â íàñòîÿùèé ìîìåíò ìàêðîñêîïè÷åñêèìè ìàðêåðàìè ðàçâèòèÿ íåäîñòàòî÷íîñòè âèòàìèíà Ñ íà äåòñêèõ êîñòíûõ îñòàíêàõ ïðèíÿòî ñ÷èòàòü: ïîðîç íà òåìåííîé è çàòûëî÷íîé êîñòè, ïîðîç êëèíîâèäíîé êîñòè, ïîðîç âåðõíå÷åëþñòíîé êîñòè, ïîðîç àëüâåîëÿðíûõ îòðîñòêîâ âåðõíåé è íèaeíåé, ïîðîç âíóòðè àëüâåîë çóáîâ, íàëè÷èå ïîðîòè÷åñêîãî ãèïåðîñòîçà ãëàçíèö è ñâîäà ÷åðåïà, ïîðîç âíóòðåííåé ïîâåðõíîñòè âåòâåé íèaeíåé ÷åëþñòè, ïîðîç ëîïàòîê â îáëàñòè íàäîñòíîé è ïîäîñòíîé ÿìêè, ïîðîç è ïåðèîñòèò äèàôèçîâ äëèííûõ êîñòåé ïîñòêðàíèàëüíîãî ñêåëåòà, ïîðîç â ìåòàôèçàðíûõ çîíàõ íà äëèííûõ êîñòÿõ êîíå÷íîñòåé [Ortner, Ericksen, 1997;Ortner, Butler, 2001]. ...
The paper analyses the causes of pathological conditions discovered on the bone remains in children
and adolescents from town cemeteries of the Golden Horde period in the Lower Volga region.
Materials and methods. The skeletal material of the study included 189 bones: 11 skeletal remains
from the necropolises of Vodyansky fortress, 43 from the necropolises of Tsarevsky settlement, 48 from the
Vakurovsky underground burial mound, and 86 from the Mayachny bugor mound of the Krasnoyarsk hillfort.
The standard method of studying pathological abnormalities on the human skeleton was used. In order to
reveal osteoporosis of the bone tissue, methodical recommendations given in the works of D. Ortner, M.
Eriksen, D. Ortner, V. Butler et al. were used.
Results. The study of anthropological series made it possible to get the age characteristics of the groups,
to identify pathological abnormalities in the dental system, markers of microelements deficiencies in the
body, as well as inflammatory processes in the cranial box and the postcranial skeleton. As a result of the
review of the series, it was established that children in the large cities of the Golden Horde in the Lower Volga
region most often died before the age of 3 years.
Discussion. Diseases arising from the lack of trace elements Fe, vitamins C and B12 were the main
factors affecting child mortality in the Golden Horde cities. The causes of the widespread physiological stress
markers, as well as such diseases as scurvy and anemia, are exogenous and include ecology, diet, and
lifestyle. As a result of the assessment of the time and nature of the development of mineralized deposits and
enamel hypoplasia, the authors observed stress markers that developed during the transition from
breastfeeding to solid food.
... Ectocranial new bone formation ( Table 4) was suggestive of scurvy, the result of a deficiency in vitamin C. This vitamin is not synthesized by the human body and must be obtained from dietary sources such as fresh vegetables and fruits [64,65]. Skeletal changes only occur after vitamin C is reintroduced after a period of deficiency [65,66]. ...
As a reaction to widespread poverty, a system of coercive welfare developed in Switzerland during the 19th century. Poverty was often thought to result from an individual’s misconduct rather than from structural, economic or political circumstances. People whose lifestyle deviated from the desired norm or who were unable to make a living for themselves were subjected to so-called administrative detention at institutions such as workhouses and poorhouses. The excavation of the cemetery of the correctional facility/workhouse and asylum «Realta» in Cazis offered the opportunity to gain insight into the living conditions of a marginalized group of people and to shed light on aspects of coercive welfare that have hardly been addressed in historical studies. A comprehensive study of pathological alterations was used to assess possible physical causes and effects of administrative detention. Skeletal samples from regular contemporaneous cemeteries provided data for the general population and thus allowed us to detect peculiarities in the «Realta» assemblage. Possible cases of Stickler Syndrome, microcephaly, congenital syphilis, endemic hypothyroidism and disabilities secondary to trauma may have been the reason for the affected individuals’ institutionalisation. The high prevalence of tuberculosis was linked to the socioeconomic status and the living conditions at the facility. Several cases of scurvy and osteomalacia may have resulted from various risk factors such as poverty, alcoholism, mental illness or institutionalisation. The fracture rates, especially of ribs, were extremely high. A large proportion of the fractures were incompletely healed and most likely occurred during detention due to interpersonal violence. Underlying diseases further contributed to the high fracture rates. This first study on skeletons from an institution of administrative detention in Switzerland demonstrated how pre-existing health conditions and the socioeconomic background contributed to the chance of being detained, and how detention led to further deterioration of health.
... Scurvy is now perhaps the most commonly reported child disease in the palaeopathological literature. Initially only reported as isolated cases (Brown and Ortner 2011;Ferreira 2002;Mays 2008), it is now recognised as a powerful tool in understanding levels of stress and disease experienced by a population. Current prevalence rates for child scurvy range widely from 0.8% to 68% (Bourbou 2014;Buckley 2014;Geber and Murphy 2012;Klaus 2013;Krenz-Niedbała 2015;Lewis 2010;Lovasz et al. 2013;Mahoney-Swales and Nystrom 2009;Pêterstone et al. 2013) . ...
In 1992, Shelley Saunders provided one of the first overviews on the position of non‐adult studies in bioarchaeology. While acknowledging that things had moved on since 1968, when Johnson lamented the almost complete neglect of children in biological studies, she highlighted a number of issues that still required investigation. Now, 25 years later, how far have we come? This chapter provides an overview of the importance, position, challenges and popularity of non‐adult studies in bioarchaeology. It extends beyond the original premise of Saunder's (1992; 2000; 2008) reviews on ageing, sexing and growth methods to include the rapidly expanding area of child paleopathology. New themes, such as concerns about how we define a “child,” and the emerging interest in adolescent skeletons are explored. Throughout, the issue that a child potentially represents a frail non‐survivor resonates as we attempt to provide accurate sex and age estimates or understand levels of childhood stress.
... In general, a detailed investigation of the presence and distribution of the lesions within a skeleton followed by a differential diagnosis must be performed (Brickley & Ives, 2006;Klaus, 2015). Recently, the interest in the detection of infantile scurvy, in skeletal materials from various time periods and geographical regions, has significantly increased (e.g., Bourbou, 2014;Brickley & Ives, 2006Buckley et al., 2014;Castilla, Carretero, Gracia, & Arsuaga, 2014;Halcrow et al., 2014;Klaus, 2014;Lovász et al., 2013;Mays, 2008a;Schattmann, Bertrand, Vatteoni, & Brickley, 2016;Snoddy, Halcrow, Buckley, Standen, & Arriaza, 2017;Wrobel, 2014). Moreover, different scientific methods such as histology (Schultz, 2001), radiology (Noordin et al., 2012;Popovich, McAlhany, Adewumi, & Barnes, 2009;Tamura et al., 2000), computed tomography (Zuckerman, Garofalo, Frohlich, & Ortner, 2014), and chromatography (Koon, 2010(Koon, , 2012Pendery & Koon, 2013) were applied to support the macroscopic analyses, especially in the early stages of scurvy. ...
The study of subadult scurvy (vitamin C deficiency), also known as Möller‐Barlow's disease, is of growing interest in paleopathology. However, in Italy there is still a paucity of knowledge on nutritional stress diseases in human skeletal remains.
In the present work, the anthropological and paleopathological study on subadults found in the Early Medieval cemetery of Castel Tirolo, in South Tyrol (Italy) is reported. Referring to the macroscopic and paleopathological features described in the literature, abnormal pores, and abnormal new bone formations were analysed in multiple cranial and postcranial skeletal regions. Based on our study, 58% individuals (n=14/24) displayed abnormal lesions: three subadults were nonspecific pathological cases; nine showed few indicative, but not diagnostic, lesions; and two cases (TCT13 and TCT14) exhibited abnormal lesions highly consistent with scurvy. As a consistent diagnosis of vitamin C deficiency is still challenging, we conducted a differential diagnosis of the recorded lesions that supported the probable presence of scurvy in the two cases.
This work presents the first documentation of scurvy in Early Medieval Italy revealing new insights into the health condition and nutritional stress in historical communities in the Eastern Italian Alps.
... Reports of scurvy in archaeological remains have increased in recent years as its possible skeletal manifestations become better known (e.g., Brickley and Ives, 2006;Brown and Ortner, 2011;Geber and Murphy, 2012;Maat, 2004;Mays, 2008) and researchers become aware of the potential over-diagnosis of anemia as the explanation for the common porotic lesions observed in past populations. However, while scurvy is a possible explanation for those cases of CO that show no expansion of the bone marrow such as those included in the present study, the skeletal lesions of scurvy overlap substantially with those caused by other diseases, making diagnosis in adults uncertain (Armelagos, Sirak, Werkema, & Turner, 2014;Brickley and Ives, 2006). ...
Objectives: Porotic hyperostosis, characterized by porotic lesions on the cranial vault, and cribra orbitalia, a localized appearance of porotic lesions on the roof of the orbits, are relatively common osteological conditions. Their etiology has been the focus of several studies, and an association with anemia has long been suggested. Anemia often causes bone marrow hypertrophy or hyperplasia, leading to the expansion in trabecular or cranial diploic bone as a result of increased hematopoiesis. Hypertrophy and/or hyperplasia is often coupled with a disruption of the remodeling process of outer cortical bone, cranially and/or post-cranially, leading to the externally visible porotic lesions reported in osteological remains. In this paper, we investigate whether individuals with cribra orbitalia have increased thickness of the diploë, the common morphological direct effect of increased hematopoiesis, and thus test the relationship between the two conditions, as well as explore the type of anemia that underlie it. Methods: An analysis of medical CT scans of a worldwide sample of 98 complete, young to middle-aged adult dry skulls from the Duckworth Collection was conducted on male and female cribrotic individuals (n= 23) and non-cribrotic individuals (n= 75), all of whom lacked any evidence of porotic lesions on the vault. Measurements of total and partial cranial thickness were obtained by virtual landmark placement, using the Amira 5.4 software; all analyses were conducted in IBM SPSS 21. Results: Cribriotic individuals have significantly thinner diploic bone and thicker outer and inner tables than non-cribriotic individuals, contrary to the expected diploic expansion that would result from anemic conditions associated to bone marrow hypertrophy or hyperplasia. Additionally, individuals without cribra orbitalia and those with the condition have distinctive cranial thickness at particular locations across the skull and the severity to which cribra orbitalia is expressed also differentiates between those with mild and those with a moderate to severe form of the condition. Conclusions: Our results suggest a complex pattern of causality in relation to the pathologies that may lead to the formation of porotic lesions on the vault and the roof of the orbits. A form of anemia may be behind the osteological changes observed in porotic hyperostosis and cribra orbitalia, but it is unlikely to be the same type of anemic condition that underlies both types of osteological lesions. We suggest that cribra orbitalia may be associated to anemias that lead to diploic bone hypocellularity and hypoplasia, such as those caused by anemia of chronic disease and, to a lesser extent, of renal failure, aplastic anemia, protein deficiency and anemia of endocrine disorders, and not those that lead to bone marrow hypercellularity and hyperplasia and potential porotic hyperostosis. This leads us to the conclusion that the terms porotic hyperostosis and cribra orbitalia should be used to reflect different underlying conditions.
... Reports of scurvy in archaeological remains have increased in recent years as its possible skeletal manifestations become better known (e.g., Brickley and Ives, 2006;Brown and Ortner, 2011;Geber and Murphy, 2012;Maat, 2004;Mays, 2008) and researchers become aware of the potential over-diagnosis of anemia as the explanation for the common porotic lesions observed in past populations. However, while scurvy is a possible explanation for those cases of CO that show no expansion of the bone marrow such as those included in the present study, the skeletal lesions of scurvy overlap substantially with those caused by other diseases, making diagnosis in adults uncertain (Armelagos, Sirak, Werkema, & Turner, 2014;Brickley and Ives, 2006). ...
... Another disease related to diet is scurvy, which results from insufficient vitamin C and may produce black staining of the roots of the teeth because of hematomas, as was found among Dutch whalers buried at Spitsbergen in the seventeenth and eighteenth centuries (Maat 2004). Scurvy may also present in the form of porotic and proliferative endo-and ectocranial lesions (Brickley and Ives 2006;Mays 2008), especially among children ( Ortner et al. 2001;Ortner et al. 1999). Other ailments particular to children are occipital ulcers and infections that result from cradleboarding (Holliday 1993). ...
Building on the notion that human remains provide a window into the past, especially regarding identity, the contributors to this volume reflect on intentional and ritualized practices of manipulating the human head within ancient societies. These essays explore the human head's symbolic role in political, social, economic, and religious ritual over the centuries. By focusing on the various ways in which the head was treated at the time of death, as well as before and following, scholars uncover the significant social meaning of such treatment. This illuminating collection highlights biological and cultural manipulations of human heads, ultimately revealing whose skulls and heads were collected and why, whether as ancestors or enemies, as insiders or outsiders, as males, females, or children. Featuring a wealth of case studies from scholars across the globe, this volume emphasizes social identity and the use of the body in ritual, making it particularly helpful to all those interested in the cross-cultural handling of skulls and heads.
... To evaluate disease, a series of features for each analysis method were scored as present, absent, or " unable to score " in recorded individuals. Macroscopic analysis was performed using visual examination with a hand lens and relied on previously identified paleopathological features consistent with clinical findings for infantile scurvy and rickets (Ortner and Ericksen, 1997; Ortner and Mays, 1998; Ortner et al., 1999 Ortner et al., , 2001 Ortner, 2003; Brickley and Ives, 2006; Mays et al., 2006; Mays, 2008; Brickley and Ives, 2008; Geber and Murphy, 2012) (Table 1). To evaluate subtle rachitic bone deformities, comparison between bones of the same type and side was undertaken. ...
Disease co-occurrence is defined as the presence and interaction of multiple diseases in a single individual. The phenomenon occurred in the past, but detailed analyses of individuals affected by co-occurrence seldom appear. This paper presents 12 possible cases of scurvy and rickets co-occurrence from the Saint-Amé skeletal collection in Douai, France, dated to the 16-18th century. Each individual was evaluated for evidence of both diseases using macroscopic and radiographic techniques. Additional backscatter scanning electron microscopy evaluation for evidence of rickets was completed on a sub-sample of seven co-occurrence cases. Co-occurrence detection increased with the use of multiple techniques. No unique features identifying scurvy and rickets co-occurrence were observed; instead features associated with both diseases were present. Following clinical expectations, scurvy features were clearly developed while rickets features were subtle. Possible disease sequence and socio-cultural implications are suggested. The study's findings are important to further research on disease co-occurrence as information on cases enhances our ability to understand site context.
... Another disease related to diet is scurvy, which results from insufficient vitamin C and may produce black staining of the roots of the teeth because of hematomas, as was found among Dutch whalers buried at Spitsbergen in the seventeenth and eighteenth centuries (Maat 2004). Scurvy may also present in the form of porotic and proliferative endo-and ectocranial lesions (Brickley and Ives 2006;Mays 2008), especially among children (Ortner et al. 2001;Ortner et al. 1999). Other ailments particular to children are occipital ulcers and infections that result from cradleboarding (Holliday 1993). ...
This introductory chapter discusses a wide variety of biological and cultural manipulations involving human heads and skulls recovered from archaeological and ethnographic contexts around the globe, notably, as they relate to early Neolithic modeled skulls from the Middle East. As a biological object subject to disease processes and patterns of physical activity, the skull is one of the most informative parts of the human body. Significant social meaning is revealed by focusing on the various ways in which the head was treated before and after a person's death. This chapter summarizes the case studies in the book and links the practices of decapitation, decoration and deformation with potential religious, economic and political motivations and questions of identity—namely whose skulls were thus treated and why.
The 1st millennium BCE in Italy was a time of agricultural intensification of staple cereal production which shaped sociocultural, political, and economic spheres of pre-Roman groups. The lifeways and foodways of the Etruscans, the greatest civilization in western Europe before Roman hegemony, are traditionally inferred from secondary written sources, funerary archaeology, archaeobotany, and zooarchaeology. However, no direct data extrapolated from the study of human skeletal remains are available to evaluate the extent to which agricultural intensification and decreased dietary diversity impacted health and the expression of skeletal indicators of metabolic disease. Macroscopic and radiological analyses were conducted on an archaeological skeletal sample of non-adults (n = 29) recovered from Pontecagnano (southern Italy) dating to the Orientalizing period (730–580 BCE). This allowed us to identify five cases of scorbutic non-adults and to assign diagnostic values to skeletal lesions of scurvy that have not been previously described in the literature. The onset of scurvy in the examined sample is related to the increased reliance of Etruscans on crops lacking vitamin C in this period of agricultural intensification. The skeletal expression of scurvy varied among the non-adults, with differences in location and disease severity; these were interpreted considering the age-at-death of the individuals coupled with feeding behaviors and interindividual variability.
We discuss, with a biocultural perspective, the connection between living condition related to the Great Peasants’ Revolt and health status of the nonadult population from the 16th century North-eastern Italy, with a particular focus on those caused by micronutrients C and D. We analysed forty-one skeletons of nonadults in primary deposition with macroscopic examination coupled with a literature review aimed at providing a differential diagnosis. Eleven nonadults present probable cases of rickets, twelve show evidence that seems to be related to scurvy, while ten individuals feature a pattern consistent with a co-occurrence condition. Finally, eight subjects have no pathological changes or evidence, and that may be considered strictly related to C or D deficiency.
This study provides a significant example of pathological lesion on nonadults coming from the same area and framed in a limited chronological period. In addition, the sample is distinguished by the number of subjects and the good preservation of their bone tissue. Finally, the work is of primary importance as the Italian panorama lacks exhaustive paleopathological publications.
The paper presents the results of a study of paleopathological, age and sex features of nomads of the second half 13th–14th centuries from kurgan burials from the territory of the Lower Volga region. The skeletal material for the study is presented by skulls and bones of 81 postcranial skeleton human remains. Research methodology of studying paleoanthropological material includes examination of the series and skull using the standard assessment program of palepathological conditions of the bones of the postcranial skeleton developed by A.P. Buzhilova and an shortened program for assessing paleodemgraphic indicators. As a result of the study, it has been identified that a small number of children in burials and a high mortality of women at a young age was typical for the nomads of the 13th–14th centuries from the Lower Volga region. The early life stages were the most difficult for the nomads as evidenced by frequent occurrence in children and adults of stress markers in the form of “cribra orbitalia”, enamel hypoplasia, bones porosity of the vault and skull facial area. This fact proves that environmental and social factors influenced quality, and arguably life expectancy of the adult population. The diet of the population of 13th–14th centuries from the Lower Volga region included mostly meat and dairy products. The incidence assessment of injuries and of physical activity signs indicates that the nomads of the Golden Horde time led a peaceful lifestyle engaging in traditional forms of economic practices.
The subject of this research is the anthropological materials acquired in the course of archaeological excavations of the solitary burial mound “Krasnaya Dubrava”, located in the Ilovlinsky district of Volgograd Region. The conduct of archaeological excavations revealed eleven burials and bone remains from 12 individuals. The anthropological materials were poorly preserved. The burials are attributed to the Late Bronze Age, possibly to the periods of Srubnaya or Pokrovskaya cultures. In the course research, the author determined the gender and age of the buried individual, as well as the occurrence of discrete-varying traits. The paleopathological analysis employed the survey method developed by A. P. Buzhilova (1995, 1998). The examination of small-numbered and poorly preserved series presented in this research is of major significance. First of all, there is no opportunity for craniological and osteological research of individuals from the burial mound of Krasnaya Dubrava, therefore, pathological and gender-age analysis allow including the anthropological materials from this archaeological site into the scientific discourse, Secondly, the acquired results broaden the representations of lifestyle peculiarities of the population of the Late Bronze Age of the Lower Volga Region. The solitary burial mound of Krasnaya Dubrava is characterized by a large number of children burials under 4 years of age, and early mortality of adults at young age. The most common teeth pathologies indicate mineralized deposits due to the absence of oral hygiene. The studied individuals also mark the diseases of metabolic nature due famine. Most likely, these factors led to the early death of children and adults. The absence of traumatic injuries on the bone remains of the population buried in the mound of Krasnaya Dubrava testifies to peaceful lifestyle of this group.
Objectives
Palaeopathological analysis is key for characterising population health at the individual level and across large assemblages but is rarely exploited to unite the remains of disarticulated individuals. This study explores the potential for individual identification through differential diagnosis of periosteal lesions in a commingled deposit, both to ascertain the number of individuals represented and provide a differential diagnosis.
Materials and Methods
The late Neolithic Xagħra Circle hypogeum on Gozo contains the remains of more than 800 individuals, most of which were transformed to a collective disarticulated assemblage. Across the excavated population, pathological observations are strikingly low. In one specific 1x1 m area in a single stratigraphic context, fragmented and disarticulated cranial and post-cranial non-adult bones were identified that displayed periosteal new bone formation. To aid differential diagnosis, macroscopic analysis, taphonomic analysis, and micro-CT (μCT) imaging were integrated.
Results
This approach, when combined with osteobiographical analyses, reveals that the elements most likely derive from one individual, a young child, who presents a probable case of scurvy. The potential for micronutrient co-morbidities are also explored, but without further microscopic study it cannot be determined if this individual also experienced iron-deficiency anaemia and/or rickets.
Discussion
In the context of the Mediterranean and Europe in later prehistory, reported cases of scurvy are currently low and often reveal periods of environmental instability and resource insufficiency. Our finding of non-adult scurvy in late 3rd millennium BC Malta contributes to a developing picture of an increasingly unstable palaeoenvironment and declining population health at this time, although it may also indicate an individual case of poor childhood health within this broader context.
Introduction. The paper is devoted to the examination of craniological materials of the late middle age originating from the Shareniy Bugor archaeological complex.
Methods and materials. A complete series which includes 33 individual remains is now kept by the Research Institute and the Museum of Anthropology of Moscow State University. The access to scientific information on the series has been opened for the first time. The series consists of 24 male skulls, 4 female brain capsules, two childrens and 3 adolescent craniums.
Analysis. The standard assessment program of pathological conditions on postcranial skeleton and skull bones developed by A.P. Buzhilova (1995, 1998) was applied in the course of examination of the anthropological material.
Results. A wide range of cranium anomalies, various dentition diseases, endocrine disease markers, signs of exposure to low temperatures, episodic stress traces and numerous injuries were recorded as a result of the examination of the bone material.
Conclusions. The series under consideration does not meet the paleopopulation criteria, i.e. cannot be a prototype of a really existing group of medieval urban population. Signs of unintentional artificial deformity of the occipital type were recorded on the skulls of the studied sample. The identified stress markers indicate that the urban population of the Volga Delta was exposed to the pressure of negative factors due to the natural and social environment including cold temperatures, hunger, war, etc. The population group originating from Shareniy Bugor settlement probably specialized in living in the river area, which led to a specific diet and the appearance of cases of diseases typical for people spending a long time in a cold water environment. Extremely high rates of injuries, including combat near-death and lethal ones, wounds to the skull facial area characterize the studied part of the population as a group that actively participated in hostilities. A series of skulls originating from Shareniy Bugor settlement probably belongs to a specific social stratum or the handicraft part of the population of the Golden Horde city of Khadzhi-Tarkhan which was engaged in river fishing and whose appearance (hairstyle and constantly worn headdress) was very different from most townspeople; they probably actively defended the city during the raids of enemies.
This paper presents a case study of a young infant, from a larger isotopic and osteological investigation of Bronze/Iron Age (14th-4th century BCE) skeletal assemblages from Croatia and Slovenia. The osteological analysis of this infant identified pathological lesions including abnormal porosity and new bone formation consistent with malnutrition and phases of recovery. The distribution and appearance of these pathological lesions (i.e. diffuse micro-porosities and plaques of subperiosteal new bone formation on the skull and long bones) led to the conclusion that this infant probably suffered from scurvy (vitamin C deficiency). The diet and nitrogen balance of this individual were investigated by incremental dentine sampling and stable carbon and nitrogen isotope analysis. This sampling method provided a high resolution record of dietary and metabolic changes from pre-birth to around the time of death. The resulting isotope data exhibited unusually high δ¹³C values for this region and time period (between −11.3‰ and −12.6‰), while δ¹⁵N values were observed to be c. 3‰ above that of rib collagen sampled from contemporary adults recovered from the same site. The isotope profiles generated from the incremental dentine analysis show that δ¹³C and especially δ¹⁵N continue to increase until death. The evidence from the skeletal remains and high resolution isotopic data support the hypothesis that this infant suffered from severe malnutrition and an increasingly negative nitrogen balance. The paper discusses some scenarios which could have resulted in these unusual isotope ratios, whilst considering the diagnosis of possible metabolic disease. The paper also addresses the need for context when interpreting isotopic results. The isotope data should not be viewed in isolation, but rather as part of a multidisciplinary approach, considering the multiple causes of isotopic variability.
Malnutrition is a lack of a key component in one's diet. Bioarchaeologists tend to look at community‐level trends in food usage as it is influenced by cultural and environmental factors often using a biocultural and/or cultural ecology theoretical perspective. They typically focus on nutrients like iron and protein, and vitamins C and D. To assess prehistoric community dietary health issues, they also attempt to link the presence of macroskeletal lesions found on human burials to specific or general dietary problems: for example, anemia from a lack of dietary iron with cranial pitting often found on the skull or eye orbits. There are other variables that influence the health of communities and specific individuals, such as the effects of acute and chronic dietary starvation events, cooking strategies, the presence of infectious agents, and the strength of one's immune system. Each of these variables plays an important role in human health outcome.
Individual descriptions of age and paleo-pathological features observed on bones of children and adolescents of the late Sarmatian time originating from burial mounds from the territory of the Lower Volga region are presented in the paper. The method of paleo-pathological analysis of human bone remains was applied in the study. We determined the age of individual remains according to the methods and schemes presented in the works of Russian and international scientific community. The material of the study is represented by the skeletal remains of 8 people aged 0 to 16 years stored in the anthropological laboratory of the Volgograd State University. As a result of the conducted study of children and adolescent skeletons of the late Sarmatian period, previously established by the scientists information on the rare occurrence of children in the burials of this culture was confirmed. This situation is typical to most archaeological monuments in the Lower Volga and Lower Don regions of the 2nd - 4th century AD which proves the paleo-demographic uniqueness of the late Sarmatian culture. On the basis of the research on the dental pathologies expansion we make an assumption about the susceptibility of the children’s population to episodic stresses of various etiologies. The children population of the late Sarmatian period lacked oral hygiene as evidenced by the early appearance of tartar. The nature of the ration of the immature population of the 2nd - 4th century AD allows to reproduce the complex analysis of stress markers. The lack of caries and a high percentage of tartar indicate that the diet was dominated by meat and dairy products with a low carbohydrate inclusion. Porosis, revealed on bone remains, testifies to the problems with the vitamin “C” assimilation. The presence of cases of hyperostosis in the examined group means that the majority of individuals in childhood suffered from severe chronic diseases. Signs of nonspecific infections found on the bones of the skull and the postcranial skeleton, along with markers of micronutrient deficiencies in the human body testify to the hard living conditions of nomadic children.
This paper presents the results of a study of bone remains of impuberal individuals from the Early Sarmatian burial mounds located in the Lower Volga region. When working with bone remains, we analyzed frequency of occurrence of various stress indicators and other abnormalities, taking into account biological age of the individuals buried there.
The comparison of paleopathology results with the data from archaeological and ethnographic written sources made it possible to assess some aspects of the life of the early Sarmatian population. Thus, the number of children and adolescents in the early Sarmatian burials corresponds to the established paleodemographic standards proving the normal demographic situation in the paleopopulation. Reconstruction of nutrition patterns allows us to assert that breastfeeding in early Sarmatians was long. Meat and dairy products were the basis of the diet of both older children and adults. In the life of the population, there must have been occasional famine periods, for instance, due to livestock loss. The nomads’ diet was limited to meat and milk products, did not provide proper nutrition and caused numerous diseases such as scurvy and porosis. Paleopathology data demonstrate the spread of helminthiases
and various infections in the Sarmatians.
This chapter presents some of the most common pathological conditions identified on human skeletal remains, divided into broad categories: developmental anomalies, metabolic diseases, hematopoietic diseases, endocrine disorders, infectious diseases, tumors, trauma, joint disease, and dental diseases. The emphasis is on the way each condition manifests on the skeleton; thus lists of representative lesions associated with different conditions are given. In addition, the general steps followed in any macroscopic paleopathological analysis are outlined, and the osteological paradox and its implications in paleopathological interpretation are briefly presented. Suggested recording protocols for selected conditions are provided and the statistical tests appropriate for various types of data are discussed.
Paleopathology exists at the intersection of medicine and anthropology. Clinical data, contextualized using anthropological perspectives, form the basis of paleopathological understandings of metabolic bone diseases. However, perceived dichotomies between method and theory, biology and culture, description and interpretation, and process and categorization reinforce pervasive conceptions of the two fields as contrasting. Significant differences in the evidence, methodologies, and approaches available affect how paleopathology utilizes clinical data. In discussing disease manifestations for which available evidence differs, paleopathologists often rely on features that connect indirectly to clinical observations through the interpretation of physiological processes. For manifestations that have been extensively studied bioarchaeologically, paleopathologists tend to support diagnoses by citing other paleopathological studies, rather than directly engaging with clinical literature. Both clinical and anthropological data and approaches contribute significantly to excellent paleopathological research, which will continue to apply clinical data as directly as possible while incorporating anthropological perspectives to add meaning to interpretations.
The Archaeology of Human Bones provides an up to date account of the scientific analysis of human skeletal remains from archaeological sites. This completely revised edition reflects the latest developments in scientific techniques for studying human skeletons and the latest applications of those techniques in archaeology. In particular, the sections on ancient DNA and bone stable isotopes have been comprehensively updated, and two completely new chapters have been introduced, covering metric study of the postcranial skeleton and ethical dimensions of the study of human remains. The Archaeology of Human Bones introduces students to the anatomy of bones and teeth, utilising a large number of images. It analyzes the biasing effects of decay and incomplete recovery on burial data from archaeological sites, and discusses what we may learn about burial rites from human remains. Subsequent chapters focus on demographic analysis of earlier populations, normal skeletal variation, disease and injury, isotopic and DNA analysis of bone, the study of cremated bone and ethical aspects of working with ancient human remains. Current scientific methods are explained, alongside a critical discussion of their strengths and weaknesses. The ways in which scientific analyses of human skeletal remains can contribute to tackling major archaeological or historical issues is illustrated by means of examples drawn from studies from around the world. Technical jargon is kept to a minimum, and each chapter contains a summary of the main points that a student should grasp and a list of further reading targeted to enable students to follow up major issues covered in the book. Featuring case studies from around the world and with copious illustrations, The Archaeology of Human Bones continues to be a crucial work for students of archaeology.
Diverse pathological processes can produce overlapping or even indistinguishable patterns of abnormal bone formation or destruction, representing a fundamental challenge in the understanding of ancient diseases. This paper discusses increasing rigor in differential diagnosis through the paleopathological study of scurvy. First, paleopathology's use of descriptive terminology can strive to more thoroughly incorporate international standards of anatomical terminology. Second, improved observation and description of abnormal skeletal features can help distinguish between anemia or vitamin C deficiency. Third, use of a structured rubric can assist in establishing a more systematic, replicable, and precise decision-making process in differential diagnosis. These issues are illustrated in the study of two new cases of suspected scurvy from northern Peru. From this, it appears possible that ectocranial vascular impressions may further examined as a morphological marker of scurvy in the skeleton. Also, increased paleopathological attention to pellagra is long overdue, especially as it may produce generally comparable lesions to scurvy. This paper reflexively speaks to the process of paleopathological problem solving and the epistemology of our discipline-particularly regarding the ways in which we can continuously improve description and the construction of diagnostic arguments.
Diagnosing scurvy (vitamin C deficiency) in adult skeletal remains is difficult despite documentary evidence of its past prevalence. Analysis of 20 European colonists buried at Saint Croix Island in New France during the winter of 1604–1605, accompanied by their leader Samuel de Champlain's eyewitness account of their symptoms, provided the opportunity to document lesions of adult scurvy within a tightly dated historical context. Previous diagnoses of adult scurvy have relied predominantly on the presence of periosteal lesions of the lower limbs and excessive antemortem tooth loss. Our analysis suggests that, when observed together, reactive lesions of the oral cavity associated with palatal inflammation and bilateral lesions at the mastication muscle attachment sites support the differential diagnosis of adult scurvy. Antemortem loss of the anterior teeth, however, is not a reliable diagnostic indicator. Employing a biocultural interpretive approach, analysis of these early colonists’ skeletal remains enhances current understanding of the methods that medical practitioners used to treat the disorder during the Age of Discovery, performing rudimentary oral surgery and autopsies. Although limited by a small sample and taphonomic effects, this analysis strongly supports the use of weighted paleopathological criteria to diagnose adult scurvy based on the co-occurrence of specific porotic lesions.
Metabolic disorders, such as scurvy, manifested in human skeletal remains provide insight into health, nutrition, and environmental quality in past populations. Porous cranial vault lesions are often used to diagnose metabolic conditions in subadult remains, but overlapping gross lesion expressions have led to over-diagnosis of anemia and under-diagnosis of scurvy. Studies by Ortner and colleagues have suggested that specific porous cranial lesions are pathognomonic of scurvy, but additional diagnostic tools are necessary. In this technical report, we offer a preliminary assessment of cranial vault thickness (CVT) at the site of porous lesions (sensu lato porotic hyperostosis, cribra orbitalia) as a method for distinguishing between scurvy and anemia in subadult crania. Computed Tomography (CT) was used to measure CVT at various landmarks associated with porotic hyperostosis and cribra orbitalia, complemented by lesion scores, from scorbutic (N = 11), anemic (N = 3), and non-pathological (N = 28) subadult crania used as a control group. Results indicate that CVT consistently distinguishes scorbutic from non-pathological individuals, while anemic individuals overlap with both – likely a function of small sample size in this study. Despite current limitations, CVT has the potential to be an objective diagnostic tool for distinguishing scurvy and expanding reconstructions of nutritional adequacy over the life course in past populations.
Archaeological evidence of scurvy in Greece has previously included only a few cases. Recently, during the study of a Middle Byzantine (11th–12th centuries A.D.) Greek population from Crete, Greece, four non-adult skeletons were found to exhibit abnormal porosity and reactive new bone formation, mainly on the cranial and post-cranial bones, which vary in extent and severity. These lesions are similar to those reported in previous studies of juvenile scurvy, suggesting that most likely the individuals suffered from this condition at the time of death. Further, a biocultural approach is applied here in order to contextualize these findings, as well as to explore the reasons for the sporadic appearance of the disease. It is proposed that these cases are indicative of undernutrition and that the development of scurvy in this Middle Byzantine Greek population might be associated with weaning and the type/quality of solid foods introduced after cessation of breastfeeding. The reported cases are important because archaeological evidence of scurvy in this geographical area is relatively rare, and they contribute to the broader global understandings of the cultural variables that mediate the expression of skeletal manifestations of juvenile scurvy.
Scurvy is a disease caused by vitamin C deficiency and is a key paleopathological indicator of subadult health and nutritional status in the past. Yet, little is known about scurvy in human remains from South America and the Peruvian Central Andes in particular. In the Lambayeque Valley Complex on the north coast of Peru, a sample of 641 archaeologically recovered subadults (A.D. 900–1750) were scored for the skeletal manifestations of vitamin C deficiency, testing the hypotheses that scurvy was common in this region and that prevalence increased following European contact. The findings reveal only five convincing cases of scurvy; overall prevalence appears extremely low, and scurvy did not become perceptibly more common following conquest. Of diagnostic interest, complex ectocranial vascular impressions were documented in two cases. Though rarely attributed to scurvy, examination suggests they formed during scorbutic episodes. Another Colonial Period subadult may demonstrate comorbidity between scurvy and rickets. This work also provides new questions for the investigation of scurvy in Andean South America.
Documentary sources on scurvy in early Europe are largely post-Mediaeval and portray it as affecting sailors, soldiers, or victims of famine. But is this an accurate assessment? This article conducts a meta-analysis of palaeopathological evidence for scurvy in Europe and explores how these data augment documentary perspectives and extend our knowledge of scurvy back into the more remote past. There is little evidence for scurvy in skeletal remains associated with European military campaigns, but there is evidence of scurvy as a maritime problem among whalers and in veterans of the British Royal Navy. It was also frequent in burials from the 19th century Great Irish Famine. Because of their greater propensity to form diagnostic skeletal scorbutic lesions, subadults are usually the focus of palaeopathological studies of attritional civilian cemeteries. In subadults from some large cemeteries dating from the 3rd to 19th centuries A.D. in the British Isles scorbutic changes are often rare or absent. This suggests that normal seasonal and year-to-year fluctuations in availability of vitamin C-rich foods were usually insufficient to produce an appreciable number of skeletal cases. Subadult scurvy occurs at higher prevalence in some populations, likely due to cultural factors associated with weaning and childhood diets.
Reactive new bone on the endocranial surface of the skull in non-adults has recently received a lot of attention in the palaeopathological literature. These features appear as layers of new bone on the original cortical surface, expanding around meningeal vessels, as isolated plaques, ‘hair-on-end’ extensions of the diploë or, as ‘capillary’ impressions extending into the inner lamina of the cranium. These lesions are commonly found on the occipital bone, outlining the cruciate eminence, but have also been recorded on the parietal and frontal bones, and appear to follow the areas of venous drainage. Although recognized as resulting from haemorrhage or inflammation, their precise aetiology is still a matter of controversy. This paper outlines their possible causes and examines their nature and distribution in a group of non-adults from four archaeological sites in England. It is recommended that, when recording these lesions in the future, additional skeletal pathologies, the age of the child, and nature and distribution of the lesions also be taken into account. Copyright © 2004 John Wiley & Sons, Ltd.
Subadult scurvy is not well documented in archeological human remains despite the existence of many biomedical references indicating that bone changes do occur in some cases and, because of this, should be observable in human burials. There are several potential reasons for this gap in our knowledge of scurvy. Not all children who suffered from scurvy died of the disease or from other causes when they had scurvy. Scurvy may not leave characteristic bone changes in every case of the disease. Some of the pathological conditions associated with scurvy have been known for many years, but these features may be rare or difficult to differentiate from other pathological conditions. Recently a lesion of the skull has been described (Ortner and Ericksen [1997] International Journal of Osteoarchaeology 7:212–220) that is probably pathognomonic for scurvy, specifically porous and sometimes hypertrophic lesions of the greater wing of the sphenoid. This lesion is bilateral and highly associated with evidence of inflammation at other anatomical sites in the skull. A survey of subadult skulls (N = 363) in the human skeletal collection from Peru at the National Museum of Natural History, Smithsonian Institution, reveals a prevalence of 10% of skulls that exhibit plausible evidence of scurvy. Some cases of scurvy also have cribra orbitalia that has been attributed to anemia. In most of the Peruvian scurvy cases, anemia is an unlikely possibility because there is no evidence of marrow hyperplasia. This highlights the need for caution in using lesions of the orbit as an indicator of anemia when there is no other evidence of this disease elsewhere in the skeleton. Anatomical evidence of scurvy offers the potential of providing new and important evidence of diet in archeological human populations. Am J Phys Anthropol 108:321–331, 1999. © 1999 Wiley-Liss, Inc.
The aim of the study was to search for data on dental development correlated to age and use this information for building up a 'tooth development diagram'. The diagram was based on the following four relatively easy recognized stages in tooth development: commencement of mineralization, completion of crown, eruption (the cusp(s) penetrating the gingival, and completion of root(s). Data concerning these stages from both deciduous and permanent dentition collected from available literature formed the base of the diagram.
Rickets and osteomalacia are the subadult and adult expressions of a disease in which the underlying problem is a failure to mineralize bone protein (osteoid). The most common cause of this disease is a physiological deficiency in vitamin D. The associated problems include deformed bones and this condition is well known in pre-modern medical texts and documents as a fairly common cause of morbidity. Given these facts, it is surprising that the literature on palaeopathology provides very little evidence of this disease in archaeological human skeletal samples.The medieval sample (N=687) of human remains from Wharram Percy, North Yorkshire, England contains a remarkable subsample of eight burials in which a spectrum of pathological features is expressed. The subsample includes infants ranging in age from 3 to 18 months at the time of death.Ten abnormal bone features were identified in the subsample, including: (i) cranial vault porosity; (ii) orbital roof porosity; (iii) deformation of the mandibular ramus; (iv) deformation of arm bones; (v) deformation of leg bones; (vi) flared costo-chondral ends of ribs; (vii) irregular and porous cortex of the costo-chondral ends of the ribs; (viii) abnormality of the growth plates of long bones; (ix) irregular and porous surfaces of the metaphyseal cortex; (x) thickening of the long bones, particularly in the metaphyseal areas. Not all of these features were found in all of the cases. Nevertheless, the overall pattern of skeletal abnormality fits well with the anatomical and radiological conditions associated with rickets. © 1998 John Wiley & Sons, Ltd.
Scurvy in children is poorly known in the palaeopathological literature despite biomedical references indicating that bone changes do occur in some cases and should be observable in human skeletal remains. Research on infants' and children's skulls in museum and anatomical collections in the USA and Europe reveals a complex of features on the external surface of the greater wing of the sphenoid and adjacent bone tissue that may be caused by scurvy. The lesions are bilateral and are characterized by porosity and, in some cases, hypertrophic bone formation. These abnormal bone changes are probably the result of a reaction to chronic haemorrhage in the deep vasculature associated with temporalis muscle function. While these lesions resemble those seen in anaemia and infection, their distinctive anatomical location and association with chewing should differentiate them, in most cases, from other disease conditions. These features are also associated with porous, hypertrophic lesions of the orbital roof and provide additional evidence that caution is needed in attributing porous lesions of the orbital roof solely to anaemia. © 1997 John Wiley & Sons, Ltd.
Skulls and mandibles from the Romano-British site of Poundbury, Dorset and a medieval site at Abingdon in Oxfordshire were examined for porosity which has been considered to be indicative of the presence of scurvy. In addition, a number of skulls from various locations in Peru were examined. Virtually all the skulls had porosity at at least one site and in all cases the palate was most frequently affected. The rank order of affected sites showed some differences between the three samples but the most striking change was the frequency with which the cranial vault and maxilla were affected in the Peruvian skulls compared with the British. The differences were not statistically significant, however. None of the appearances was consistent with those of known cases of infantile scurvy and we doubt whether scurvy can be diagnosed on the basis of porosity in the skull and mandible unless it conforms to recognized clinical patterns. Copyright © 2003 John Wiley & Sons, Ltd.
Very limited information is available on the normal size of the anterior fontanelle but this measurement may be of value in the early diagnosis for example of bone diseases, and of hypothyroidism. The purpose of this study was to provide a reference range applicable to the first two years of life, using a larger sample population than previous studies. Measurements were made of the anterior-posterior and transverse dimensions in 334 full term infants between birth and the age of 24 months. Despite the wide variation, both in size and age of closure, it proved possible to define a reference range and also, for the first time, to present a centile chart.
Six healthy volunteers from the Iowa State Penitentiary at Fort Madison, Iowa, participated in studies of human scurvy. They were hospitalized on the Metabolic Ward of University Hospitals in Iowa City, Iowa, and fed a diet totally devoid of vitamin C.
One of the men withdrew from the study because of personal reasons. The remaining five subjects developed clinical scurvy in 84 to 97 days, manifested by signs and symptoms of fatigue, hemorrhagic phenomena, swollen joints, swollen bleeding gums, follicular hyperkeratosis, muscular aches and pains, and emotional changes.
Urinary ascorbic acid rapidly declined to undetectable levels early in the course of depletion and blood levels progressively became too low to measure accurately. Serum protein abnormalities appeared that consisted primarily of a decrease in albumin and an increase in alpha-2 and gamma globulins. Other changes occurred in serum lipids.
Radioisotopic studies indicated progressive depletion of the body pools during the depletion phase of the study and repletion in proportion to the amount of ascorbic acid administered daily. This study confirms and extends the observations made in our earlier study that the full clinical syndrome does not appear until the normal body pool has been depleted to less than 300 mg.
The minimal amount of ascorbic acid necessary to prevent or cure scurvy appears to be slightly less than 10 mg daily. Once again our observations are in accord with those of the British Medical Research Council. Estimates of the optimal intake of ascorbic acid must be made on the basis of these data plus a knowledge of the biological and physiological variables of mankind.
The authors surveyed subadult human skeletons from Native American archeological sites in the United States for evidence of skeletal lesions associated with scurvy. Geographic regions surveyed include the Midatlantic area, the Southeast (Florida), the Southwest, and the Plains. The prevalence of probable subadult scurvy ranged from zero in the Plains samples to 38% in a small sample from Florida. These data indicate the likelihood that scurvy was a significant childhood disease in many Native American groups. Reasons for variation in prevalence remain speculative but include regional and seasonal variation in food types and abundance, cultural patterns of storage and utilization, periodic food shortages, and the relative importance of corn in the diet. These factors are part of a nutritional complex that is related to disease prevalence which can be studied through evidence seen in archeological human remains.
Scurvy, a deficiency of vitamin C, now most often occurs in disadvantaged groups seen frequently in EDs: alcoholics with poor nutrition, the isolated elderly, and the institutionalized. Its prominent clinical features are lethargy; purpuric lesions, especially affecting the legs; myalgia; and, in advancing disease, bleeding from the gums with little provocation. Common misdiagnoses are vasculitis, blood dyscrasias, and ulcerative gingivitis. Untreated, scurvy is inevitably fatal as a result of infection or sudden death. Fortunately, individuals with scurvy, even those with advanced disease, respond favorably to administration of vitamin C.
The age at which the anterior fontanelle closed in 1677 infants varied between 4 and 26 months, with 90% between 7 and 19 months. In the first year, 41.6% closed, of which 2.7% occurred by 6 months and 13.5% by 9 months. Compared to data in older textbooks, this suggests a trend towards earlier closure of the fontanelle.
Recent investigations of human skeletal material from the historic St. Martin's cemetery, England, found a range of abnormal lesions in six infants that are almost certainly related to scurvy. Porous and proliferative bone lesions affecting the cranial bones and scapulae were found, and this paper presents images obtained using both macroscopic and scanning electron microscope examination of the lesions. Previous work on infantile scurvy (Ortner et al., 1997-2001) relied heavily on changes at the sphenoid, which is often missing in archaeological bone, so the identification of changes attributable to scurvy on other cranial bones and the scapulae is encouraging. The ability to recognize changes related to scurvy on a range of bones will ensure an enhanced potential for recognition of this disease in future research involving archaeological bone. Research on historical documents from Birmingham dating to the eighteenth and nineteenth centuries, combined with the probable cases of scurvy identified, supports the view that the paucity of cases of infantile scurvy from the archaeological record reflects a lack of understanding and recognition of bone manifestations, rather than a lack of occurrence in this period. Changes linked to scurvy were only found in infants from the poorer sections of the community from St. Martin's, and this is almost certainly linked to patterns of food consumption and may be related to shortages of potatoes, due to blight, experienced during this period.
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