Cribra orbitalia and porotic hyperostosis in a Greek colonial population (5th to 3rd centuries BC) from the Black Sea

Cribra orbitalia and porotic hyperostosis in Greek skeletal remains have typically been attributed to a genetic anaemia, most notably thalassemia due to the presence of endemic malaria in the Mediterranean region. This paper reports the results of an analysis of cribra orbitalia and porotic hyperostosis in a Greek colonial population (5th to 3rd centuries BC) from the Black Sea. Archaeological evidence, stable isotopic data, and other skeletal indicators of physiological stress are examined to determine the most likely cause(s) of these lesions. While the possibility that some of the colonists of Apollonia suffered from thalassemia cannot be entirely discounted, the skeletal evidence examined in this study is not consistent with a diagnosis of thalassemia. We must therefore be cautious in assuming that cribra orbitalia and porotic hyperostosis in Greek skeletal remains, and indeed skeletal remains from any region where malaria was endemic in the past, is always indicative of this condition. Nutritional deficiencies and exposure to infectious diseases probably played an equally, if not more, important role in the development of these lesions. Copyright © 2006 John Wiley & Sons, Ltd.     

Thalassaemia: Its diagnosis and interpretation in past skeletal populations

The diagnosis of thalassaemia in archaeological populations has long been hindered by a lack of pathogonomic features, and the non‐specific nature of cribra orbitalia and porotic hyperostosis. In fact, clinical research has highlighted more specific diagnostic criteria for thalassaemia major and intermedia based on changes to the thorax (‘rib‐within‐a‐rib’ and costal osteomas). A recent re‐examination of 364 child skeletons from Romano‐British Poundbury Camp, Dorset revealed children with general ‘wasting’ of the bones and three children who demonstrated a variety of severe lesions (e.g. zygomatic bone and rib hypertrophy, porotic hyperostosis, rib lesions, osteopenia and pitted diaphyseal shafts) that are inconsistent with dietary deficiency alone, and more consistent with a diagnosis of genetic anaemia. Two of these children displayed rib lesions typical of those seen in modern cases of thalassaemia. The children of Poundbury Camp represent the first cases of genetic anaemia identified in a British archaeological population. As thalassaemia is a condition strongly linked to Mediterranean communities, the presence of this condition in a child from England, found within a mausoleum, suggests that they were born to wealthy immigrant parents living in this small Roman settlement in Dorset. This paper explores the diagnostic criteria for genetic anaemia in the archaeological literature and what its presence in ancient populations can contribute to our knowledge of past human migration. Copyright © 2010 John Wiley & Sons, Ltd.     

Health Consequences of European Contact in the Great Plains: A Comparison of Systemic Stress Levels in Pre‐ and Post‐Contact Arikara Populations

The biocultural effects of European contact varied considerably throughout the Americas. Some populations were decimated by colonialism, while others benefited from trade relationships and access to new technologies. It has been suggested that initial contact with European fur traders and explorers was economically favourable for Plains village populations, thereby facilitating a period of cultural florescence. In this study, we evaluate the hypothesis that Plains groups were better off than their predecessors during the initial contact period by comparing frequencies of enamel hypoplasia, cribra orbitalia, and porotic hyperostosis in pre‐ and post‐contact Arikara skeletal assemblages. We included both juveniles and adults in our sample to capture variation in the stress experience of different segments of the population. Our analysis revealed similarly low frequencies of cribra orbitalia in the pre‐ and post‐contact groups and no observed cases of porotic hyperostosis. Enamel hypoplasia, however, was significantly more prevalent among post‐contact Arikara villagers when compared to their pre‐contact counterparts, which suggests that stress levels were higher after European contact. Additionally, enamel hypoplasia was most common among post‐contact juveniles. The elevated frequency of enamel hypoplasia in the post‐contact sample combined with the low frequencies of cribra orbitalia and porotic hyperostosis suggests that disease stress, rather than nutritional deficiencies, was likely responsible for the decline in overall health following European contact. These results also suggest that juveniles are sensitive indicators of systemic stress within a population and should be included in bioarchaeological analyses of prehistoric health when available. Copyright © 2015 John Wiley & Sons, Ltd.     

Cribra orbitalia and cribra cranii in Roman skeletal remains from the Ravenna area and Rimini (I–IV century AD)

Cribra orbitalia and cribra cranii are considered good indicators of the health and nutritional status of ancient populations, as their presence is often associated with chronic acquired anaemia. The distribution of these lesions in two Roman samples from the Ravenna area and Rimini was considered as a measure of health in relation to their respective environments. Enamel hypoplasia was also assessed as it is symptomatic of childhood physiological stresses such as malnutrition, infectious diseases, physiological traumas, and the like. The differential analysis suggests that the lesions observed are due to chronic acquired anaemia, probably caused by a poor diet, worm infestation, infections and parasitic diseases. Copyright © 2004 John Wiley & Sons, Ltd.     

Cribra orbitalia,sinusitis and linear enamel hypoplasia in Swedish Roman Iron Age adults and subadults

Maxillary and frontal sinusitis, cribra orbitalia and linear enamel hypoplasia were recorded as indicators of nutritional and environmentally related stress in an Early Iron Age (0–260 AD ) population from Sweden. The material comprised the skeletal remains of 99 adults and 45 subadults (aged 20 years and under). Maxillary sinusitis and cribra orbitalia were recorded in the majority of subadults and adults. In contrast, linear enamel hypoplasia was uncommon and occurred mainly in the subadults. In seven cases (12.7%) there was a clear co‐occurrence of periapical lesions and maxillary sinusitis. A significant co‐occurrence of maxillary sinusitis and frontal sinusitis was found in the adults. The least common combination in sex‐determined adults was cribra orbitalia and enamel hypoplasia, only 7.7% exhibiting both lesions. The significantly higher incidence of this combination among subadults suggests an association with life‐threatening conditions. Overall, the results showed that the Early Iron Age community studied suffered foremost from upper respiratory diseases. Copyright © 2010 John Wiley & Sons, Ltd.     

Anaemia in the Ancient Indus Valley

The Harappan, or Indus Valley, civilization is considered by many to be among the earliest and most developed of ancient civilizations, with features such as a highly specialized and functionally integrated economy, centralized bureaucratic institutions and a large population base. Two of 29 crania recovered during the most recent cemetery excavations at Harappa display cranial lesions of porotic hyperostosis, suggestive of chronic anaemia. No lesions consistent with the effects of genetic anaemias were exhibited by any of the 92 individuals for which postcranial remains were preserved, however, suggesting that an acquired iron deficiency is the most likely diagnosis. This low prevalence of anaemia may be linked to a good nutritional base in a diverse ecological setting, and few gastrointestinal and other infections due to high standards of personal and community hygiene. A genetic anaemia may be responsible for an apparent higher frequency of porotic hyperostosis at Mohenjo-Daro, a Harappan site that is located in a different environmental zone, but the small samples available for these and other South Asian sites render these conclusions tentative. © 1997 by John Wiley & Sons, Ltd. Int. J. Osteoarchaeol., 7 : 115–123 (1997) No. of Figures: 2. No. of Tables: 1. No. of References: 57.     

In sickness or in health? Assessment of Early Iron Age human skeletons from Toutswe sites,east central Botswana

The general health of Early Iron Age (AD 700 to 1300) mixed farmers in east central Botswana has not been studied before. In this study the bones and teeth of 84 individuals from ten Toutswe sites were analysed for osteological manifestations of disease, with the aim of assessing the general health of the Toutswe communities. These individuals were aged between newborn and 75 years old, and include both sexes. Results indicate the presence of diseases commonly found in archaeological populations such as osteoarthritis, spina bifida occulta, cribra orbitalia, porotic hyperostosis and enamel hypoplasias. One possible case of DISH was found. The frequency of lesions was comparable with or even lower than at other similar sites, such as K2 and Mapungubwe and other parts of southern Africa. The samples represent communities with relatively low levels of stress and infections. This seems to support the results of the palaeodemographic analysis, which indicated that the Toutswe people were better off than those of neighbouring K2 and Mapungubwe. Copyright © 2008 John Wiley & Sons, Ltd.     

Implications of Reappraising the Iron‐Deficiency Anemia Hypothesis

In 2009, Walker and colleagues questioned the validity of the iron‐deficiency anemia hypothesis as an explanatory mechanism for the presence of porotic hyperostosis (PH) and cribra orbitalia. They presented evidence demonstrating that iron deficiency inhibits, rather than promotes, marrow hypertrophy and argued a link between both PH and hemolytic or megaloblasic anemias (including vitamin B₁₂ deficiency). This paper suggests that dismissing the iron‐deficiency anemia hypothesis may be premature, but, if dismissed, may result in unforeseen consequences. Vitamin B₁₂ deficiency and iron deficiency often result from similar proximate causes, i.e. lack of animal protein in the diet and sanitation problems that lead to parasitic or diarrheal diseases, thereby promoting nutrient losses. As a result, vitamin B₁₂ deficiency and iron deficiency commonly co‐occur. In individuals with a co‐occurrence of iron deficiency and vitamin B₁₂ deficiency, a possible inhibition of marrow hypertrophy caused by iron deficiency may prevent the development of PH, despite the presence of (vitamin B₁₂) nutritional deficiency. The implications of dismissing the iron‐deficiency anemia hypothesis are that many skeletal populations may exhibit hidden heterogeneity, i.e. individuals who are the most nutritionally stressed, with multiple nutrient deficiencies, would mimic the non‐stressed individuals and neither would show evidence of PH. However, the inclusion of multiple stress indicators and greater understanding of biocultural context in bioarchaeological analyses may mitigate the potential impacts of hidden heterogeneity in the expression of PH. Copyright © 2013 John Wiley & Sons, Ltd.     

Health Patterns of the Etruscan Population (6th–3rd Centuries bc) in Northern Italy: The Case of Spina

A sample of 303 skeletons from the Etruscan necropolis of Spina (Ferrara, Italy, 6th–3rd centuries bc ) was examined for paleopathological lesions in order to assess the general health, diseases and quality of life of this Iron Age population. The observed pathologies included porotic hyperostosis, specific and aspecific infections, metabolic and endocrine disorders, tumours and osteoarthritis. A total of 46.7% of adults and 7.7% of subadults showed at least one pathological lesion. Statistical comparisons were made between sexes and adult‐age classes (20–35 years and >35 years) to analyse the prevalence of the lesions. The analysis of porotic hyperostosis and osteoperiostitis allowed to determine the general health status of this group, and the analysis of osteoarthritis allowed to hypothesise a gender division of labour. The results suggest a relatively high‐life expectancy for the time as well as good health and quality of life. The few specific infections and metabolic disorders indicate fairly good nutrition, while the high frequency of porotic hyperostosis can be partly linked to some type of hereditary anaemia. Copyright © 2015 John Wiley & Sons, Ltd.     

Porotic hyperostosis in a Late Upper Palaeolithic skeleton (Villabruna 1, Italy)

Porotic hyperostosis (PH) is a well‐recognised skeletal indicator of physiological stress occurring during the early years of childhood growth. Although frequently found starting from the Neolithic, PH is poorly documented among earlier Palaeolithic hunter–gatherers. This study reports a case of PH in a Late Upper Palaeolithic skeleton (Villabruna 1) from northern Italy. Macroscopic and radiographic examinations of the skeleton show symmetric porotic lesions of the cranial vault, hair‐on‐end appearance, thinning of the cortical bone, diploic expansion and very slight cribra orbitalia (CO). All lesions are highly remodelled and suggest a condition suffered long before death. A differential diagnosis, carried out in order to discriminate between infectious and acquired conditions, points to anaemia as likely aetiology for the changes observed. Absence of postcranial involvement, lesion healing and survival to adulthood suggest a diagnosis of acquired anaemia. Among acquired anaemias, both dietary and infectious models are discussed in light of the individual's skeletal characteristics, as well as geographic location, paleoenvironmental data, subsistence modality and dietary information. The combined analysis of these data suggests that parasitic infestation resulted in megaloblastic anaemia in this individual. Copyright © 2009 John Wiley & Sons, Ltd.     

Bioarchaeological inferences from a Neolithic ossuary from Alepotrypa Cave,Diros, Greece

Alepotrypa Cave, one of the richest and best preserved Neolithic sites in Greece, was occupied by early farmers from ca. 5000 to 3200 BC . Study of human remains from this site contributes important information to the bioarchaeological record for this period. The remains are from the cave's Ossuary II, a secondary deposit containing the disarticulated remains of at least 20 individuals, including adults and sub‐adults. A high frequency of porotic hyperostosis and cribra orbitalia suggests the presence of chronic iron deficiency anaemia. A combination of two possible factors could explain this situation, including reliance on an iron‐deficient cereal diet, and presence of high pathogen and parasitic loads resulting from poor hygiene and contamination of the communal water source. These lesions may also be related to some type of inflammatory process. Some 31% of individuals display healed cranial depressed fractures, indicating evidence of violent (non‐lethal) confrontations. Stable isotope analysis reveals a predominantly terrestrial C₃ diet, with little evidence of marine food consumption, despite close proximity to coastal resources. The presence of various domesticated plants suggests that these C₃ foods may have been agricultural. Moreover, a high frequency of dental caries is consistent with a diet involving significant carbohydrate consumption. Copyright © 2000 John Wiley & Sons, Ltd.     

Cribra orbitalia: a non‐human primate perspective

Cribra orbitalia, a porous lesion involving the orbital roofs, is one of the most‐studied skeletal pathologies in bioarchaeology, and yet uncertainty still exists regarding its aetiology and significance. In contrast to the hundreds of reports of cribra orbitalia in human skeletal remains, little is known of this condition in non‐human primates. Previously, cribra orbitalia has only been reported in catarrhines, with just two cases in cercopithecoids. To provide a broader, phylogenetic perspective on cribra orbitalia, a sample of primate skeletal material was examined to evaluate the occurrence of this condition. The taxonomically diverse sample consists of 380 non‐hominoid (non‐ape) modern primates from both wild and captive populations. Cribra orbitalia is present in 16 individuals, including cercopithecines, colobines, platyrrhines and a prosimian, substantially expanding the known taxonomic range of this condition. Modern primates—with their varied habitats, diets, levels of parasitism, etc.—provide a set of natural experiments regarding conditions and physiologies which may influence the aetiology and impact of cribra orbitalia. More generally, it is suggested here that studies of non‐human primate skeletal pathologies have the potential for providing significant insight on human paleopathologies. Copyright © 2009 John Wiley & Sons, Ltd.     

Amino acids in archaeological bone (2)

Amino acid levels were compared in archaeological bone from four prehistoric Pacific populations: two from New Zealand and two from Papua New Guinea. One group from each region showed cribra orbitalia or porotic hyperostosis. The fewest significant differences were found between the two skeletally healthy groups, and the greatest number of significant differences between the two groups showing pathology. However, canonical discriminant analysis revealed a distinctive amino acid profile for each of the four groups. While the pre- and post-mortem environment may influence amino acid profiles, it is premature to draw specific conclusions as to the influence of diet, disease and burial conditions.     

Subadult Age at Death and Health Status at Niah Cave,Borneo (1500–200 bc)

Southeast Asia's transition to rice agriculture is often used as an exception to the general pattern of health decline at the agricultural transition. Niah Cave is the largest known Southeast Asian Neolithic cemetery, providing valuable information about subadult health during the agricultural transition in this region. This study examines the health status and mortuary treatment of subadult skeletal remains (Minimum Number of Individuals (MNI) = 49) from the Neolithic cemetery of Niah Cave, Sarawak, Malaysia (1500–200 bc ). This study found that few cases of cribra orbitalia (4.6%) and porotic hyperostosis (14%). However, nonspecific infections may have been a risk factor for subadults as over half (65%) died with active cases of periosteal reactions on their long bones. Differential diagnosis determined that possible factors for this include parasite load, rickets and scurvy. Mortuary practices indicate that subadults may have been treated differently in phases 1 and 2 but were grated similar mortuary treatment in phases 3 and 4. This study suggests that changes in mobility patterns may have placed subadults at risk for increased parasite load and vitamin deficiency, while the role of subadults within the community may have changed over time. Copyright © 2017 John Wiley & Sons, Ltd.     

Child Health in Five Early Medieval Irish Sites: A Multidisciplinary Approach

With the aim to reconstruct child health in five early medieval (5th–12th c. CE) Irish sites, an osteoarchaeological study of three biological stress indicators – cribra orbitalia, linear enamel hypoplasia (LEH) and periostitis – has been conducted on 229 skeletons. In addition, Irish early medieval written sources testifying on child health during this period were consulted. These data were furthermore combined with the results of stable isotope analyses (nitrogen and carbon) conducted on subadult bone specimens. Cribra orbitalia was found in 27.5% of the studied individuals (48.6% of subadults were affected), with only two cases active at the time of death. The prevalence of LEH per individual is 63.5% (78.9% in subadults and 59.7% in adults). The age ranges of LEH formation vary between 1.9 and 4.8 years for the maxillary teeth and between 1.8 and 6.2 years for the mandibular teeth. Periosteal inflammations were recorded in over one third of the studied subadults (36.2%) with six cases active at the time of death. The stable isotope results suggest a diet based on terrestrial food sources, with little or no marine input. The presented data strongly suggest that most of the individuals were exposed to a high level of physiological stress during their childhood, and as such does not support the so called ‘osteological paradox’ hypothesis. The observed disturbances were probably caused by a synergistic effect of various biological and socio‐cultural factors. Although the historical records indicate certain differences in diet and lifestyle between social classes and the sexes, this study showed that the children of all ages had poor health in all social classes across a wide geographical location for the full time period of the early medieval. Copyright © 2016 John Wiley & Sons, Ltd.     

Diet,nutritional status and oral health in hunter‐gatherers from the central‐northern coast of Patagonia and the Chubut river lower valley,Argentina

Archaeological research in central‐northern Patagonia (Atlantic coast and lower the valley of Chubut river) showed that this area was used since at least the Middle Holocene. Stable isotope analyses (¹³C and ¹⁵N) of human bone samples indicate that hunter‐gatherers living in that area had a terrestrial‐marine diet including guanaco meat, land plants, mollusks and pinnipeds. Despite this general trend, intersite variability and changes through time were noted, especially after the late Holocene. These results have been reinforced by archaeofaunal, technological and bioarchaeological records. In this paper, three hypotheses are examined: (a) the diet of these populations was complete and rich enough to ensure good health status and avoid nutritional deficiencies; (b) carbohydrate consumption increased progressively after 1000 BP, when pottery technology was adopted and (c) this kind of mixed diet would have been qualitatively more nutritious than that of other populations of the region, which would have resulted in better nutritional and healthy conditions. These three hypotheses are compared with dental results obtained from 563 permanent teeth from 45 individuals (34 adults and 11 juveniles from both sexes), rescued from burial sites. Indicators of oral health were assessed through the observation of caries, abscesses, wear, pulpar cavity exposure and ante mortem loss. Features of nutritional status such as enamel hypoplasia, porotic hyperostosis and cribra orbitalia were also examined. Given the availability of direct radiocarbon dating for most of the sample, three temporal series were determined: ‘Before 1000 BP’, ‘1000–5000 BP’ and ‘Post‐contact’. No evidence of alimentary stress or iron deficiency was found in individuals from the three series, which accounts for healthy and good nutritional life conditions. After 1000 BP, the results show a progressive increase in the caries percentage and a decrease in abscesses, dental wear and ante mortem losses frequency. This is possibly related to more consumption of processed foods in the last 1000 years. These results were compared with similar studies based on samples from different environments and latitudes of Patagonia. Evidence suggests that mixed diets (marine‐terrestrial) would have been more appropriate and nutritionally complete than exclusively marine or terrestrial diets. Copyright © 2010 John Wiley & Sons, Ltd.     

Assessing Oneota Diet And Health: A Community And Lifeway Perspective

Abstract

This preliminary study uses a gross measure of potential nutritional adequacy as a starting point from which to examine the interplay of the dietary impact of corn agriculture and the complexity of community health. We use subsistence data from three Oneota sites (ca. A.D. 1300 to 1650) in the La Crosse locality of southwestern Wisconsin, Tremaine (47 -Lc-95), OT (47 -Lc-262) and Filler (47 -Lc-149), to model nutritional adequacy of diet at each site. Following the assessment of available nutrients, skeletal pathologies often interpreted within a dietary framework in Oneota studies (dental caries, enamel hypoplasias, porotic hyperostosis, and cribra orbitalia) are considered. The Tremaine site with its longhouses and associated human burials provides an important context for understanding health, diet and disease in an Oneota community. We suggest that the etiology of the skeletal pathologies is best understood within a framework that incorporates lifeway choices linked to settlement and subsistence impacts on the community, such as increasing population density within longhouses, rather than explanations that focus on issues of nutrient availability due to food shortages or narrowing of food choices.     

Skeletal evidence for morbidity and mortality in Copper Age samples from northeastern Hungary

Analysis of 183 human skeletons representing the Copper Age in northeastern Hungary indicates slightly less morbidity and mortality than found in previous studies of later Bronze Age and Iron Age samples from the same area. Mean adult age at death was 33.4 years for males and 32.9 years for females. Life table reconstruction revealed a life expectancy at birth of about 28 years, and at age 15 of about 17 years. Frequencies of dental hypoplasia (<1%) and carious lesions (2.3%) were relatively low. Comparisons of the Copper Age data reported here with previously published studies of later Bronze Age and Iron Age samples from the same area revealed little or no change in life expectancy at age 15, long bone diaphyseal circumference, estimated living stature, frequencies of dental hypoplasia, alveolar abscesses, tooth loss, adult porotic hyperostosis or trauma. Temporal increases were detected in life expectancy at birth, dental caries frequency, cribra orbitalia, subadult periosteal lesions and vertebral osteoarthritis. The study is part of a larger effort to examine long‐term temporal changes in skeletal samples from that region. Copyright © 2008 John Wiley & Sons, Ltd.