Scurvy in adults and youngsters: the Dutch experience. A review of the history and pathology of a disregarded disease

Prior to the Dutch maritime expansion of the 17th and 18th centuries, scurvy was known in the Low Countries as an endemic disease. From the end of the 16th century the disease started to draw much more attention due to increasing long sea journeys of sailors. Already in the Dutch medical literature of the 16th century, a strong relation was expressed between the prolonged taking of foodstuffs of poor quality and the risk of contracting scurvy. Although from that time, many Dutch physicians recommended oranges, scurvy grass and brook‐lime, it took 200 years before inadequate therapy on the fleet was replaced by systematic prevention. Why did the old time effective recommendations for the therapy of scurvy stay inadequate for mariners? To understand, maritime and medical history were unfolded and evaluated with respect to palaeopathological findings reported for 39 cases of active scurvy and one case of healed scurvy. The palaeopathology of scurvy in adults and still growing youngsters was investigated from the remains of 50 Dutch whalers who had been buried during the 17th and 18th centuries on an island of the Spitsbergen Archipelago. Conforming the clinical literature, the original haematomas from scurvy were found as a black staining at the tips of dental roots. In the weight‐bearing bones of the lower extremities large black stains were positioned bilaterally around endofractures of the metaphyses, bilaterally on joint surfaces and bilaterally at epiphyseal discs of youngsters. In the non‐weight‐bearing bones they were often found unilaterally, such as at insertions of muscles. Immunoenzymatic staining of microscopic sections proved that the black stains were from remnants of denatured haemoglobin. No microscopic bone repair activities had happened. In a case of healed scurvy it could even be demonstrated how many times the recovery process had taken place from the layers of appositional bone which had replaced the original subperiosteal haematomas. Copyright © 2004 John Wiley & Sons, Ltd.     

Childhood scurvy in a medieval burial from Mačvanska Mitrovica,Serbia

The type and distribution of abnormalities in the skeleton of a child 2 years of age indicates that the child likely suffered from scurvy at the time of death. The burial is from the archaeological site of Zidine, Mačvanska Mitrovica, Serbia dated to the Medieval Period. Abnormal porosity and reactive woven bone formation are present affecting both the axial and appendicular skeleton. This case of scurvy is important because archaeological evidence of scurvy in this geographical location and at this time period is unknown. It is also important because the relative completeness of the skeleton and the widespread evidence of skeletal abnormalities provide additional insight regarding the skeletal manifestations of scurvy in young children. Copyright © 2009 John Wiley & Sons, Ltd.     

Adult scurvy in skeletal remains of late 19th century mineworkers in Kimberley,South Africa

Throughout history, scurvy has been a well‐known disease which develops due to restricted resources of fresh fruit and vegetables. The condition results from an extended limited intake of vitamin C. Although skeletal lesions associated with infantile scurvy have been well described by many authors, very little literature is available on adult scurvy and the resulting skeletal lesions. The purpose of this study was to investigate the skeletal remains of a 19th century mining population from Kimberley, South Africa, for any skeletal lesions that may be indicative of adult scurvy. Scurvy was well documented as being extremely prevalent in this population. The skeletal remains of 107 individuals, presumed to have died around 1898, were studied. The majority of these individuals were males between 19 and 45 years of age. It is likely that most individuals were migrant workers at the diamond mines. All bones were visually assessed for macroscopic indications of pathological bone alterations associated with healed scurvy. Bone samples were also taken from ambiguous lesions in order to perform histological investigations. Lesions indicative of possible healed adult scurvy were observed in 16 individuals. These lesions included bilateral ossified haematomas, osteoperiostitic bone changes and periodontal disease. Histological investigation confirmed the presence of ossified haematomas on the anterior tibiae of some individuals. Hospital records and historical documents describing the incidence of scurvy in the local hospitals and the daily diet of the black mine workers supported these findings. Copyright © 2009 John Wiley & Sons, Ltd.     

Scurvy as a factor in the loss of the 1845 Franklin expedition to the Arctic: a reconsideration

In 1845, an expedition, commanded by Sir John Franklin, set out to discover the Northwest Passage. The ships entered the Canadian Arctic, and from September 1846 were beset in ice off King William Island. A note left by the expedition in May 1847 reported all was well, but by April 1848, 24 of the 129 men had died. The ice‐locked ships were deserted in April 1848, but the 105 survivors were so weakened that all perished before they could reach safety. The causes of the morbidity and mortality aboard the ships have long been debated, and many commentators have argued that scurvy was an important factor. This study evaluates the historical evidence for the likely effectiveness of anti‐scorbutic precautions taken on polar voyages at that time, and investigates whether the skeletal remains associated with the expedition provide evidence for scurvy. Skeletal remains available for study were carefully examined for pathological changes, and lesions potentially consistent with scurvy were subject to histological analysis. Where remains were no longer accessible, use was made of published osteological work. It is argued that the anti‐scorbutic measures customarily taken on mid 19^th century British naval polar voyages were such that there is no a priori reason to suppose that scurvy should have been a problem prior to the desertion of the ships. The analysis of the skeletal evidence provided little in the way of bony lesions consistent with the disease, and cannot therefore be used to support the presence of scurvy. Factors other than scurvy may been the main causes of morbidity and mortality in the 11 months prior to the desertion of the ships. Copyright © 2012 John Wiley & Sons, Ltd.     

An examination of skulls from two British sites for possible evidence of scurvy

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.     

Did Children in Medieval and Post‐medieval Poland Suffer from Scurvy? Examination of the Skeletal Evidence

Late‐medieval 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 emphasise 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 and colleagues, 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. Copyright © 2015 John Wiley & Sons, Ltd.     

Presence and Absence: An Exploration of Scurvy in the Commingled Subadults in the Spring Street Presbyterian Church Collection,Lower Manhattan

This paper presents the results of an examination of scurvy in the commingled subadult remains (minimum number of individuals = 70) of the Spring Street Presbyterian Church. This historic congregation in New York City had active burial vaults from 1820 to 1846. Scurvy is a vitamin C deficiency that results in haemorrhaging at the sites of muscle origin and insertion, particularly around the skull. These resulting lesions can occur in subadults undergoing growth, weaning and dietary stress. Applying diagnoses suggested by recent research, this article examines specific sites on the skull for lesions consistent with and suggestive of scurvy. Findings include 30 elements that display associated pathology. This population data are drawn from maxillae, sphenoids and orbits. Two osteobiographies are also presented. By connecting the biological data to the socio‐cultural environment of the church, this article raises questions of how to interpret the presence and absence of scurvy in a commingled collection. Copyright © 2016 John Wiley & Sons, Ltd.     

Metropolitan Scurvy in the Shadow of the Cook Voyages

Recent scholarship on scurvy in 18th-century Britain has focused on the disease in the context of voyages of exploration, especially those bound for the Pacific Ocean. Using materials from quack physicians, print culture and popular song, this essay contends that the problem of scurvy was just as acute in metropolitan London and elsewhere in Britain. By studying representations of the disease and its markets at home in Britain, it aims to shed new light on the treatment and perception of the disease at sea, particularly during the voyages of James Cook (1768?79).     

Scurvy‐related Morbidity and Death among Christopher Columbus' Crew at La Isabela,the First European Town in the New World (1494–1498): An Assessment of the Skeletal and Historical Information

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 the present‐day Dominican Republic. The town was founded in 1494 by Christopher Columbus (1451–1506) and occupied for only 4 years. This study analyses 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. Copyright © 2014 John Wiley & Sons, Ltd.     

Trephination as a possible treatment for scurvy in a middle bronze age (ca. 2200 BC) skeleton

Although trephination of sub-adults in antiquity is rare, scurvy both infantile and adult, is even more rare in the archaeological record. Pathological changes appearing in the maxilla, mandible and orbits of a child of 8–9 years of age are highly suggestive of infantile scurvy. Advanced forms of this metabolic disturbance lead to severe subperiosteal haemorrhaging, at times turning the skin of the face and skull black. This condition may have led to the trephination along the sagittal suture as a form of blood letting in hopes of draining the subperiosteal haemorrhage in the cranium. Although cause and effect are often confusing in antiquity, the surgical intervention presented here led to the ultimate death of the child.     

A regional investigation of subadult dietary patterns and health in late Iron Age and Roman Dorset,England

This is the first regional analysis of the impact of Romanisation on subadult dietary patterns and related health parameters in Britain. A sample of 200 subadults from late Iron Age (LIA) and Romano-British (RB) Dorset were examined for dental health and specific metabolic diseases, and a sub-sample of 29 individuals were selected for nitrogen and carbon isotope analysis. The results showed that dental health declined in the Romano-British period and the incidence of scurvy and rickets rose. Increased consumption of marine foods in the RB period is indicated by an increase in δ¹³C between the LIA and RB subadults. After early childhood, there was no age-dependent variation in dietary protein in the RB and LIA populations from Dorset. We propose that these changes related to the introduction of urban living, Romanised diets and population migration.     

Pathological Evidence in Newborn Children from the Sixteenth Century in Huelva (Spain)

Archaeological infant remains rarely appear in the palaeopathological literature; above all there are few references to neonatal individuals. This work presents four infant pathological specimens from the crypt of the Ermita de la Soledad (sixteenth to nineteenth century, Huelva, Spain). The bones analysed—one right hemifrontal, two humeri and a femur—belong to at least two individuals of between 0 and 6 months of age. The differential diagnosis of the lesions—mainly detachments of the outer layer of cortical bone, areas of juxtametaphysial osteolysis and epiphysial destructuralization—supports the hypothesis of an infectious aetiology, such as congenital treponematosis and haematogenous osteomyelitis, although illness caused by a deficiency, such as scurvy or rickets, cannot be ruled out.     

Bone changes in the human skull probably resulting from scurvy in infancy and childhood

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.     

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.     

New light on the personal identification of a skeleton of a member of Sir John Franklin’s last expedition to the Arctic, 1845

In 1845, an expedition, commanded by Sir John Franklin, set out to try and discover the north-west passage. All 129 men on this ill-fated voyage perished. Over the years, skeletal remains associated with the final throes of the expedition have been located on and near King William Island, Nunavut, in the Canadian arctic. In general, even a tentative personal identification for these remains has proved impossible. An exception is some skeletal remains that were recovered in 1869 and brought back to England and interred beneath the memorial to the Franklin expedition in Greenwich. In the 19th century, these were tentatively identified as of one of HMS Erebus’s lieutenants, Henry Le Vesconte, a conclusion that has been widely accepted in studies of the Franklin voyage. Renovations to the monument in 2009 provided an opportunity for scientific examination of the remains, and to re-evaluate the personal identification made nearly 140 years before. The current work, which is the first modern scientific analysis of a fairly complete skeleton associated with the Franklin voyage, describes the remains and the artefacts interred with them, discusses the pathological conditions present, and evaluates the personal identification using osteological techniques and isotope geochemistry. Results indicate that the remains are of an adult male of European ancestry. Although some writers have suggested that scurvy or tuberculosis may have been important causes of morbidity and mortality on the Franklin expedition, osteological analysis and, in the case of tuberculosis, DNA analysis, provided no evidence for their presence in these remains. Isotopic studies indicate that the personal identification as Le Vesconte is unlikely to be correct. From the isotopic results and forensic facial reconstruction, HDS Goodsir, an assistant surgeon on the expedition, appears a more likely identification, but the results do not allow a firm conclusion.     

Ossified haematomas and infectious bone changes on the anterior tibia: histomorphological features as an aid for accurate diagnosis

Examination of the histological structure of bone not only helps investigators to estimate age at death but can also aid in the diagnosis of palaeopathological lesions. The purpose of this paper is to assess whether histological features as described in the literature can confirm the macroscopic diagnoses of ossified subperiosteal haematomas associated with healed scurvy and syphilitic bone changes observed on the anterior tibiae of individuals from a 19th century mining community from Kimberley South Africa. The frequent occurrence of these two diseases amongst the deceased was well established in related hospital documents and governmental documents. A section of bone was removed from lesions on the tibiae of 14 individuals. These bone changes were macroscopically diagnosed as being indicative of either treponematosis ossified subperiosteal haematomas or non‐specific periostitis. Cross‐sections were prepared for microscopic investigation using a manual ground section technique. Ossified haematomas were histologically identified in seven individuals. These sections were characterised by normal cortical bone an intact original periosteal surface and newly formed radiating trabecular bone apposing it. Three phases of ossified subperiosteal haematoma formation and remodelling could be distinguished. Infectious bone changes most likely associated with treponematosis were observed in one individual. These were characterised by lysis and numerous resorption holes/channels. No clear distinction could be made between the internal spongy cortical or newly formed bone. Histological features described by some authors as characteristic of this condition could not be identified. In addition three individuals presented with microscopic features indicative of both the aforementioned bone affections and three did not show any pathological changes on microscopic level. It was concluded that although specific pathological conditions can most likely not be diagnosed purely on the basis of histomorphological observations broad distinctions could be made between lesions caused by the ossification of subperiosteal haematomas and bone changes due to infectious diseases. Copyright © 2009 John Wiley & Sons Ltd.     

From convicts to colonists: the health of prisoners and the voyage to Australia, 1823-53

From 1815, naval surgeons accompanied all convict voyages from Britain and Ireland to the Australian colonies. As their authority grew, naval surgeons on convict ships increasingly used their medical observations about the health of convicts to make pointed and sustained criticisms of British penal reforms. Beyond their authority at sea, surgeons' journals and correspondence brought debates about penal reform in Britain into direct conversation with debates about colonial transportation. In the 1830s, naval surgeons' claims brought them into conflict with their medical colleagues on land, as well as with the colonial governor, George Arthur. As the surgeons continued their attempts to combat scurvy, their rhetoric changed. By the late 1840s, as convicts' bodies betrayed the disturbing effects of separate confinement as they boarded the convict ships, surgeons could argue convincingly that the voyage itself was a space that could medically, physically and spiritually reform convicts. By the mid-1840s, surgeons took the role of key arbiters of convicts' potential contribution to the Australian colonies.     

Soldiers Mistakenly Reported Killed in Action: Three German World War II Examples Related to Operation Dragoon in August 1944

Abstract

While researching the histories of 492 German soldiers killed in Southern France in August and September 1944, three cases of soldiers having falsely been reported as killed in action were discovered. There were different reasons for each of the misidentifications; in the first case, the precise circumstances are unclear, but may have occurred after an accidental exchange of identification tags with a fellow soldier; the second case was probably caused by a mistaken report from a witness; the third seems to have been misidentification by medical personnel unfamiliar with the bodies they were dealing with. The Wehrmacht used poorly designed identification tags, while there was no use of methods such as fingerprinting and tooth charts when identification tags were not available. Unreliable methods such as visual identification or witness testimony were deemed to be sufficient to report a soldier dead. As a consequence, false reports of death seem to have been relatively commonplace.     

Environmental Geochemistry and Health

Abstract

During the first half-century of political independence, Americans were on the periphery of international science, little more than a minor appendage of European science. However, beginning about 1830, Americans began making great intellectual and institutional strides in science. Although progress varied from discipline to discipline, the end result was the establishment of an autonomous community, conducting research comparable to and in some case superior to, that of their European counterparts. This review records this evolution, utilizing three disciplines as case studies – astronomy, botany, and experimental physics.