Porotic lesions in immature skeletons from Stara Torina,late medieval Serbia

Porotic lesions of immature skeletons have been attracting scientific attention for more than a century. These changes have been documented worldwide and are considered to be one of the indicators of health and/or nutritional status of past human populations. These lesions have frequently been referred to as a nutritional stress indicator, a manifestation of iron‐deficiency anaemia, and a condition caused by chronic infections. In this study, 327 immature skeletons from the medieval graveyard of Stara Torina (Serbia) were examined for macroscopic signs of four types of porotic lesions: cribra orbitalia, femoral cribra, humeral cribra, and porotic hyperostosis. Femoral cribra was observed in 83.25% of femora, humeral cribra in 58.46% of cases, cribra orbitalia in 46.12% of orbits, while porotic hyperostosis was recorded in only 2.94% of skulls. The majority of skeletons affected by cribra presented symmetrical lesions. Association between all types of cribra was recorded in 33.33% of skeletons. Historical data supported the hypothesis that the investigated population was exposed to frequent infections, especially parasitic ones, which led to the development of porotic bone lesions via several mechanisms: parasite‐induced blood loss and diarrhoea (both iron and magnesium malabsorption) or anaemia as a hepcidin‐mediated body adaptive response to infection. Copyright © 2008 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.     

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.     

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.     

The necropolis of Vallerano (Rome, 2nd–3rd century AD): an anthropological perspective on the ancient Romans in the Suburbium

The present study investigates the skeletal remains of individuals who were part of a Roman suburban community, in order to assess lifestyle and living conditions in the town's outskirts during the Roman Imperial age. The existence of the community was linked to the functioning of one of the many villas that surrounded the town of Rome at that time. In order to assess health, several indicators were explored, including mortality, oral pathologies and specific (cribra orbitalia) and aspecific (linear enamel hypoplasia) indicators of nutritional and physiological impairment. The sample, which probably represents the labour force of the villa, shows a high number of individuals dying in the early adult age and very few living beyond 50. Subadults were frequently affected by pathological conditions which may indicate anaemia and/or inflammations and infections, as witnessed by the frequency of cribra orbitalia. Growth was also impaired, as the individuals suffered from systemic disturbances during the early years of life that led to the formation of linear enamel hypoplasia (LEH) in their teeth. Frequency of LEH is very high, as well as its multiple occurrence through time (2.44 defects per individual) and its onset occurs from the earliest age classes. Diet, on the other hand, does not seem to have been particularly carbohydrate based. Oral pathologies are very low, which is consistent with meat consumption complementing a diet rich in low‐calorific products of agriculture and seemingly low in refined carbohydrates. Copyright © 2005 John Wiley & Sons, Ltd.     

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.     

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.     

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.     

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.     

Thalassemia: macroscopic and radiological study of a case

Differentiation of the genetic and the acquired anaemias, particularly in areas of the world where they may co‐exist, has been a challenge for palaeopathologists for over 100 years. In this paper we present macroscopic and radiographic skeletal lesions that are associated with the thalassemias in a 14‐year‐old girl from a modern reference collection of the University of Athens. This individual is of known sex, age, cause of death, place and dates of birth and death. The case is examined in terms of epidemiology, growth, distribution and severity of lesions and differential diagnosis. The entire skeleton is affected by marrow hyperplasia: lesions of the axial skeleton are extreme, and the appendicular skeleton is severely affected as well. The odontofacial manifestations that are diagnostic of thalassemia and differentiate it from other anaemias are present and include: maxillary and mandibular hyperplasia, reduced sinuses, displacement of maxillary dental structures, overbite, and generalised osteopenia. The development of extreme bone lesions and the ‘advanced’ age‐at‐death of this individual is explained as either the result of thalassemia major under a low transfusion regimen that was the norm during her lifetime, or to a form of thalassemia intermedia that allows survival to later life at the expense of gross skeletal alterations. The present status of skeletal studies in Greece does not support the identification of a genetic anaemia in past populations. The potential contribution of the current analysis in differentiating the anaemias in antiquity is evaluated. Copyright © 2006 John Wiley & Sons, Ltd.     

HEALTH SELECTION EFFECTS IN CHINA'S INTERNAL MIGRATION

Drawing data from the 2008 survey of Internal Migration and Health in China, we compare various health indicators among current rural-to-urban migrants, rural residents who never migrated, return migrants, and urban citizens. Two health-selective mechanisms, the healthy migrant hypothesis and the salmon bias hypothesis, are empirically tested. Results provide empirical support to both these hypotheses. After controlling for individual's age, sex, socioeconomic status and major health-related behaviours, current rural-to-urban migrants are still better off than rural residents who never migrated regarding their self-rated general health, chronic diseases, self-perceived physical discomfort and lung capacity. Current rural-to-urban migrants are also less likely to have chronic diseases or to report physical discomfort than return migrants. Except for self-reported chronic diseases and abnormally high heart rate, there is no significant difference between rural-to-urban migrants and urban residents regarding the health measures used in this study.     

Health status of the Venda,a post‐antibiotic community in rural South Africa

This paper examines the health status of a rural African community during the emergence of Westernisation. A total of 157 skeletons, which included 120 adults (55 males and 51 females), 37 juveniles, and 14 individuals of unknown age, were analysed. Date of death ranged from 1910 to 1999, with the majority of individuals (52%) being buried after 1960. The bones were examined for infectious diseases, trauma and degenerative changes. More than half of the individuals in the sample had no pathological lesions on their skeletal remains. No cribra orbitalia was present. One case of leprosy and three cases of osteomyelitis were recorded. The most common findings were osteophytes on the vertebral bodies (syndesmophytes) (17%) and osteoarthritis (7%). The low occurrence of chronic disease is unexpected given that malaria was endemic and intestinal worms were common. Explanations for these results include adequate intake of iron from dietary sources, death from acute infectious diseases, administration of antibiotics, and poor preservation of adult skeletal remains. Copyright © 2007 John Wiley & Sons, Ltd.     

The end of slavery: Disease patterns and cultural behaviours of African Americans in Suriname

There have been few bioanthropological studies related to African Americans, either slaves or free people. The results of an analysis of eight skeletons of African ancestry (five males and three females) acquired in Suriname at the end of the 19th century by Dr J. Spilzley and currently housed in the Duckworth Collection (University of Cambridge) are presented. Dental abrasion related to habitual pipe smoking was observed in four individuals, confirming the widespread use of pipe to smoke tobacco among slaves observed in other related sites. Our results indicate a very poor state of oral health for these individuals, with females presenting a higher frequency of dental carious lesions and antemortem tooth loss in comparison with males. The presence of cribra orbitalia in some individuals suggests, as observed in other diaspora skeletal series, individuals suffering from severe stress, caused by poor nutrition, infectious diseases, or both. Such appalling life conditions agree with many written records, which describe very harsh work conditions and very deprived diets. Our results, although based in a small sample, contribute to a better understanding of the cultural behaviours as well as the patterns of disease that afflicted the African Americans in Suriname in the 19th century. Copyright © 2010 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.     

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.     

A Roman Skeleton with Possible Treponematosis in the North‐East of the Iberian Peninsula: A Morphological and Radiological Study

The main goal of this paper is to describe and discuss pathological lesions observed in a Roman skeleton (between 2^nd and 3^rd century AD) from the north‐east region of the Iberian Peninsula (St Nicasi 18–24 site. Gavà, Barcelona), which may be compatible with treponematosis. Most of the skeleton, with the exception of the neurocranium, was recovered. Only the left tibia was affected, whereas the rest of the recovered skeletal remains were unaffected. Macroscopic examination revealed a male individual between 25 and 30 years of age at death with a sabre‐shaped left tibia. The proximal half of the diaphysis was pitted and the bone overall enlarged. The surface of the tibia showed occasional vascular impressions where, in some instances, small raised plaques of new bone appeared to bridge over them, specifically in the most affected area of the proximal half of the tibia. No destructive lesions were observed. Radiographic examination and gross inspection at the cross section of the tibia showed encroachment into the medullary cavity of coarse cancellous bone and cancellization of the cortex. The observed lesions indicate that the tibia was affected by a chronic infectious disease. Differential diagnoses were considered, and these included other infectious diseases, fibrous dysplasia, Paget's disease, chronic varicose ulcers affecting bone and trauma, with the conclusion that the disease affecting the tibia could have been treponematosis. This could be significant in the history of the treponematoses being one of the oldest examples of treponematosis in pre‐Columbian Europe. Copyright © 2011 John Wiley & Sons, Ltd.     

Unequal in life? Human remains from the Danish excavations of Tylos tombs

The Danish excavations in Bahrain of Tylos graves at Sar and from Pylon T158 resulted in the recovery of seventeen skeletons. Apart from a single infant, all remains were of adults with females dying, on average, at a younger age than males. Among the pathological conditions identified, porotic hyperostosis (frequently linked to anaemia) was common. Infectious lesions were observed including two cases tentatively diagnosed as tuberculosis. The only other pathological condition noted was a possible case of skeletal fluorosis. This range of disease is comparable to other skeletal samples dating to the Tylos period. Measurements also indicate that these samples are similar to other Tylos remains from Bahrain. A feature of this period is the disparity in health between males and females, evidenced by differences in robusticity and height. This disparity is more marked than in other periods and it is argued that it is evidence of a greater inequality on the island during this period.     

HEALTH OF HOME-BASED SEX WORKERS AND THEIR CHILDREN IN RURAL ANDHRA PRADESH,INDIA

This study uses secondary data from 2006 to assess the physical and mental health of rural, home-based sex workers and their young children in rural Andhra Pradesh state of India. The analyses of survey and clinical data show a high level of morbidity amongst sex worker women and their children. Women show high levels of nutritional deficiencies, anaemia, weight loss and hospitalisation. Women's mental health is particularly serious, with 92 per cent being depressed and 57 per cent having attempted suicide. The majority have experienced domestic and work-related violence, including rape. Clinical assessments of sex workers’ children show that most have received vaccinations, but almost half have parasites, dental problems and nutritional deficiencies. Both the physical and mental health of sex worker mothers are associated with the health of their children. Therefore, health interventions focusing on sex worker mothers have the potential to improve the health of their children.