Rural Rickets: Vitamin D Deficiency in a Post‐Medieval Farming Community from the Netherlands

Rickets is caused by vitamin D deficiency as a result of limited exposure to sunlight and inadequate diet. In the 19^th century, rickets was endemic in most northern European cities. In post‐Medieval Netherlands, rickets is documented in low frequencies in a few urban samples, but has not been studied in contemporaneous rural populations. Beemster is a rural farming community in the Netherlands that was established in the 17^th century upon drained land, with the Middenbeemster cemetery in use until 1866 AD. Ninety‐five individuals from the ages of 32 weeks in utero to 15 years were examined for rickets in order to understand factors that can cause vitamin D deficiency in rural, non‐industrialized populations. To identify rickets in the Beemster sample, ten features were scored, with bending deformities of the lower limb and one other feature, or at least three non‐bending features, having to be present in order for diagnosis. Nine individuals (9.5%) had evidence of rickets—a high prevalence, especially for a rural community where ample sunlight was available. The two and three year old Beemster infants were most heavily affected with an age‐specific prevalence of 30.4%. Two three‐month‐old infants also had rickets. Some of the affected may have developed rickets secondarily, as a result of a different illness, but cultural practices including prolonged swaddling, occlusive clothing, and keeping the young indoors, are suggested to have contributed to this high rickets prevalence. Dietary variables including poor weaning foods and common episodes of malnutrition may have also contributed to vitamin D deficiency. This study demonstrates the value of careful analysis of pathological conditions in subadults and highlights that rickets was not only a disease of cities, but affected populations that would appear to have been at low risk, because of maladaptive cultural practices. Copyright © 2013 John Wiley & Sons, Ltd.     

Rickets in a High Social Class of Renaissance Italy: The Medici Children

Exploration of the Medici Chapels in the Basilica of San Lorenzo in Florence revealed the burials of nine juvenile members of the Medici family (16th–17th centuries). The estimated children's skeletal ages ranged from newborns to 5‐year‐olds, showing a series of bone abnormalities, in particular diffuse periosteal new bone and bowing of long bones. The comparable pathological lesions, including porosity evident on the skull, orbital roofs, costocondral ribs and growth plates between metaphyses and epiphyses, enlargement of metaphyses and sternal rib ends, and long bone bending, are interpreted as the skeletal manifestation of rickets. The diagnosis of a metabolic disease linked to vitamin D deficiency would appear to be unexpected for children brought up at the court of a Renaissance elite class family like the Medici of Florence. Analysis of the historical and social background is particularly helpful to understand the causes of the onset of the disease in this aristocratic group. Documentary sources, supported by ¹³C and ¹⁵N bone collagen analysis, attest that weaning of these children took place when they were around 2 years old. With a prolonged breast‐feeding and a delay in introducing solid food in the diet, vitamin D deficiency is expected to rise considerably, in particular if the other main risk factor, namely inadequate sunlight exposition, is associated with this human milk‐based diet. Copyright © 2013 John Wiley & Sons, Ltd.     

Evaluation and interpretation of residual rickets deformities in adults

Recent research has considerably improved the recognition and recording of rickets and osteomalacia in archaeological human bone, but the recognition and recording of residual deformities of rickets present in adults is still limited. The aim of this study was to assist with differential diagnosis of residual rickets deformities and determine which of the deformities that are characteristic of rickets could be identified in the adult skeleton. Long bone deformities were investigated, with research focusing on deformities of the leg bones. One hundred and thirty‐five adults from the historic cemetery of St Martin's, Birmingham, where vitamin D deficiency was known to have been widespread, were analysed. Deformities of leg bones were three times as frequent as arm bone deformities, and deformity of both the femur and tibia was the most frequently recorded combination of leg bones. Medial bending of the tibiae and anterior bending of femora, both at the proximal end, were the most frequently recorded types of deformities. A review of a range of conditions that can cause bowing deformities, and comparison of bowing recorded in children with rickets and the present cases, concluded that the most likely cause of the deformities recorded was residual changes linked to rickets. In this community, bowing deformities linked to rickets were quite common amongst adults and probably did not have adverse social consequences, but further studies are required to determine whether this attitude to deformity was more widespread. Copyright © 2008 John Wiley & Sons, Ltd.     

Skeletal evidence for hyperparathyroidism in a 19th century child with rickets

The skeletal remains of a child aged 2.5–3.5 years, recovered during archaeological excavations at the churchyard of St Martin's Church, Birmingham, UK, were examined using gross observation, radiography and scanning electron microscopy. Lesions suggestive of the presence of rickets and of secondary hyperparathyroidism were found. This appears to be a first report of secondary hyperparathyroidism in response to rickets in a palaeopathological specimen. The potential of microscopic examination of bone for interpreting disease processes is emphasised. Copyright © 2006 John Wiley & Sons, Ltd.     

Secular decline in cranioskeletal size over two millennia of interior central California prehistory: Relation to calcium deficit in the reconstructed diet and demographic stress

An osteometric study of residual rickets (RR) skeletal plasticity has been made of a time-ordered sequence of fifteen series of adult skeleton sets (n=359) from the Great Valley of central California (GV), spanning the three archaeological horizons of California Indian prehistory in this region: Early (EH), Middle (MH) and Late (LH). By least-squares linear regression analysis, a clear and continuous downward trend obtained in cranioskeletal size in both sexes, proceeding from EH to LH in the GV sequence, pari passu with a steady upward trend in the RR-15 score. To ascertain if dietary calcium deficit (CADEF), a known cause of active rickets, can explain the observed secular increase in RR, the aboriginal diet was reconstructed by the diet grid method: CADEF was found to rise from borderline in the EH, to moderate in the MH, to severe in the LH, as the subsistence base shifted gradually away from hunted prey, and storable seed foods—mainly leached acorn meal—became the dominant source of energy. Further regression analysis has shown that the secular upward trend in CADEF is highly correlated with the temporal clines of the GV sequence, directly with the RR-15 score, and inversely with cranioskeletal size: in round numbers, one grade of CADEF brings about a loss of 120 cm³ or 4 per cent in partial skeleton volume. Two biocultural influences—demographic stress (DS) in females, and the less common ‘male nutritional advantage interaction co-factor’ (MNAIC)—modulate the primary bone antitrophic CADEF effect: DS enhancing, MNAIC ameliorating.     

A possible fatal wounding in the prehistoric Pacific Islands

This paper reports two cases of prehistoric interpersonal violence from Taumako Island, southeast Solomon Islands. The first case is a young child with a bone point found in situ in a lower lumbar vertebra. It is concluded that this child most likely died as the result of the injury. The second case is a male of advanced age with a well‐remodelled depression fracture on the frontal bone of the skull. This individual also has a remodelled penetrating wound to the left iliac crest of the pelvis. Warfare is thought to have been endemic in much of the Solomon Islands before European arrival. However, besides the two cases reported here there is little other evidence of trauma in the Taumako population. The young child is the first case of an in situ weapon reported from the prehistoric Pacific Islands. Copyright © 2000 John Wiley & Sons, Ltd.     

Infancy and childhood in the pre‐Columbian North American Southwest–first results of the palaeopathological investigation of the skeletons from the Grasshopper Pueblo,Arizona

Infant and child skeletons (n = 369) from the pre‐Columbian Grasshopper Pueblo site in east‐central Arizona (US) dating from the 14^th century AD were examined macroscopically and with low‐power microscopy. They were studied as a representative example of a typical Mogollon community with respect to frequencies of deficiency and inflammatory diseases. First results revealed very poor living conditions, which are characteristic for this time period in the North American Southwest because of lack of food due to climatic and political changes. Thus, non‐specific stress indicators were frequently observed. In the group of deficiency diseases, anaemia was found in more than 50% of individuals, and in the group of inflammatory diseases, meningeal irritations were diagnosed in more than 70%. Copyright © 2007 John Wiley & Sons, Ltd.     

Elder Abuse: Evaluating the Potentials and Problems of Diagnosis in the Archaeological Record

The elderly are the most neglected demographic in archaeology. In today's youth‐obsessed society, the elderly are consistently denigrated, particularly those perceived to be physically or mentally frail. A related and growing concern in contemporary populations is the physical abuse of the elderly, believed to be an escalating phenomenon. This study is the first to examine the risk factors, social context and patterns of trauma associated with elder abuse in the present, with the aim of providing diagnostic criteria to apply to past societies. The utility of skeletal evidence in the identification of violent trauma has been detailed in cases of child and intimate partner abuse, both modern and archaeological. Investigating the skeletal evidence for elder abuse is potentially more complex because of the confounding physiological effects of the ageing process, lack of clinical research and contemporary ageist attitudes towards older people. Within the clinical and bioarchaeological literature, there has been a tendency to dismiss injuries in older individuals as the product of accident or opportunistic violence. A proportion of elder members of past societies is likely to have been victims of abuse and family violence. While there are no pathognomonic skeletal features of elder abuse, multiple injuries to the bones of the following are indicative: cranium, maxilla‐facial region, dentition, cervical vertebrae, clavicles, ribs and spiral fractures to the humeri. Attention is also drawn to decubiti as indirect skeletal indicators of immobility and possibly neglect. Archaeological context is important to consider, including non‐normative burials or those indicating social marginalisation. Bioarchaeological evidence has the potential to provide a long‐term perspective on the care and treatment of past elders. Copyright © 2015 John Wiley & Sons, Ltd.     

The effect of growth on stable nitrogen isotope ratios in subadult bone collagen

Stable nitrogen isotopes have been used to reconstruct infant feeding practices as nursing infants have elevated δ¹⁵N ratios compared with their mothers. However, infancy is also a time of rapid growth, which may alter nitrogen isotope diet‐to‐tissue spacing. Several studies have documented a decrease in δ¹⁵N during growth in tissues with relatively fast accretion rates. This study investigates the effect that the growth of long bones, via collagen accretion, has on δ¹⁵N ratios. Long bones from individuals aged seven to nineteen years were obtained from a protohistoric ossuary in Ontario, Canada. Analysis of juveniles and adolescents permitted the examination of growth in a group who were not also nursing. It is concluded that a nitrogen isotope growth effect is not detectable in bone collagen from juveniles and adolescents, because: (1) δ¹⁵N ratios are not significantly different among the epiphyses, metaphyses and diaphysis of a growing long bone; (2) δ¹⁵N ratios are not significantly different between faster‐growing versus slower‐growing metaphyses; and (3) δ¹⁵N ratios are not significantly different between bones (or areas of a bone) that are still undergoing growth, versus bones that have ceased growing. The relatively slow speed of collagen accretion may explain why a growth effect is not manifested. Ultimately this research lends support to the use of nitrogen isotopes from bone collagen for infant feeding reconstructions. Copyright © 2009 John Wiley & Sons, Ltd.     

Residual rickets or osteomalacia: a case dating from the 16–18th centuries from Krosno Odrzańskie,Poland

A skeleton from a 16–18^th century burial site in Krosno Odrzańskie, Poland, was examined using classical morphological, metric and macroscopic palaeopathological observations, as well as radiography and tomography of the skull and long bones. A wide variety of the observed bone deformations probably occurred as a consequence of past rickets and/or osteomalacia, whose primary cause may also have been chronic renal failure. Preservation of the bones enables a discussion of the cause of such pathological changes. The subject under study appears to be a very interesting example of an individual whose skeleton shows advanced pathological alterations associated with the subject's vitamin D deficiency, overall health conditions and relatively long lifespan. Copyright © 2008 John Wiley & Sons, Ltd.     

Insights into the processes behind the contamination of degraded human teeth and bone samples with exogenous sources of DNA

A principal problem facing human DNA studies that use old and degraded remains is contamination from other sources of human DNA. In this study we have attempted to contaminate deliberately bones and teeth sampled from a medieval collection excavated in Trondheim, Norway, in order to investigate this poorly understood phenomenon. Five pairs of teeth and bone samples were bathed in water containing various concentrations (from 10⁻⁹ and 10⁻²¹ g/l) of purified ΦX174 DNA. Subsequently the samples were subjected to a routine decontamination protocol involving a bleach bath followed by exposure to λ=254 nm ultraviolet light, prior to DNA extraction and analysis for evidence of the persistence of the contaminant. The results support previous speculation that bone is more susceptible to water‐borne sources of contaminant DNA, although both bone and teeth are readily contaminated and are difficult to decontaminate using the tested protocol. We believe that this is largely due to the porous nature of bone and teeth facilitating the deep penetration of the contaminant DNA. To simulate a more realistic handling situation, 27 further teeth were directly handled and washed, then decontaminated, prior to assaying for the residual presence of the handler's DNA. Surprisingly, although our results suggest that a large proportion of the teeth were contaminated with multiple sources of human DNA prior to our investigation, we were unable to contaminate the samples with further human DNA. One potential explanation may be the deposition of sediment or other structural changes that occur within the samples as they desiccate post‐excavation, which may protect samples from subsequent contamination, but also prevent the efficacy of bleach baths in decontaminating specimens. Copyright © 2006 John Wiley & Sons, Ltd.     

A Simple(R) Model to Predict the Source of Dietary Carbon in Individual Consumers

Quantitative individual human diet reconstruction using isotopic data and a Bayesian approach typically requires the inclusion of several model parameters, such as individual isotopic data, isotopic and macronutrient composition of food groups, diet‐to‐tissue isotopic offsets and dietary routing. In an archaeological context, sparse data may hamper a widespread application of such models. However, simpler models may be proposed to address specific archaeological questions. As a consequence of the intake of marine foods, individuals from the first century ad Roman site of Herculaneum showed well‐defined bone collagen radiocarbon age offsets from the expected terrestrial value. Taking as reference these radiocarbon offsets and using as model input stable isotope data (δ¹³C and δ¹⁵N), the performance of two Bayesian mixing model instances (routed and concentration‐dependent model versus non‐routed and concentration‐independent) was compared to predict the carbon contribution of marine foods to bone collagen. Predictions generated by both models were in good agreement with observed values. The model with higher complexity showed only a slightly better performance in terms of accuracy and precision. This demonstrates that under similar circumstances, a simple Bayesian approach can be applied to quantify the carbon contribution of marine foods to human bone collagen.     

Osteometric scoring of adult residual rickets skeletal plasticity in two archaeological populations from southeastern England: Relationship to sunshine and calcium deficits and demographic stress

An osteometric scoring technique is developed for the quantification of rickets deformational effects persisting in the healed adult skeleton. Termed RR-15 scoring (for residual rickets estimate, based on 15 main diagnostic osteometric traits), the method is first validated for sunshine deficit, and is then tested in a comparison of three climatically distinct archaeological populations from southeastern England. Two well-dated cemetery series were sampled: the Saint Bride's Church columbarium collection (SBC) from London at the time of the Industrial Revolution, for which the sex, age, and calender year at death of each individual are known; and the early Anglo-Saxons from Abingdon, near Oxford (AAS). Estimates of insolation in the past were developed indirectly by reference to δ¹⁸O mass spectrometer analyses of dated layers of the Greenland ice sheet. In SBC and AAS, the RR-15 score varies primarily as a direct function of computed sunshine deficit, but is also incremented by deficits of bioavailable calcium in their reconstructed diets, and by demographic stress in AAS, the inferred result of a high birth rate. The amounts of interglobular dentine present in the permanent first and third molar crowns of SBC and AAS have been shown to correlate similarly with sunshine and calcium deficits. The relatively high RR-15 score obtained in a small sample of northwestern European neanderthals lends quantitative support to the bioenvironmental hypothesis that sunshine-deficit rickets accounts for much of their paranormal gross morphology.     

Isolation and Isotopic Analysis of Individual Amino Acids from Archaeological Bone Collagen: A New Method Using Rp‐hplc

This paper presents a new method for the isolation and isotopic analysis of some individual amino acids from proteins. The technique and its constituent steps are discussed; then isotopic analyses of amino acids from several samples of bone collagen from the Late Roman site of Poundbury, Dorset, UK are presented. The applications of the method are discussed, as well as some advantages of this technique relative to other methods. Although developed for use with archaeological bone collagen, the technique is equally applicable to other proteinaceous materials. The use of reversed‐phase HPLC avoids problems of isotopic fractionation inherent in using ion‐exchange HPLC. Amino acids are isolated preparatively, allowing both carbon and nitrogen isotopic values to be measured on a single sample using CF‐IRMS. Since amino acids are isotopically analysed in an underivatized form (unlike GC‐C‐IRMS), the method also presents the possibility of collecting the CO₂ generated during CF‐IRMS: this would allow the subsequent dating by ¹⁴C‐AMS of individual amino acids isolated from archaeological samples.     

A pre‐Columbian case of congenital syphilis from Anatolia (Nicaea, 13th century AD)

In this study, the skeleton of an approximately 15‐year‐old child, dating back to the Late Byzantine period (13th century AD) is examined with the aim of determining where this specimen fits in the continuing arguments on the origins of syphilis. It was unearthed during an excavation at an amphitheatre in Nicaea dating to the Roman period. The Nicaea specimen displays common symptoms found in the majority of people with congenital syphilis such as Hutchinson's incisor, mulberry molar, darkened enamel, radial scar on frontal bone, sabre tibia, syphilitic dactylitis, and gummatous and non‐gummatous osteomyelitis on almost every post‐cranial bone. Because of the sub‐periosteal new bone formation, the medullary spaces in some long bones are narrowed or completely obliterated. These lesions, which were observed via macroscopic and radiological examination, reflect the late stages of congenital syphilis. The specimen, when examined together with increasing numbers of other finds from the Old World, contributes to the argument that venereal syphilis did exist in the Old World before 1493, and brings forward the need to revise the Columbian hypothesis, which maintains that syphilis is a new disease carried to the Old World from the New World by Columbus' crew. Copyright © 2005 John Wiley & Sons, Ltd.     

Multiple bone tuberculosis in a child from predynastic Upper Egypt (3200 BC)

Tuberculosis, one of the most ancient human diseases, was present in ancient Egypt and has been observed since predynastic times. Excavations in the predynastic to early dynastic necropolis of Adaima, Upper Egypt (3500–2700 BC) led to the discovery of a number of remarkably well‐preserved skeletons of children. The skeletal remains of a 4.5–5‐year‐old child dated from Nagada III A2 (3200–3100 BC) displayed various lesions on the post‐cranial skeleton: spondylitis on the thoracic (T12) and lumbar (L1) vertebrae, partial lytic destruction of the right radio‐ulnar joint, lytic lesions on the scapula and a clavicle, dactylitis on the short bones of hands and feet, enlargement (spina ventosa) and periosteal new bone formation on the long bones. Radiographs show well‐defined radiolucent (cyst‐like) lesions in the metaphysis and the diaphysis of long tubular bones (ulna, radius, femur, tibia, fibula). The lesions recorded during macroscopic and radiological analysis strongly suggest a case of multiple bone tuberculosis. The occurrence of this case of tuberculosis in a child provides a picture of a period where tuberculosis must have been endemic throughout the population living during the origins of urban settlement in Upper Egypt during the predynastic period. Copyright © 2009 John Wiley & Sons, Ltd.     

Stable Carbon and Oxygen Isotope Spacing Between Bone and Tooth Collagen and Hydroxyapatite in Human Archaeological Remains

Spacing between stable isotope values in bones and teeth is a valuable tool for examining dietary influences and diagenesis. This study examines carbon and oxygen isotope values from collagen and hydroxyapatite (structural carbonate and phosphate) in archaeological human bones and teeth to derive species‐specific correlation equations and isotope spacing values. The δ¹³C_collagen and δ¹³C_{structural carbonate} in bone and dentin collagen show a strong correlation (R = 0.87, 0.90, respectively) with an average Δ¹³C_carb‐coll spacing of 5.4‰. The consistency of this isotope spacing with other large mammals and in humans with both low and high protein intake (as indicated by enriched δ¹⁵N values) suggests a similar allocation of protein‐derived carbon and whole diet‐derived carbon to collagen and structural carbonates, respectively, as other terrestrial mammals regardless of absolute meat intake. The δ¹⁸O_{structural carbonate} and δ¹⁸O_phosphate show the strongest correlation in enamel (R = 0.65), weaker correlations in dentin (R = 0.59) and bone (R = 0.35), with an average Δ¹⁸O_carb‐phos of 7.8‰. This isotope spacing is slightly lower than previously reported for large mammals and limited available data for humans. The results potentially indicate species‐specific fractionations and differing access to body water and blood‐dissolved inorganic carbonates in the presence of collagen formation. The use of correlation between δ¹⁸O_{structural carbonate} and δ¹⁸O_phosphate to determine diagenetic state is not recommended. The strength of this correlation observed in bones and teeth is variable and alternate indicators of diagenetic state (i.e. C:N ratios of collagen) provide more robust and independent evidence of isotope preservation despite presence/absence of a strong isotope correlation. Published 2012. This article is a U.S. Government work and is in the public domain in the USA.     

A Probable Case of Acute Childhood Leukemia: Skeletal Involvement,Differential Diagnosis,and the Bioarchaeology of Cancer in South America

Cancer involves a complex spectrum of disease conditions. However, cancer has received relatively limited attention in paleopathology and bioarchaeology as it is infrequently encountered in the skeletal record, and its differential diagnosis in dry bone remains challenging. Of all neoplastic disorders, one of the most infrequently described forms in ancient skeletons is leukemia, or the myeloproliferative neoplasms of the reticuloendothelial system affecting bone marrow and blood. This case study describes and interprets a suite of lytic and proliferative lesions in the skeletal remains of an Early/Middle Colonial‐era child (ca. A.D. 1533–1620) excavated at the ruins of Eten, southwestern Lambayeque Valley Complex (north coast of Peru). A secondary burial contained the incomplete postcranial remains of a 5–6 year‐old child whose bones were characterized by abnormal porous loci in the right clavicle, scapulae, long bones of the upper limb, ribs, and thoracic and lumbar vertebrae. Additionally, fine areas of new bone formation were present on the clavicle and ribs. Multiple pathological conditions were evaluated in a differential diagnosis, including taphonomic changes and various bone resorbing and forming disorders. The lesions are most consistent with acute childhood leukemia and represent the first of its kind described in Andean South America. The identification of this condition helps focus research questions involving the bioarchaeology of cancer in the Andes, especially regarding the significance of neoplastic disorders in relation to the broader reconstruction of past human health in Peru. Copyright © 2014 John Wiley & Sons, Ltd.     

REVIEWING CHILD ABUSE POLICY IN AMERICA: A SOCIAL SERVICE APPROACH

For all the recent attention to the problems of child abuse and neglect, this specific policy area has rarely been examined as belonging to the more general area of social service policy. This article begins to remedy this omission. First, the article examines child abuse policy in terms of the conflicts of value faced in the formation of social service policy. Next, the relationship between child abuse and other recent social service issues responding to familial violence or childhood dependency is discussed. Here the article shows that governmental response to child abuse has been used to encourage governmental interest in adoption reform, sexual exploitation of children, domestic violence, and day care.