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.     

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.     

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.     

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.     

Nutritional and disease stress of juveniles from the Dakhleh Oasis,Egypt

Bioarchaeologists use skeletal health indicators to measure how ancient populations adapted to their physical, cultural and biological environments. Skeletons of infants and children are rarely included in these kinds of analyses because of factors such as poor preservation, small sample size, incomplete recovery or research design. In this study, skeletal remains of juveniles aged from foetal to 15 years (N = 238) from Kellis 2, a Romano‐Byzantine cemetery in the Dakhleh Oasis, Egypt, are analysed to shed light on how infants and children were affected by Roman policies during the early years of the Christianisation of Egypt. Non‐specific indicators of physiological stress (cribra orbitalia, enamel hypoplasia and osteoperiostitis) are analysed for post‐natal individuals and interpreted in the context of the physical, cultural and biological landscapes. Results from these analyses suggest moderate levels of skeletal and dental stress with a marked improvement in general health from pre‐Roman times. This study contributes to a better understanding of juvenile paleoepidemiology and mortuary practices in Egypt during the Romano‐Byzantine period. Copyright © 2010 John Wiley & Sons, Ltd.     

Multiple Injury and Health in Past Societies: An Analysis of Concepts and Approaches,and Insights from a Multi‐Period Study

Earlier clinical and bioarchaeological studies found that injury recidivists were most likely to be young adult males. Since then, the clinical meaning of the injury recidivist has expanded to include all individuals with multiple injuries, and other aspects of health have been considered. Our study sought to apply these advances to paleopathology and place multiple injuries in a wider context by investigating: the age and sex distribution of those with single and multiple fractures, and if people with multiple injuries had poorer general health. The sample of 213 males and 190 females (≥18 years old) from six populations in England, Siberia, and Sudan ranged in date from the 3rd century BC to the mid‐19th century AD. Health variables included cribra orbitalia, porotic hyperostosis, periostitis, Schmorl's nodes, enamel hypoplasias, dental caries, and periodontitis. Ante‐mortem injuries were: fractures (0/1/≥2), myositis ossificans, dental trauma, and sharp‐force injuries. The data were analysed using chi‐square and hierarchical loglinear analyses (P = 0.05). No significant three‐way association between age, sex, and injury was found. There was no difference between the sexes when individuals with single versus multiple injuries were compared. There were significant differences in the age‐distribution of people with 0 and 1/≥2 fractures. Males and those 26–35 years old were most likely to have fractures and multiple injuries. Porotic hyperostosis was significantly associated with fractures. There was no significant relationship between general poor health and multiple injuries. Copyright © 2016 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.     

Retracted: A Possible Case of Hypopituitarism in Neolithic China

A human skeleton with a possible case of hypopituitarism is reported. The individual (burial M53) is from the site of Guanjia, a Neolithic settlement in northern China, dated to the Late Yangshao period (6000–5500 bp ). On the basis of the fully erupted third permanent molars and moderate occlusal dental wear resulting in substantial exposure of dentine, the initially estimated age‐at‐death was placed between 26 and 33 years. However, dimensions of the postcranial skeleton fall significantly below and outside the range from contemporaneous adult populations, and along with delayed epiphyseal fusion present throughout the skeleton, the postcranial age is concordant to that of an 11‐ to 13‐year‐old child. Most long bone epiphyses display incomplete fusion or are entirely unfused, but a lack of microporosity in the metaphyseal areas near growth plates indicates a cessation of longitudinal bone growth. Because no signs of porotic hyperostosis, cribra orbitalia, periosteal lesions or linear enamel hypoplasia are observed, the restricted growth of this individual is likely caused by a growth hormone disorder and is unrelated to nutritional deficiencies or systemic infection. Copyright © 2011 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.     

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.     

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.     

A Palaeopathological Assessment of the Late 19th and Early 20th Century Khoesan

Since the arrival of Dutch colonists in the Cape of Good Hope, South Africa, Khoesan populations were subjected to severe political and economic marginalisation and often fell prey to racial conflict. These circumstances persisted until the early 20th century, during which an astonishing number of Khoesan skeletons were transported from South Africa to various locations in Europe, as at the time, different institutions competed to obtain these remains. The purpose of this study was to assess the health status of the late 19th and early 20th century Khoesan. Skeletal remains housed in two different European institutions were studied. The sample comprised 140 specimens from the Rudolf Pöch Skeletal Collection in Vienna, Austria, and 15 specimens from the Musée de l'Homme in Paris, France. These individuals represent both sexes and were aged between newborn and 75 years, with 54 being younger than 20 years of age. Results indicated high levels of typical disease conditions associated with groups under stress, such as periostitis, cribra orbitalia and porotic hyperostosis. Treponemal disease, rickets, osteoarthritis and trauma were also encountered amongst other more specific indicators of health and disease. This study provided additional knowledge on the health status and lives of the Khoesan people during this turbulent period and created new awareness regarding a group of severely mistreated individuals. Copyright © 2014 John Wiley & Sons, Ltd.     

Relationship between cribra orbitalia and enamel hypoplasia in the early medieval Slavic population at Borovce,Slovakia

Cribra orbitalia and enamel hypoplasia were examined in an early medieval (8^th to beginning of 12^th century AD) skeletal sample of 451 individuals from Borovce, Slovakia. More than 40% of these individuals died before reaching 20 years of age. The relationship between the occurrence of orbital and enamel lesions was analysed by focusing on the age‐specific distribution, and on its influence on demographic parameters. Both features were found in 11.2% of the observed skulls. The presence of orbital and dental lesions showed a considerable impact on mortality as well as the life expectancy. Generally, the highest mortality was observed among 0–4 year old individuals. The greatest discrepancy in the demographic parameters, however, appeared between the affected and unaffected individuals aged 10–14 and 15–19 years. In these two age groups the co‐occurrence of both lesions was most frequently recorded. These individuals obviously had a history of sickness, and thus could not cope with further bouts of disease and with the increased physiological demands of pubertal growth. The missing correlation in younger age categories can be largely explained by the difficulty of macroscopically examining the permanent dentition, since an interrelationship between the age at hypoplasia development and the occurrence of cribra orbitalia was detected. Several differences between the individuals with enamel defects and both conditions were observed in the distribution of age at hypoplasia formation. According to these results, several factors, such as impaired health status, growth demands and diet, influence the development of enamel hypoplasia and cribra orbitalia in a particular population. It is possible that after reaching a certain threshold, the underlying factors act synergistically in a kind of vicious cycle as the balance between the immune system, metabolism, and exogenous factors such as pathogens and nutrition, is disturbed. Copyright © 2007 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.     

The relationship of bone mineral density and other growth parameters to stress indicators in a medieval juvenile population

In this study the radii of 34 juveniles from Wharram Percy, a British medieval site, were measured for bone mineral density (BMD) using dual energy X‐ray absorptiometry (DXA) in order to investigate evidence of stress including Harris lines, cribra orbitalia and deficient cortical index, which is usually attributed to poor nutrition. BMD measurements are used in modern children to assess growth and development and generally correlate with linear growth. Only rare chronic illnesses affect bone mineral accrual in children. Radiographs of the radii were examined to assess cortical index and of the femora and radii for Harris lines. The results indicate that BMD is well correlated with dental age and linear growth, but is poorly correlated with cortical index. The variability in cortical index indicates the influence of environmental factors. There is no relationship between BMD and the presence or absence of Harris lines or cribra orbitalia. Thus, despite obvious evidence of skeletal stress in this juvenile population, bone was not under‐mineralised and bone mineral accrual proceeded normally with growth. This reinforces the conclusion that cortical index is a more sensitive indicator of environmental stress than either Harris lines or cribra orbitalia, and may be compared with BMD measurements to assess the effect of stress on growth. Copyright © 2005 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.     

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.     

A Case of Maternal and Perinatal Death in Neolithic Southern Vietnam,c. 2100–1050 BCE

Despite ostensibly elevated rates of young female mortality in the past, believed to be associated with the risks of pregnancy and child birth, surprisingly few cases of pregnant female burials are reported in the bioarchaeological literature. This paper describes and discusses the case of a young female who died and was interred with an unborn full‐term breech foetus at the Neolithic site of An Son, southern Vietnam c. 2100–1050BCE. Her exceptionally poor oral health, evidence for cribra orbitalia, linear enamel hypoplasia, small stature and compromised gynaecological competence, contributes to a differential diagnosis that explores a range of additional complications that may have contributed to the death of both mother and unborn child. An examination and appreciation of this case contribute to our knowledge of the reproductive age and health of young females in Neolithic Southern Vietnam and the challenges they faced during pregnancy and childbirth. Copyright © 2011 John Wiley & Sons, Ltd.