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.     

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.     

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.     

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.     

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.     

Diagnostic criteria for identification of seashell as a trephination implement

Scanning electron microscopy has been applied to experimentally cut bone samples and an ethnographical example of trephination on a human skull in order to produce diagnostic criteria for the identification of mollusc shells as cutting implements used in trephination. Shell scrapes are identifiable by parallel striations in the direction of cut, crossed at 90° by chatter marks caused by uneven movement of the fragile shell-edge across the bone surface.     

Rickets and child abuse: the case of a two year old girl from the 4th century in Lisieux (Normandy)

The burial of a child of two years of age from the 4^th century site of Lisieux‐Michelet (Calvados, France) was examined for bone hyperplasia and a variety of mechanical deformations recognized in association with skeletal trauma. Results of DNA analysis of bone using the PCR method identified this child as female. Microscopic features of the teeth (interglobular dentine) and a sample taken from the tibia conclusively determined that this child suffered from vitamin D‐resistant rickets and possibly X‐linked hypophosphataemic rickets as its most common form of occurrence. In addition, evidence for child abuse is suspected based on the presence of cranial and tooth fractures and the appearance of successive plaque‐like endocranial (meningeal) appositions. This is the first palaeopathological report of child abuse in antiquity. Copyright © 2002 John Wiley & Sons, Ltd.     

Like You Need a Hole in the Head: Tool Innovation a Possible Cause of Trephination. A Case from Kerma,Nubia

This paper presents one case from Kerma (ind‐14.1.595 or K317) which was initially reported to have a ‘fatal traumatic wound’ in the front of the skull. The individual has a dime sized, circular hole with no radiating or concentric fracture lines associated with it. It also shows clear evidence of healing along the inside edges of the pathology. This was according to the preliminary, and only, analysis performed when excavated at Kerma (1913–1916), which was most likely performed by a crew member not formerly trained in anthropology, or medical science. Differential diagnosis will be discussed with respect to this lesion actually being a form of traumatic injury, possible remnants of a bony tumour, and trephination, among other diagnoses. Trephination has been identified in ancient Egypt and Nubian studies, though it is a rarity. Although trephination is a possible cause for the present lesion, this example does not fit the morphology of any other examples of the practise from this region or time period. Given that there have been similar borings witnessed on architecture from the Egyptian Old Kingdom, this lesion may suggest implementation of an already present architectural tool for medical purposes among the Kerma Nubians. Copyright © 2011 John Wiley & Sons, Ltd.     

Fishing Gear from a 7th-Century Shipwreck off Dor, Israel

The ancient anchorage of Dor, Israel, contains wreck-sites from several periods. Underwater exploration of one Byzantine wreck discovered the remains of a medium-size boat constructed with iron nails. Coin-finds dated it to c .665 AD, after the Muslim conquest. The wreck was probably caused by natural agents, but an event in the Byzantine-Muslim conflict can not be discounted. The artefacts include a group of objects testifying to the practice of light-fishing. Literary sources indicate a prevalence of light-fishing, but archaeological finds are very rare. This discovery clearly indicates light-fishing in late antiquity. A sounding-lead and steelyard can be seen as auxiliary to the fishing.
© 2007 The Authors     

The pearls and pitfalls of skull trephination as described in the Hippocratic treatise "On Head Wounds"

The purpose of our current study is to describe the guidelines regarding trephination as suggested in the Hippocratic writer's book, "Peri ton en cephali traumaton" ("On Head Wounds"). The ancient Greek text was reviewed as well as two English translations. The Hippocratic author described the indications, timing, and techniques of trephination for patients with head injury. He emphasized that attention should be paid to the details of the employed technique. He also commented on the difference of skull thickness at different anatomical sites and also between different age groups. The Hippocratic recommendations provided details for the performance of trephination by the ancient Greek physicians that are still considered important in modern neurosurgery.     

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.     

No laughing matter: Antiquity in Greek political cartoons

Abstract

This article discusses the deployment of antiquity in Greek political cartoons covering the period from 1974 to the present. It argues that in order to function cartoons must rely on preconceptions and widespread popular beliefs; they thus can be seen as an important source for the investigation of popular stereotypes of antiquity. Moreover they engage actively in the construction of visual memory through the visualization of abstract notions. Greek political cartoons are shown often to use the most easily recognisable themes from antiquity and rely on its moral authority (stemming from the position of antiquity in the national imagination and public discourse) in order to critique and ridicule policies and politicians. The authority of antiquity itself, however, is rarely questioned. Cartoons and antiquity are not involved in a simple relationship of representation; theirs is rather a relationship of engagement, a relationship of veneration and submission which constructs a reality where the dividing lines between the past and the present are blurred, a reality which is structured by the powerful symbolic order of national memory.     

Partial cranial trephination by means of Hippocrates' trypanon from 5th century BC Himera (Sicily,Italy)

The paper deals with a new case of partial cranial trephination found in one of the necropolises of the Greek colony of Himera in Sicily. It is one of the very few cases of cranial trephination of Greek classical age. Macroscopic as well as radiological investigations prove that the operation was perimortal as no growth of new bone could be detected, SEM‐EDS microanalysis of the piece revealed the traces left by the tool used during trephination. The review of ancient Greek and Latin medical and surgical texts permitted us to establish that the tool used in Himera was a (trypanon) mentioned by Hippocrates and named terebra by Latin authors. Copyright © 2010 John Wiley & Sons, Ltd.     

The woman of Pritschoena: an example of the German neolithic neurosurgery in Saxony-Anhalt

We present an outstanding example of successful prehistoric double trephination dating between 2700 and 2200 BC, most likely to the Corded Ware culture, at the end of the Neolithic Age. The particularity of this case is the presence of a double trephination, one frontal over the sinus sagittal superior and one parietal right. There is evidence that the patient survived months to years after the operations. The purpose of the procedure is not known. The case confirms the astonishing degree of technical skills reached in Saxony-Anhalt over 4500 years ago without anesthetic, antiseptic, or technologic aids.     

ACCESSING PAST BELIEFS AND PRACTICES: THE CASE OF LEMNIAN EARTH*

Lemnian Earth, a medicine in the shape of a stamped clay tablet (sphragis) from Lemnos, northeastern Greece, was much valued in antiquity and in the post‐medieval period as an antidote to poison and a treatment for other ailments. Although it was among the first archaeological materials to be subjected to chemical analysis (in 1807), there is still no clear understanding as to what made Lemnian Earth an effective medicine. We argue that Lemnian Earth, the artefact, was not the same as Lemnian Earth, the raw material. We suggest a composition for the artefact by scrutinizing the documentary evidence for its properties and by considering the geochemical processes that led to the formation of the raw material and the ritual relating to its extraction. The study of the latter highlights the need for archaeological materials scientists to recognize ritual as a possible manifestation of physical and chemical processes carried out within the framework of past beliefs and practices.     

The woman behind the syndrome: Frey's syndrome — the untold story*

We present an outstanding example of successful prehistoric double trephination dating between 2700 and 2200 BC, most likely to the Corded Ware culture, at the end of the Neolithic Age. The particularity of this case is the presence of a double trephination, one frontal over the sinus sagittal superior and one parietal right. There is evidence that the patient survived months to years after the operations. The purpose of the procedure is not known. The case confirms the astonishing degree of technical skills reached in Saxony-Anhalt over 4500 years ago without anesthetic, antiseptic, or technologic aids.     

Anatomical evidence for the antiquity of human footwear: Tianyuan and Sunghir

Trinkaus [Trinkaus, E., 2005. Anatomical evidence for the antiquity of human footwear use. J. Archaeol. Sci. 32, 1515–1526] provided a comparative biomechanical analysis of the proximal pedal phalanges of western Eurasian Middle Paleolithic and Middle Upper Paleolithic humans, in the context of those of variably shod recent humans. The anatomical evidence indicated that supportive footwear was rare in the Middle Paleolithic but became frequent by the Middle Upper Paleolithic. Based on that analysis, additional data are provided for the Middle Upper Paleolithic (∼27,500 cal BP) Sunghir 1 and the earlier (∼40,000 cal BP) Tianyuan 1 modern humans. Both specimens exhibit relatively gracile middle proximal phalanges in the context of otherwise robust lower limbs. The former specimen reinforces the association of footwear with pedal phalangeal gracility in the Middle Upper Paleolithic. Tianyuan 1 indicates a greater antiquity for the habitual use of footwear than previously inferred, predating the emergence of the Middle Upper Paleolithic.