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.     

Skeletal manifestations of vitamin D deficiency osteomalacia in documented historical collections

The frequency with which changes related to vitamin D deficiency are recorded in juvenile bone from archaeological contexts makes it clear that conditions conducive to such deficiency were fairly widespread at a number of points in the past. Although changes will take longer to be manifest in the adult skeleton than in juveniles, and may not be as obvious, the scarcity of reported cases suggests that it is likely that cases of osteomalacia are being overlooked in archaeological human bone. Vitamin D is probably better described as a hormone, rather than a vitamin, and the production of vitamin D within the body following exposure to sunlight allows adequate mineralisation of bone to take place. Lack of exposure to sunlight, which can be caused by a range of factors, is probably one of the main causes of vitamin D deficiency. The result of such a deficiency is a general weakening of the skeleton. The range of skeletal changes recorded across different bones of the skeleton in two documented historical pathology collections (the Galler collection, Basel, and the collection of the Federal Museum for Pathological Anatomy, Vienna), are discussed for scapulae, vertebrae, ribs, sterna, pelves and femora. The likelihood of each feature being preserved in archaeological skeletal material is considered. Although the changes associated with osteomalacia may lead to fragmentation of the skeleton, the presence of characteristic changes on bones from across the skeleton should make the condition identifiable using macroscopic examination, even where the skeleton is not well preserved. The identification of cases of osteomalacia in archaeological skeletal material is potentially significant because of the socio‐cultural information that can be implied from diagnosis of the condition. Copyright © 2005 John Wiley & Sons, Ltd.     

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

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

A possible case of coccidioidomycosis from the Los Muertos site,Tempe, Arizona

Coccidioidomycosis is a fungal disease endemic to southwestern North America and parts of Central and South America. Coccidioidomycosis frequently disseminates to the human skeleton and produces mostly lytic skeletal lesions. However, this disease is infrequently described within archaeological populations. As a result, it is important to report potential cases in order to improve current understanding of the appearance and distribution of lesions resulting from coccidioidomycosis in archaeological specimens. This study describes skeletal lesions in an adult male recovered from the Los Muertos site, Tempe, Arizona (AD 500–1450). These lesions are present on the inferior border of the left scapular spine, the medial portion of the left first metacarpal head, and the medial portion of the right first metatarsal. The lesions are predominantly lytic with sclerotic and, in some cases, healed cortical bone distributed around their margins. Evidence of skeletal healing is recorded within the destructive focus of one lesion. Geographical information on pathogen endemism, overall lesion distribution, and agricultural‐era Hohokom behaviour suggest that coccidioidomycosis is the most likely diagnostic option for these lesions. Mounting evidence for possible infections in the palaeopathological literature, combined with high frequencies of nutritional stress levels in endemic regions, suggests that coccidioidomycosis contributed at least moderately to morbidity in the American Southwest. Copyright © 2006 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 Unusual Erosive Arthropathy from Medieval England

In palaeopathology, diagnosis of skeletal disease is classically made with reference to changes wrought by known diseases in modern or recent cases. This report presents a skeleton from medieval England which shows a form of erosive arthropathy. A more precise diagnosis is problematic because the alterations appear inconsistent with any of the principle forms of erosive arthropathy in current clinical classification. The distribution of lesions in the axial and appendicular skeleton resembles that in seronegative spondyloarthropathies. The nature of the lesions however, which are almost entirely lytic and concentrated principally at synovial articulations rather than entheses, is inconsistent with seronegative spondyloarthropathies and is more consistent with pathophysiology of rheumatoid arthritis. These observations raise the possibility that the manifestations of erosive arthropathies may have altered over time and/or that our clinical understanding of the skeletal distribution of lesions in these diseases may be incomplete. These scenarios would have profound implications for our ability to identify the various forms of erosive arthritis in archaeological populations, but further work investigating erosive arthritis in patients, together with systematic studies of skeletal cases, would be required before firm conclusions can be made. Copyright © 2016 John Wiley & Sons, Ltd.     

Variable nucleotide tandem repeat (VNTR) typing of two palaeopathological cases of lepromatous leprosy from Mediaeval England

Using ancient DNA methods, we have examined in detail two archaeological cases of leprosy from Mediaeval England. The first was a child skeleton with rhino-maxillary changes typical of lepromatous leprosy (LL). The second case was the skeleton of a male adult who showed both typical rhino-maxillary changes and osteitis/periostitis on the leg and foot bones. Bone powder was sampled from both cases and DNA extracts were prepared. These were subjected to a series of polymerase chain reactions (PCRs) specific for regions on the Mycobacterium leprae genome. The repetitive element RLEP was used for confirmation of M. leprae DNA and then three polymorphic regions were successfully amplified and sequenced to determine the number of variable nucleotide tandem repeats (vntr) at these loci. These were the microsatellite regions ML2344 and ML2172 and the minisatellite region ML0058. Genotyping data from the strains preserved within the skeletal remains were compared with those obtained for a reference strain of M. leprae. Variation at these three loci was found between both burials and the reference strain, indicating that vntr typing of LL cases from the archaeological record is a useful way of confirming disease and an additional means of authenticating aDNA data. This demonstrates the feasibility of targeting multiple loci for phylogenetic studies of leprosy strains from archival sources.     

Evidence of surgery in Ancient India: trepanation at Burzahom (Kashmir) over 4000 years ago

The article describes a neolithic skeleton with multiple‐trepanated skull found in Kashmir, the archaeological circumstances of the find, the dating, the background, the skeletal evidence, the details of the trepanation and possible affiliations of the Indus civilization. It speculates briefly about possible medical grounds for the surgery. Copyright © 2001 John Wiley & Sons, Ltd.     

Medieval Britain and Ireland in 1989

Abstract

CHILDHOOD IS A TIME of rapid biological growth and development, and a stage of the life course during which bodies are particularly sensitive to social and environmental stressors. As a consequence, events which may impact upon a child’s care and treatment can become physically embodied within their bones and teeth. The skeletal remains of children have been neglected within archaeological discourse until recently, but they are, in fact, a particularly important demographic for understanding the impact of social processes on past population health. This research examines the prevalence of skeletal disease in children (≤16 years) in Britain (England, Wales and Scotland) between ad 1000 and 1700. Data for a total of 4,626 children from 95 sites were collated from published and unpublished skeletal reports and analysed for evidence of skeletal changes reflecting disease. A biocultural approach was adopted in which the evidence was interpreted in relation to ecological, social, economic and environmental conditions. It was observed that childhood levels of skeletal stress did increase significantly after 1540. It was noted that during the Reformation sociocultural and economic factors added to stressors in the ecology of the medieval child. The effects of the Reformation were found to be the greatest aggravator in the rise of morbidity prevalence over seven centuries. Differences in morbidity patterns between non-adult age categories indicated that a state of ‘childhood’ existed until at least eleven years of age, after which there appears to have been a gradual transition into adolescence and adulthood.     

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

Late‐medieval and post‐medieval writings report that scurvy was a widespread condition in medieval and early historical Poland. Archaeological and historical data indicate that the diet of children was based on foods poor in vitamin C and contained small amounts of raw plant products. Also, historians emphasise that in medieval and post‐medieval Poland, there were seasonal fluctuations in food availability, frequently accompanied by poor harvests. Both resulted in long periods of poor nutrition, which affected children most severely. The aim of this study was to investigate skeletal manifestations of scurvy in subadult remains from medieval and post‐medieval Poland. Following standards described by Ortner and colleagues, anatomical sites pathognomonic of scurvy in subadults (<17 years) were assessed for abnormal porosity and hypertrophic bone among skeletons excavated from three sites: Ostrów Lednicki (dated to the 11th–14th centuries AD), Cedynia (10th–14th centuries AD) and Słaboszewo (14th–17th centuries AD). In total, 3.6% of all examined children were found to bear traces of vitamin C deficiency. The prevalence of scorbutic lesions was 4.5% for Cedynia, 2.6% for Ostrów Lednicki and 3.6% for Słaboszewo. The majority of affected children were less than 7 years of age. Scurvy was likely more widespread in the living populations than it appears from the calculation of skeletal markers, because some individuals might have recovered or died before obvious traces became apparent. Also, in some children, scurvy might not have reached an advanced stage, identifiable in the skeletal material. The prevalence of scurvy reflects not only dietary patterns but also food storage and preparation techniques adopted in the Polish territories during the Middle Ages, which contributed to low intakes of vitamin C. Copyright © 2015 John Wiley & Sons, Ltd.     

The Archaeology of War: A North American Perspective

This article reviews recent archaeological research on warfare in prestate societies of native North America. This survey comprises six regions: Arctic/Subarctic, Northwest Coast, California, Southwest/Great Basin, Great Plains, and Eastern Woodlands. Two lines of evidence, defensive settlement behavior and injuries in human skeletal remains, figure prominently in archaeological reconstructions of violence and warfare in these regions. Burning of sites and settlements also has been important for identifying the consequences of war and investigating more subtle aspects of strategy and directionality. Weaponry and iconography have to date provided important but more limited insights. Although considerable disparities exist between regions in the archaeological evidence for intra- and intergroup violence, all regions show a marked increase after A.D. 1000. These findings suggest that larger forces may have been responsible for escalating violence throughout North America at this time.     

Metastatic carcinoma in a leper skeleton from a Medieval cemetery in Chichester England

Both leprosy and metastatic cancer are well documented in the literature on human skeletal palaeopathology. The manifestation of both pathological conditions in a single archaeological skeleton has not been reported. A case from a Medieval site in Chichester, England exhibits bone lesions and patterns of skeletal involvement indicative of both these diseases. Evidence of leprosy is largely restricted to the lower tibiae, fibulae and the bones of the feet. Fine destructive foci and reactive fibre bone associated with metastatic cancer are distributed in many of the remaining areas of the skeleton. There is minimal overlap in the areas of the skeleton involved in the two pathological processes.     

Severe vertebral collapse in a juvenile from the graveyard (13th/14th–19th centuries) of the São Miguel church (Castelo Branco,Portugal): differential palaeopathological diagnosis

Diseases that culminate into vertebral collapse are of intricate diagnosis both in palaeopathology and modern clinical practice. When analysing human skeletal remains from the archaeological record this difficulty is amplified due to the absence of complementary medical diagnostic information. This is especially evident when the distinction between tuberculous and pyogenic spondylitis is intended. Taking into consideration this challenging task and based on the macroscopic and radiological study of the skeleton number 8, a specimen exhumed from the East necropolis (13th/14th to 19th centuries) of the São Miguel church, at the Portuguese city of Castelo Branco, the aims of the work here presented are to discuss the range of possible aetiological factors, especially infectious ones, ascribable to the striking pathological changes noticed on this 12‐year‐old individual. These included alterations on the axial skeleton, namely extensive vertebral destruction, presenting as a gibbus deformity, and correlated thoracic deformities. Consubstantiated on palaeopathological and clinical research, tuberculous spondylitis seems to be the most probable cause for the reported lesions. However, the scrutiny between this condition and other pyogenic spinal infections is of extreme complexity when analysing ancient human remains and deserves in‐depth future investigations. Within the framework of the Portuguese archaeological record, the specimen here presented is of major relevance since the pattern and severity of the spinal osseous changes observed were not previously reported. Further, if tuberculous spondylitis is assumed as the most probable diagnosis, the case here presented represents one of the earliest skeletal evidence of this condition in Portugal. Copyright © 2009 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 Relationship Between Molar Wear and Age in an Early 19th Century AD Archaeological Human Skeletal Series of Documented Age at Death

Crown height of molar teeth was measured in a 19th century Dutch skeletal collection of known age at death. Results indicate an approximately linear relationship between crown height and age. A closer relationship between age and crown height exists for the mandibular than the maxillary molars. The mandibular molars wear at a faster rate than the maxillary molars. There is no evidence for any difference in wear rates between first, second and third molars. No effect on wear rate of ante-mortem loss of occlusal partner nor of dental caries could be detected. The rate of wear in the study material was markedly slower than that which characterizes most archaeological groups and the burials are drawn from a rather heterogeneous urban population; these factors mean that dental wear ageing would be expected to perform less well in this material than for most archaeological groups. Despite this, strong correlations were observed between molar wear and adult age at death; that this was the case despite circumstances unfavourable for its use supports the idea that dental wear is a reliable ageing technique for most archaeological skeletal material.     

Probable Atretic Cephalocele in an Adult Female from Punta Secca (Sicily,Italy)

Excavations at Punta Secca, Sicily (Italy), in 2008 uncovered a substantially built tomb of ca ad 625/630 inside a private house and accompanying evidence for libations and funerary feasting in honour of the deceased. Inside the tomb were the skeletal remains of an adult female aged approximately 20/25 years and a child aged approximately 3/5 years. DNA analysis showed the child to be female and the adult and child to have been consanguineous. Archaeological and epigraphic evidence demonstrates that they were Christians. The cranium of the adult female showed an enlargement of the central portion of the occipital bone and a circular depression that terminated in a bifurcated foramen (diameter 3.25 mm). The former is likely an instance of occipital bunning; the latter is the first attested example of atretic cephalocele from an archaeological context. Tombs do not normally occur in ancient houses, and the hypothesis is advanced that the individual may have suffered from medical side effects, such as seizures, which caused rejection of the adult female by the local Christian community but veneration of her by her family as a holy woman. Copyright © 2012 John Wiley & Sons, Ltd.     

Túnel: A Case Study of Avian Zooarchaeology and Taphonomy

Although not often considered, there are many osteological characters unique to the avian skeleton that influence the taphonomy of bird bones. These characters are reviewed and their archaeological significance discussed herein. The presence of marrow in many avian long bones is important to interpretation of avian remains from archaeological sites because the presence of marrow affects bone density and, in turn, preservation. Other structural properties that affect avian bone preservation include cortical wall thickness, length and pneumatic state. Based on an analysis of approximately 10,000 bird bones from the archaeological site of Túnel, Tierra del Fuego, Argentina, I found that specific breakage patterns resulted from natural taphonomic processes acting as a result of the unique avian bone characteristics. This information may allow researchers to distinguish breakage patterns in avian bones resulting from natural taphonomic processes from breakage patterns that are culturally induced.     

Skeletal Manifestations of Skin Ulcer in the Lower Leg

Skin ulcers of the lower leg are known to cause both destructive and, more commonly, bone‐forming lesions. Typically, bone‐forming lesions in this disorder have clearly defined margins although there may be extensive reactive bone formation involving much or all of the adjacent diaphysis. These lesions are best described in patients from tropical areas, and in these environmental contexts, these are known as tropical ulcers, but leg ulcers can be caused by a variety of diseases and conditions, of which vascular insufficiency plays an important role among the elderly. The lesions are important clinically because of the disability associated with the ulcer and because of complications that can develop including osteomyelitis and cancer. In most cases, the bone lesions caused by ulcer are easily diagnosed in archaeological human skeletal remains and provide some insight into the prevalence of this disorder in antiquity. In this paper, we review the gross and radiological manifestations of bone lesions resulting from overlying skin ulcer in tibiae of 13 cases including archaeological and modern medically documented skeletons. In two of the cases, there is medical documentation regarding the presence of a chronic ulcer on the lower leg. The objectives of this paper were to explore the diversity of bone lesions associated with ulcers of the tibia and to provide an improved basis for the diagnosis of this disorder in human skeletal remains. Copyright © 2011 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.