Comparison of child morbidity in two contrasting medieval cemeteries from Denmark

Chronic maxillary sinusitis in palaeopathology: A review of methods

OBJECTIVE

This study reviews the palaeopathological literature discussing maxillary sinusitis to examine current trends and issues within the study of this condition, and to make recommendations for future research in this area.

MATERIALS

Seventy-five studies were identified through a literature search of digital and physical sources.

METHODS

Information regarding study metadata, the populations investigated, sinusitis diagnostic criteria, and sinusitis prevalence was examined.

RESULTS

Populations from the UK and Europe were the most studied, reflecting both palaeopathology's systemic colonialism and academic legacies. Most studies used diagnostic criteria published in the mid-1990s, with some subsequent studies modifying these criteria.

CONCLUSIONS

The diagnostic criteria from 1995 are widely used but do not include all possible bone changes seen within sinusitis. There is also a need for researchers to engage in issues of data reductionism when using descriptive categories for archaeological sites and populations.

SIGNIFICANCE

This paper provides considerations as to how the 1995 diagnostic criteria may be revised by future researchers and synthesises much of the published sinusitis prevalence data to assist researchers interested in the palaeopathology of respiratory disease.

LIMITATIONS

More general osteological research, which includes palaeopathological information, was likely missed from this review due to the choice of key terms and languages used in the literature search.

SUGGESTIONS FOR FURTHER RESEARCH

Additional research into sinusitis in archaeological populations outside of Western Europe is required. Further work examining the ability to compare pathological data from macroscopic observation and medical imaging would be advantageous to palaeopathology as a whole.

A growth area: A review of the value of clinical studies of child growth for palaeopathology

Studies of living children demonstrate that early life stress impacts linear growth outcomes. Stresses affecting linear growth may also impact later life health outcomes, including increased cardiometabolic disease risk. Palaeopathologists also assess the growth of children recovered from bioarchaeological contexts. Early life stresses are inferred to affect linear growth outcomes, and measurements of skeletal linear dimensions alongside other bioarchaeological information may indicate the types of challenges faced by past groups. In clinical settings, the impacts of stress on growing children are typically measured by examining height. Palaeopathologists are limited to examining bone dimensions directly and must grapple with incomplete pictures of childhood experiences that may affect growth. Palaeopathologists may use clinical growth studies to inform observations among past children; however, there may be issues with this approach. Here, we review the relationship between contemporary and palaeopathological studies of child and adolescent growth. We identify approaches to help bridge the gap between palaeopathological and biomedical growth studies. We advocate for: the creation of bone-specific growth reference information using medical imaging and greater examination of limb proportions; the inclusion of children from different global regions and life circumstances in contemporary bone growth studies; and greater collaboration and dialogue between palaeopathologists and clinicians as new studies are designed to assess linear growth past and present. We advocate for building stronger bridges between these fields to improve interpretations of growth patterns across human history and to potentially improve interventions for children living and growing today.

Tracking breastfeeding and weaning practices in ancient populations by combining carbon, nitrogen and oxygen stable isotopes from multiple non-adult tissues

This paper explores the potential of combining different isotope systems from different tissues to improve resolution when reconstructing breastfeeding and weaning practices (BWP) in archaeology. Additionally, we tested whether changes in diet can be detected in deciduous teeth. Rib collagen samples from 22 infants/children from the archaeological site of Bacuranao I (Mayabeque, Cuba) were processed for nitrogen (δ¹⁵N) and carbon (δ¹³C_co) stable isotopes and assessed using a Bayesian model (WARN). In addition, enamel of 48 teeth from 30 infants/children were analyzed for oxygen (δ¹⁸O_en) and carbon (δ¹³C_en) stable isotopes. Data revealed that the timing of weaning cannot be characterized precisely by analyzing either δ¹⁸O or δ¹⁵N. While a depletion in both δ¹⁵N and δ¹³C_co is only evident after one year, the WARN model suggested that the weaning process started at around 3 months and ended around 1.7 years. Most teeth were enriched in δ¹⁸O_en compared to deciduous incisors, suggesting a breastfeeding signal. However, a high variability in δ¹⁸O was found between similar teeth from the same individuals. Higher enrichment in δ¹⁸O_en, and variability, was observed in tissues formed during the first six months of life. A δ¹³C enrichment of 1.0‰ was observed among deciduous teeth and ribs. While most individuals enriched in δ¹⁵N showed enrichment in δ¹³C, the δ¹⁸O values were more variable. Our data suggests that stable isotopes of deciduous teeth, especially δ¹³C_en, can be used to detect changes in diet during the weaning process. It is also possible that the δ¹⁸O enrichment observed in M1 is influenced by the effects of cooking techniques on weaning foods. The combination of multiple isotope systems and tissues overcome some of the limitations posed by single tissue approaches.

Lack of biological mortality bias in the timing of dental formation in contemporary children: Implications for the study of past populations

OBJECTIVES

Biological mortality bias is the idea that individuals who perish (non-survivors) are biologically distinct from those who survive (survivors). If biological mortality bias is large enough, bioarchaeological studies of nonsurvivors (skeletal samples) cannot accurately represent the experiences of the survivors of that population. This effect is particularly problematic for the study of juvenile individuals, as growth is particularly sensitive to environmental insults. In this study, we test whether biological mortality bias exists in one dimension of growth, namely dental development.

MATERIALS AND METHODS

Postmortem computed tomography scans of 206 children aged 12 years and younger at death were collected from two institutions in the United States and Australia. The sample was separated into children dying from natural causes as proxies for non-survivors and from accidental causes as proxies for survivors. Differences in the timing of dental development were assessed using sequential logistic regressions between dental formation stages and residual analysis of dental minus chronological age.

RESULTS

No consistent delay in age of attainment of dental stages was documented between survivors and non-survivors. Delays between survivors and non-survivors in dental relative to chronological age were greatest for infants, and were greater for females than for males.

DISCUSSION

Lack of biological mortality bias in dental development reinforces confidence in juvenile age estimates and therefore in skeletal growth profiles and growth studies. As dental development is known to be less environmentally sensitive than skeletal growth and development, further studies should examine biological mortality bias in long bone length.

Iron deficiency anemia, population health and frailty in a modern Portuguese skeletal sample

Introduction

Portugal underwent significant political, demographic and epidemiological transitions during the 20^th century resulting in migration to urban areas with subsequent overcrowding and issues with water sanitation. This study investigates population health during these transitions and interprets results within a framework of recent history and present-day public health information. We investigate skeletal evidence for anemia (cribra orbitalia and porotic hyperostosis) as indicators of stress and frailty–i.e., whether the lesions contribute to susceptibility for disease or increased risk of death.

Methods

The presence and severity of skeletal lesions were compared against known sex and cause of death data to investigate potential heterogeneity in frailty and the relationship between lesions and risk of dying over time. Additionally, we tested for the presence of selective mortality in our data (i.e., whether or not the sample is biased for individuals with higher frailty). Our sample derives from a large, documented, modern Portuguese collection from Lisbon and is the first study of its kind using a documented collection. The collection represents primarily middle-class individuals.

Results and conclusions

Analyses indicated that porotic hyperostosis became more common and severe over time, while cribra orbitalia severity increased over time. Neither process was linked to cause of death. However, there was a significant relationship to sex; males exhibited a higher prevalence and severity of lesions and increased mortality. A Gompertz function showed decreased survivorship in early life but increased survivorship over age 60. Using comorbidities of anemia, we were unable to detect selective mortality–i.e., in our sample, lesions do not represent a sign of poor health or increased frailty and are not significantly linked with a decreased mean age-at-death. However, lesion prevalence and severity do reflect the socioeconomic processes in urban Lisbon during the 1800s and 1900s and the possibility of water-borne parasites as the contributing factor for iron deficiency anemia.

Childhood health as reflected in adult urban and rural samples from medieval Denmark

This study examines the evidence of three skeletal markers relating to childhood health that leave permanent observable changes in the adult skeleton. Two are well known to paleopathology, namely Harris lines (HL) and linear enamel hypoplasia (LEH). The third skeletal marker is less commonly used; the permanent changes in the temporal bones, induced by chronic or recurrent infectious middle ear disease (IMED) in childhood. A total of 291 adult skeletons from an urban (n = 109) and a rural (n = 182) cemetery, from the Danish medieval period (1050-1536 CE) were included. The markers were examined for their co-occurrence, and differences between the two samples. No statistically significant difference for the three skeletal markers between the two samples was found. A trend was nevertheless apparent, with greater frequencies for all three skeletal markers for the urban population. A statistically significant relationship was found only between IMED and HL. This positive relation was very low (r_ɸ = 0.307, 0.275) and may be considered non-existent. The lack of co-occurrence is interpreted as if an individual was exposed to conditions that could cause the osteological expression of all three markers this could be a life-threatening health condition, during developing years.

The effect of leprotic infection on the risk of death in medieval rural Denmark

INTRODUCTION

Paleopathological studies of leprosy in Danish skeletal collections show that many individuals suffered from this stigmatized disease during the Middle Ages. This study examines the risk of death associated with leprotic infection in individuals from the Danish rural cemetery of Øm Kloster (AD 1172-1536). Specifically, we modeled the influence of leprotic infection on age-specific mortality accounting also for sex and social status (lay person / monastic).

MATERIALS AND METHODS

The sample consisted of 311 adult individuals from the Øm Kloster skeletal collection housed at the Institute of Forensic Medicine, University of Southern Denmark (ADBOU). We modeled morbidity and mortality using a three-state illness-death model with the following parameterizations for the three transition hazards: (1) nonlesioned to lesioned: constant; (2) nonlesioned to dead: Gompertz-Makeham; and (3) lesioned to dead: Gompertz-Makeham, directly proportional to the hazard of the well to dead transition.

RESULTS

The mortality hazard of lesioned individuals exceeded that of nonlesioned individuals by a factor of 1.4 (40%) across all individuals, 1.7 for females, 1.0 for males, 1.3 for lay persons, and 1.7 for monastics. Overall, 15% of the sample died with skeletal manifestations of leprosy, though it is likely that a higher percentage of the population carried the bacterium.

DISCUSSION

This study improves understanding of past health and population dynamics focusing on a chronic infectious disease. The methods employed could informatively be applied to larger analyses of community health from skeletal collections by incorporating more than one disease into the multistate model and inferring individual frailty using various skeletal markers.

Paleomicrobiology of Leprosy

The use of paleomicrobiological techniques in leprosy has the potential to assist paleopathologists in many important aspects of their studies on the bones of victims, solving at times diagnostic problems. With Mycobacterium leprae, because of the unique nature of the organism, these techniques can help solve problems of differential diagnosis. In cases of co-infection with Mycobacterium tuberculosis, they can also suggest a cause of death and possibly even trace the migratory patterns of people in antiquity, as well as explain changes in the rates and level of infection within populations in antiquity.

Stressing out in medieval Denmark: An investigation of dental enamel defects and age at death in two medieval Danish cemeteries

The influence of early life stress on later life experiences has become a major focus of research in medicine and more recently in bioarchaeology. Dental enamel, which preserves a record of childhood stress events, represents an important resource for this investigation when paired with the information from adult skeletal remains, such as age at death. The purpose of this research was to use a life history approach to the exploration of sex differences in the relationship between childhood stress and adult longevity by examining accentuated striae of Retzius (AS). A medieval Danish sample (n=70) drawn from the rural cemetery of Sejet and the urban cemetery of Ole Wormsgade was considered for AS and age at death. The results suggest sex differences in survivorship, with more stress being associated with reduced survivorship in males and increased survivorship in females. A consideration of AS formation time also suggests a difference in the impact of developmental timing between males and females. These results are interpreted in terms of differential frailty and selective mortality, drawing in both biomedical and cultural perspectives.

Frail or hale: Skeletal frailty indices in Medieval London skeletons

To broaden bioarchaeological applicability of skeletal frailty indices (SFIs) and increase sample size, we propose indices with fewer biomarkers (2-11 non-metric biomarkers) and compare these reduced biomarker SFIs to the original metric/non-metric 13-biomarker SFI. From the 2-11-biomarker SFIs, we choose the index with the fewest biomarkers (6-biomarker SFI), which still maintains the statistical robusticity of a 13-biomarker SFI, and apply this index to the same Medieval monastic and nonmonastic populations, albeit with an increased sample size. For this increased monastic and nonmonastic sample, we also propose and implement a 4-biomarker SFI, comprised of biomarkers from each of four stressor categories, and compare these SFI distributions with those of the non-metric biomarker SFIs. From the Museum of London WORD database, we tabulate multiple SFIs (2- to 13-biomarkers) for Medieval monastic and nonmonastic samples (N = 134). We evaluate associations between these ten non-metric SFIs and the 13-biomarker SFI using Spearman's correlation coefficients. Subsequently, we test non-metric 6-biomarker and 4-biomarker SFI distributions for associations with cemetery, age, and sex using Analysis of Variance/Covariance (ANOVA/ANCOVA) on larger samples from the monastic and nonmonastic cemeteries (N = 517). For Medieval samples, Spearman's correlation coefficients show a significant association between the 13-biomarker SFI and all non-metric SFIs. Utilizing a 6-biomarker and parsimonious 4-biomarker SFI, we increase the nonmonastic and monastic samples and demonstrate significant lifestyle and sex differences in frailty that were not observed in the original, smaller sample. Results from the 6-biomarker and parsimonious 4-biomarker SFIs generally indicate similarities in means, explained variation (R2), and associated P-values (ANOVA/ANCOVA) within and between nonmonastic and monastic samples. We show that non-metric reduced biomarker SFIs provide alternative indices for application to other bioarchaeological collections. These findings suggest that a SFI, comprised of six or more non-metric biomarkers available for the specific sample, may have greater applicability than, but comparable statistical characteristics to, the originally proposed 13-biomarker SFI.

Growth and health status of children and adolescents in medieval Central Europe

Subadult growth and health have been analyzed in three cemetery samples from medieval Poland, including two early-urban sites: Cedynia dated to the 10t-14th centuries AD, and Ostrów Lednicki dated to the 13th-15th centuries AD, and a rural site Słaboszewo dated to the 14th-17th centuries AD. The nutritional status was not expected to have substantially differed among the settlements, due to the culturally induced undiversified diet of children, and predominant share of medium-to-low status individuals. However, city life and village life were supposed to differ in factors correlated with the spread of infections, and as such it was expected to find significant differences in respiratory health among early-urban and rural dwellers.The prevalences of diet-dependent diseases, scurvy and rickets, were found to be statistically indistinguishable among the three studied populations, while higher frequency of skeletal signs of poor respiratory health was observed in early-urban Cedynia than rural Słaboszewo. Slightly lower prevalences of skeletal stress indicators were found for the rural than the early-urban site. Skeletal growth profiles and the dynamics of long bone growth were found to be remarkably similar for the early-urban samples (Cedynia and Ostrów Lednicki), with the rural subadults having the shortest diaphyseal lengths, and lower growth dynamics.It can be concluded that adverse factors associated with the urban settlement were more detrimental to respiratory health than those in the village. A variety of factors are potentially responsible for this pattern, including population density, building structure, quality of air and water, sanitation, and occupation. Perhaps, the key factor in response to environmental and socio-cultural constraints was the stability of living conditions in the village, which allowed the inhabitants to develop sufficient adaptive mechanisms. In contrast, the history of strongholds such as Cedynia was changeable due to political situation, military threats and migrations of people.

A method for estimating age of medieval sub-adults from infancy to adulthood based on long bone length

OBJECTIVES

To develop a series of regression equations for estimating age from length of long bones for archaeological sub-adults when aging from dental development cannot be performed. Further, to compare derived ages when using these regression equations, and two other methods.

MATERIAL AND METHODS

A total of 183 skeletal sub-adults from the Danish medieval period, were aged from radiographic images. Linear regression formulae were then produced for individual bones. Age was then estimated from the femur length using three different methods: equations developed in this study, data based on a modern population (Maresh: Human growth and development (1970) pp 155-200), and, lastly, based on archeological data with known ages (Rissech et al.: Forensic Sci Int 180 (2008) 1-9). As growth of long bones is known to be non-linear it was tested if the regression model could be improved by applying a quadratic model.

RESULTS

Comparison between estimated ages revealed that the modern data result in lower estimated ages when compared to the Danish regression equations. The estimated ages using the Danish regression equations and the regression equations developed by Rissech et al. (Forensic Sci Int 180 (2007) 1-9) were very similar, if not identical. This indicates that the growth between the two archaeological populations is not that dissimilar.

DISCUSSION

This would suggest that the regression equations developed in this study may potentially be applied to archaeological material outside Denmark as well as later than the medieval period, although this would require further testing. The quadratic equations are suggested to yield more accurate ages then using simply linear regression equations.

Bone Mineral Density in Children From Anthropological and Clinical Sciences: A Review

Bone mineral density (BMD) is a frequent topic of discussion in the clinical literature in relation to the bone health of both adults and children. However, in archaeological and/ or anthropological studies the role of BMD is often cited as a possible factor in the poor skeletal preservation which can lead to an under-representation of juvenile skeletal remains. During skeletal development and growth throughout childhood and adolescence changes take place in both the size and shape of bones and these changes also result in the increasing of mineral content. BMD can be affected by many factors, which include, age, genetics, sexual maturation, amount of physical activity and dietary calcium. This paper aims to review the clinical and anthropological literature on BMD and discuss the numerous methods of measurement and how the availability of certain methods such as Dual-energy x-ray absorptiometry (DEXA) and quantitative computed tomography (QCT) can influence the study of bone density in archaeological skeletal collections and also the future potential for forensic anthropological studies.

Dental health and lifestyle in four early mediaeval juvenile populations: comparisons between urban and rural individuals, and between coastal and inland settlements

Dental stress markers such as enamel hypoplasia and caries are suitable indicators of population health and lifestyle, although they must be recorded and interpreted carefully. To date, they have been predominantly studied in adult samples, whereas juvenile remains are also affected by these lesions. In this study, dental enamel hypoplasia and caries were both evaluated on 613 non-adult individuals from four early mediaeval Moravian and Frankish skeletal series, who had experienced contrasting environments and lifestyles. The aim of this study is to assess the relationship between these biological traits and living conditions, and how this is manifested in the juvenile dental remains. Significant differences between populations were found in stress markers, dental lesions and the way these were manifested. Exposure to stressful conditions varies between urban and rural populations and is related to age groups. Although the children under investigation seem to have had different diets, it is difficult to distinguish the biological contribution (different enamel susceptibility) from the lifestyle contribution (different food, environment) in the formation of caries. Moreover, such studies must be interpreted carefully due to the possibility of intra- and inter-observer errors and the subjectivity of the scoring techniques. Nevertheless, this study also demonstrates that results of an investigation of juvenile skeletal remains can be as informative as a study of adults and that juvenile skeletons can be included in large bioarchaeological population studies.

Adolescent health in medieval Serbia: signs of infectious diseases and risk of trauma

Although pattern of health in adults has been frequently assessed in past human populations, health status of adolescents as a distinct life stage has usually been overlooked. Inconsistency in number and meaning of recognised age categories in anthropological literature, as well as chronological age ranges used to define them, further complicate the interpretation of adolescent health. In this study, we analysed signs of pathological conditions on skeletal remains of 81 adolescents from a medieval site of Stara Torina (northern Serbia). Diagnostic palaeopathological procedures comprised gross examination, digital radiography, and histological analysis. Skeletal signs of anaemia such as cribra orbitalia and other porotic phenomena as well as signs of non-specific bone infection were observed frequently, while evidence of bone trauma was recorded in a very low percentage of individuals. In addition, we recorded two conditions relatively rarely observed in palaeopathological contexts: a case of skull and vertebral asymmetry indicative of congenital muscular torticollis, and a case of a fibrous cortical defect on distal femur. Comparison with available information from other medieval adolescent samples from Serbia demonstrated that while mortality was relatively constant throughout the sample, Stara Torina showed a much higher occurrence of bone disease. Characteristics of observed skeletal conditions, supported by available historical reports, suggest that the health of medieval adolescents in the examined population was most significantly affected by infectious processes.

Morbidity, rickets and long-bone growth in post-medieval Britain--a cross-population analysis

BACKGROUND

Vitamin D deficiency rickets is associated with skeletal deformities including swollen rib junctions, bowing of the legs, and the flaring and fraying of the wrist and long-bone metaphyses. There is, however, scarce information on the direct effect of rickets on skeletal growth in either present or past populations.

AIM

The study investigated the effect of vitamin D deficiency rickets on long-bone growth in two post-medieval skeletal populations from East London (Broadgate and Christ Church Spitalfields). Subsequently, inter-population growth variations in relation to non-specific environmental stress (dental enamel defects), industrialization, urbanization and socio-economic status during infancy (birth to 3 years) and early childhood (3-7 years) were examined.

SUBJECTS AND METHODS

Data on long-bone diaphyseal length dimensions and stress indicators of 234 subadults from Anglo-Saxon, late medieval and post-medieval archaeological skeletal samples were analysed using both linear and non-linear growth models.

RESULTS

Rickets had no effect on the growth curves for any of the long bones studied. However, pronounced variations in growth between the four populations were noted, mainly during infancy. The diaphyseal length of long bones of Broadgate were significantly smaller-per-age than those of Spitalfields and the other samples up to the age of 4 years, and were associated with a high prevalence of enamel defects during early infancy.

CONCLUSION

Socio-economic status, rather than urbanization, industrialization or rickets, was the central factor behind the observed differences in growth among the post-medieval populations. The observed inter-population growth variations were only significant during infancy.

Dimensions of health and social structure in the early intermediate period cemetery at Villa El Salvador, Peru

This paper examines relationships between the social structure of a community and the health of its members, based on analysis of human skeletal remains (N = 64) from Villa El Salvador XII (100 BC-AD 100), a prehistoric cemetery located in the lower Lurín Valley, Peru. The ambiguity of social status as conventionally inferred from archaeological context is among the principal complicating factors in such an inquiry. We use multidimensional scaling of skeletal markers to identify the presence of patterned health-based heterogeneity in our sample, without making a priori assumptions about underlying social structure at Villa El Salvador. This procedure situates every skeleton relative to all others in the sample on the basis of multiple health markers, eliciting health groups. Once recognized, the relevance of those groups to social structure can be evaluated by comparison with a broad range of presumptive archaeological status indicators. We test the hypothesis that the distribution of stress indicators in human skeletons covaries with archaeological indicators of social differentiation. Based on multivariate analysis of skeletal indicators, we conclude that the cemetery at Villa El Salvador was utilized by two social groups with different geographic affinities: one of local coastal origin, and the other probably from the upper Lurín Valley or adjacent higher altitudes. These groups differ in skeletal characteristics related to childhood health, probably reflecting systematic contrasts in the growth environments of the studied individuals. This same division is independently supported by the distribution of cranial deformation, a possible marker of ethnicity. We also document some inequality in the distribution of labor among male individuals, as reflected by the relative advancement of degenerative joint disease, and congruent with differences in the number and quality of associated funerary offerings.