Cribra orbitalia and porotic hyperostosis: A biological approach to diagnosis

A morphological and molecular approach to investigating infectious disease in early medieval Iberia: The necropolis of La Olmeda (Palencia, Spain)

OBJECTIVE

Here we investigate infectious diseases that potentially contribute to osteological lesions in individuals from the early medieval necropolis of La Olmeda (6th-11th c. CE) in North Iberia.

MATERIALS AND METHODS

We studied a minimum number of 268 individuals (33 adult females; 38 adult males, 77 unknown/indeterminate sex; and 120 non-adults), including articulated and commingled remains. Individuals with differential diagnoses suggesting chronic systemic infectious diseases were sampled and bioinformatically screened for ancient pathogen DNA.

RESULTS

Five non-adults (and no adults) presented skeletal evidence of chronic systemic infectious disease (1.87% of the population; 4.67% of non-adults). The preferred diagnoses for these individuals included tuberculosis, brucellosis, and malaria. Ancient DNA fragments assigned to the malaria-causing pathogen, Plasmodium spp., were identified in three of the five individuals. Observed pathology includes lesions generally consistent with malaria; however, additional lesions in two of the individuals may represent hitherto unknown variation in the skeletal manifestation of this disease or co-infection with tuberculosis or brucellosis. Additionally, spondylolysis was observed in one individual with skeletal lesions suggestive of infectious disease.

CONCLUSIONS

This study sheds light on the pathological landscape in Iberia during a time of great social, demographic, and environmental change. Genetic evidence challenges the hypothesis that malaria was absent from early medieval Iberia and demonstrates the value of combining osteological and archaeogenetic methods. Additionally, all of the preferred infectious diagnoses for the individuals included in this study (malaria, tuberculosis, and brucellosis) could have contributed to the febrile cases described in historical sources from this time.

The Role of Fe, S, P, Ca, and Sr in Porous Skeletal Lesions: A Study on Non-adult Individuals Using pXRF

Portable X-ray fluorescence is a new tool in the study of human bone. This research aims to investigate if variations in bone elemental concentrations are related with porous skeletal lesions (PSLs). One hundred well-preserved non-adult skeletons aged 0-11 years were selected from the archaeological site Convent of São Domingos, Lisbon (18th-19th century). Measuring a standard reference material and calculating the technical error of measurement assured elemental data reliability. Moreover, measuring soil samples excluded possible contamination of bones with elements from the soil, except for Pb. Additionally, the Ca/P ratio indicates maintenance of bone integrity. Cribra cranii, orbitalia, humeralis, and femoralis were recorded as present/absent, and the estimated intra-/inter-observer errors were low. The multivariate analysis found higher odds of having cribra orbitalia (OR = 1.76; CI = 0.97-3.20) and cribra femoralis (OR = 1.42; CI = 0.73-2.74) in individuals with lower Fe and higher S. Furthermore, higher levels of P, Ca, and Sr increased the odds of individuals developing cribra femoralis (OR = 2.30; CI = 1.23-4.29). Age also correlated with increased odds of exhibiting cribra orbitalia (OR = 1.86; CI = 0.94-3.68), cribra femoralis (OR = 6.97; CI = 2.78-17.45), and cribra humeralis (OR = 8.32; CI = 2.71-25.60). These findings suggest a shared etiology for these three cribras, contrasting with the higher Fe levels in individuals with cribra cranii. Lower Fe and higher S levels in individuals with cribra suggest a complex etiology, possibly involving conditions like megaloblastic or chronic disease anemia(s). Age-related elemental changes support the hypothesis that age influences cribra frequencies. This study highlights PSL complexity and opens new avenues for research.

Biocultural and social determinants of ill health and early mortality in a New Mexican paediatric autopsy sample

RESULTS.

Hispanic children have higher odds of growth stunting than non-Hispanic White children. Native American children die younger and have higher odds of respiratory diseases and porous lesions than Hispanic and non-Hispanic Whites. Rural/urban location does not significantly impact age at death, but housing type does. Individuals who lived in trailers/mobile homes had earlier ages at death. When intersections between housing type and housing location are considered, children who were poor and from impoverished areas lived longer than those who were poor from relatively well-off areas.

CONCLUSIONS.

Children's health is shaped by factors outside their control. The children included in this study embodied experiences of social and ELS and did not survive to adulthood. They provide the most sobering example of the harm that social factors (structural racism/discrimination, socioeconomic, and political structures) can inflict.

Investigating the association between intestinal parasite infection and cribra orbitalia in the medieval population of Cambridge, UK

OBJECTIVE

Cribra orbitalia is believed to be a skeletal indicator of chronic anaemia, scurvy, rickets or related metabolic diseases. It has been suggested that it may be used as a proxy indicator for intestinal parasite infection, as parasites often cause anaemia today. Our aim is to investigate this association in the medieval population of Cambridge, UK.

MATERIALS

Individuals excavated from the cemeteries of the Augustinian friary and All Saints by the Castle parish church, and aged from 7 to adulthood.

METHODS

We undertook parasite analysis of the pelvic sediment and control samples of 46 burials with intact orbital roofs.

RESULTS

Human roundworm (Ascaris lumbricoides) and/or whipworm (Trichuris trichiura) were identified in the pelvic sediment of 22 individuals, and cribra orbitalia noted in 11 individuals. Barnards test showed no association between parasite infection and cribra orbitalia (p = .882).

CONCLUSION

We found no association between infection and cribra orbitalia infection in this medieval adult population, calling into question this hypothesis, at least for adults.

SIGNIFICANCE

High or low cribra orbitalia prevalence in adults should not be used to infer rates of intestinal parasite infection.

LIMITATIONS

The individuals in the study were over the age of 7, with no younger children. It is possible that only parasites which cause marked anaemia (such as hookworm, schistosomiasis or malaria) may cause cribra orbitalia, while less marked anaemia from roundworm and whipworm may not do so.

SUGGESTIONS FOR FURTHER RESEARCH

Repeating this study in younger children, when most cribra orbitalia appears to form.

Perspectives on anemia: Factors confounding understanding of past occurrence

OBJECTIVE

This paper reviews factors confounding the understanding of the past occurrence of anemia. Using the evidence gathered, a framework is presented of ways forward to enable greater confidence in diagnosing acquired anemia in paleopathology, facilitating insights into longer-term perspectives on this globally relevant condition.

RESULTS

To date, porotic lesions have been central to paleopathological investigations of anemia. The fact that porotic bone lesions are omnipresent and have multiple causes but are likely to have a relatively low, age-related frequency in individuals with anemia, a condition that will have been common in past communities, is confounding.

METHODS

Establishing frameworks that move away from porotic lesions is proposed to facilitate higher levels of more accurate anemia diagnoses in paleopathology.

SIGNIFICANCE

Acceptance of the fundamental principle that anemia may be better considered as a condition requiring metric evaluation of bone structures, supplemented by careful consideration of lesions, will advance understanding of acquired anemia in past communities. Such an approach would provide a clear basis for further consideration of congenital conditions causing anemia, such as sickle-cell disease and thalassemia.

LIMITATIONS

This paper simply opens the conversation on the better diagnosis of anemia in paleopathology; it starts the iterative process of achieving some consensus and progress on diagnosing anemia in paleopathology.

SUGGESTIONS FOR FURTHER RESEARCH

Engagement with ideas presented, sharing data and development of metric parameters will assist in identifying the effects of marrow hyperplasia on bone, enabling more robust work on the important topic of anemia.

Medieval monastic health: Variation in skeletal signs of inflammation and developmental stress between religious orders in London

OBJECTIVES

Previous bioarchaeological analyses of medieval monastic and nonmonastic cemeteries in London revealed evidence of lower risks of mortality, and thus better health, in the monastic settings. However, comparison of the two monastic communities, Bermondsey Abbey and Merton Priory, which adhered to different religious ideals, suggested lower risks of mortality in the former. This study examines patterns of skeletal biomarkers, which reflect developmental stress or inflammation, in an attempt to clarify the possible underlying mechanisms producing apparent health differences in these monastic communities.

MATERIALS AND METHODS

This study uses skeletal data on age-at-death, periosteal new bone formation (PNBF), and cribra orbitalia from 558 adults (18 years of age and older) estimated to be male from Bermondsey Abbey and Merton Priory. Biomarker age patterns are assessed via Kaplan-Meier survival analysis and binary logistic regression. Differences in frequencies of biomarkers between the monastic sites are evaluated using Chi-square and hierarchical log-linear analyses.

RESULTS

In general, PNBF is positively associated with age, and cribra orbitalia is negatively associated with age. The frequency of PNBF formation is significantly higher and that of cribra orbitalia is significantly lower in Bermondsey Abbey compared with Merton Priory.

CONCLUSIONS

The differences in frequencies of these skeletal biomarkers support previous findings suggesting that health conditions were better in Bermondsey Abbey than in Merton Priory. The age patterns of cribra orbitalia suggest that these differences reflect conditions and the greater health-promoting effects of religiosity or isolation from the lay community in Bermondsey Abbey rather than differences in selective admissions processes.

Bioanthropological analysis of human remains from the archaic and classic period discovered in Puyil cave, Mexico

OBJECTIVES

Determine the geographic place of origin and maternal lineage of prehistoric human skeletal remains discovered in Puyil Cave, Tabasco State, Mexico, located in a region currently populated by Olmec, Zoque and Maya populations.

MATERIALS AND METHODS

All specimens were radiocarbon (14 C) dated (beta analytic), had dental modifications classified, and had an analysis of 13 homologous reference points conducted to evaluate artificial cranial deformation (ACD). Following DNA purification, hypervariable region I (HVR-1) of the mitogenome was amplified and Sanger sequenced. Finally, Next Generation Sequencing (NGS) was performed for total DNA. Mitochondrial DNA (mtDNA) variants and haplogroups were determined using BioEdit 7.2 and IGV software and confirmed with MITOMASTER and WebHome softwares.

RESULTS

Radiocarbon dating (14 C) demonstrated that the inhabitants of Puyil Cave lived during the Archaic and Classic Periods and displayed tabular oblique and tabular mimetic ACD. These pre-Hispanic remains exhibited five mtDNA lineages: A, A2, C1, C1c and D4. Network analysis revealed a close genetic affinity between pre-Hispanic Puyil Cave inhabitants and contemporary Maya subpopulations from Mexico and Guatemala, as well as individuals from Bolivia, Brazil, the Dominican Republic, and China.

CONCLUSIONS

Our results elucidate the dispersal of pre-Hispanic Olmec and Maya ancestors and suggest that ACD practices are closely related to Olmec and Maya practices. Additionally, we conclude that ACD has likely been practiced in the region since the Middle-Archaic Period.

Socio-cultural practices may have affected sex differences in stature in Early Neolithic Europe

The rules and structure of human culture impact health as much as genetics or environment. To study these relationships, we combine ancient DNA (n = 230), skeletal metrics (n = 391), palaeopathology (n = 606) and dietary stable isotopes (n = 873) to analyse stature variation in Early Neolithic Europeans from North Central, South Central, Balkan and Mediterranean regions. In North Central Europe, stable isotopes and linear enamel hypoplasias indicate high environmental stress across sexes, but female stature is low, despite polygenic scores identical to males, and suggests that cultural factors preferentially supported male recovery from stress. In Mediterranean populations, sexual dimorphism is reduced, indicating male vulnerability to stress and no strong cultural preference for males. Our analysis indicates that biological effects of sex-specific inequities can be linked to cultural influences at least as early as 7,000 yr ago, and culture, more than environment or genetics, drove height disparities in Early Neolithic Europe.

Parasites in ancient Egypt and Nubia: Malaria, schistosomiasis and the pharaohs

The civilizations of ancient Egypt and Nubia played a key role in the cultural development of Africa, the Near East, and the Mediterranean world. This study explores how their location along the River Nile, agricultural practices, the climate, endemic insects and aquatic snails impacted the type of parasites that were most successful in their populations. A meta-analysis approach finds that up to 65% of mummies were positive for schistosomiasis, 40% for headlice, 22% for falciparum malaria, and 10% for visceral leishmaniasis. Such a disease burden must have had major consequences upon the physical stamina and productivity of a large proportion of the workforce. In contrast, the virtual absence of evidence for whipworm and roundworm (so common in adjacent civilizations in the Near East and Europe) may have been a result of the yearly Nile floods fertilising the agricultural land, so that farmers did not have to fertilise their crops with human faeces.

Infantile scurvy as a consequence of agricultural intensification in the 1st millennium BCE Etruria Campana

The 1st millennium BCE in Italy was a time of agricultural intensification of staple cereal production which shaped sociocultural, political, and economic spheres of pre-Roman groups. The lifeways and foodways of the Etruscans, the greatest civilization in western Europe before Roman hegemony, are traditionally inferred from secondary written sources, funerary archaeology, archaeobotany, and zooarchaeology. However, no direct data extrapolated from the study of human skeletal remains are available to evaluate the extent to which agricultural intensification and decreased dietary diversity impacted health and the expression of skeletal indicators of metabolic disease. Macroscopic and radiological analyses were conducted on an archaeological skeletal sample of non-adults (n = 29) recovered from Pontecagnano (southern Italy) dating to the Orientalizing period (730-580 BCE). This allowed us to identify five cases of scorbutic non-adults and to assign diagnostic values to skeletal lesions of scurvy that have not been previously described in the literature. The onset of scurvy in the examined sample is related to the increased reliance of Etruscans on crops lacking vitamin C in this period of agricultural intensification. The skeletal expression of scurvy varied among the non-adults, with differences in location and disease severity; these were interpreted considering the age-at-death of the individuals coupled with feeding behaviors and interindividual variability.

Assessing the association of skeletal indicators of stress with mean age-at-death in sub-adults

OBJECTIVES

The present study investigated the association of skeletal indicator of stress presence with mean age-at-death as a means of understanding whether commonly studied indicators are indeed indicative of increased frailty.

MATERIALS AND METHODS

Using a medieval Gaelic population from Ballyhanna (Co. Donegal), the present study assessed the association between skeletal indicators of stress and mean age-at-death using the Kaplan-Meier survival function with log rank test to determine whether these indicators were associated with younger age-at-death, and therefore increased frailty, in sub-adults only (0 to 18 years, N = 139) and through comparison to an all-ages cohort (N = 318).

RESULTS

Only linear enamel hypoplasia was found to be associated with significantly decreased survivorship across the all-ages cohort but, conversely, was associated with increased survivorship when analysis was restricted to sub-adults. All other indicators assessed were associated with increased age-at-death for both all-age cohorts and sub-adult cohorts (cribra orbitalia), increased age-at-death when assessing all ages only (porotic hyperostosis and healed periosteal lesions); or were sufficiently rare in adults to prevent comparative analysis (stunting and micronutrient deficiency). Increased survivorship in individuals with higher numbers of co-morbid skeletal indicators was observed for both sub-adults alone and all age cohort.

DISCUSSION

These findings suggest that these commonly recorded skeletal indicators may be more accurately viewed simply as records of stressor exposure and subsequent survival only, rather than providing evidence that these sub-adults are frailer than their similarly aged-at-death peers. Thus, the demographic and sociocultural context is essential to the interpretation of observed skeletal indicators of stress.

The Black Death in Hereford, England: A demographic analysis of the Cathedral 14th-century plague mass graves and associated parish cemetery

OBJECTIVES

This study explores the paleoepidemiology of the Black Death (1348-52 AD) mass graves from Hereford, England, via osteological analysis. Hereford plague mortality is evaluated in the local context of the medieval city and examined alongside other Black Death burials.

METHODS

The Hereford Cathedral site includes mass graves relating to the Black Death and a 12th-16th century parish cemetery. In total, 177 adult skeletons were analyzed macroscopically: 73 from the mass graves and 104 from the parish cemetery. Skeletal age-at-death was assessed using transition analysis, and sex and stress markers were analyzed.

RESULTS

The age-at-death distributions for the mass graves and parish cemetery were significantly different (p = 0.0496). Within the mass graves, young adults (15-24 years) were substantially over-represented, and mortality peaked at 25-34 years. From 35 years of age onwards, there was little variation in the mortality profiles for the mass graves and parish cemetery. Males and females had similar representation across burial types. Linear enamel hypoplasia was more prevalent within the mass graves (p = 0.0340) whereas cribra orbitalia and tibial periostitis were underrepresented.

CONCLUSIONS

Mortality within the Hereford mass graves peaked at a slightly older age than is seen within plague burials from London, but the overall profiles are similar. This demonstrates that young adults were disproportionately at risk of dying from plague compared with other age groups. Our findings regarding stress markers may indicate that enamel hypoplasia is more strongly associated with vulnerability to plague than cribra orbitalia or tibial periostitis.

More than urns: A multi-method pipeline for analyzing cremation burials

Burial rites of archaeological populations are frequently interpreted based on cremated remains of the human body and the urn they were deposited in. In comparison to inhumations, information about the deceased is much more limited and dependent on fragmentation, selection of body regions, taphonomic processes, and excavation techniques. So far, little attention has been paid to the context in which urns are buried. In this study, we combined archaeological techniques with anthropology, computed tomography, archaeobotany, zooarchaeology, geochemistry and isotopic approaches and conducted a detailed analysis on a case study of two Late Bronze Age urns from St. Pölten, Austria (c. 1430 and 1260 cal. BCE). The urns were recovered en-bloc and CT-scanned before the micro-excavation. Osteological and strontium isotope analysis revealed that the cremated remains comprised a young adult female and a child that died at the age of 10-12 years. Both individuals had been subject to physiological stress and were likely local. Animal bones burnt at different temperatures suggested different depositional pathways into the urn and pit as part of the pyre, food offerings, and unintentional settlement debris. Eight wild plant and five crop plant species appeared as part of the local landscape, as food offerings and fire accelerants. Sediment chemistry suggests that pyre remains were deposited around the urns during burial. Multi-element geochemistry, archaeobotany, and zooarchaeology provide insights into the Late Bronze Age environment, the process of cremation, the gathering of bones and final funerary deposition.

Skeletal manifestations of disease experience: Length of illness and porous cranial lesion formation in a contemporary juvenile mortality sample

OBJECTIVES

Porous lesions of the orbit (cribra orbitalia [CO]) and cranial vault (porotic hyperostosis [PH]) are used as skeletal indicators of childhood stress. Because they are understudied in contemporary populations, their relationship to disease experience is poorly understood. This paper examines the relationship between length of childhood illness and CO/PH formation in a clinically documented sample. "Turning points," which identify the window for lesion formation for CO/PH, are defined, implications for hidden heterogeneity in frailty are considered.

METHODS

Data are from 333 (199 males; 134 females) pediatric postmortem computed tomography scans. Individuals died in New Mexico (2011-2019) and are 0.5 to 15.99 years (mean = 7.1). Length of illness was estimated using information from autopsy and field reports. Logistic regression was used to estimate predicted probabilities, odds ratios, and the temporal window for lesion formation.

RESULTS

Illness, single bouts, or cumulative episodes lasting over 1 month is associated with higher odds of CO; individuals who were never sick have lower odds of having PH. This relationship was consistent for fatal and incidental illnesses that did not cause death. The developmental window for CO formation appears to close at 8 years.

CONCLUSIONS

Those ill for over 1 month are more likely to have CO/PH than those with acute illnesses. Some individuals lived sufficiently long to form CO/PH but died of illness. Others with lesions died of circumstances unrelated to disease. This indicates hidden variation in robusticity even among ill individuals with CO/PH, which is vital in interpreting lesion frequencies in the archeological record.

Pilot study of correlation of selected genetic factors with cribra orbitalia in individuals from a medieval population from Slovakia

OBJECTIVE

The aim of this study is to investigate the potential genetic etiology of cribra orbitalia noted on human skeletal remains.

MATERIALS

We obtained and analyzed ancient DNA of 43 individuals with cribra orbitalia. The analyzed set represented medieval individuals from two cemeteries in western Slovakia, Castle Devín (11th-12th century AD) and Cífer-Pác (8th-9th century AD).

METHODS

We performed a sequence analysis of 5 variants in 3 genes associated with anemia (HBB, G6PD, PKLR), which are the most common pathogenic variants in present day of European populations, and one variant MCM6:c.1917 + 326 C>T (rs4988235) associated with lactose intolerance.

RESULTS

DNA variants associated with anemia were not found in the samples. The allele frequency of MCM6:c.1917 + 326 C was 0.875. This frequency is higher but not statistically significant in individuals displaying cribra orbitalia compared to individuals without the lesion.

SIGNIFICANCE

This study seeks to expand our knowledge of the etiology of cribra orbitalia by exploring the potential association between the lesion and the presence of alleles linked to hereditary anemias and lactose intolerance.

LIMITATIONS

A relatively small set of individuals were analyzed, so an unequivocal conclusion cannot be drawn. Hence, although it is unlikely, a genetic form of anemia caused by rare variants cannot be ruled out.

SUGGESTIONS FOR FURTHER RESEARCH

Genetic research based on larger sample sizes and in more diverse geographical regions.

Developing an archaeology of malaria. A critical review of current approaches and a discussion on ways forward

OBJECTIVE

This paper presents the current state of the art in the investigation of past malaria by providing an extensive review of previous studies and identifying research possibilities for the future.

MATERIALS

All previous research on the detection of malaria in human skeletal material using macroscopic and biomolecular approaches is considered.

METHODS

The approaches and methods used by scholars and the results they obtained are evaluated and the limitations discussed.

RESULTS

There is a link between malaria and porous lesions with significantly higher prevalence in malaria-endemic areas, however, they are not pathognomonic or specific for malaria. Malaria can be identified using biomolecular techniques, yet, to date there is no completely satisfactory method that is able to consistently diagnose the disease.

CONCLUSIONS

Using macroscopic and biomolecular techniques, malaria can be investigated in past populations and the impact of the disease studied. Yet, this is not a straightforward process and the use of multiple lines of evidence is necessary to obtain the best results.

SIGNIFICANCE

The extensive discussion on ways malaria can and cannot be identified in past populations and the suggestions for new approaches provide a steppingstone for future research into this debilitating, global disease.

LIMITATIONS

Malaria is a difficult disease to study archaeologically and successful identification depends on many intrinsic and extrinsic factors.

SUGGESTIONS FOR FURTHER RESEARCH

More large-scale spatial analyses of porous lesions as well as targeting different tissues or molecules for biomolecular identification may improve the archaeological understanding of malaria.

Skeletal Markers of Physiological Stress as Indicators of Structural Violence: A Comparative Study between the Deceased Migrants of the Mediterranean Sea and the CAL Milano Cemetery Skeletal Collection

Structural violence is an indirect form of violence that can lead to physiological consequences. Interestingly, these physiological disruptions may affect the skeletons and can therefore provide relevant information on violence and way of life in the analysis of skeletal remains. The aim of the present study was to test the hypothesis that migrants who died in the Mediterranean Sea would present physiological cranial stress markers such as cribra orbitalia (CO), porotic hyperostosis (PH), and linear enamel hypoplasia (LEH) more frequently and more severely than Italians of the 20th century. With this intent, a total of 164 crania were examined: 139 from deceased migrants recovered from a shipwreck in the Mediterranean Sea in 2015, aged between 16 and 35 years old, and 25 of the same age from the CAL Milano Cemetery Skeletal Collection. Both presence and severity of CO, PH, and LEH were evaluated. The data obtained were analyzed using Wilcoxon signed-rank and independence Chi-squared tests to compare the results between the two samples and to test whether there was an association between the sample of migrants and the occurrence of lesions. As a result, CO and PH appeared more frequently and more severely in the migrant sample. In addition, migrants were significantly associated with CO, PH, and LEH (p-values < 0.05). Although this does not imply in any way that CO, PH, and LEH are specific to migration, they should be regarded as indicators of structural violence.

The dark satanic mills: Evaluating patterns of health in England during the industrial revolution

OBJECTIVE

this research seeks to investigate the impact the industrial revolution had on the population of England.

MATERIALS

Pre-existing skeletal data from 1154 pre-Industrial (1066-1700 CE) and 4157 industrial (1700-1905) skeletons from 21 cemeteries (N = 5411).

METHODS

Context number, sex, age-at-death, stature and presence/absence of selected pathological conditions were collated. The data were compared using chi square, Kolmogorov-Smirnov, t-tests and logistic regression (α = 0.01).

RESULTS

There was a statistically significant increase in cribra orbitalia, periosteal reactions, rib lesions, fractures, rickets, osteoporosis, osteoarthritis, enamel hypoplasia, dental caries and periapical lesions in the industrial period. Osteomyelitis decreased from the pre-industrial to industrial period.

CONCLUSION

Our results confirm the industrial revolution had a significant negative impact on human health, however the prevalence of TB, treponemal disease, maxillary sinusitis, osteomalacia, scurvy, gout and DISH did not change, suggesting these diseases were not impacted by the change in environmental conditions.

SIGNIFICANCE

This is the largest study of health in the industrial revolution that includes non-adults and adults and considers age-at-death alongside disease status to date. This data supports the hypothesis that the rise of industry was associated with a significant decline in general health, but not an increase in all pathological conditions.

Was it worth migrating to the new British industrial colony of South Australia? Evidence from skeletal pathologies and historic records of a sample of 19th-century settlers

OBJECTIVES

To examine pathological evidence present in a sample of 19th -century settlers to South Australia in the context of an early industrial society.

MATERIALS

Skeletal remains of 20 adults and 45 nonadults from the government funded burial site (free ground) of St Mary's Anglican Church Cemetery, gravestones of privately funded burials and local parish records.

METHODS

Investigation of pathological manifestations of skeletal remains, church records and historic literature. Comparison with similar samples from Britain and from New South Wales.

RESULTS

Joint disease seen in 35% of adults. Porosity in bone cortices indicative of vitamin C deficiency seen in 32% of the total sample and porous lesions in the orbit (cribra orbitalia) in 7% of nonadults. Traumatic fractures identified in two adult males. Gastrointestinal conditions were the leading cause of death for nonadults, most adults died of pulmonary conditions. Life expectancy of people buried at the expense of the government was 23.8-42.6 years, those in private burials 57.1 years.

CONCLUSION

Health of migrant settlers from the St Mary's free ground did not differ much from that of a similar population in Britain nor of settlers in New South Wales. Thus, it is characteristic for lower socioeconomic groups in early industrialised societies.

SIGNIFICANCE

St Mary's sample is a rarity due scarcity of similar Australian skeletal samples.

LIMITATIONS

Small sample size and lack of similar samples for comparison.

SUGGESTIONS FOR FURTHER RESEARCH

Comprehensive investigation of dentitions in St Mary's sample and studies of more skeletal samples of early settlers in other Australian locations.

Health effects of European colonization: An investigation of skeletal remains from 19th to early 20th century migrant settlers in South Australia

The British colony of South Australia, established in 1836, offered a fresh start to migrants hoping for a better life. A cohort of settlers buried in a section of St Mary’s Anglican Church Cemetery (1847–1927) allocated for government funded burials was investigated to determine their health, with a focus on skeletal manifestations associated with metabolic deficiencies. Findings of St Mary’s sample were compared with those published for contemporary skeletal samples from two British cemeteries, St Martin’s, Birmingham, and St Peter’s, Wolverhampton, to explore similarities and differences. To investigate the changing economic background of the St Mary’s cohort, which may have influenced the location of their burial within the cemetery, the number and demographic profile of government funded burials and those in privately funded leased plots were compared. The study sample consisted of the skeletal remains of 65 individuals (20 adults, 45 subadults) from St Mary’s Cemetery ‘free ground’ section. The bones and teeth of individuals in this cohort showed evidence of pathological manifestations, including areas of abnormal porosity in bone cortices in 9 adults and 12 subadults and flaring of metaphyses (one subadult) and costochondral junctions of the ribs (one subadult). Porous lesions of orbital roof bones (Types 3 to 4) were seen on three subadults. Macroscopic examination of teeth identified enamel hypoplastic defects and micro-CT scans showed areas of interglobular dentine. Comparison of St Mary’s findings with the British samples revealed that prevalences of manifestations associated with vitamin C deficiency were higher at St Mary’s and manifestations associated with vitamin D deficiency were lower respectively. The location of burial pattern at St Mary’s Cemetery, from the mid-1840s to1860s, showed differences in the economic status of migrants. This pattern changed from the 1870s, which reflected improvements in the local economy and the economic recovery of the colony.

An integrative skeletal and paleogenomic analysis of stature variation suggests relatively reduced health for early European farmers

Human culture, biology, and health were shaped dramatically by the onset of agriculture ∼12,000 y B.P. This shift is hypothesized to have resulted in increased individual fitness and population growth as evidenced by archaeological and population genomic data alongside a decline in physiological health as inferred from skeletal remains. Here, we consider osteological and ancient DNA data from the same prehistoric individuals to study human stature variation as a proxy for health across a transition to agriculture. Specifically, we compared “predicted” genetic contributions to height from paleogenomic data and “achieved” adult osteological height estimated from long bone measurements for 167 individuals across Europe spanning the Upper Paleolithic to Iron Age (∼38,000 to 2,400 B.P.). We found that individuals from the Neolithic were shorter than expected (given their individual polygenic height scores) by an average of −3.82 cm relative to individuals from the Upper Paleolithic and Mesolithic (P = 0.040) and −2.21 cm shorter relative to post-Neolithic individuals (P = 0.068), with osteological vs. expected stature steadily increasing across the Copper (+1.95 cm relative to the Neolithic), Bronze (+2.70 cm), and Iron (+3.27 cm) Ages. These results were attenuated when we additionally accounted for genome-wide genetic ancestry variation: for example, with Neolithic individuals −2.82 cm shorter than expected on average relative to pre-Neolithic individuals (P = 0.120). We also incorporated observations of paleopathological indicators of nonspecific stress that can persist from childhood to adulthood in skeletal remains into our model. Overall, our work highlights the potential of integrating disparate datasets to explore proxies of health in prehistory.

A biological approach to adult sex differences in skeletal indicators of childhood stress

OBJECTIVES

In previous work examining the etiology of cribra orbitalia (CO) and porotic hyperostosis (PH) in a contemporary juvenile mortality sample, we noted that males had higher odds of having CO lesions than females. Here, we examine potential reasons for this pattern in greater detail. Four non-mutually exclusive mechanisms could explain the observed sex differences: (1) sex-biased mortality; (2) sexual dimorphism in immune responses; (3) sexual dimorphism in bone turnover; or (4) sexual dimorphism in marrow conversion.

SUBJECTS AND METHODS

The sample consists of postmortem computed tomography scans and autopsy reports, field reports, and limited medical records of 488 individuals from New Mexico (203 females; 285 males) aged between 0.5 and 15 years. We used Kaplan-Meier survival analysis, predicted probabilities, and odds ratios to test each mechanism.

RESULTS

Males do not have lower survival probabilities than females, and we find no indications of sex differences in immune response. Overall, males have a higher probability of having CO or PH lesions than females.

CONCLUSIONS

All results indicate that lesion formation in juveniles is influenced by some combination of sex differences in the pace of red-yellow conversion of the bone marrow and bone turnover. The preponderance of males with CO and PH likely speaks to the potential for heightened osteoblastic activity in males. We find no support for the hypotheses that sex biases in mortality or immune responses impacted lesion frequency in this sample. Sex differences in biological processes experienced by children may affect lesion formation and lesion expression in later life.

Height and health in Roman and Post-Roman Gaul, a life course approach

OBJECTIVE

The present study explores growth and health in Roman (1st-3rd centuries CE) and Post-Roman (4th-7th centuries CE) Gaul, incorporating a life-course approach, to better understand the influence of Roman practices and lifestyles on health, and the impact of cultural change from the Roman to the Post-Roman period.

MATERIALS AND METHODS

The skeletal remains of 844 individuals were analyzed for non-specific signs of physiological stress, including growth disruption (diaphyseal and adult maximum femur length), dental enamel hypoplastic defects (DEH), cribra orbitalia (CO), and periosteal reaction of the tibiae (Tibia PR).

RESULTS

The Gallo-Roman sample demonstrated shorter femoral lengths, and higher rates of DEH and Tibia PR. Post-Roman groups demonstrated longer femoral lengths and higher rates of CO.

CONCLUSIONS

Gallo-Roman individuals may have been more regularly exposed to infectious pathogens throughout childhood, inhibiting opportunities for catch-up growth, resulting in high rates of DEH and shorter femoral lengths ('intermittent stress of low lethality'). This could be the result of overcrowding and insalubrious urban environments. Higher rates of CO in the Post-Roman samples may have been influenced by dietary changes between the periods.

SIGNIFICANCE

The intertwined and often synergistic relationships between early life environment, nutrition and settlement structure is highlighted, helping to further understandings of life experiences during the Roman and Post-Roman periods.

LIMITATIONS

It was not possible to obtain sufficient data from northern regions during the Gallo-Roman period, limiting this analysis.

SUGGESTIONS FOR FURTHER RESEARCH

Further application of life course approaches can reveal subtle patterns in stress indicators.

Cribriotic lesions in archaeological human skeletal remains. Prevalence, co-occurrence, and association in medieval and early modern Netherlands

OBJECTIVE

This paper studies the prevalence, co-occurrence, and association of cribra orbitalia, cribra humeri, and cribra femora to contribute to the complex debate on cribriotic lesions and their relationship with one another.

MATERIALS

179 adults and 53 non-adults from the medieval/early modern Netherlands (800-1600 CE) for whom all three lesions could be observed are included in this study.

METHODS

Presence or absence of cribriotic lesions was studied macroscopically. Prevalence, co-occurrence, and association of lesions and their link to sex and age-at-death were assessed.

RESULTS

A clear link between prevalence of the lesions and age-at-death is found. Co-occurrence and association of all three lesions is uncommon. There is a significant moderate correlation for cribra humeri-femora in non-adults.

CONCLUSIONS

Lesion prevalence is connected to age-at-death. However, while a similar age distribution and associations between pairs of lesions are noted, due to limited co-occurrence of the three lesions, the presence of a 'cribrous syndrome' cannot supported.

SIGNIFICANCE

This is the first study investigating the prevalence, co-occurrence and association of cribra orbitalia, cribra humeri, and cribra femora in non-adults and adults contributing to discussions about the nature and the much-debated aetiology of these commonly encountered skeletal lesions.

LIMITATIONS

The number of non-adults in this study is limited, potentially obscuring meaningful patterns, as the cribrous lesions are significantly more common in younger individuals.

SUGGESTIONS FOR FURTHER RESEARCH

More research into the prevalence of the post-cranial lesions and their co-occurrence as well as into bone growth and remodelling is warranted.

Cribra orbitalia is correlated with the meningo-orbital foramen and is vascular and developmental in nature

Cribra orbitalia is a phenomenon with interdisciplinary interest. However, the etiology of cribra orbitalia remains unclear. Recently, the appearance of cribra orbitalia was identified as vascular in nature. This study assessed the relationship between anatomical variation of vasculature, as determined by the presence of meningo-orbital foramina, and the presence of cribra orbitalia in 178 orbits. Cribra orbitalia was identified in 27.5% (49:178) of orbits (22.7%, 35:154 adult orbits and 58.3%, 14:24 subadult orbits) and meningo-orbital foramina were identified in 65.8% (100:152) of orbits. Among the 150 total intact adult orbits (i.e., orbital roof and posterior orbits both intact), cribra orbitalia was found in 35 (23.3%). Of these 35 occurrences of cribra orbitalia, 32 (91.4%) had the concurrent finding of a meningo-orbital foramen. However, in the absence of the meningo-orbital foramen, cribra orbitalia was only found in three sides out of the total sample of intact orbits (3:150; 2.0%). Fisher's exact test revealed that the presence of cribra orbitalia and the meningo-orbital foramen were statistically dependent variables (p = .0002). Visual evidence corroborated statistical findings-vascular impressions joined cribra orbitalia to meningo-orbital foramina. This study identifies that individuals who possess a meningo-orbital foramen are anatomically predisposed to developing cribra orbitalia. Conversely, cribra orbitalia is unlikely to occur in an individual who does not possess a meningo-orbital foramen. Thus, the antecedent of cribra orbitalia is both vascular and developmental in nature. This report represents an important advancement in the understanding of cribra orbitalia-there is an anatomical predisposition to the development of cribra orbitalia.

The biological index of frailty: A new index for the assessment of frailty in human skeletal remains

OBJECTIVE

Frailty is the physiological stress that individuals suffer during their life. In past populations, frailty is conventionally assessed through the occurrence of different biomarkers of biological stress. Some efforts have been made to propose indexes that combine all biomarkers. However, these indices have some critical limitations: they cannot be used on incomplete skeletons, do not consider the severity and/or healing of lesions, and assign equal importance to different biomarkers. To address these limitations, we propose a new index to assess frailty in skeletal individuals.

MATERIAL AND METHODS

By statistically analyzing a large amount of osteological data available from the Museum of London, and using a Logit model, we were able to define a different weight for each reported biomarker of frailty, based on their importance in increasing the risk of premature death for the individuals.

RESULTS

The biological index of frailty (BIF) is the weighted mean of all biomarkers scored on the individuals, according to a different degree of importance assigned to each one. It also considers the severity and healing of the biomarkers when this is relevant to diagnose frailty. We applied BIF on a sample of Monastics and Non-Monastics from medieval England and compared it with the skeletal index of frailty (SFI).

DISCUSSION

BIF is the first frailty index that gives a different weight to each skeletal biomarker of stress, considers both severity and healing of the lesions, and can be applied on partial skeletal remains. The comparison with SFI showed that BIF is applicable to a larger number of skeletal individuals, revealing new differences between the Monastic and the Non-Monastic groups.

Skeletal evidence of structural violence among undocumented migrants from Mexico and Central America

OBJECTIVES

We examine the prevalence and sociodemographic risk factors of skeletal indicators of stress in forensic samples of undocumented migrants from Mexico and Central America.

MATERIALS AND METHODS

Cranial and dental remains of 319 migrants recovered in the Arizona and Texas borderlands were assessed for porotic hyperostosis (PH), cribra orbitalia (CO), and linear enamel hypoplasias (LEH). Logistic regression models for each condition were estimated to test for associations with biological sex, age, recovery location, and whether individuals were identified. Additional models estimated for a subsample of identified migrants included region of origin, residential context, and community indigeneity.

RESULTS

The full sample shows moderate crude prevalence of CO (9.6%) and LEH (34.1%), and a high prevalence of PH (49.6%). Significantly higher odds of PH are associated with being male (2.16 times higher), unidentified (1.89 times higher), and recovered in Arizona (3.76 times higher). Among identified migrants, we fail to find associations significant at the p < 0.05 level between skeletal stress and all sociodemographic variables except age.

DISCUSSION

The factors associated with PH may be related to influences on decisions to migrate and diversity among migrant sending regions. The skeletal evidence for early life stress is generally consistent with common public health concerns among impoverished communities in the region. The lesions themselves are viewed as embodied risk of physiological disturbance when resource access is structured by higher-level social, economic, and political forces. Forensic anthropologists would benefit from increased sensitivity to embodied structural violence among the vulnerable individuals and communities they serve.

Do computed tomography findings agree with traditional osteological examination? The case of porous cranial lesions

OBJECTIVE

The current study evaluates the feasibility of using clinical cranial computed tomography (CT) scans for assessing the presence and morphology of porous cranial lesions (cribra orbitalia, porotic hyperostosis).

METHODS

Observers (n = 4) conducted three independent evaluations of porous cranial lesions based on photographs, 2-D CT, and 3-D CT scans of archaeological crania. Evaluations of the crania from each viewing scenario were compared to findings from direct macroscopic observation.

MATERIALS

Twenty-two complete adult crania from the Peruvian sites of Pachacamac and Chicama.

RESULTS

We found that lesion visibility differed by location: vault lesions with porosity larger than the resolution of the CT scan were identifiable across all viewing scenarios, but orbital lesions were identifiable only when extensive porosity was accompanied by widening of the inter-trabecular spaces. Lesions in stages of advanced remodeling were not visible on CT.

CONCLUSIONS

Paleopathological criteria applied to head CTs from clinical cases of suspected cranial fracture can reliably identify moderate to severe porous cranial lesions in living individuals.

SIGNIFICANCE

This validation study opens the door to broader study of porous cranial lesions in living individuals that can address open questions about the causes and consequences of these commonly reported skeletal indicators of stress.

LIMITATIONS

Performance of all viewing scenarios was evaluated relative to assessment data from direct observation of skeletal remains, but direct observation is itself subject to error.

SUGGESTIONS FOR FURTHER RESEARCH

The increasing resolution of routine CTs makes it increasingly possible to explore skeletal lesions in clinical contexts.

Using a multimethod life history approach to navigate the osteological paradox: A case study from Prehispanic Nasca, Peru

OBJECTIVES

We leverage recent bioarchaeological approaches and life history theory to address the implications of the osteological paradox in a study population. The goal of this article is to evaluate morbidity and mortality patterns as well as variability in the risk of disease and death during the Late Intermediate period (LIP; 950-1450 C.E.) in the Nasca highlands of Peru. We demonstrate how the concurrent use of multiple analytical techniques and life history theory can engage the osteological paradox and provide salient insights into the study of stress, frailty, and resilience in past populations.

MATERIALS AND METHODS

Crania from LIP burial contexts in the Nasca highlands were examined for cribra orbitalia (n = 325) and porotic hyperostosis (n = 270). All age groups and both sexes are represented in the sample. Survivor/nonsurvivor analysis assessed demographic differences in lesion frequency and severity. Hazard models were generated to assess differences in survivorship. The relationship between dietary diversity and heterogeneity in morbidity was assessed using stable δ¹⁵ N and δ¹³ C isotope values for bone collagen and carbonate. One hundred and twenty-four crania were directly AMS radiocarbon dated, allowing for a diachronic analysis of morbidity and mortality.

RESULTS

The frequency and expression of both orbital and vault lesions increases significantly during the LIP. Survivor/nonsurvivor analysis indicates cranial lesions co-vary with frailty rather than robusticity or longevity. Hazard models show (1) decreasing survivorship with the transition into the LIP, (2) significantly lower adult life expectancy for females compared to males, and (3) individuals with cranial lesions have lower survivorship across the life course. Stable isotope results show very little dietary diversity. Mortality risk and frequency of pathological skeletal lesions were highest during Phase III (1300-1450 C.E.) of the LIP.

CONCLUSION

Results provide compelling evidence of increasing physiological stress and mortality in the Nasca highlands during the LIP, but also reveal substantial heterogeneity in frailty and the risk of death. Certain members of society experienced a heavier disease burden and higher mortality compared to their contemporaries. Elevated levels of disease and lethal trauma among females account for some of the sex differences in survivorship but cannot explain the large degree of female-biased mortality. We hypothesize that parental investment in males or increased female fertility rates may explain these differences.

An epidemiological approach to the analysis of cribra orbitalia as an indicator of health status and mortality in medieval and post-medieval London under a model of parasitic infection

OBJECTIVES

Many individuals living in medieval and post-medieval London suffered issues with sanitation, food insecurity, infectious disease, and widespread exposure to parasites from a multitude of sources, causing increased risk of death for many inhabitants. We examine this stressful environment and its relationship with various demographic and temporal dimensions, using cribra orbitalia (CO) as an indicator of stress, to model an increased risk of dying under the expectations of our proposed parasitic model of infection.

MATERIALS AND METHODS

We analyze the relationship between CO and mortality across seven medieval and post-medieval cemeteries from London by the covariates of sex, status, and age-at-death. A survival analysis (Cox regression) and a binomial logit estimated hazard and odds ratios of dying with CO across age-at-death, sex, status, and time-period within single statistical models. In addition, we provide new Bayesian age-at-death estimates for post-medieval samples.

RESULTS

The models show the rate of CO decreased over time and age-at-death, regardless of sex or status; post-medieval individuals were ~72% less likely to die with lesions than their medieval counterparts. Further, individuals with CO had ~1% decrease in risk of dying with CO per year of age.

DISCUSSION

These results suggest increased mortality risk for those with lesions indicative of anemia (CO), and selective mortality of younger individuals during the medieval period. Despite sex-specific nutritional and occupational hazards, and status-based access to resources, the prevalence of CO was similar across sex and status, which suggests living with parasitic infection that caused anemia was an everyday reality for medieval and post-medieval Londoners.

The elusive parasite: comparing macroscopic, immunological, and genomic approaches to identifying malaria in human skeletal remains from Sayala, Egypt (third to sixth centuries AD)

Although malaria is one of the oldest and most widely distributed diseases affecting humans, identifying and characterizing its presence in ancient human remains continue to challenge researchers. We attempted to establish a reliable approach to detecting malaria in human skeletons using multiple avenues of analysis: macroscopic observations, rapid diagnostic tests, and shotgun-capture sequencing techniques, to identify pathological changes, Plasmodium antigens, and Plasmodium DNA, respectively. Bone and tooth samples from ten individuals who displayed skeletal lesions associated with anaemia, from a site in southern Egypt (third to sixth centuries AD), were selected. Plasmodium antigens were detected in five of the ten bone samples, and traces of Plasmodium aDNA were detected in six of the twenty bone and tooth samples. There was relatively good synchronicity between the biomolecular findings, despite not being able to authenticate the results. This study highlights the complexity and limitations in the conclusive identification of the Plasmodium parasite in ancient human skeletons. Limitations regarding antigen and aDNA preservation and the importance of sample selection are at the forefront of the search for malaria in the past. We confirm that, currently, palaeopathological changes such as cribra orbitalia are not enough to be certain of the presence of malaria. While biomolecular methods are likely the best chance for conclusive identification, we were unable to obtain results which correspond to the current authentication criteria of biomolecules. This study represents an important contribution in the refinement of biomolecular techniques used; also, it raises new insight regarding the consistency of combining several approaches in the identification of malaria in past populations.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s12520-021-01350-z.

Increased dental fluctuating asymmetry is associated with active skeletal lesions, but not mortality hazards in the precontact Southwest United States

OBJECTIVE

This study examines whether individuals with higher dental fluctuating asymmetry (DFA) are frailer than those with lower DFA, by examining whether increased DFA is associated with skeletal lesion formation.

SUBJECTS AND METHODS

150 individuals with permanent teeth and 64 individuals with deciduous teeth. All individuals are Ancestral Puebloans from archaeological sites in modern-day New Mexico. We estimate DFA in three ways: (a) deciduous DFA only, (b) permanent DFA only, and (c) a composite of permanent and deciduous DFA. We analyzed DFA alongside lesion status for cribra orbitalia (CO) and porotic hyperostosis (PH), as well as the presence/absence of enamel hypoplasia (EH). All stress indicators were further analyzed for their impact on mortality hazards.

RESULTS

We find that individuals with active CO and PH lesions have increased DFA, while those with healed lesions have lower DFA. We found no relationship between EH and DFA. Further, DFA alone does not predict individual mortality but CO does.

CONCLUSIONS

Individuals with increased DFA are frailer and therefore, less capable of buffering themselves against perturbations to their health than those with lower DFA. All results indicate that individuals in this study with lower DFA were more successful in buffering themselves against random environmental impacts during childhood. While DFA alone does not predict mortality hazard, its relationship to lesion status (lower DFA in individuals with healed lesions) indicates that it would be a valuable addition to studies of health and stress.

The character of parietal and orbital alterations in the superfamily Hominoidea (families Hominidae [exclusive of Homo] and Hylobotidae)

Parietal external surface disruption routinely referred to as porotic hyperostosis, and orbital alterations (cribra orbitalia), have been attributed to anemia-related bone marrow hyperplasia in humans. A recent study in humans identified that they were actually vascular in nature. Skeletons were examined and epi-illumination surface microscopy was performed on the parietal region and orbit of 156 Hominidae and 123 Hylobotidae to assess if these phenomena were trans-phylogenetic. Trans-cortical channels were recognized on the basis of visualized ectocranial surface defects penetrating the parietal; cribra orbitalia, by alteration of the normally smooth orbital roof appearance. Trans-cortical parietal channels, ranging in size from 20 to 100 µm, are rare in Gorilla and Pan troglodytes and absent in Pan paniscus. They are universally present in adult Pongo abeli and in Hylobatidae, independent of species. Cribra orbitalia was common in Hylobotidae, Pongo pygmaeus and P. abelii, less prevalent in adult P. troglodytes, and not recognized in any Gorilla gorilla or P. paniscus examined. The proliferative form predominated, with the exception of Hylobates concolor and muelleri, in which uncalcified vascular grooves predominated. No correlation was observed between the presence of either trans-cortical channels or cribra orbitalia and fractures, osteoarthritis, or inflammatory arthritis. Parietal alterations observed in apes are trans-cortical channels, analogous to those observed in humans, and do not represent porosity. Similarly, cribra orbitalia in apes is confirmed as vascular in nature. The proliferative form apparently represents calcification of blood vessel walls, indistinguishable from observations in humans. Predominant presence in adults rather than in juveniles suggests that both forms are acquired rather than developmental in derivation. Sex and bone alteration/disease-independence suggests that mechanical, endocrine, and inflammatory phenomena do not contribute to the development of either. Further, independent occurrence of trans-cortical channels and cribra orbitalia suggests that they do not have a shared etiology.

Cribra orbitalia is a vascular phenomenon unrelated to marrow hyperplasia or anemia: Paradigm shift for cribra orbitalia

The orbital phenomenon, cribra orbitalia, has long been a source of controversy, especially with regard to its nature, derivation, and relationship to anemia. Therefore, the external surfaces of orbital roofs were systematically examined microscopically in human skulls from historical collections. Superior orbital surfaces of 278 individual crania within the Hamann-Todd collection were assessed at various magnifications using epi-illumination microscopy to identify the presence of cribra orbitalia and characterize its nature. Also, 12 additional individuals with diagnosed anemia in the Hamann-Todd collection were evaluated. Orbital roof alterations, present in one-third of examined crania, had two discrete appearances: Vascular grooves (45%) and application of new bone in a vascular branching pattern on the orbit surface (55%). Porosity of the orbit was not observed. Evaluation of the orbits of 12 individuals with diagnosed anemia revealed one with a single deep defect, suggesting a space-occupying phenomenon, but no evidence of bone accretion, vascular grooves, or porosity. Cribra orbitalia has often been lumped indiscriminately as an indicator of organismal stress, rather than identified as a indicating a specific etiology. Neither that perspective nor porosity are supported by high resolution examination of orbital roof changes. Recognition of the blood vessel imprint pattern falsifies previous speculations and provides a new paradigm. The actual character of cribra orbitalia is documented and new hypotheses generated. While population prevalence of cribra orbitalia seems excessive for explanation on the basis of these hypotheses, the imprints are clearly vascular in origin.

Cribra orbitalia and porotic hyperostosis are associated with respiratory infections in a contemporary mortality sample from New Mexico

OBJECTIVES

Cribra orbitalia (CO) and porotic hyperostosis (PH) are porous cranial lesions (PCLs) classically associated with iron-deficiency anemia in bioarchaeological contexts. However, recent studies indicate a need to reassess the interpretation of PCLs. This study addresses the potential health correlates of PCLs in a contemporary sample by examining relationships between the known cause of death (COD) and PCL presence/absence.

METHODS

This study includes a sample of 461 juvenile individuals (6 months to 15 years of age) who underwent examination at the University of New Mexico's Office of the Medical Investigator between 2011 and 2019. The information available for each individual includes their sex, age at death, and their COD and manner of death.

RESULTS

Odds ratio of having CO (OR = 3.92, p < .01) or PH (OR = 2.86, p = .02) lesions are increased in individuals with respiratory infections. Individuals with heart conditions have increased odds of having CO (OR = 3.52, p = .03) lesions, but not PH.

CONCLUSION

Individuals with respiratory infection are more likely to have CO and/or PH. CO appears to have a greater range of health correlates than PH does, as indicated by the heart condition results. However, individuals with congenital heart defects are at higher risk for respiratory infections, so bony alterations in cases of heart conditions may be due to respiratory illness. Since respiratory infection remains a leading cause of mortality today, CO and PH in bioarchaeological contexts should be considered as potential indicators of respiratory infections in the past.

Diverse variola virus (smallpox) strains were widespread in northern Europe in the Viking Age

Smallpox, one of the most devastating human diseases, killed between 300 million and 500 million people in the 20th century alone. We recovered viral sequences from 13 northern European individuals, including 11 dated to ~600-1050 CE, overlapping the Viking Age, and reconstructed near-complete variola virus genomes for four of them. The samples predate the earliest confirmed smallpox cases by ~1000 years, and the sequences reveal a now-extinct sister clade of the modern variola viruses that were in circulation before the eradication of smallpox. We date the most recent common ancestor of variola virus to ~1700 years ago. Distinct patterns of gene inactivation in the four near-complete sequences show that different evolutionary paths of genotypic host adaptation resulted in variola viruses that circulated widely among humans.

A paleoepidemiological approach to the osteological paradox: Investigating stress, frailty and resilience through cribra orbitalia

OBJECTIVES

The Osteological Paradox posits that skeletal lesions may differentially be interpreted as representing resilience or frailty. However, specific consideration of the etiologies and demographic distributions of individual skeletal indicators can inform the criteria on which to differentiate stress, frailty, and resilience. Adopting a life history approach and adaptive plasticity model, this study proposes a framework for the analysis and interpretation of a commonly reported skeletal lesion, cribra orbitalia, which considers the underlying mechanisms of the condition, the clinical and epidemiological literature relating to anemia and malnutrition, and the bioarcheological evidence.

MATERIALS AND METHODS

Data were extracted from the European (n = 33 populations) and American (n = 19 populations) modules of the Global History of Health Project. Kaplan-Meier and Cox regression analyses were applied, where time was the age-at-death, and the factor or covariate was presence or absence of cribra orbitalia.

RESULTS

Of 37 samples that produced significant results, 21 demonstrated a change in relationship when the subadults were excluded from analysis. When subadults were included, individuals with cribra orbitalia present had statistically significant lower survival time. With subadults excluded, the relationship either became nonsignificant or was reversed.

DISCUSSION

We demonstrate that in many cases the inclusion of subadults in analysis impacts upon the apparent mortality associated with cribra orbitalia. Examining cribra orbitalia in children and adults has two separate goals: in children, to determine the prevalence and risk of death associated with active lesions and stress; and in adults, to determine whether childhood health assaults that cause cribra orbitalia are associated with frailty or resilience.

Spatial paleopathology: A geographic approach to the etiology of cribrotic lesions in the prehistoric Andes

OBJECTIVE

The ubiquity of cribra orbitalia in skeletal samples has led to rigorous debate over their etiology, with most concluding that nutrition, physiological stressors, and environmental disease vectors synergistically contribute to lesion development. To parse the relative contributions of these etiological factors in the prehistoric Andes, this spatial paleopathological meta-analysis investigates the relationship between population-wide prehistoric Andean cribra orbitalia rates and geographic, climatic, and hydrological variables.

METHODS

Crude prevalence patterns of cribra orbitalia from 61 archaeological sites were plotted and analyzed with geostatistical methods to explore spatial patterns in the distribution of anemia-associated lesions. Multiple linear regression modeling was performed on 19 spatial variables suspected to contribute to various forms of anemia that result in cribrotic lesions.

RESULTS

Spatially-clustered high cribra orbitalia rates exist around the Central Peruvian coast, but are paradoxically low on the Ecuadorian coast. Multiple regression shows that elevation, temperature, and precipitation were not predictive of lesion rates. Multiple regression models show that aridity and seasonal variability in freshwater supply, together, explained a third of the variation in lesion rates.

CONCLUSION

While cribra orbitalia has long been tied to coastal proximity, these results suggest environmental constraints such as the need for water storage could have promoted malnutrition and pathogenic infection more than mere coastal proximity.

LIMITATIONS OF THIS STUDY

This analysis is limited by the paucity of data from highland sites and by the assumption that burials are local to the excavation site.

SUGGESTIONS FOR FUTURE RESEARCH

Future studies will integrate isotopic and remotely-sensed data into models to explore links between water security, nutrition, and disease.

Metabolic diseases in Andean paleopathology: Retrospect and prospect

John Verano's 1997 synthesis of Andean paleopathology guided two decades of research and was instrumental in establishing modern Andean paleopathology. This paper reviews the current state and new directions in the study of skeletal metabolic disorders in the Central Andean archaeological record. Key historical, ecological, methodological, and contextual issues intersect with the study of metabolic bone diseases in Andean paleopathology. This paper further examines known temporal and spatial distribution of these disorders, as well as the strengths and weaknesses of the record of linear enamel hypoplasias, cribra orbitalia, porotic hyperostosis, scurvy, and rickets. Many other metabolic bone diseases have yet to be documented such as pellagra, hypophosphatasia, osteomalacia, and mucopolysaccharidosis among others. This work closes with considerations in the search for these undocumented diseases, but such an effort is only one part of new wave of advancements just on the horizon. The study of metabolic diseases in Andean paleopathology can lead the development of more sophisticated approaches to data collection, analysis, and interpretation - especially regarding theoretical interpretations from various bodies of social theory to the Developmental Origins of Health and Disease hypothesis, life history approaches, and phenotypic adaptive plasticity and constraint.

Child development, physiological stress and survival expectancy in prehistoric fisher-hunter-gatherers from the Jabuticabeira II shell mound, South Coast of Brazil

In this study, we shed light on the interdependency of child growth, morbidity and life expectancy in the fisher-hunter-gatherers of the Jabuticabeira II shell mound (1214-830 cal B.C.E. - 118-413 cal C.E.) located at the South Coast of Brazil. We test the underlying causes of heterogeneity in frailty and selective mortality in a population that inhabits a plentiful environment in sedentary settlements. We reconstruct osteobiographies of 41 individuals (23 adults and 18 subadults) using 8 variables, including age-at-death, stature, non-specific stress markers (cribra orbitalia, porotic hyperostosis, periosteal reactions, periapical lesions and linear enamel hypoplasia), as well as weaning patterns based on stable isotope data to examine how stress factors module growth and survival. Our results show that shorter adult statures were linked to higher morbidity around weaning age and higher chances of dying earlier (before 35 years) than taller adult statures. In addition, short juvenile stature was related to physiological stressors and mortality. The adult "survivors" experienced recurrent periods of morbidity during childhood and adulthood, possibly associated with the high parasite load of the ecosystem and dense settlement rather than to malnourishment. An association between early-stress exposure and premature death was not demonstrated in our sample. To explain our data, we propose a new model called "intermittent stress of low lethality". According to this model, individuals are exposed to recurrent stress during the juvenile and adult stages of life, and, nevertheless survive until reproductive age or later with relative success.

A probable case of infantile cortical hyperostosis in 2nd-4th centuries AD Romania

OBJECTIVE

This study aims to discuss the differential diagnosis for the pathological alterations displayed on an infant skeleton from Romania.

MATERIALS

One infant skeleton retrieved form the bathhouse of an abandoned Roman fort and dated between the 2nd and the 4th centuries AD.

METHODS

All available skeletal elements were analyzed macroscopically. In addition, the isotopic signatures (δ13C and δ15N) and the control region of the human mitochondrial genome for this archaeological sample were analyzed.

RESULTS

Based on dental development and long bone length, the skeleton was aged between birth and 2 months of age. Pathological lesions were noted on the mandible and diaphyses of long bones, but spared the metaphyses.

CONCLUSIONS

The perinatal age of the individual, along with lesion morphology and location, suggests a diagnosis of infantile cortical hyperostosis.

LIMITATIONS

The analysis would benefit from further stable isotope and mitochondrial genome analyses, which was limited due to the absence of comparative human and faunal remains from the site.

SUGGESTIONS FOR FURTHER RESEARCH

Further multidisciplinary research on human archaeological remains from Romania would provide a clearer image of past disease and life histories in this geographic area.