Human Parasites in Medieval Europe: Lifestyle, Sanitation and Medical Treatment

Investigating femoral growth disruption in subadults from the 10th-13th century St. Étienne cemetery of Toulouse, France

OBJECTIVES

The skeleton embodies an individual's environment and lived experiences. Studying childhood growth disruption can, therefore, aid in understanding the experiences of children in the past. This study evaluates growth disruption in a medieval Toulousian subadult sample to explore factors that may have influenced childhood growth and mortality at this site and to assess the utility of Harris line (HL) interpretations in bioarchaeology.

MATERIALS AND METHODS

Femoral growth disruption was assessed in n = 71 subadults (0.125-12.42 years) from the 10th-13th century St. Étienne cemetery of Toulouse, France, using femoral length, total area, cortical area, and relative cortical area. Femoral radiographs were assessed for HLs. To determine the prevalence of growth disruption, z-scores were calculated using data from the Denver growth study.

RESULTS

The majority of subadults in this sample suffered from femoral growth disruption. Young children (1.0-3.99 years) were the most affected, with >65% experiencing reduced appositional growth and linear growth stunting at time-of-death. Additionally, while many individuals presented with observable HLs, linear and appositional growth did not significantly differ between individuals with and without HLs.

DISCUSSION

Maternal malnutrition and inadequate complementary feeding practices likely contributed to the high prevalence of growth disruption among the youngest individuals in the study. The older children and adolescents buried at St. Étienne experienced an amelioration in growth deficits, indicating an improvement in nutrition and/or disease load. The results of this study suggest that more consideration is required when interpreting the presence/absence of HLs, and that studies assessing HLs may benefit from using a more individualistic approach.

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.

Continuity in intestinal parasite infection in Aalst (Belgium) from the medieval to the early modern period (12th-17th centuries)

OBJECTIVE

To characterize patterns in the taxonomic diversity of parasites infecting the population of Aalst, Belgium, between the 12th and 17th centuries.

MATERIALS

14 sediment samples from seven cesspits dated 1100-1700 CE.

METHODS

Digital light microscopy and Enzyme-linked immunosorbent assay (ELISA).

RESULTS

We identified eggs of four species of helminths: whipworm (Trichuris trichiura), roundworm (Ascaris lumbricoides), Echinostoma fluke and Dicrocoelium fluke. ELISA results for protozoal parasites were negative.

CONCLUSIONS

Taxonomic diversity of parasite infections remained constant from the 12th to the 17th centuries. Roundworm and whipworm, spread by poor sanitation, were dominant. Two species of zoonotic parasites were also identified, including for the first time ever in the Low Countries the Echinostoma fluke, which may have been spread by eating uncooked freshwater animal foods.

SIGNIFICANCE

Analysis of sediment samples spanning such a broad chronology (six centuries) from a single city offers the opportunity to track diachronic change, which is rare in paleoparasitological studies.

LIMITATIONS

We were unable to acquire samples from cesspits dating to the 14th century.

SUGGESTIONS FOR FURTHER RESEARCH

Additional data from other Low Countries towns may strengthen the patterns identified in this paper. A similar approach can be used to investigate towns in different regions of the world.

Intestinal parasite infection in the Augustinian friars and general population of medieval Cambridge, UK

OBJECTIVE

To investigate how lifestyle may have impacted the risk of contracting intestinal parasites in medieval England . Regular clergy (such as those living in monasteries) and the lay population form interesting groups for comparison as diet and lifestyle varied significantly. Monasteries were built with latrine blocks and hand washing facilities, unlike houses of the poor.

MATERIALS

Sediment samples from the pelvis, along with control samples from feet and skull, of 19 burials of Augustinian Friars (13th-16th century), and 25 burials from All Saints by the Castle parish cemetery (10th-14th century), Cambridge.

METHODS

We analysed the sediment using micro-sieving and digital light microscopy to identify the eggs of intestinal parasites.

RESULTS

Parasite prevalence (roundworm and whipworm) in the Augustinian friars was 58%, and in the All Saints by the Castle parishioners just 32% (Barnards Test score statistic 1.7176, p-value 0.092).

CONCLUSIONS

It is interesting that the friars had nearly double the infection rate of parasites spread by poor hygiene, compared with the general population. We consider options that might explain this difference, and discuss descriptions and treatment of intestinal worms in medical texts circulating in Cambridge during the medieval period.

SIGNIFICANCE

This is the first study to compare prevalence of parasite infection between groups with different socioeconomic status from the same location.

LIMITATIONS

Quality of egg preservation was suboptimal, so our data may under-represent the true prevalence.

SUGGESTIONS FOR FURTHER RESEARCH

Larger studies with greater statistical power, covering different time periods and regions.

Liver Fluke Infection Throughout Human Evolution

The species of liver fluke that infect humans are zoonotic parasites that we share with other animals. The complex way in which humans have interacted with their environment, and the animals that live alongside them, has affected our ancestors' risk of infection by these helminths for millions of years. Here, we describe the range of flukes that can survive in the human liver and the health consequences that result from infection. Our focus is on Clonorchis sinensis (Chinese liver fluke), Fasciola hepatica (sheep liver fluke), F. gigantica (giant liver fluke), Opisthorchis viverrini (Southeast Asian liver fluke), O. felineus (cat liver fluke), and Dicrocoelium dendriticum (lancet liver fluke). We use our knowledge of where different kinds of liver flukes are endemic to estimate when and where human ancestors would have been exposed to infection over deep time. DNA evidence is used to investigate the evolutionary origins of the major species of liver flukes. The archaeological evidence for different species of fluke helps to show in which periods of human history they were most common. These flukes spread to humans from wild animals in early prehistory because of our ancestor's hunter-gatherer lifestyle and later from farm animals after the development of agriculture. We explore when and how some species have been able to spread across the world, whereas others are limited to particular geographic regions because of the endemic distribution of snail and vertebrate intermediate hosts. It is clear that human activity and migrations have played a key role in the expanding geographical range where we find liver flukes endemic today.

Transmission of Zoonotic Diseases in the Daily Life of Ancient Pompeii and Herculaneum (79 CE, Italy): A Review of Animal-Human-Environment Interactions through Biological, Historical and Archaeological Sources

There is no doubt that the cultural and urban environments contributed to the animal-human interaction in the daily life of the ancient Roman world. The singularity of the circumstances of the burial of Pompeii and Herculaneum, together with literary sources and the extraordinary state of preservation of the archaeological and biological material found, has provided researchers with an opportunity, unique in its kind, to reconstruct the life and ways of living of its inhabitants. This study illustrates the main drivers and mechanisms for the distribution and transmission of zoonotic diseases in these ancient Roman populations, such as (i) the large number and role that different animal species played in the ancient Roman world; (ii) the environmental conditions for the survival of parasites, pathogens and vectors; (iii) the great variety and intensity of commercial activities and occupations that presented certain risks of infections; (iv) the absence of adequate safety controls during processing, distribution and preservation of foodstuffs in unsuitable environments and some culinary habits; (v) the inadequate mechanisms of the disposal of human waste and the biotic contamination of watercourses and reservoirs; and finally (vi) the use of animals related to religious and cultural practices.

Estimating molecular preservation of the intestinal microbiome via metagenomic analyses of latrine sediments from two medieval cities

Ancient latrine sediments, which contain the concentrated collective biological waste of past whole human communities, have the potential to be excellent proxies for human gastrointestinal health on the population level. A rich body of literature explores their use to detect the presence of gut-associated eukaryotic parasites through microscopy, immunoassays and genetics. Despite this interest, a lack of studies have explored the whole genetic content of ancient latrine sediments through consideration not only of gut-associated parasites, but also of core community gut microbiome signals that remain from the group that used the latrine. Here, we present a metagenomic analysis of bulk sediment from medieval latrines in Riga (Latvia) and Jerusalem. Our analyses reveal survival of microbial DNA representative of intestinal flora as well as numerous parasites. These data are compared against parasite taxon identifications obtained via microscopy and ELISA techniques. Together, these findings provide a first glimpse into the rich prokaryotic and eukaryotic intestinal flora of pre-industrial agricultural populations, which may give a better context for interpreting the health of modern microbiomes.

This article is part of the theme issue ‘Insights into health and disease from ancient biomolecules’.

Epidemiological insights from a large-scale investigation of intestinal helminths in Medieval Europe

Helminth infections are among the World Health Organization's top neglected diseases with significant impact in many Less Economically Developed Countries. Despite no longer being endemic in Europe, the widespread presence of helminth eggs in archaeological deposits indicates that helminths represented a considerable burden in past European populations. Prevalence of infection is a key epidemiological feature that would influence the elimination of endemic intestinal helminths, for example, low prevalence rates may have made it easier to eliminate these infections in Europe without the use of modern anthelminthic drugs. To determine historical prevalence rates we analysed 589 grave samples from 7 European sites dated between 680 and 1700 CE, identifying two soil transmitted nematodes (Ascaris spp. and Trichuris trichiura) at all locations, and two food derived cestodes (Diphyllobothrium latum and Taenia spp.) at 4 sites. The rates of nematode infection in the medieval populations (1.5 to 25.6% for T. trichiura; 9.3-42.9% for Ascaris spp.) were comparable to those reported within modern endemically infected populations. There was some evidence of higher levels of nematode infection in younger individuals but not at all sites. The genetic diversity of T. trichiura ITS-1 in single graves was variable but much lower than with communal medieval latrine deposits. The prevalence of food derived cestodes was much lower (1.0-9.9%) than the prevalence of nematodes. Interestingly, sites that contained Taenia spp. eggs also contained D. latum which may reflect local culinary practices. These data demonstrate the importance of helminth infections in Medieval Europe and provide a baseline for studies on the epidemiology of infection in historical and modern contexts. Since the prevalence of medieval STH infections mirror those in modern endemic countries the factors affecting STH decline in Europe may also inform modern intervention campaigns.

A comparative study of parasites in three latrines from Medieval and Renaissance Brussels, Belgium (14th-17th centuries)

The aim of this study is to determine the species of parasite that infected the population of Brussels during the Medieval and Renaissance periods, and determine if there was notable variation between different households within the city. We compared multiple sediment layers from cesspits beneath three different latrines dating from the 14th–17th centuries. Helminths and protozoa were detected using microscopy and enzyme-linked immunosorbent assay (ELISA). We identified Ascaris sp., Capillaria sp., Dicrocoelium dendriticum, Entamoeba histolytica, Fasciola hepatica, Giardia duodenalis, Taenia sp. and Trichuris sp. in Medieval samples, and continuing presence of Ascaris sp., D. dendriticum, F. hepatica, G. duodenalis and Trichuris sp. into the Renaissance. While some variation existed between households, there was a broadly consistent pattern with the domination of species spread by fecal contamination of food and drink (whipworm, roundworm and protozoa that cause dysentery). These data allow us to explore diet and hygiene, together with routes for the spread of fecal–oral parasites. Key factors explaining our findings are manuring practices with human excrement in market gardens, and flooding of the polluted River Senne during the 14th–17th centuries.

THE EXPOSOME IN HUMAN EVOLUTION: FROM DUST TO DIESEL

Global exposures to air pollution and cigarette smoke are novel in human evolutionary history and are associated with about 16 million premature deaths per year. We investigate the history of the human exposome for relationships between novel environmental toxins and genetic changes during human evolution in six phases. Phase I: With increased walking on savannas, early human ancestors inhaled crustal dust, fecal aerosols, and spores; carrion scavenging introduced new infectious pathogens. Phase II: Domestic fire exposed early Homo to novel toxins from smoke and cooking. Phases III and IV: Neolithic to preindustrial Homo sapiens incurred infectious pathogens from domestic animals and dense communities with limited sanitation. Phase V: Industrialization introduced novel toxins from fossil fuels, industrial chemicals, and tobacco at the same time infectious pathogens were diminishing. Thereby, pathogen-driven causes of mortality were replaced by chronic diseases driven by sterile inflammogens, exogenous and endogenous. Phase VI: Considers future health during global warming with increased air pollution and infections. We hypothesize that adaptation to some ancient toxins persists in genetic variations associated with inflammation and longevity.

Intestinal parasites in six Islamic medieval period latrines from 10th-11th century Córdoba (Spain) and 12th-13th century Mértola (Portugal)

OBJECTIVE

To investigate the types of intestinal parasites that infected people living in Islamic period southern Iberia (al-Andalus), and compare with other regions of Europe.

MATERIALS

Four cesspits from 10^th-11^th century CE Córdoba (Spain), and two from 12^th-13^th century Mértola (Portugal).

METHODS

Sediment from each cesspit was analyzed using digital light microscopy and enzyme-linked immunosorbent assay (ELISA).

RESULTS

Analysis revealed eggs of roundworm (Ascaris lumbricoides) in every cesspit analyzed, but no evidence of other species of helminth or protozoal parasites.

CONCLUSION

Differences were noted between parasite species found in Mediterranean Europe and northern Europe, where a range of zoonotic parasites were endemic alongside sanitation-related parasites. We suggest that the scarcity of zoonotic parasites in southern Europe in the medieval period may reflect contrasts in climate between northern and southern Europe.

SIGNIFICANCE

The repeated identification of roundworm eggs suggests that al-Andalus was less hygienic than historically depicted. We did not note a difference between parasites found in Muslim and Christian regions of Iberia, and the predominance of parasites spread by fecal contamination of food is consistent with past research.

LIMITATIONS

The eggs of some species of parasite are fragile, so may theoretically have been present in the population but did not survive for us to identify them.

SUGGESTIONS FOR FURTHER RESEARCH

To further investigate the role of climate upon the parasites that affected past human populations.

Intestinal parasites at the Late Bronze Age settlement of Must Farm, in the fens of East Anglia, UK (9th century B.C.E.)

Little is known about the types of intestinal parasites that infected people living in prehistoric Britain. The Late Bronze Age archaeological site of Must Farm was a pile-dwelling settlement located in a wetland, consisting of stilted timber structures constructed over a slow-moving freshwater channel. At excavation, sediment samples were collected from occupation deposits around the timber structures. Fifteen coprolites were also hand-recovered from the occupation deposits; four were identified as human and seven as canine, using fecal lipid biomarkers. Digital light microscopy was used to identify preserved helminth eggs in the sediment and coprolites. Eggs of fish tapeworm (Diphyllobothrium latum and Diphyllobothrium dendriticum), Echinostoma sp., giant kidney worm (Dioctophyma renale), probable pig whipworm (Trichuris suis) and Capillaria sp. were found. This is the earliest evidence for fish tapeworm, Echinostoma worm, Capillaria worm and the giant kidney worm so far identified in Britain. It appears that the wetland environment of the settlement contributed to establishing parasite diversity and put the inhabitants at risk of infection by helminth species spread by eating raw fish, frogs or molluscs that flourish in freshwater aquatic environments, conversely the wetland may also have protected them from infection by certain geohelminths.

Ancient DNA from latrines in Northern Europe and the Middle East (500 BC-1700 AD) reveals past parasites and diet

High-resolution insight into parasitic infections and diet of past populations in Northern Europe and the Middle East (500 BC- 1700 AD) was obtained by pre-concentration of parasite eggs from ancient latrines and deposits followed by shotgun sequencing of DNA. Complementary profiling of parasite, vertebrate and plant DNA proved highly informative in the study of ancient health, human-animal interactions as well as animal and plant dietary components. Most prominent were finding of soil-borne parasites transmitted directly between humans, but also meat-borne parasites that require consumption of raw or undercooked fish and pork. The detection of parasites for which sheep, horse, dog, pig, and rodents serves as definitive hosts are clear markers of domestic and synanthropic animals living in closer proximity of the respective sites. Finally, the reconstruction of full mitochondrial parasite genomes from whipworm (Ascaris lumbricoides) and roundworm species (Trichuris trichiura and Trichuris muris) and estimates of haplotype frequencies elucidates the genetic diversity and provides insights into epidemiology and parasite biology.

Intestinal parasites from the 2nd-5th century AD latrine in the Roman Baths at Sagalassos (Turkey)

The aim of this research was to determine the species of intestinal parasite present in a Roman Imperial period population in Asia Minor, and to use this information to improve our understanding of health in the eastern Mediterranean region in Roman times. We analyzed five samples from the latrines of the Roman bath complex at Sagalassos, Turkey. Fecal biomarker analysis using 5β-stanols has indicated the feces were of human origin. The eggs of roundworm (Ascaris) were identified in all five samples using microscopy, and the cysts of the protozoan Giardia duodenalis (which causes dysentery) were identified multiple times in one sample using ELISA. The positive G. duodenalis result at Sagalassos is particularly important as it represents the earliest reliable evidence for this parasite in the Old World (i.e. outside the Americas). As both these species of parasite are spread through the contamination of food and water by fecal material, their presence implies that Roman sanitation technologies such as latrines and public baths did not break the cycle of reinfection in this population. We then discuss the evidence for roundworm in the writings of the Roman physician Galen, who came from Pergamon, another town in western Asia Minor.

Human parasites in the Roman World: health consequences of conquering an empire

The archaeological evidence for parasites in the Roman era is presented in order to demonstrate the species present at that time, and highlight the health consequences for people living under Roman rule. Despite their large multi-seat public latrines with washing facilities, sewer systems, sanitation legislation, fountains and piped drinking water from aqueducts, we see the widespread presence of whipworm (Trichuris trichiura), roundworm (Ascaris lumbricoides) and Entamoeba histolytica that causes dysentery. This would suggest that the public sanitation measures were insufficient to protect the population from parasites spread by fecal contamination. Ectoparasites such as fleas, head lice, body lice, pubic lice and bed bugs were also present, and delousing combs have been found. The evidence fails to demonstrate that the Roman culture of regular bathing in the public baths reduced the prevalence of these parasites. Fish tapeworm was noted to be widely present, and was more common than in Bronze and Iron Age Europe. It is possible that the Roman enthusiasm for fermented, uncooked fish sauce (garum) may have facilitated the spread of this helminth. Roman medical practitioners such as Galen were aware of intestinal worms, explaining their existence and planning treatment using the humoural theory of the period.

From Fossil Parasitoids to Vectors: Insects as Parasites and Hosts

Within Metazoa, it has been proposed that as many as two-thirds of all species are parasitic. This propensity towards parasitism is also reflected within insects, where several lineages independently evolved a parasitic lifestyle. Parasitic behaviour ranges from parasitic habits in the strict sense, but also includes parasitoid, phoretic or kleptoparasitic behaviour. Numerous insects are also the host for other parasitic insects or metazoans. Insects can also serve as vectors for numerous metazoan, protistan, bacterial and viral diseases. The fossil record can report this behaviour with direct (parasite associated with its host) or indirect evidence (insect with parasitic larva, isolated parasitic insect, pathological changes of host). The high abundance of parasitism in the fossil record of insects can reveal important aspects of parasitic lifestyles in various evolutionary lineages. For a comprehensive view on fossil parasitic insects, we discuss here different aspects, including phylogenetic systematics, functional morphology and a direct comparison of fossil and extant species.

The Importance of Fossils in Understanding the Evolution of Parasites and Their Vectors

Knowledge concerning the diversity of parasitism and its reach across our current understanding of the tree of life has benefitted considerably from novel molecular phylogenetic methods. However, the timing of events and the resolution of the nature of the intimate relationships between parasites and their hosts in deep time remain problematic. Despite its vagaries, the fossil record provides the only direct evidence of parasites and parasitism in the fossil record of extant and extinct lineages. Here, we demonstrate the potential of the fossil record and other lines of geological evidence to calibrate the origin and evolution of parasitism by combining different kinds of dating evidence with novel molecular clock methodologies. Other novel methods promise to provide additional evidence for the presence or the life habit of pathogens and their vectors, including the discovery and analysis of ancient DNA and other biomolecules, as well as computed tomographic methods.