Scurvy at the agricultural transition in the Atacama desert (ca 3600-3200 BP): nutritional stress at the maternal-foetal interface?

High prevalence of adult and nonadult scurvy in an early agricultural transition site from Mainland Southeast Asia was associated with decreased survivorship

OBJECTIVES

The osteological paradox recognizes that the presence of lesions is not always directly related with increased mortality. When combined with the clinical, historical, and epidemiological literature on scurvy, survivorship analysis, a form of statistical analysis to assess the relationship between the presence of diseases in the archeological record and survival, helps determine the overall burden of the disease both in terms of morbidity and mortality. This article explores the relationship between scurvy and survivorship in 26 adults from Man Bac, a Neolithic site from northern Vietnam together with prepublished evidence of scurvy in the nonadult population (n = 44).

METHODS

Diagnosis of scurvy included differential diagnosis combined with the Snoddy, A. M. E., Buckley, H. R., Elliott, G. E., Standen, V. G., Arriaza, B. T., & Halcrow, S. E. (2018). Macroscopic features of scurvy in human skeletal remains: A literature synthesis and diagnostic guide. American Journal of Physical Anthropology, 167(4), 876-895. https://doi.org/10.1002/ajpa.23699 threshold criteria and the Brickley, M. B., & Morgan, B. (2023). Assessing diagnostic certainty for scurvy and rickets in human skeletal remains. American Journal of Biological Anthropology, 181, 637-645 diagnostic certainty approaches. Kaplan-Meier survival curves were produced to assess the relationship between the presence of probable scurvy and age-at-death.

RESULTS

The prevalence of probable scurvy in adults (35%) was considerably lower than reported for the nonadults (80%). Almost all lesions observed in the adults were in a mixed stage of healing. Kaplan-Meier analysis demonstrated no difference in survivorship between infants and children (<15 years) with or without probable scurvy, whereas a meaningful difference was observed for the adults and adolescents (15+ years).

CONCLUSIONS

The findings demonstrate that scurvy considerably decreased survivorship to older age categories. The degree of lesion remodeling, however, indicates that scurvy was not necessarily the direct cause of death but contributed to an overall disease burden that was ultimately fatal.

Evidence of non-adult vitamin C deficiency in three early medieval sites in the Jaun/Podjuna Valley, Carinthia, Austria

OBJECTIVE

This study aims to determine and discuss the prevalence of non-adult scurvy cases from the early medieval Jaun/Podjuna Valley in southern Austria.

MATERIALS

86 non-adult individuals were assessed from three early medieval sites.

METHODS

Morphological characteristics associated with suggestive and probable scurvy were observed macroscopically and under 20-40x magnification.

RESULTS

A significant relationship between the prevalence of scurvy and age group was observed. Perinates (46%, 6/13) and children (27.5%, 8/28) showed a high prevalence of skeletal features indicating a diagnosis of scurvy, while no cases of scurvy were observed in adolescents and adults.

CONCLUSIONS

In this Alpine region, scurvy occurred frequently in infants and children. Seasonal fluctuations of diet are discussed as factors triggering scurvy.

SIGNIFICANCE

This study sheds new light on the prevalence of scurvy in the Alpine region and how the region developed after the fall of the Roman Noricum. It also models ways in which multiple lines of evidence can contribute to the diagnostic process.

LIMITATIONS

Poor preservation posed a challenge to identifying probable cases of scurvy. Likewise, non-adult remains are difficult to diagnose due to their developing nature and it is not always possible to distinguish between normal bone growth and pathological growth.

SUGGESTIONS FOR FURTHER RESEARCH

Future applications of biomolecular studies will help illustrate changes in diet that may have contributed to vitamin deficiencies.

A macroscopic assessment of porosity and new bone formation on the inferior pars basilaris: Normal growth or an indicator of scurvy?

OBJECTIVES

This research aims to determine the aetiology of porosity and subperiosteal new bone formation on the inferior surface of the pars basilaris.

MATERIALS

A total of 199 non-adult individuals aged 36 weeks gestation to 3.5 years, from a total of 12 archaeological sites throughout the UK, including Iron Age (n=43), Roman (n=12), and post-medieval (n=145) sites, with a preserved pars basilaris.

METHODS

The pars basilaris was divided into six segments, with porosity (micro and macro) and subperiosteal new bone formation recorded on the inferior surface in scorbutic and non-scorbutic individuals. Scurvy was diagnosed using criteria from the palaeopathological literature that was developed using a biological approach.

RESULTS

There was no statistically significant difference in microporosity between scorbutic and non-scorbutic individuals in four out of the six segments analysed. There was a significant negative correlation between age and microporosity in non-scorbutic and scorbutic individuals. A significant difference in subperiosteal new bone formation was observed between scorbutic and non-scorbutic individuals.

CONCLUSIONS

Microporosity on the inferior pars basilaris should not be considered among the suite of lesions included in the macroscopic assessment of scurvy in non-adult skeletal remains (less than 3.5 years).

SIGNIFICANCE

This study highlights the risk of over diagnosing scurvy in past populations.

LIMITATIONS

It is difficult to distinguish between physiological (normal) and pathological (abnormal) bone changes in the skeleton of individuals less than one year of age.

SUGGESTIONS FOR FURTHER RESEARCH

Future research should focus on the analysis of individuals over 3.5 years of age.

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.

The frequency and macromorphological classification of abnormal blood vessel impressions and periosteal appositions of the dura mater in an early modern osteological collection from Poland

OBJECTIVE

The macromorphological characteristics and frequency of endocranial abnormal blood vessel impressions (ABVI) and periosteal appositions of dura mater (PADM), and their association with sex, age-at-death and scurvy-like lesions were studied. The possible etiologies of these lesions were discussed.

MATERIALS

A total of 144 adult skulls excavated from an early modern (16th-19th c. CE) cemetery at the Czysty Square in Wrocław (Poland) were examined, most of which were intact.

METHODS

The endocranial surface was inspected with an endoscope for the presence, location, and severity of ABVI and PADM. Frequencies of ABVI and PADM were grouped by sex and age-at-death.

RESULTS

A little more than a half (53.5 %) of the examined skulls were affected by ABVI and/or PADM. PADM were more frequent in females. However, both alteration types occurred with similar frequencies across all age-at-death categories.

CONCLUSIONS

The high frequency of ABVI and PADM suggests that meningeal infections and/or hemorrhage among inhabitants of early modern Wrocław, especially in females, were common.

SIGNIFICANCE

The paper emphasizes the need for using an endoscope in standard anthropological analysis of intact skulls, as it allows for a nondestructive inspection of the endocranial surface.

LIMITATIONS

The endoscope did not allow for an accurate examination of the middle cranial fossa.

SUGGESTIONS FOR FURTHER RESEARCH

Comparative studies with other historical populations are necessary to better understand the possible etiologies of macromorphological and demographic characteristics of ABVI and PADM.

The role of dietary calcium in the etiology of childhood rickets in the past and the present

For more than two centuries, lack of sunlight has been understood to cause vitamin D deficiency and documented as a primary cause of rickets. As such, evidence of rickets in the archeological record has been used as a proxy for vitamin D status in past individuals and populations. In the last decade, a clinical global consensus has emerged wherein it is recognized that dietary calcium deficiency also plays a role in the manifestation of rickets and classic skeletal deformities may not form if dietary calcium is normal even if vitamin D is deficient. This disease is now clinically called "nutritional rickets" to reflect the fact that rickets can take calcium deficiency-predominant or vitamin D deficiency-predominant forms. However, there are currently no paleopathological studies wherein dietary calcium deficiency is critically considered a primary etiology of the disease. We review here the interplay of calcium, vitamin D, and phosphorous in bone homeostasis, examine the role of dietary calcium in human health, and critically explore the clinical literature on calcium deficiency-predominant rickets. Finally, we report a case of rickets from the late Formative Period (~2500-1500 years ago) of the Atacama Desert and argue the disease in this infant is likely an example of calcium deficiency-predominant rickets. We conclude that most archeological cases of rickets are the result of multiple micronutrient deficiencies that compound to manifest in macroscopic skeletal lesions. For clinicians, these factors are important for implementing best treatment practice, and for paleopathologists they are necessary for appropriate interpretation of health in past communities.

Twenty-first century bioarchaeology: Taking stock and moving forward

This article presents outcomes from a Workshop entitled "Bioarchaeology: Taking Stock and Moving Forward," which was held at Arizona State University (ASU) on March 6-8, 2020. Funded by the National Science Foundation (NSF), the School of Human Evolution and Social Change (ASU), and the Center for Bioarchaeological Research (CBR, ASU), the Workshop's overall goal was to explore reasons why research proposals submitted by bioarchaeologists, both graduate students and established scholars, fared disproportionately poorly within recent NSF Anthropology Program competitions and to offer advice for increasing success. Therefore, this Workshop comprised 43 international scholars and four advanced graduate students with a history of successful grant acquisition, primarily from the United States. Ultimately, we focused on two related aims: (1) best practices for improving research designs and training and (2) evaluating topics of contemporary significance that reverberate through history and beyond as promising trajectories for bioarchaeological research. Among the former were contextual grounding, research question/hypothesis generation, statistical procedures appropriate for small samples and mixed qualitative/quantitative data, the salience of Bayesian methods, and training program content. Topical foci included ethics, social inequality, identity (including intersectionality), climate change, migration, violence, epidemic disease, adaptability/plasticity, the osteological paradox, and the developmental origins of health and disease. Given the profound changes required globally to address decolonization in the 21st century, this concern also entered many formal and informal discussions.

Differential diagnosis of metabolic disease in a commingled sample from 19th century Hisban, Jordan

OBJECTIVE

This research attempts a differential diagnosis of skeletal lesions in a commingled sample from Hisban, Jordan, focusing on non-adults in the assemblage.

MATERIALS

2,883 well-preserved skeletal elements and 9 relatively complete skulls representing an MNI of 32 non-adults (<18 years old).

METHODS

All skeletal elements were observed macroscopically and pathophysiological processes underlying any lesions or other anomalies were assessed, followed by a comparative approach to rule out potential diagnoses.

RESULTS

The skeletal lesions observed were caused by inflammation due to chronic hemorrhaging, marrow hyperplasia due to an increase in hemopoiesis, rapid bone growth, and the impact of biomechanical strain on poorly mineralized elements. Rickets, scurvy, and acquired anemias best fit this pattern of lesions, although inflammation from other sources such as trauma or infection could not be definitively ruled out.

CONCLUSIONS

The in utero and postnatal environments at Hisban were conducive to the development of vitamin C and D deficiencies from birth until 2 years of age. The analysis of commingled remains requires an ontological shift in the importance of the individual to the population in paleopathology.

SIGNIFICANCE

This investigation demonstrates the efficacy of a combined biological and comparative approach in differential diagnosis in complicated commingled collections. In addition, it emphasizes the importance of the mother-infant dyad in understanding metabolic disease.

LIMITATIONS

Histological and radiographic analyses were not included in this diagnostic study due to COVID-19 travel restrictions.

SUGGESTIONS FOR FURTHER RESEARCH

Isotopic analysis to investigate childhood diet and histological and radiographic analyses to assess survival of deficiencies.

Paleopathology and children in the Andes: Local/situated biologies and future directions

In the decades since Verano (1997) published his foundational piece on Andean paleopathology, scholars have recognized the importance of the bioarchaeology of childhood. Yet, scholarship on ancient childhood in the Andes deemphasizes paleopathology. Nonadult paleopathological data are often employed in large-scale, biocultural studies focused on environmental or political adaptations; however, they can also elucidate children's individual lived experiences and roles in society. To generate culturally-meaningful paleopathological data, we must take a contextualized approach to our analyses and interpretations. Disparate use of chronological age in published datasets makes synthesis across studies problematic, and ethnohistorical and ethnographic data on Andean children demonstrate that developmental age categories, rather than chronological age ranges, are most appropriate. Further, paleopathological data can best inform our investigations when they are combined with related datasets such as those on sex, diet, activity, and mobility. With that in mind, we use the theoretical framework of "local biologies" (and the related "situated biologies"), where biology is viewed as heavily contingent on culturally-specific beliefs and practices and local physical, sociocultural, and political environments (Lock, 1993, 2001; Niewöhner and Lock, 2018). Local biologies approaches can enrich social bioarchaeology and paleopathology to by specifically situating children and their experiences within the ancient Andean world.

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.

Cases of endocranial lesions on juvenile skeletons from Longshan cultural sites in Henan Province, China

Endocranial lesions were recognized on eight out of the 31 juveniles (25.8%) that were recovered from three Neolithic archaeological sites in Henan province. The remains of juveniles were recovered from urn burials at the Jiazhuang site (2200-2030 BCE) and graves at the Pingliangtai (2300-2100 BCE) and Haojiatai sites (2448-1700 BCE). The presence of endocranial lesions on all eight of these juvenile skulls was associated with a range of lesions on other bones, including areas of abnormal porosity and subperiosteal new bone deposition on either the sphenoid, maxilla, mandibular ramus, or orbit, as well as subperiosteal lesions on the postcranial bones. Several plausible explanations for the formation of these endocranial lesions in our eight cases include scurvy, shaken baby syndrome, and intrathoracic disease (such as tuberculosis or pulmonary infection). We show that the presence of endocranial lesions had a strong correspondence with skeletal markers of dietary deficiency, i.e. scurvy, and in one case, anemia. Millet was a key component of the Longshan subsistence in the area, while paleobotanical evidence of fruit and leafy vegetables appears to be limited, likely resulting in a nutrient deficient diet. The coupling of endocranial lesions with skeletal signs of dietary deficiency can be direct, as scurvy favors hemorrhaging, or mediated by physiological or sociocultural factors, and thereby represents comorbidity.

'One tooth one child': evaluating the effects of diet and fertility on the oral health of women from archaeological sites in South America

Women from ancient societies have shown a higher prevalence of dental caries in comparison with men. Recent research has shown that the relationship between increased oestrogen production during pregnancy and decreased salivary flow is a possible cause for the higher levels of caries in women, which is in contrast to the traditional view of sexual division of labour resulting in unequal access to cariogenic food. In order to test these two hypotheses, individuals exhumed from 12 South American archaeological sites were examined for markers of oral health (caries, ante mortem tooth loss, deep caries, and enamel hypoplasia) and compared in terms of fertility (Crude Birth Rate) and subsistence systems. Our results suggest that diet and other cultural practices remain the most important factors affecting oral health and that the effects of hormones can be masked by them. Such findings add to the discussion regarding the availability of micronutrients in such societies affecting caries experience in pregnant women, because of their special nutritional requirements.

Macroscopic features of scurvy in human skeletal remains: A literature synthesis and diagnostic guide

The past two decades have seen a proliferation in bioarchaeological literature on the identification of scurvy, a disease caused by chronic vitamin C deficiency, in ancient human remains. This condition is one of the few nutritional deficiencies that can result in diagnostic osseous lesions. Scurvy is associated with low dietary diversity and its identification in human skeletal remains can provide important contextual information on subsistence strategy, resource allocation, and human-environmental interactions in past populations. A large and robust methodological body of work on the paleopathology of scurvy exists. However, the diagnostic criteria for this disease employed by bioarchaeologists have not always been uniform. Here we draw from previous research on the skeletal manifestations of scurvy in adult and juvenile human skeletal remains and propose a weighted diagnostic system for its identification that takes into account the pathophysiology of the disease, soft tissue anatomy, and clinical research. Using a sample of individuals from the prehistoric Atacama Desert in Northern Chile, we also provide a practical example of how diagnostic value might be assigned to skeletal lesions of the disease that have not been previously described in the literature.

Let's talk about stress, baby! Infant-feeding practices and stress in the ancient Atacama desert, Northern Chile

AIMS AND OBJECTIVES

The transition to an agricultural economy is often presumed to involve an increase in female fertility related to changes in weaning practice. In particular, the availability of staple crops as complementary foods is hypothesized to allow earlier weaning in agricultural populations. In this study, our primary aim is to explore whether this model fits the agricultural transition in the Atacama Desert using incremental isotopic analysis. A secondary aim of this study is to identify isotopic patterns relating to weaning, and assess how these may be differentiated from those relating to early life stress.

MATERIALS AND METHODS

We use incremental isotopic analysis of dentine to examine changes in δ¹⁵ N and δ¹³ C values from infancy and childhood in sites of the Arica region (n = 30). We compare individuals from pre-agricultural and agricultural phases to establish isotopic patterns and relate these patterns to maternal diet, weaning trajectory and physiological stress.

RESULTS

We find that there is no evidence for systematic temporal or geographic variation in incremental isotopic results. Instead, results from all time periods are highly variable, with weaning completed between 1.5 and 3.5 years. Characteristics of the incremental profiles indicate that both in utero and postnatal stress were a common part of the infant experience in the Atacama.

DISCUSSION

In the Atacama Desert it appears that the arrival of agricultural crops did not result in uniform shifts in weaning behavior. Instead, infant and child diet seems to have been dictated by the broad-spectrum diets of the mothers, perhaps as a way of mitigating the stresses of the harsh desert environment.