Porotic Hyperostosis and Paleoepidemiology: A Forensic Perspective on Anemia among the Ancient Maya

Porotic lesions caused by childhood anemia are commonly found on ancient Maya crania and have been cited as evidence for extremely poor nutrition during the Classic Period. We reconsider this characterization in the light of recent data on childhood anemia in rural Guatemala and the prevalence of porotic hyperostosis in crania of forensic skeletal remains of rural highland Maya from Plan de Sanchez, Baja Verapaz, which date to 1982. The abundance of porotic hyperostosis in adults from Plan de Sanchez fits well with the number of modern rural children suffering from anemia, but the lesions are very rare compared to archaeological series. Although some minor change in diet and infection may contribute to differences in porotic hyperostosis, it is likely that higher mortality leads to fewer anemic lesions in modern adult crania. We hypothesize that more anemic children survived to adulthood in the past than do today, iron-deficiency anemia, porotic hyperostosis, Maya, nutrition, forensic anthropology, osteological paradox]