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.     

Dental caries in a Portuguese identified skeletal sample from the late 19th and early 20th centuries

Dental caries was investigated in 600 adult dentitions belonging to the identified osteological collections of the Museum of Anthropology, University of Coimbra, Portugal (late 19th/early 20th centuries). The main advantage of this sample compared to an archaeological source is the presence of known demographic parameters such as age, sex, and occupation. The aim of this study is to investigate the issues involved in comparing caries data derived from archaeological death assemblages with statistics compiled from clinical studies of the living. When only the upper dentition was considered, higher rates were observed in females than in males. No differences were found between sexes for lower teeth. In both sexes, both the percentage of carious teeth and the severity of lesions were found to increase with age, demonstrating that caries activity continued throughout life. The slight decrease observed for the age group 70–79 years is probably due to the increased antemortem tooth loss in the elderly. Caries was most common at contact areas (32.9%) and rarest at smooth crown surfaces (6.5%). Root surface caries was graphed in relation to the exposure of roots, and it was confirmed that the degree of root exposure was not strongly related to the frequency of carious lesions on the exposed root surface, although both increased with age. Molars were attacked more frequently by caries as a whole than premolars, canines or incisors. The results are similar to studies of recent living populations with a limited access to professional dental care. Am J Phys Anthropol, 2009. © 2009 Wiley‐Liss, Inc.     

Assessing diagnostic certainty for scurvy and rickets in human skeletal remains

Objectives

Identifying scurvy and rickets has important implications for understanding adaptations and variability among past communities, and bioarchaeologists now regularly evaluate these conditions. Due to the increased number of studies, cases with less clear-cut lesions and variable preservation are now frequently reported. Despite an improved understanding of the biological mechanisms for disease expression, there is a lack of consensus on the language used to express diagnostic certainty, limiting comparability. This article aims to address these issues and provide recommendations on more consistent diagnostic terminology using widely accepted diagnostic methodology based on biological mechanisms.

Materials and Methods

We review diagnostic terms used in bioarchaeology by considering published cases of rickets, scurvy and co-occurrence alongside M.B.B.'s past project notes. We also consider differences in the diagnosis of rickets and scurvy in living and archeological individuals.

Results

We provide recommendations on a framework that can be used to show diagnostic certainty in cases of rickets, scurvy, and co-occurrence. Core lesions of rickets and scurvy are used alongside a limited lexicon of diagnostic terminology based on the Istanbul protocol.

Discussion

It is not the number of lesions that determines whether an individual is assigned to a particular diagnosis category, but rather the range and expression of lesions present. Avoiding a “tick-list” approach to core lesions of these diseases will be critical to ensure that identifying rickets and scurvy continues to contribute to understanding adaptations and variability among past communities. The framework allows more consistency in diagnostic certainty, facilitating greater comparability in research.     

External auditory exostosis in prehistoric Chilean populations: A test of the cold water hypothesis

Over one thousand prehistoric crania (n = 1,149) from northern Chile were analyzed to determine if the presence of external auditory exostosis (EAE) was a type of subsistence-induced pathology, a consequence of habitual fishing i the cold water of the Pacific Ocean, rather than genetically determined. To test this occupational hypothesis, the sample was divided according to chronology, type of economy, site elevation, and sex. The crania came from 43 sites, including the coast, lowland valleys (100–2,000 m), and highlands (2,000 to 4,000 m) with a time frame of 7,000 B.C. to the Inca era (1500 A.D.). There was a significant association between EAE, environment, and sex. The coastal inhabitants had the highest prevalence of EAE with 30.7% (103/336), followed by 2.3% (6/264) for the valley people and 0% (0/549) for highlanders. Coastal and valley men were significantly more affected than their female counterparts. Contrary to expectations, there was nonsignificant association between EAE and economy and/or chronology. In the Arica area, the early Chinchorro fishers, without agriculture, had 27.7% (26/94) EAE, the subsequent agro-pastoralists, 42.7% (32/75), and the late Arican agro-pastoral fishers had 35.6% (36/101) EAE. Apparently, with the advent of agriculture, the coastal Arican populations increased their ocean harvests, rather than decreased them, to gain a surplus in order to trade with nonmaritime groups. Am J Phys Anthropol 103:119–129, 1997. © 1997 Wiley-Liss, Inc.     

A fine line: a comparison of methods for estimating ages of linear enamel hypoplasia formation

It is accepted that linear enamel hypoplasias (LEHs), a specific type of enamel thickness deficiency, are related to periodic physiological disruptions to enamel matrix secretion during times that teeth are developing. Thus, LEHs are treated as general indicators of metabolic stress. Because the disruptions that cause LEHs affect only the portion of the crown that is in the process of forming, determining their locations allows researchers to reconstruct chronologies of stressful events. It is widely held that the many of the commonly used macroscopic methods for estimating the timing of LEHs are imprecise and do not conform to our current understanding of the process of enamel formation. The goal of the present study is to compare estimated ages of LEH formation produced by two of the most commonly used macroscopic methods to those derived from data in recent histological studies that include more precise information about the timing of crown formation across diverse human populations. These approaches are compared in two ways: 1) by creating a theoretical model using simulated LEHs and 2) empirically, by analyzing data collected on a sample of ancient Nubians from Semna South (present-day Sudan). Results indicate that the approach derived from histological studies provides significantly higher age estimates than the commonly used methods and this difference is particularly marked in early forming LEHs. The magnitude of this difference is large enough to produce divergent interpretation of bioarchaeological datasets and suggests that reevaluation of the methods used to estimate ages of LEH formation may be justified.     

Os intermetatarseum: A heritable accessory bone of the human foot

The os intermetatarseum is a relatively common accessory bone of the human foot located at the tarsometatarsal border between the first and second metatarsals. It can occur as an independent ossicle or as an osseous spur projecting from the proximal ends of the first two metatarsals, or the distal end of the first cuneiform. To determine the frequency of this congenital defect in native North American groups and East Asians from Japan, the skeletons of 846 Native Americans and 125 modern Japanese and Ainu were examined for the presence of the os intermetatarseum. The North American skeletons are from archaeological sites in various parts of Canada and the United States, including the Arctic coast, the Subarctic, the Aleutian Islands, the Northern Plains, the Illinois River area, and the Southwest. Overall frequencies ranged from no occurrence among the Arctic samples to 8% of individuals from Pecos Pueblo. Second metatarsal spurs occurred in particularly high frequencies among American Indians, whereas the East Asians were only found to have os intermetatarseums associated with the first cuneiform. Because pedigrees have shown the os intermetatarseum to be an inherited defect, its high frequency among some Native Americans may be due, in part, to a higher degree of genetic relatedness among the individuals in the North American samples than among the relatively modern East Asians. Am J Phys Anthropol 107:199–209, 1998. © 1998 Wiley-Liss, Inc.     

Brief Communication: A likely case of scurvy in a rural Early Classic Maya burial from Actun Uayazba Kab,Belize

A Maya burial of a late adolescent (Burial 98‐3) found in the rockshelter entrance of Actun Uayazba Kab (AUK), Belize, displays a combination of lesions that is consistent with scurvy. Signs include large, active lesions on the posterior surfaces of maxilla; relatively mild porotic hyperostosis along the midline of the skull on the parietals and occipital; cribra orbitalia; potential pinprick lesions on the greater wings of sphenoid and temporal; reactive lesions on the palate, temporal lines of frontal and parietals, and external and internal surfaces of zygomatics; small lesions on the popliteal surfaces of both femora; and periodontal disease. Identification of scurvy at AUK potentially informs the analysis of other primary burials and scattered bone found there and at other nearby sites, which often reveal evidence of nonspecific lesions that are usually attributed to anemia and infection, but that are also consistent with scurvy. The social and ecological context of this Protoclassic (0–AD 300) individual, who lived in a rural agricultural community with no evidence of complex social hierarchy, contrasts with typical discussions of disease among the Maya, which tend to focus on the degrading effects of overcrowding and resource deficiencies. While scurvy has been largely overlooked in the Maya area, this study supports earlier arguments for its presence that were based largely on clinical and ethnographic analogies and suggests the need to incorporate scurvy into broader synergistic models of ancient health. Am J Phys Anthropol 155:476–481, 2014. © 2014 Wiley Periodicals, Inc.     

Brief communication: Twentieth-century replication of an Egyptian mummy: Implications for paleopathology

Replication in a modern human cadaver of ancient Egyptian mummification focused on tools used by ancient Egyptian embalmers, the use of natron (a mixture of sodium carbonate, bicarbonate, and chloride) in the preparation of the mummy, surgical procedures in the removal of the viscera and brain, and histologic examination of the viscera. The first three areas have been reported separately (Brier and Wade [1997] ZAS 124:89–100). In this paper, we demonstrate a degree of histologic preservation comparable to that seen in Egyptian mummies, indicating the effectiveness of ancient mummification and that the histologic appearance of such mummies is little altered by the passage of millennia. Am J Phys Anthropol 107:417–420, 1998. © 1998 Wiley-Liss, Inc.     

The causes of porotic hyperostosis and cribra orbitalia: A reappraisal of the iron‐deficiency‐anemia hypothesis

Porosities in the outer table of the cranial vault (porotic hyperostosis) and orbital roof (cribra orbitalia) are among the most frequent pathological lesions seen in ancient human skeletal collections. Since the 1950s, chronic iron‐deficiency anemia has been widely accepted as the probable cause of both conditions. Based on this proposed etiology, bioarchaeologists use the prevalence of these conditions to infer living conditions conducive to dietary iron deficiency, iron malabsorption, and iron loss from both diarrheal disease and intestinal parasites in earlier human populations. This iron‐deficiency‐anemia hypothesis is inconsistent with recent hematological research that shows iron deficiency per se cannot sustain the massive red blood cell production that causes the marrow expansion responsible for these lesions. Several lines of evidence suggest that the accelerated loss and compensatory over‐production of red blood cells seen in hemolytic and megaloblastic anemias is the most likely proximate cause of porotic hyperostosis. Although cranial vault and orbital roof porosities are sometimes conflated under the term porotic hyperostosis, paleopathological and clinical evidence suggests they often have different etiologies. Reconsidering the etiology of these skeletal conditions has important implications for current interpretations of malnutrition and infectious disease in earlier human populations. Am J Phys Anthropol 2009. © 2009 Wiley‐Liss, Inc.     

Habituation: cultural curiosity or developmental determinant?

The induction and reversal of habituation for auxin or cytokinin have been brought about by exposure of callus tissue to low or high concentrations of the growth substance in question. Since the growth rate of the tissues must be measured in the presence or absence of the growth substance being tested, habituation can be demonstrated only in callus. However some developmental processes in the intact plant seem to imply the possible involvement of habituation-like processes in normal development. Evidence for this, and the implications for the action of growth substances in plant development are considered.     

A large archosauriform tooth with multiple supernumerary carinae from the Upper Triassic of New Mexico (USA), with comments on carina development and anomalies in the Archosauria

Here we report a tooth of a large archosauriform from the Upper Triassic of New Mexico, USA that displays developmental anomalies of carina formation. This tooth has two supernumerary carinae, both on the lingual side of the tooth. Previously, carina anomalies of this sort were primarily known from theropod dinosaurs, but always from the labial surface. Integrating this specimen into a reassessment of the published accounts of carina anomalies in other fossil diapsids reveals that supernumerary carinae are more widespread throughout Archosauriformes than previously reported. Our interpretation of this developmental anomaly highlights the present lack of understanding of tooth development in archosaurs, particularly carina formation, and suggests that crown morphology development in archosauriforms may be constrained differently than it is in mammals. This developmental constraint may explain the differences observed between the complexity found in mammal and archosauriform cusp morphology.     

The skull and vertebral column pathology of Ancient Egyptians. A study of the Marro Collection

The skull and vertebral column pathology of the Ancient Egyptian skeletal remains of the Marro Collection (1118 individuals) is mainly represented by “common” degenerative and inflammatory osteo-articular alterations. Apart from these, three cases of ankylosing spondylitis and two cases of probable multiple myeloma are described in detail. The frequency of these conditions seems to be almost the same as in modern times. Furthermore, a skull with larger osteolitic areas of probable metastatic origin is described.     

No skeletal dysplasia in the nariokotome boy KNM‐WT 15000 (homo erectus)—A reassessment of congenital pathologies of the vertebral column

The Nariokotome boy skeleton KNM‐WT 15000 is the most complete Homo erectus fossil and therefore is key for understanding human evolution. Nevertheless, since Latimer and Ohman (2001) reported on severe congenital pathology in KNM‐WT 15000, it is questionable whether this skeleton can still be used as reference for Homo erectus skeletal biology. The asserted pathologies include platyspondylic and diminutive vertebrae implying a disproportionately short stature; spina bifida; condylus tertius; spinal stenosis; and scoliosis. Based on this symptom complex, the differential diagnosis of spondyloepiphyseal dysplasia tarda, an extremely rare form of skeletal dysplasia, has been proposed. Yet, our reanalysis of these pathologies shows that the shape of the KNM‐WT 15000 vertebrae matches that of normal modern human adolescents. The vertebrae are not abnormally flat, show no endplate irregularities, and thus are not platyspondylic. As this is the hallmark of spondyloepiphyseal dysplasia tarda and related forms of skeletal dysplasia, the absence of platyspondyly refutes axial dysplasia and disproportionate dwarfism. Furthermore, we neither found evidence for spina bifida occulta nor manifesta, whereas the condylus tertius, a developmental anomaly of the cranial base, is not related to skeletal dysplasias. Other fossils indicate that the relatively small size of the vertebrae and the narrow spinal canal are characteristics of early hominins rather than congenital pathologies. Except for the recently described signs of traumatic lumbar disc herniation, the Nariokotome boy fossil therefore seems to belong to a normal Homo erectus youth without pathologies of the axial skeleton. Am J Phys Anthropol, 2013. © 2013 Wiley Periodicals, Inc.     

High rate of Microsporum canis feline and canine dermatophytoses in Northeast Brazil: Epidemiological and diagnostic features

Over a one year period (November 2000-December 2001), clinical specimens from 189 dogs and 38 cats, from the city of Fortaleza, Ceará, Brazil, were examined at the Specialized Medical Mycology Center at the Federal University of Ceará to detect animals with dermatophytoses. The mycological analyses were conducted by direct microscopy and by fungal culture on Sabouraud agar, Sabouraud chloramphenicol agar and Mycosel agar. Dermatophytes were isolated from 27 of the 189 (14.3%) canine specimens and 14 of the 38 (36.8%) feline specimens. The identified dermatophytes were Microsporum canis (95%), M. gypseum (2.5%) and Trichophyton mentagrophytes var. mentagrophytes (2.5%). Microsporum canis was the most common species isolated (92.6% and 100%, for dogs and cats respectively). The percentage of positive direct microscopic examinations of clinical specimens and positive cultures was 61%. There was a high proportion of positive cultures from cats less than 1 year of age, but in dogs no significant differences were detected. There were no significant differences between the sexes. Dermatophytes were more frequently isolated in March, April and May, but no significant differences were detected in the seasonal distribution of canine and feline dermatophytoses.