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.

     

Paleoepidemiology of cribra orbitalia: Insights from early seventh millennium BP Con Co Ngua,Vietnam

Objectives

We test the hypothesis that the condition(s) leading to the development of cribra orbitalia at Con Co Ngua, an early seventh millennium sedentary foraging community in Vietnam, effectively reduced the resilience of the population to subsequent health/disease impacts. An assessment of both the implications and potential etiology of cribra orbitalia in this specific population is carried out.

Methods

The effective sample included 141 adults aged ≥15 years (53 females, 71 males, and 17 unknown sex) and 15 pre-adults aged ≤14 years. Cribra orbitalia was identified by way of cortical bone porosity of the orbital roof initiated within the diplöic space, rather than initiated subperiosteally. The approach is also robust to the misidentification of various pseudo-lesions. Resultant data was analyzed using Kaplan–Meier survival analysis.

Results

Median survival is higher in adults aged ≥15 years without cribra orbitalia than those with this lesion. For the pre-adult cohort, the opposite pattern is seen where median survival is higher in those with cribra orbitalia than those without.

Conclusion

Adults displayed increased frailty and pre-adults increased resilience with respect to cribra orbitalia. The differential diagnosis for a survival analysis of adults and pre-adults with and without cribra orbitalia included iron deficiency anemia and B12/folate deficiency, parasitism (including hydatid disease and malaria) in addition to thalassemia. The most parsimonious explanation for observed results is for both thalassemia and malaria being the chief etiological agents, while appreciating these conditions interact with, and can cause, other forms such as hematinic deficiency anemias.

     

Biocultural analysis of sex differences in mortality profiles and stress levels in the late medieval population from Nova Raca, Croatia

Human skeletal remains of 104 individuals from the late medieval (14th-18th century) Nova Raca cemetery, in continental Croatia, are described. Historic data from the parish Book of the Dead, relevant to a period in the early 19th century, suggest that females may have been under greater stress than males. To test this hypothesis, the skeletal material is analyzed for the presence and distribution of enamel hypoplasias and cribra orbitalia. Observations are also made on the presence and pattern of dental disease, skeletal infection, trauma, osteoarthritis, vertebral degenerative changes, and Schmorl's depression frequencies. The mortuary sample, consisting of 36 subadults and 68 adults, exhibits underrepresentation of subadults, and differential adult male/female mortality profiles. Peak female mortality is between 21-25 years, compared to peak male mortality between 31-35 years. Average adult female age at death is 29.9 years, compared to 34.1 years in adult males. Significant sex differences are present in the frequencies of enamel hypoplasia. Adult females have higher frequencies of hypoplastic teeth, and a larger number of defects in the teeth affected than in males. Subadults in the series also exhibit higher frequencies of hypoplastic teeth, and a larger number of defects in the teeth affected than in adults, documenting a relationship between enamel hypoplasia-causing stress events and reduced life expectancy. Significant sex differences are also present in dental pathology frequencies, possibly reflecting differences in resource access. Sex differences in vertebral osteoarthritis and Schmorl's depression frequencies may reflect differential activity patterns.     

Validation of Inverse Seasonal Peak Mortality in Medieval Plagues,Including the Black Death,in Comparison to Modern Yersinia pestis-Variant Diseases

Background

Recent studies have noted myriad qualitative and quantitative inconsistencies between the medieval Black Death (and subsequent “plagues”) and modern empirical Y. pestis plague data, most of which is derived from the Indian and Chinese plague outbreaks of A.D. 1900±15 years. Previous works have noted apparent differences in seasonal mortality peaks during Black Death outbreaks versus peaks of bubonic and pneumonic plagues attributed to Y. pestis infection, but have not provided spatiotemporal statistical support. Our objective here was to validate individual observations of this seasonal discrepancy in peak mortality between historical epidemics and modern empirical data.

Methodology/Principal Findings

We compiled and aggregated multiple daily, weekly and monthly datasets of both Y. pestis plague epidemics and suspected Black Death epidemics to compare seasonal differences in mortality peaks at a monthly resolution. Statistical and time series analyses of the epidemic data indicate that a seasonal inversion in peak mortality does exist between known Y. pestis plague and suspected Black Death epidemics. We provide possible explanations for this seasonal inversion.

Conclusions/Significance

These results add further evidence of inconsistency between historical plagues, including the Black Death, and our current understanding of Y. pestis-variant disease. We expect that the line of inquiry into the disputed cause of the greatest recorded epidemic will continue to intensify. Given the rapid pace of environmental change in the modern world, it is crucial that we understand past lethal outbreaks as fully as possible in order to prepare for future deadly pandemics.     

新疆鄯善洋海青铜时代居民眶顶板筛孔样病变的调查

本文对新疆鄯善洋海出土的61例(成年个体45例,未成年个体16例)遗骸进行了眶顶板筛孔样病变的观察。在被调查的成年个体中眶顶板筛孔样病变的患病率为44.4%,未成年个体的患病率为75%,且成年个体眶顶板筛孔样病变的患病率性别差异显著。这种病变的高频率现象,很可能与当时单一的饮食结构、低营养水平及不良卫生状况等因素所诱发的缺铁性贫血有关。为深入研究我国新疆地区古代居民眶顶板筛孔样病变的患病率及其发病原因提供了一组基础数据。     

Osteological and dental markers of health in the transition from the Late Antique to the Early Medieval period in Croatia

The purpose of this study is to analyze health at the transition from the Late Antique (LA) to the Early Medieval (EM) period in Croatia. Results of the analyses of skeletal remains are compared with historical and archaeological data to test the hypothesis that the transition was catastrophic. An additional objective is to determine whether the transition was a uniform process, or differentially affected the past inhabitants of Croatia because of various local considerations. To accomplish this, four markers of health: cribra orbitalia, linear enamel hypoplasia, nonspecific periostitis, and trauma were compared in 981 skeletons: 477 from nine urban LA sites, and 504 from six rural EM sites. Data were collected by sex and age for individual, and for co-occurrences of various features. Because continental and Adriatic Croatia has different ecological features, data were specifically tabulated for the two regions. Comparisons between the continental and Adriatic regions of the LA series showed no significant differences in the frequencies of the analyzed markers of stress. Comparisons between the LA and EM series showed similar frequencies in continental Croatia--suggesting no significant discontinuity of living conditions, and a significant increase of cribra orbitalia, periostitis, and trauma frequencies during the EM period in Adriatic Croatia. The deterioration of living conditions primarily affected subadults and males. These data suggest that the transition from the LA to the EM period in Croatia was not a uniform process, but differentially affected population biology most likely because of local cultural, socio-economical or political considerations.     

Paleopathology of the commoners at Tell Amarna, Egypt, Akhenaten's capital city

The Egyptian Pharaoh Akhenaten initiated worship of a single god and established a new capital city (Tell Amarna) that was built and occupied only once from 1350-1330 BCE. This single short occupation offers a unique opportunity to study a short time period. The royal tombs have long been known and studied, but the location of graves for the common inhabitants has been an archaeological puzzle for more than 50 years. Recently four cemeteries have been located and the analysis of commingled bones from the South Tombs cemetery is presented here. The remains yield the following demographic profile: 53 adults with 19 females and 18 males; 14 juveniles between the ages of 5 and 17; and 3 infants. Arthritis and degenerative joint disease of the spine and joints indicates that DJD was not excessive. Only 2 to 8% of the adult population exhibits arthritis. There are 3 healed fractures of the arm (2 to 8% of the adult sample). There is 1 healed compressed fracture of the skull suggesting violence. The adult infection rate is between 2 and 8% with 3 healed and 1 active case of periostitis and no severe infections. Anemia is implicated by 23% of adult frontals exhibiting cribra orbitalia. Life for the common residents of Amarna appears to not have been as good as initially postulated.     

High throughput, multiplexed pathogen detection authenticates plague waves in medieval Venice, Italy

Background

Historical records suggest that multiple burial sites from the 14th–16^th centuries in Venice, Italy, were used during the Black Death and subsequent plague epidemics.

Methodology/Principal Findings

High throughput, multiplexed real-time PCR detected DNA of seven highly transmissible pathogens in 173 dental pulp specimens collected from 46 graves. Bartonella quintana DNA was identified in five (2.9%) samples, including three from the 16th century and two from the 15th century, and Yersinia pestis DNA was detected in three (1.7%) samples, including two from the 14th century and one from the 16th century. Partial glpD gene sequencing indicated that the detected Y. pestis was the Orientalis biotype.

Conclusions

These data document for the first time successive plague epidemics in the medieval European city where quarantine was first instituted in the 14th century.     

Female biological resiliency: Differential stress response by sex in human remains from ancient Nubia

This research presents male-female differences in stress response evidenced in human remains from the Medieval site of Kulubnarti in Sudanese Nubia. This analysis is unique in that a direct comparison of subadult males and females is rarely possible using archaeological remains. Rather, such analyses invariably rely on evidence of subadult differences retained in adult (sexable) skeletons. In the case of Kulubnarti, natural mummification has made it possible to measure sex-specific differences among subadults as well as adults following five avenues of investigation: 1) mortality, 2) growth and development, 3) enamel hypoplasia, 4) cribra orbitalia, and 5) cortical bone maintenance. A comparison of mean life expectancy (eox) values for males and females aged 10–55+ years revealed a consistent pattern of greater female survivorship, particularly in childhood (age 10 category) where female life expectancy exceeds that of males by 19%. Measures of growth and development, enamel hypoplasia, cribra orbitalia, and cortical bone loss were subsequently used to test a hypothesis of greater female resiliency based on the mortality data. Male-female differences in skeletal maturation are pronounced with male skeletal ages averaging a significant 2.9 years below their dental age. Females show no significant differences with an average skeletal age 0.75 years ahead of dental age. Males begin hypoplasia formation one year earlier than females and, prior to age four, average 18% more hypoplasias (p<0.05). Also, by age 8, males have on average more than twice the frequency of cribra orbitalia (p<0.05). In contrast to their consistent pattern of reduced childhood stress, adult females lose significantly more cortical bone than their male counterparts and have less cortical bone across the adult age range. Nevertheless, females outnumber males of all ages with a sex-ratio below but parallel to that observed in modern populations. The rapid age-related reduction in males relative to females, even in old age, suggests a continuing female resiliency in spite of their greater rate of osteopenia and may reflect a reproductive advantage to the population through heightened female survival and adaptability.     

Health status of the Neolithic population of Alepotrypa Cave, Greece

During the Neolithic, human health and lifestyle changed following the adoption of domesticated plants and animals and sedentism. This paper presents a study on human osteological remains from Alepotrypa Cave, an important and very well-preserved Late and Final Greek Neolithic site occupied from 5000-3200 BC. The Alepotrypa sample comes from primary and secondary burials as well as scattered bone, and consists of a minimum number of 161 individuals. It includes equal proportions of adults and subadults and males and females, is characterized by high child mortality, and falls within the range of other Neolithic sites in terms of age profiles and stature. The most frequent pathological conditions observed in this population are: 1) anemic conditions (cribra orbitalia and porotic hyperostosis), mild or healed in manifestation, most probably of nutritional origin, resulting from a poor diet focused on terrestrial resources such as domesticated cereals; 2) osteoarthritis and musculoskeletal stress markers, indicative of increased physical activity and heavy workloads; and 3) elevated prevalence of healed, depressed cranial fractures, serving as evidence of violent, nonlethal confrontations. Teeth exhibit a low prevalence of dental carries and linear enamel hypoplasia. The overall demographic, pathological, and behavioral results are consistent with observations of Neolithic populations elsewhere in Greece and the Mediterranean.     

Sex differences in periodontal disease in catastrophic and attritional assemblages from medieval london

Periodontal disease is one of the most common chronic diseases in living populations, and most studies that have examined sex differences in periodontal disease have found higher frequencies in men compared to women. This study examines sex differences in periodontal disease in two cemeteries from medieval London: the East Smithfield cemetery (c. 1349–1350), an exclusively Black Death cemetery that represents catastrophic mortality (n = 161), and the St. Mary Graces cemetery (c. 1350–1538), a post‐Black Death attritional assemblage that represents normal medieval mortality (n = 100). The results reveal a significantly higher frequency of periodontal disease, independent of age, among males compared with females in St. Mary Graces, but no significant difference between the sexes in East Smithfield. The sex differences in the attritional assemblage might reflect heightened susceptibility to periodontal disease in the living population or sex differences in frailty. The differences in the sex patterns of periodontal disease between the two cemeteries might be the result of disproportionately negative effects of the Great Bovine Pestilence and consequent decreases in dairy availability on female oral health among victims of the Black Death. Am J Phys Anthropol, 2012. © 2012 Wiley Periodicals, Inc.     

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.     

Continuity or discontinuity of the life-style in central Italy during the Roman Imperial Age-Early Middle Ages transition: diet, health, and behavior

Dento-alveolar pathologies and alterations (dental wear, caries, abscesses, ante mortem tooth loss (AMTL), calculus, hypoplastic defects, and chipping) and skeletal markers of health (cribra orbitalia and periostitis) were analyzed in two skeletal samples from the necropolises of Quadrella (I-IV c. AD) and Vicenne-Campochiaro (VII c. AD) in the Molise region of central Italy. The aim was to determine if the Roman Imperial Age-Early Middle Ages transition characterized by political, socioeconomic, and cultural transformations affected the biology of these populations, particularly their alimentation and health status. The frequencies of caries and AMTL, similar in the two samples, suggest a high consumption of carbohydrates. The higher levels of heavy wear, calculus, and interproximal chipping in the Vicenne population indicate a greater use of fibrous foods (both meat and others), in line with the dietary model of Germanic peoples. Health conditions do not appear to have been good in either period, as shown by the high frequencies of linear hypoplasia and the presence of cribra orbitalia and periostitis. The diet of the individuals buried with horses of the Vicenne population did not differ from that of the rest of the population, whereas there were evident differences in the use of the teeth for nonmasticatory activities among these individuals. Therefore, from the point of view of alimentation and health status, the profound socioeconomic and cultural transformations during the Late Antiquity-Early Middle Ages transition do not seem to have been translated into a true discontinuity of the two Molisan populations.     

The MAD legacy: How meaningful is mean age-at-death in skeletal samples

This study examines the representativeness of palaeodemographic reconstructions from human skeletal remains. Mean age-at-death (MAD) is the primary statistic used in interpretations of changing patterns of health and well being from palaeodemographic analyses. A series of sampling experiments were conducted on three documented 19th century samples representing the total cemetery population from which skeletal samples could be drawn. Comparisons of the age-at-death distributions of simulated skeletal samples to the parent population were made to assess the relative magnitude of deviation associated with different types of bias (age, sex, temporal). From the examples presented, variability in age-at-death distribution is high in samples of less than 100, suggesting that for samples of less than 100analyzable individuals, it is probable that the mortality profiles constructed are not an accurate reflection of the cemetery. It is proposed that whateverprocess mean age-at-death reflects for past populations (fertility or mortality), is irrelevant if the sample on which the statistic is calculated is not representative of the population. Given that most cemetery samples will be subject, differentially, to biases at a variety of levels, comparative studies based on palaeodemographic data cannot be considered reliablewithout careful control for those biases. It is suggested that representativeness is the primary theoretical obstacle for researches to overcome, and that it is necessary to shift our focus to rigorously exploring those factors that bias our samples. Without some direct quantification of the representativeness of a sample, palaeodemographic estimators such as mean age-at-death are meaningless and any subsequent interpretations regarding the past, dubious at best.     

Oral and physiological paleohealth in cold adapted peoples: Northeast Asia, Hokkaido

This paper examines variables useful in reconstructing oral (caries, antemortem tooth loss, alveolar defects) and physiological (cribra orbitalia, linear enamel hypoplasia) well-being in two bioarchaeological assemblages from Hokkaido, Japan: Okhotsk (n = 37 individuals) and Jomon (n = 60). Findings are compared and contrasted with each other, with published series from Honshu Japan, and samples from climatically near-equivalent Alaska. It was found that more meaningful comparisons of Hokkaido paleohealth could be made with Alaskan material, rather than the more southerly Jomon. Results were ambiguous with respect to physiological well-being. Low levels of LEH in the cold-adapted samples suggest operating in arctic and subarctic environments with marine-based subsistence regimes is not physiologically expensive. However, the relatively high levels of cribra orbitalia in Hokkaido, relative to Alaska, suggest the picture is not straightforward: the reasons for elevated cribra orbitalia in Hokkaido are unclear. The subarctic and arctic samples formed three broadly similar groupings in terms of oral health profiles: (1) Aleuts and Eskimo; (2) Ipiutak and Tigara; (3) Hokkaido Jomon, Okhotsk, and Kodiak Island. Differences between these groupings could be explained with a combination of sample demographics and subsistence orientations. The extremely high frequency of caries in one sample, caribou hunting Ipiutak, may have been influenced by factors such as low levels of dietary magnesium and potentially cariogenic foodstuffs, such as preparations of caribou stomach contents. It was concluded that oral health profiles are potentially sensitive to differences in subsistence strategies among cold-adapted hunter-gatherers, although they lack predictive value.     

Social "status" and biological "status": a comparison of grave goods and skeletal indicators from Pontecagnano.

Comparison of funerary treatment and skeletal biology can be very informative about the interplay of social status and meanings and actual life conditions in ancient communities, but such comparison is rarely done, due in part to the disciplinary separation of bioanthropology and social archaeology in many archaeological traditions. In this paper, we analyze relations between skeletal pathologies and grave goods in a sample of 94 individuals from Pontecagnano (Salerno, Italy, seventh-third centuries BC). The results show that the relationship between health, activity, and social status as expressed in grave goods was complex. Some biological indicators considered typical of "stress" or biological status (enamel hypoplasia, cribra orbitalia, adult stature) bore no relation to social status. Other indicators, particularly those of activity and stress in adult life (trauma, Schmorl's nodes, periostitis), covaried with grave assemblage and help to outline a possible division of labor. As this analysis shows, when skeletal and archaeological data are used in conjunction, the result is a deeper picture of the social and economic life of the community than can be obtained from either source.     

Paleopathologic findings in Hallstatt Period humans of Oberpfalz. Conclusions concerning the environment

Pathological findings from early Iron Age inhumation burials from three cemeteries of the Hallstatt Period (Beilngries, Dietfurt and Schirndorf) in the Upper Palatinate (Bavaria) were compiled. Particular stress was laid upon possible conclusions concerning environmental conditions. The infrequency of cribra orbitalia demonstrates that the studied groups did not suffer from a deficiency of iron. The uncommon fractures of the extremity bones and lesions of the skull give at present the image of a peaceful era during the Hallstatt period in the Upper Palatinate. Caries could be ascertained by 5.4% of the adults from Dietfurt, by 4.9% of those from Schirndorf. In the Dürrnberg the percentage of such cases was lower (2.2%). This can be explained on the one side by the earlier death-rate climax on the Dürrnberg and on the other by differing nutritional habits. The teeth of the adult population from Dietfurt show enamel hypoplasia in only 14.9% of all cases. This low percentage gives cause to suppose that sufficient Vitamin A, C and D were present in the nutrition of the studied populations.     

Morbidity in the marshes: using spatial epidemiology to investigate skeletal evidence for Malaria in Anglo-Saxon England (AD 410-1050)

Concerns over climate change and its potential impact on infectious disease prevalence have contributed to a resurging interest in malaria in the past. A wealth of historical evidence indicates that malaria, specifically Plasmodium vivax, was endemic in the wetlands of England from the 16th century onwards. While it is thought that malaria was introduced to Britain during the Roman occupation (AD first to fifth centuries), the lack of written mortality records prior to the post-medieval period makes it difficult to evaluate either the presence or impact of the disease. The analysis of human skeletal remains from archaeological contexts is the only potential means of examining P. vivax in the past. Malaria does not result in unequivocal pathological lesions in the human skeleton; however, it results in hemolytic anemia, which can contribute to the skeletal condition cribra orbitalia. Using geographical information systems (GIS), we conducted a spatial analysis of the prevalence of cribra orbitalia from 46 sites (5,802 individuals) in relation to geographical variables, historically recorded distribution patterns of indigenous malaria and the habitat of its mosquito vector Anopheles atroparvus. Overall, those individuals living in low-lying and Fenland regions exhibited higher levels of cribra orbitalia than those in nonmarshy locales. No corresponding relationship existed with enamel hypoplasia. We conclude that P. vivax malaria, in conjunction with other comorbidities, is likely to be responsible for the pattern observed. Studies of climate and infectious disease in the past are important for modeling future health in relation to climate change predictions.     

A health assessment of high status Christian burials recovered from the Roman-Byzantine archeological site of Elaiussa Sebaste, Turkey.

The purpose of this study is to assess the state of health of 116 individuals whose remains were excavated from Byzantine period burials underneath the floor of an important Christian basilica from the site of Elaiussa Sebaste, Turkey. Elaiussa Sebaste was a Mediterranean coastal community, which began as a Roman town and continued as an early Christian Byzantine community until the end of the 7th century AD. The burials date from the middle of the 6th through the middle of the 7th centuries AD. We attempt to determine how high social status has influenced the type and frequency of skeletal lesions exhibited in this sample. All strata of this population show a number of chronic and acute health problems as indicated by skeletal lesions. Yet, only the frequency of degenerative joint disease (DJD) differs by sex, with males exhibiting a higher rate of DJD than females, p=0.09. There is no difference in the frequency of trauma among adult males and females. Non-specific skeletal lesions (cribra orbitalia, porotic hyperostosis, and periostitis) often associated with dietary and general stressors, but also with specific systemic diseases, are common in both sexes. The sub-adults primarily exhibit periostitis of the long bones and do not show skeletal lesions specific to malaria. It seems that high social ranking did not prevent serious ailments from affecting the health of individuals living in the Elaiussa Sebaste community.