Cribra orbitalia,a possible sign of anemia in early historic native populations of the British Columbia coast

Excavated and museum skeletons of the postcontact period revealed cribra orbitalia in four native ethnolinguistic divisions of the British Columbia coast, Haida, Kwakiutl, Nootka, and Coast Salish. Affected skulls were distributed among 25 of 35 localities, indicating widespread occurrence in a mainly heterogeneous population. Manifestations were similar to porotic hyperostosis, and additional lesions in the sample tend to support the concept that cribra orbitalia is related to anemia. Both inherited and acquired disorders may have been involved in the etiology. A uniquely high incidence of 52.9% occurred in immature of the Haida, a relatively homogeneous population. However, marked variability in expression by age group and by sex in the total sample is suggestive of iron-deficiency anemia. The data and historical information parallel modern expectations of susceptibility. Among 454 skulls, cribra orbitalia occurred in 32.7% of growing children and adolescents, 19% of infants and toddlers, 13.3% of adult females, and 4.8% of adult males. Postcontact disruptions and disease may have figured in promoting iron-deficiency anemia, but noted precontact occurrences may also have been due to the disorder.     

Secular trend and age distribution of cribra orbitalia in Japanese

Cribra orbitalia is currently regarded as an indicator of environmental conditions. The prevalence and severity of this lesion in Japanese populations from prehistoric Jomon to modern times were recorded and discussed. Since the lesion was low in both frequency and grade in the late and final Jomon people from Chiba Prefecture, they presumably lived in relatively favorable environmental conditions. The increased prevalence of the lesion in the medieval Muromachi citizens of Kamakura may be attributed to the poor hygiene and social conditions. The high prevalence and marked severity of the lesion in the citizens of Edo (the old name of Tokyo) in the 17th century suggested that they lived under extremely unfavorable situations of nutrition, sanitation and medical care. Cribra orbitalia was most prevalent in adolescence (81.3%) among the Edo citizens. The incidence of the most severe type of lesion rose gradually during childhood, reached a peak in adolescence, and then gradually decreased with age. These findings would reflect intense marrow hyperplasia in the orbital roof associated with both iron deficiency anemia of long standing during the immature period and increased iron requirement in adolescence. The results obtained support the hypothesis that iron deficiency anemia is the primary factor in the etiology of cribra orbitalia. It was concluded that the incidence and severity of cribra orbitalia due to various anemic reactions reflected the dietary, hygienic, social and environmental circumstances of the populations investigated.     

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。     

Notes on some skeletal changes in pre-European contact Australian aborigines

This is a brief account of skeletal changes noted in large collections of pre-European contact Australian aboriginal remains. These changes included evidence of congenital anomalies, dental disease, degenerative arthropathy, trauma and infection. The most interesting infective process is treponarid.     

Cribra orbitalia and trace element content in human teeth from neolithic and early bronze age graves in southern Poland

Determination of element levels in bones and teeth can complement knowledge of the diagnostics and etiology of various diseases in prehistoric populations. Calcium (Ca), cadmium (Cd), copper (Cu), iron (Fe), and lead (Pb) content were analyzed in teeth from human skeletons dated to 3,000–1,400 BC from Malopolska Upland loess. Levels of iron and calcium were determined using atomic absorption spectroscopy (AAS), and lead, cadmium, and copper levels were measured using anodic stripping voltametry (ASV). Molar teeth from specimens with cribra orbitalia were selected for analyses, and teeth from specimens with no pathological changes were used as a control. No significant correlations between the content of particular elements and the tooth class, specimen age, or depth of burial pit were observed. The Fe content in specimens with cribra orbitalia is not the best measure for this disease's etiology. Thus, interelement correlations and proportions might give a better picture of the biological condition of the specimen and of the investigated groups. Am J Phys Anthropol 103:201–207, 1997. © 1997 Wiley-Liss, Inc.     

The Alto Salaverry child: a case of anemia from the Peruvian preceramic.

Excavations during 1974 at the Peruvian Preceramic site of Alto Salaverry led to the discovery of a child's skeleton. The fragmentary skeleton exhibits cribra orbitalia, a pitting of the orbital roof associated with anemia. This specimen provides the first evidence of anemia in a population of the predominantly non-agricultural Peruvian Preceramic and extends the antiquity of the pathology among Precolumbian Peruvians.     

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.     

Porotic hyperostosis: relationship between orbital and vault lesions

The exact nature of the relationship between orbital and skull vault lesions of porotic hyperostosis has remained a controversial issue among anthropologists. Many researchers believe that lesions in both areas are related and have a common etiology; others remain unconvinced of any relationship and prefer to consider orbital and vault lesions as separate conditions with their own etiology. This paper explores the issue by comparing data on microscopic, macroscopic, radiographic, and demographic aspects of orbital and vault lesions from both clinical and anthropological studies. The results of these comparisons support the views that there is a relationship between lesions on both areas and that they share a common etiology.     

Genetic and socio-cultural differentiation in the aborigines of Arnhem Land, Australia

Four tribes of Arnhem Land were surveyed for dermatoglyphics; based on pattern intensity indices, total ridge-counts, and a distance statistic combining the two, it was shown that the tribes can be arranged into western (Tiwi, Gunwinggu) and eastern (“Murngin” and Andilyaugwa) groups. This substantiates observations made on Arnhem Land by linguists and social anthropologists. From a survey of allele frequency traits of blood factors and P.T.C. tasting, distance statistics were computed between the four tribes. These confirmed the relative isolation of the extreme Arnhem Land tribes. Distance statistics were also computed between the four tribes and two Central Australian tribes, the Aranda and Wailbri. The Aranda and “Murngin” were relatively close together agreeing with theories that the Aranda are derived from a not too remote southwards migration from north Arnhem Land, as supported by linguistic data. Correlations between the biological, geographical and linguistic distances were positive, and generally agreed with the expectation that socio-cultural and linguistic barriers are important in regulating gene flow between populations. This study emphasizes the need to consider biological distances in association with ecological and socio-cultural factors.     

Porotic hyperostosis: new evidence to support the anemia theory

The etiology of skull lesions known as porotic hyperostosis has long been a matter for speculation. The most widely accepted theory at present suggests that an anemia, either acquired or genetic, is responsible for lesion development. However, acceptance of this theory is not universal and the nature of the relationship between orbital and vault lesions remains a controversial issue. This paper provides a much broader field of supportive evidence on which to base the anemia theory. This involves a synthesis of information from the clinical and anthropological literature as well as new data from two skeletal collections: Poundbury Camp, a Romano-British series, and the Hodgson collection, a 19th century East Asian series. A comparison is made between clinical and anthropological data at the macroscopic, microscopic, radiographic, and demographic levels of analysis. This approach reveals the similarities in expression between clinically diagnosed anemias and porotic hyperostosis.     

A radiographic study of porotic hyperostosis

Skull lesions known as porotic hyperostosis have been of interest to researchers since the mid-19th century. The etiology of porotic hyperostosis has long been a matter for speculation yet there has never been complete acceptance or substantiation of any one of the many theories proposed. Today the most widely accepted theory suggests that anemias of either acquired or genetic origin are responsible for porotic hyperostosis. The present study tests this hypothesis using criteria which were chosen after the examination of clinical radiographs of patients with various types of anemia. These criteria are: the presence of “hair-on-end” trabeculation, outer table thinning, texture changes, diploic thickening, orbital roof thickening, orbital rim changes, and the underdevelopment of frontal sinuses. A comparison of these criteria from the clinical X-rays with X-rays of skulls with porotic hyperostosis provides a more rigorous, repeatable, and standardized method upon which to base a diagnosis. This approach enables radiography to provide the necessary link between the clinical and anthropological with which to investigate the origin of porotic hyperostosis.     

Cribra orbitalia in two temporally disjunct population samples from the Dakhleh Oasis, Egypt

Cribra orbitalia (CO), an osseous sign of anemic stress, occurs in 67% (n = 296) of the pre-Roman (n = 153) and Roman (n = 143) period crania from the Dakhleh Oasis, Egypt. CO is primarily a childhood condition in these samples, and its prevalence is significantly higher in virtually all cohorts in the pre-Roman group, including among females, who display higher rates of active lesions. This temporal trend suggests that the underlying causative factors (i.e., synergism between disease and nutrition) were less pervasive in the Roman period. In both population samples, anemic stress develops in some perinates prior to the expected minimum age for the development of iron deficiency anemia. This suggests additional causes of anemic stress in the Dakhleh population. A strong candidate is folic acid deficiency and its concomitant, megaloblastic anemia, which results from weaning of infants on goat's milk, a known practice in ancient Egypt. The putative incorporation of other food items in the weanling diet, particularly honey, a confirmed source of C. botulinum, represents yet another retrospective data source to help understand the epidemiological profile of cribra orbitalia in this population. Comparative data from other Egyptian populations, though limited, show similar patterns, however, they display a lower prevalence than the data from Dakhleh.     

Porotic hyperostosis: representative of a childhood condition

Porotic hyperostosis is currently considered to be one of several stress markers available for assessing the health and nutritional status of past human populations. The present study questions one of the basic assumptions underlying its use; that is, that the occurrence of porotic hyperostosis in an individual represents an episode of anemia that was current or had occurred within a relatively short period prior to death. A synthesis of data from a Romano-British site Poundbury Camp, anthropological and clinical studies, and information on bone physiology suggests that lesions of porotic hyperostosis seen in adults are most probably representative of a childhood episode of anemia. Lesions seen in adults are the result of bone changes occurring in the growth period that have not undergone complete remodelling. This viewpoint has implications for future interpretation of data on porotic hyperostosis obtained from skeletal collections.     

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.     

Porotic hyperostosis in a marine-dependent California Indian population

A maize-based iron- and protein-deficient diet is commonly cited as the most important cause of porotic hyperostosis among American Indian agriculturalists. An alternative to this maize dependence hypothesis is suggested by the analysis of 432 crania from the nonagricultural, fish-dependent population of the Channel Island area of southern California. Cribra orbitalia, a form of porotic hyperostosis associated with iron deficiency anemia, is just as common among these fisherpeople, whose diet was rich in iron and essential amino acids, as it is among maize-dependent agriculturalists. Northern Channel Island crania have much more cribra orbitalia than those from the California mainland. The highest incidence is on San Miguel, a small geographically isolated island with a shortage of fresh water and terrestrial resources. The Indians who lived on Santa Cruz, the largest of the northern Channel Islands with the greatest diversity of terrestrial plants and animals, have less cribra orbitalia than those who lived on Santa Rosa or San Miguel Island. This geographical distribution appears to be explained by island-mainland and interisland differences in water contamination, exposure to fish-borne parasites, and nutritional adequacy of the diet. The prevalence of porotic hyperostosis in a population with a heavy dietary dependence on marine resources shows that among prehistoric American Indians, this condition is not always associated with an iron- and protein-deficient diet of cultigens. It seems likely that high nutrient losses associated with diarrheal disease are often more significant in the etiology of porotic hyperostosis than a low dietary intake of essential nutrients.     

On the genetic uniqueness of the Ami aborigines of Formosa

In the attempt to reconstruct the prehistory of Pacific and Indian Ocean populations, Taiwan's aborigines appear to be of particular interest. Linguistic and archeological evidence indicates that the dispersal of Austronesian speakers throughout the islands of Oceania and Southeast Asia may have originated from Taiwan about 5,000 years ago. The Ami are Taiwan's largest aboriginal group. Here, we report on six polymorphic point mutation loci in Ami individuals and compare allelic frequencies to worldwide populations. In order to examine the genetic characteristics and relationships of the Ami aborigines, we used the allelic frequency data to generate expected heterozygosities, power of discrimination values, maximum likelihood phylogenetic trees, principal component maps, and centroid gene flow plots. These analyses argue for the genetic isolation and uniqueness of the Ami people. Data supportive of limited gene flow and/or small population size, as well as genetic similarities to Native Americans, were observed.