Porotic hyperostosis as a marker of health and nutritional conditions during childhood: studies at the transition between Imperial Rome and the Early Middle Ages

The biological index of frailty: A new index for the assessment of frailty in human skeletal remains

OBJECTIVE

Frailty is the physiological stress that individuals suffer during their life. In past populations, frailty is conventionally assessed through the occurrence of different biomarkers of biological stress. Some efforts have been made to propose indexes that combine all biomarkers. However, these indices have some critical limitations: they cannot be used on incomplete skeletons, do not consider the severity and/or healing of lesions, and assign equal importance to different biomarkers. To address these limitations, we propose a new index to assess frailty in skeletal individuals.

MATERIAL AND METHODS

By statistically analyzing a large amount of osteological data available from the Museum of London, and using a Logit model, we were able to define a different weight for each reported biomarker of frailty, based on their importance in increasing the risk of premature death for the individuals.

RESULTS

The biological index of frailty (BIF) is the weighted mean of all biomarkers scored on the individuals, according to a different degree of importance assigned to each one. It also considers the severity and healing of the biomarkers when this is relevant to diagnose frailty. We applied BIF on a sample of Monastics and Non-Monastics from medieval England and compared it with the skeletal index of frailty (SFI).

DISCUSSION

BIF is the first frailty index that gives a different weight to each skeletal biomarker of stress, considers both severity and healing of the lesions, and can be applied on partial skeletal remains. The comparison with SFI showed that BIF is applicable to a larger number of skeletal individuals, revealing new differences between the Monastic and the Non-Monastic groups.

Gastrointestinal infection in Italy during the Roman Imperial and Longobard periods: A paleoparasitological analysis of sediment from skeletal remains and sewer drains

OBJECTIVE

This study aims to investigate parasitic infection in Italy during the Roman period (27 BCE-476 CE) and subsequent Longobard (Lombard) period (6th-8th CE).

MATERIALS

Sediment samples from drains and burials from Roman Imperial-period sites in Italy (Lucus Feroniae, Oplontis, Vacone, and Vagnari), Late Antique and Longobard-period burials at Selvicciola (ca. 4th-8th CE), and Longobard-period burials at Vacone and Povegliano Veronese.

METHODS

Microscopy was used to identify helminth eggs and enzyme-linked immunosorbent assay (ELISA) to detect protozoan antigens.

RESULTS

Roundworm and whipworm were found in pelvic sediment from Roman-period burials, while roundworm and the protozoan Giardia duodenalis were identified in Roman-period drains. In pelvic sediment from the Late Antique through Longobard periods, roundworm and Taenia tapeworm eggs were identified.

CONCLUSIONS

Fecal-oral parasites were found throughout Imperial Roman Italy, suggesting that gastrointestinal infections caused a significant disease burden. In the Longobard period we see continuity in transmission of fecal-oral parasites, and the appearance of zoonotic parasites acquired from eating undercooked meat.

SIGNIFICANCE

A wealth of information exists about certain diseases in the Roman period, but relatively little is known about intestinal parasites in Italy during the Roman and Longobard periods. This is the first evidence for Giardia in Roman period Italy, and for any parasites in the Longobard period in Italy.

LIMITATIONS

Low egg concentrations and lack of controls for some samples makes it difficult to differentiate true infections from environmental contamination in some cases.

SUGGESTIONS FOR FUTURE RESEARCH

Continual study of samples from Roman and Longobard period Italy.

Patterns of frailty in non-adults from medieval London

Famine has the potential to target frail individuals who are at greater risk of mortality than their peers. Although children have been at elevated risk of mortality during recent famines, little is known about the risks posed to children during the medieval period. This study uses burials from the St. Mary Spital cemetery (SRP98), London (c. 1120-1540) to examine the relationships among non-adult age at death, burial type (attritional or famine), and four skeletal lesions (porotic hyperostosis, cribra orbitalia, linear enamel hypoplasia [LEH], and periosteal new bone formation). Hierarchical log-linear analysis reveals significant associations between famine burials and LEH, independent of age. Significant associations also exist between age and the presence of cribra orbitalia, porotic hyperostosis, and periosteal lesions, with all three lesions present in greater frequencies among older children and adolescents, independent of burial type. The LEH results suggest that early exposure to stressors increased frailty among non-adults in the context of famine. The associations between age and the other skeletal indicators suggest that, in both famine and non-famine conditions, frailer individuals died at younger ages and before skeletal lesions could manifest, while their less frail peers survived multiple physiological insults before succumbing to death at older ages.

Osteoarchaeological Studies of Human Systemic Stress of Early Urbanization in Late Shang at Anyang, China

Through the analysis of human skeletal remains and mortuary practice in Yinxu, this study investigates the impact of early urbanization on the commoners during the Late Shang dynasty (ca. 1250-1046 B.C.). A total of 347 individuals examined in this study represent non-elites who were recovered from two different burial contexts (formally buried in lineage cemeteries and randomly scattered in refuse pits). Frequencies of enamel hypoplasia (childhood stress), cribra orbitalia (childhood stress and frailty) and osteoperiostitis (adult stress) were examined to assess systemic stress exposure. Our results reveal that there was no significant difference in the frequency of enamel hypoplasia between two burial groups and between sexes, suggesting these urban commoners experienced similar stresses during childhood, but significantly elevated levels of cribra orbitalia and osteoperiostitis were observed in the refuse pit female cohort. Theoretically, urbanization would have resulted in increased population density in the urban centre, declining sanitary conditions, and increased risk of resource shortage. Biologically, children would be more vulnerable to such physiological disturbance; as a result, high percentages of enamel hypoplasia (80.9% overall) and cribra orbitalia (30.3% overall) are observed in Yin commoners. Adults continued to suffer from stress, resulting in high frequencies of osteoperiostitis (40.0% total adults); in particular, in the refuse pit females who may also reflect a compound impact of gender inequality. Our data show that the non-elite urban population in the capital city of Late Shang Dynasty had experienced extensive stress exposure due to early urbanization with further social stratification only worsening the situation, and eventually contributing to collapse of the Shang Dynasty.

Human parasites in the Roman World: health consequences of conquering an empire

The archaeological evidence for parasites in the Roman era is presented in order to demonstrate the species present at that time, and highlight the health consequences for people living under Roman rule. Despite their large multi-seat public latrines with washing facilities, sewer systems, sanitation legislation, fountains and piped drinking water from aqueducts, we see the widespread presence of whipworm (Trichuris trichiura), roundworm (Ascaris lumbricoides) and Entamoeba histolytica that causes dysentery. This would suggest that the public sanitation measures were insufficient to protect the population from parasites spread by fecal contamination. Ectoparasites such as fleas, head lice, body lice, pubic lice and bed bugs were also present, and delousing combs have been found. The evidence fails to demonstrate that the Roman culture of regular bathing in the public baths reduced the prevalence of these parasites. Fish tapeworm was noted to be widely present, and was more common than in Bronze and Iron Age Europe. It is possible that the Roman enthusiasm for fermented, uncooked fish sauce (garum) may have facilitated the spread of this helminth. Roman medical practitioners such as Galen were aware of intestinal worms, explaining their existence and planning treatment using the humoural theory of the period.

Analysis of cribra orbitalia in the earliest inhabitants of medieval Vilnius

The purpose of this work is to present an analysis of cribra orbitalia (CO) from the population of a medieval cemetery in Vilnius, Lithuania, dated between the end of the 13th to the beginning of the 15th centuries. The sample consisted of 208 individuals with sufficiently preserved orbits: 82 subadults and 122 adults. CO was correlated with sex, age-at-death, and three skeletal indicators of biological health: linear enamel hypoplasia, periostitis, and adult femur length as a proxy value for stature. Siler's and Gompertz-Makeham's parametric models of mortality as well as χ2 statistics were used to evaluate these relationships. Almost one-third of all analyzed individuals had signs of CO, including approximately 60% of the subadults. There was a very strong relationship between the age-at-death and incidence of CO, i.e., individuals with the lesion were dying much younger. The frequency of CO among the sexes was not statistically significant. On the other hand, CO had a negative effect only on adult males, i.e., males who had the lesion died at a younger age. Furthermore, CO and linear enamel hypoplasia were positively related for subadults, whereas no significant relationships were found among adults of corresponding sex. Incidence of periostitis and adult stature were not related to CO.

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.

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.

Entrapment neuropathy of the optic nerve due to hyperostosis associated with congenital anemia

The authors report on the case of a 14-year-old boy who presented with bilateral visual impairment due to optic canal stenosis caused by hyperplasia of the bone marrow arising from anemia. The patient had hereditary hemolytic anemia with unstable hemoglobin of the Christchurch type. This congenital form of anemia caused hyperplasia of the bone marrow as well as hyperostosis of the entire calvarial bone, which in turn led to optic canal stenosis. The patient underwent surgical decompression of the optic canal, resulting in significant improvement in visual acuity. Pathological findings in the calvarial bone indicated hypertrophic bone marrow with no other specific features such as neoplastic pattern or fibrous dysplasia. With the exception of objective hearing impairment, no other significant cranial neuropathy has been detected thus far. On reviewing the published literature, this case was found to be the first in which hyperostosis due to congenital anemia resulted in symptomatic entrapment neuropathy of the optic nerve. The authors concluded that surgical decompression effectively improves visual acuity.

Prevalence and etiology of acquired anemia in Medieval York, England

This paper presents three distinct models for the development of acquired anemia: iron-deficiency anemia produced by the inadequate intake and/or absorption of iron, the anemia of chronic disease (ACD) caused by the body's natural iron-withholding defense against microbial invaders, and megaloblastic anemia caused by insufficient intake and/or absorption of vitamin B(12) or folic acid. These etiological models are used to interpret the distribution and etiology of anemia among adult individuals interred at the Medieval Gilbertine Priory of St. Andrew, Fishergate, York (n = 147). This bioarchaeological analysis uncovered not only a strong relationship between decreasing status and increasing prevalence of anemia for both men and women, but also identified clear sex-based differences at this site. Within the high-status group, blood and iron loss as a result of rampant parasitism likely produced an environment ripe for the development of iron-deficiency anemia, while the parasitic consumption of vitamin B(12) may have caused occasional cases of megaloblastic anemia. As status decreases, the interpretation of anemia becomes more complex, with megaloblastic anemia and ACD emerging as viable, potentially heavy contributors to the anemia experiences of low-status people at St. Andrew's. Apart from status effects, women (especially young women) are disproportionately affected by anemia when compared to men within their own status group and, on average, are also more likely to have experienced anemia than their male peers from other status groups. This suggests that high iron-demand reproductive functions helped to make iron-deficiency anemia a chronic condition in many women's lives irrespective of their status affiliation.

Anemia and childhood mortality: Latitudinal patterning along the coast of pre-Columbian Peru

Hrdlicka ([1914] Smithson. Inst. Misc. Collect. 61:1-69) reported that pre-Columbian skeletal material from the coastal lowland Andean region exhibited a high frequency of porotic hyperostosis, a pathological condition of bone that generally is thought to indicate childhood anemia. While subsequent studies tended to reinforce this conclusion, factors implicated in the condition have yet to be fully explored in the region as a whole. This study explores regional and intravalley variation as one step in establishing biocultural variables that increase the apparent risk of childhood anemia. The study sample includes 1,465 individuals: 512 from Peruvian collections housed at the Field Museum of Natural History, and 953 from systematically excavated contexts from Moquegua, Peru. Environmental stressors, such as parasites and disease, rather than specific dietary practices were found to be more likely associated with childhood anemia in these coastal Andean samples. The study supports cribra orbitalia as an earlier expression of porotic hyperostosis and suggests that porotic hyperostosis, as recorded here, cannot be easily dismissed as a result of cranial shape modification. No clear temporal patterns were observed. Finally, the study establishes that comparing data for children and adults can reveal the relative association between childhood anemia and mortality. Childhood mortality associated with anemia was elevated where the presence of tuberculosis or tuberculosis-like conditions was more common and the presence of water-borne pathogens was negligible. In contrast, those buried at lower altitudes, closer to the coast, and consuming mainly marine resources were less likely to die in childhood with anemia than in the other contexts studied.