Cribra orbitalia in the ancient Nile Valley and its connection to malaria

Investigating the association between intestinal parasite infection and cribra orbitalia in the medieval population of Cambridge, UK

OBJECTIVE

Cribra orbitalia is believed to be a skeletal indicator of chronic anaemia, scurvy, rickets or related metabolic diseases. It has been suggested that it may be used as a proxy indicator for intestinal parasite infection, as parasites often cause anaemia today. Our aim is to investigate this association in the medieval population of Cambridge, UK.

MATERIALS

Individuals excavated from the cemeteries of the Augustinian friary and All Saints by the Castle parish church, and aged from 7 to adulthood.

METHODS

We undertook parasite analysis of the pelvic sediment and control samples of 46 burials with intact orbital roofs.

RESULTS

Human roundworm (Ascaris lumbricoides) and/or whipworm (Trichuris trichiura) were identified in the pelvic sediment of 22 individuals, and cribra orbitalia noted in 11 individuals. Barnards test showed no association between parasite infection and cribra orbitalia (p = .882).

CONCLUSION

We found no association between infection and cribra orbitalia infection in this medieval adult population, calling into question this hypothesis, at least for adults.

SIGNIFICANCE

High or low cribra orbitalia prevalence in adults should not be used to infer rates of intestinal parasite infection.

LIMITATIONS

The individuals in the study were over the age of 7, with no younger children. It is possible that only parasites which cause marked anaemia (such as hookworm, schistosomiasis or malaria) may cause cribra orbitalia, while less marked anaemia from roundworm and whipworm may not do so.

SUGGESTIONS FOR FURTHER RESEARCH

Repeating this study in younger children, when most cribra orbitalia appears to form.

Parasites in ancient Egypt and Nubia: Malaria, schistosomiasis and the pharaohs

The civilizations of ancient Egypt and Nubia played a key role in the cultural development of Africa, the Near East, and the Mediterranean world. This study explores how their location along the River Nile, agricultural practices, the climate, endemic insects and aquatic snails impacted the type of parasites that were most successful in their populations. A meta-analysis approach finds that up to 65% of mummies were positive for schistosomiasis, 40% for headlice, 22% for falciparum malaria, and 10% for visceral leishmaniasis. Such a disease burden must have had major consequences upon the physical stamina and productivity of a large proportion of the workforce. In contrast, the virtual absence of evidence for whipworm and roundworm (so common in adjacent civilizations in the Near East and Europe) may have been a result of the yearly Nile floods fertilising the agricultural land, so that farmers did not have to fertilise their crops with human faeces.

Developing an archaeology of malaria. A critical review of current approaches and a discussion on ways forward

OBJECTIVE

This paper presents the current state of the art in the investigation of past malaria by providing an extensive review of previous studies and identifying research possibilities for the future.

MATERIALS

All previous research on the detection of malaria in human skeletal material using macroscopic and biomolecular approaches is considered.

METHODS

The approaches and methods used by scholars and the results they obtained are evaluated and the limitations discussed.

RESULTS

There is a link between malaria and porous lesions with significantly higher prevalence in malaria-endemic areas, however, they are not pathognomonic or specific for malaria. Malaria can be identified using biomolecular techniques, yet, to date there is no completely satisfactory method that is able to consistently diagnose the disease.

CONCLUSIONS

Using macroscopic and biomolecular techniques, malaria can be investigated in past populations and the impact of the disease studied. Yet, this is not a straightforward process and the use of multiple lines of evidence is necessary to obtain the best results.

SIGNIFICANCE

The extensive discussion on ways malaria can and cannot be identified in past populations and the suggestions for new approaches provide a steppingstone for future research into this debilitating, global disease.

LIMITATIONS

Malaria is a difficult disease to study archaeologically and successful identification depends on many intrinsic and extrinsic factors.

SUGGESTIONS FOR FURTHER RESEARCH

More large-scale spatial analyses of porous lesions as well as targeting different tissues or molecules for biomolecular identification may improve the archaeological understanding of malaria.

Height and health in Roman and Post-Roman Gaul, a life course approach

OBJECTIVE

The present study explores growth and health in Roman (1st-3rd centuries CE) and Post-Roman (4th-7th centuries CE) Gaul, incorporating a life-course approach, to better understand the influence of Roman practices and lifestyles on health, and the impact of cultural change from the Roman to the Post-Roman period.

MATERIALS AND METHODS

The skeletal remains of 844 individuals were analyzed for non-specific signs of physiological stress, including growth disruption (diaphyseal and adult maximum femur length), dental enamel hypoplastic defects (DEH), cribra orbitalia (CO), and periosteal reaction of the tibiae (Tibia PR).

RESULTS

The Gallo-Roman sample demonstrated shorter femoral lengths, and higher rates of DEH and Tibia PR. Post-Roman groups demonstrated longer femoral lengths and higher rates of CO.

CONCLUSIONS

Gallo-Roman individuals may have been more regularly exposed to infectious pathogens throughout childhood, inhibiting opportunities for catch-up growth, resulting in high rates of DEH and shorter femoral lengths ('intermittent stress of low lethality'). This could be the result of overcrowding and insalubrious urban environments. Higher rates of CO in the Post-Roman samples may have been influenced by dietary changes between the periods.

SIGNIFICANCE

The intertwined and often synergistic relationships between early life environment, nutrition and settlement structure is highlighted, helping to further understandings of life experiences during the Roman and Post-Roman periods.

LIMITATIONS

It was not possible to obtain sufficient data from northern regions during the Gallo-Roman period, limiting this analysis.

SUGGESTIONS FOR FURTHER RESEARCH

Further application of life course approaches can reveal subtle patterns in stress indicators.

Cribriotic lesions in archaeological human skeletal remains. Prevalence, co-occurrence, and association in medieval and early modern Netherlands

OBJECTIVE

This paper studies the prevalence, co-occurrence, and association of cribra orbitalia, cribra humeri, and cribra femora to contribute to the complex debate on cribriotic lesions and their relationship with one another.

MATERIALS

179 adults and 53 non-adults from the medieval/early modern Netherlands (800-1600 CE) for whom all three lesions could be observed are included in this study.

METHODS

Presence or absence of cribriotic lesions was studied macroscopically. Prevalence, co-occurrence, and association of lesions and their link to sex and age-at-death were assessed.

RESULTS

A clear link between prevalence of the lesions and age-at-death is found. Co-occurrence and association of all three lesions is uncommon. There is a significant moderate correlation for cribra humeri-femora in non-adults.

CONCLUSIONS

Lesion prevalence is connected to age-at-death. However, while a similar age distribution and associations between pairs of lesions are noted, due to limited co-occurrence of the three lesions, the presence of a 'cribrous syndrome' cannot supported.

SIGNIFICANCE

This is the first study investigating the prevalence, co-occurrence and association of cribra orbitalia, cribra humeri, and cribra femora in non-adults and adults contributing to discussions about the nature and the much-debated aetiology of these commonly encountered skeletal lesions.

LIMITATIONS

The number of non-adults in this study is limited, potentially obscuring meaningful patterns, as the cribrous lesions are significantly more common in younger individuals.

SUGGESTIONS FOR FURTHER RESEARCH

More research into the prevalence of the post-cranial lesions and their co-occurrence as well as into bone growth and remodelling is warranted.

Cribra orbitalia is correlated with the meningo-orbital foramen and is vascular and developmental in nature

Cribra orbitalia is a phenomenon with interdisciplinary interest. However, the etiology of cribra orbitalia remains unclear. Recently, the appearance of cribra orbitalia was identified as vascular in nature. This study assessed the relationship between anatomical variation of vasculature, as determined by the presence of meningo-orbital foramina, and the presence of cribra orbitalia in 178 orbits. Cribra orbitalia was identified in 27.5% (49:178) of orbits (22.7%, 35:154 adult orbits and 58.3%, 14:24 subadult orbits) and meningo-orbital foramina were identified in 65.8% (100:152) of orbits. Among the 150 total intact adult orbits (i.e., orbital roof and posterior orbits both intact), cribra orbitalia was found in 35 (23.3%). Of these 35 occurrences of cribra orbitalia, 32 (91.4%) had the concurrent finding of a meningo-orbital foramen. However, in the absence of the meningo-orbital foramen, cribra orbitalia was only found in three sides out of the total sample of intact orbits (3:150; 2.0%). Fisher's exact test revealed that the presence of cribra orbitalia and the meningo-orbital foramen were statistically dependent variables (p = .0002). Visual evidence corroborated statistical findings-vascular impressions joined cribra orbitalia to meningo-orbital foramina. This study identifies that individuals who possess a meningo-orbital foramen are anatomically predisposed to developing cribra orbitalia. Conversely, cribra orbitalia is unlikely to occur in an individual who does not possess a meningo-orbital foramen. Thus, the antecedent of cribra orbitalia is both vascular and developmental in nature. This report represents an important advancement in the understanding of cribra orbitalia-there is an anatomical predisposition to the development of cribra orbitalia.

On the Way to the Fluvial Anthroposphere—Current Limitations and Perspectives of Multidisciplinary Research

Floodplains represent a global hotspot of sensitive socioenvironmental changes and early human forcing mechanisms. In this review, we focus on the environmental conditions of preindustrial floodplains in Central Europe and the fluvial societies that operated there. Due to their high land-use capacity and the simultaneous necessity of land reclamation and risk minimisation, societies have radically restructured the Central European floodplains. According to the current scientific consensus, up to 95% of Central European floodplains have been extensively restructured or destroyed. Therefore, question arises as to whether or when it is justified to understand Central European floodplains as a ‘Fluvial Anthroposphere’. The case studies available to date show that human-induced impacts on floodplain morphologies and environments and the formation of specific fluvial societies reveal fundamental changes in the medieval and preindustrial modern periods. We aim to contribute to disentangling the questions of when and why humans became a significant controlling factor in Central European floodplain formation, and how humans in interaction with natural processes and other chains of effects have modified floodplains. As a conclusion, we superimpose emerging fields of research concerning the onset of the Fluvial Anthroposphere and provide 10 specific thematic objectives for future multidisciplinary work.

Malaria in Europe: A Historical Perspective

Endemic malaria, which claimed 229 million new cases and 409,000 deaths in 2019 mainly in Africa, was eradicated from Europe by the mid-20th century. Historical descriptions of intermittent tertian and quartan fever reported in texts of Hippocrates in Greece and Celsus in Italy suggest malaria. A few paleomicrobiology investigations have confirmed the presence of malarial parasite Plasmodium falciparum in 1st, 2nd, and 5th century infected individuals in diverse regions of Italy, and Plasmodium sp. later in Bavaria. The causative Plasmodium pathogens, discovered in the 19th century in Algeria, were controversially used as therapeutic agents in the European pharmacopeia more than two centuries after effective quinine-based treatments had been introduced in Europe. How Europe managed to eradicate malaria and what the history of malaria was in Europe are of medical interest, and this review traces research pathways for a renewed understanding of malaria eradication in Europe through combined historical and paleomicrobiological investigations.

The elusive parasite: comparing macroscopic, immunological, and genomic approaches to identifying malaria in human skeletal remains from Sayala, Egypt (third to sixth centuries AD)

Although malaria is one of the oldest and most widely distributed diseases affecting humans, identifying and characterizing its presence in ancient human remains continue to challenge researchers. We attempted to establish a reliable approach to detecting malaria in human skeletons using multiple avenues of analysis: macroscopic observations, rapid diagnostic tests, and shotgun-capture sequencing techniques, to identify pathological changes, Plasmodium antigens, and Plasmodium DNA, respectively. Bone and tooth samples from ten individuals who displayed skeletal lesions associated with anaemia, from a site in southern Egypt (third to sixth centuries AD), were selected. Plasmodium antigens were detected in five of the ten bone samples, and traces of Plasmodium aDNA were detected in six of the twenty bone and tooth samples. There was relatively good synchronicity between the biomolecular findings, despite not being able to authenticate the results. This study highlights the complexity and limitations in the conclusive identification of the Plasmodium parasite in ancient human skeletons. Limitations regarding antigen and aDNA preservation and the importance of sample selection are at the forefront of the search for malaria in the past. We confirm that, currently, palaeopathological changes such as cribra orbitalia are not enough to be certain of the presence of malaria. While biomolecular methods are likely the best chance for conclusive identification, we were unable to obtain results which correspond to the current authentication criteria of biomolecules. This study represents an important contribution in the refinement of biomolecular techniques used; also, it raises new insight regarding the consistency of combining several approaches in the identification of malaria in past populations.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s12520-021-01350-z.

Cribra orbitalia is a vascular phenomenon unrelated to marrow hyperplasia or anemia: Paradigm shift for cribra orbitalia

The orbital phenomenon, cribra orbitalia, has long been a source of controversy, especially with regard to its nature, derivation, and relationship to anemia. Therefore, the external surfaces of orbital roofs were systematically examined microscopically in human skulls from historical collections. Superior orbital surfaces of 278 individual crania within the Hamann-Todd collection were assessed at various magnifications using epi-illumination microscopy to identify the presence of cribra orbitalia and characterize its nature. Also, 12 additional individuals with diagnosed anemia in the Hamann-Todd collection were evaluated. Orbital roof alterations, present in one-third of examined crania, had two discrete appearances: Vascular grooves (45%) and application of new bone in a vascular branching pattern on the orbit surface (55%). Porosity of the orbit was not observed. Evaluation of the orbits of 12 individuals with diagnosed anemia revealed one with a single deep defect, suggesting a space-occupying phenomenon, but no evidence of bone accretion, vascular grooves, or porosity. Cribra orbitalia has often been lumped indiscriminately as an indicator of organismal stress, rather than identified as a indicating a specific etiology. Neither that perspective nor porosity are supported by high resolution examination of orbital roof changes. Recognition of the blood vessel imprint pattern falsifies previous speculations and provides a new paradigm. The actual character of cribra orbitalia is documented and new hypotheses generated. While population prevalence of cribra orbitalia seems excessive for explanation on the basis of these hypotheses, the imprints are clearly vascular in origin.

Cribra orbitalia and porotic hyperostosis are associated with respiratory infections in a contemporary mortality sample from New Mexico

OBJECTIVES

Cribra orbitalia (CO) and porotic hyperostosis (PH) are porous cranial lesions (PCLs) classically associated with iron-deficiency anemia in bioarchaeological contexts. However, recent studies indicate a need to reassess the interpretation of PCLs. This study addresses the potential health correlates of PCLs in a contemporary sample by examining relationships between the known cause of death (COD) and PCL presence/absence.

METHODS

This study includes a sample of 461 juvenile individuals (6 months to 15 years of age) who underwent examination at the University of New Mexico's Office of the Medical Investigator between 2011 and 2019. The information available for each individual includes their sex, age at death, and their COD and manner of death.

RESULTS

Odds ratio of having CO (OR = 3.92, p < .01) or PH (OR = 2.86, p = .02) lesions are increased in individuals with respiratory infections. Individuals with heart conditions have increased odds of having CO (OR = 3.52, p = .03) lesions, but not PH.

CONCLUSION

Individuals with respiratory infection are more likely to have CO and/or PH. CO appears to have a greater range of health correlates than PH does, as indicated by the heart condition results. However, individuals with congenital heart defects are at higher risk for respiratory infections, so bony alterations in cases of heart conditions may be due to respiratory illness. Since respiratory infection remains a leading cause of mortality today, CO and PH in bioarchaeological contexts should be considered as potential indicators of respiratory infections in the past.

Spatial paleopathology: A geographic approach to the etiology of cribrotic lesions in the prehistoric Andes

OBJECTIVE

The ubiquity of cribra orbitalia in skeletal samples has led to rigorous debate over their etiology, with most concluding that nutrition, physiological stressors, and environmental disease vectors synergistically contribute to lesion development. To parse the relative contributions of these etiological factors in the prehistoric Andes, this spatial paleopathological meta-analysis investigates the relationship between population-wide prehistoric Andean cribra orbitalia rates and geographic, climatic, and hydrological variables.

METHODS

Crude prevalence patterns of cribra orbitalia from 61 archaeological sites were plotted and analyzed with geostatistical methods to explore spatial patterns in the distribution of anemia-associated lesions. Multiple linear regression modeling was performed on 19 spatial variables suspected to contribute to various forms of anemia that result in cribrotic lesions.

RESULTS

Spatially-clustered high cribra orbitalia rates exist around the Central Peruvian coast, but are paradoxically low on the Ecuadorian coast. Multiple regression shows that elevation, temperature, and precipitation were not predictive of lesion rates. Multiple regression models show that aridity and seasonal variability in freshwater supply, together, explained a third of the variation in lesion rates.

CONCLUSION

While cribra orbitalia has long been tied to coastal proximity, these results suggest environmental constraints such as the need for water storage could have promoted malnutrition and pathogenic infection more than mere coastal proximity.

LIMITATIONS OF THIS STUDY

This analysis is limited by the paucity of data from highland sites and by the assumption that burials are local to the excavation site.

SUGGESTIONS FOR FUTURE RESEARCH

Future studies will integrate isotopic and remotely-sensed data into models to explore links between water security, nutrition, and disease.

Life on a Napoleonic battlefield: A bioarchaeological analysis of soldiers from the Battle of Aspern, Austria

On the 21st-22nd of May 1809, French and Austrian soldiers engaged in battle near the village of Aspern on the outskirts of Vienna. This battle, the first defeat of Napoleon's army on land, was one of the largest and deadliest encounters during the Napoleonic Wars (1798-1815). Salvage excavations between 2009 and 2016 have revealed several battlefield burial sites in Aspern. The remains of 30 individuals were evaluated for a series of pathological conditions which develop during childhood and adulthood to elucidate the impact of Napoleonic military conditions on health. Statistical comparisons were conducted of stature estimates and frequencies of pathological conditions between the Aspern soldiers, several contemporaneous military, and two civilian samples of differing socioeconomic status. These data were compared to test the hypothesis that military conscripts had 'healthy' childhoods, but then experienced deteriorating health as a result of military conditions. The analysis revealed comparatively high mean stature, but also a high prevalence of enamel hypoplastic defects, indicating that the childhood health of the military recruits was more varied than was initially expected. High frequencies of carious lesions, dental calculus, active maxillary sinusitis and pleuritis and osteoarthritis were recorded, demonstrating the deleterious effects of military life on health.

The skeletal manifestation of malaria: An epidemiological approach using documented skeletal collections

OBJECTIVES

Recent studies in paleopathology have shown promise in associating some skeletal lesions with malarial infection. However, malaria's skeletal manifestation has never been confirmed using a large clinical reference sample from an endemic area for malaria with known individual causes of death.

MATERIALS AND METHODS

To pinpoint evidence of malaria infection on ancient skeletal remains, this study uses an epidemiological approach to compare skeletal lesions in a modern reference sample of 98 individuals from Uganda, where malaria is holoendemic, to a similar modern sample of 106 individuals from a malaria-free area.

RESULTS

Five porous skeletal lesions are identified that appear more frequently in the endemic area population, especially in anemic individuals. These appear on the cranium, vertebral column, and humeral and femoral necks. Periostitis also associates strongly with individuals in the endemic population; however, linear enamel hypoplasias show an inverse association. The identified lesions are tested for their association with each other, and then tested individually for their diagnostic power through measures of sensitivity and specificity. A diagnostic outcome algorithm is formed from the remaining skeletal lesions and their inter-lesion associations.

DISCUSSION

Several etiological explanations for the characteristic malarial skeletal lesions are explored, including severe malarial anemia, an imbalance in bone remodeling, and extramedullary erythropoiesis. The importance of careful differential diagnoses between other infectious and noninfectious causes of these lesions is discussed, including the potential for coinfection of malaria with other infectious diseases. The findings of this study are pivotal in establishing diagnostic criteria by which we can identify the prevalence and impact of malaria on past populations.