Evidence of non-adult vitamin C deficiency in three early medieval sites in the Jaun/Podjuna Valley, Carinthia, Austria.

OBJECTIVE: This study aims to determine and discuss the prevalence of non-adult scurvy cases from the early medieval Jaun/Podjuna Valley in southern Austria. MATERIALS: 86 non-adult individuals were assessed from three early medieval sites. METHODS: Morphological characteristics associated with suggestive and probable scurvy were observed macroscopically and under 20-40x magnification. RESULTS: A significant relationship between the prevalence of scurvy and age group was observed. Perinates (46%, 6/13) and children (27.5%, 8/28) showed a high prevalence of skeletal features indicating a diagnosis of scurvy, while no cases of scurvy were observed in adolescents and adults. CONCLUSIONS: In this Alpine region, scurvy occurred frequently in infants and children. Seasonal fluctuations of diet are discussed as factors triggering scurvy. SIGNIFICANCE: This study sheds new light on the prevalence of scurvy in the Alpine region and how the region developed after the fall of the Roman Noricum. It also models ways in which multiple lines of evidence can contribute to the diagnostic process. LIMITATIONS: Poor preservation posed a challenge to identifying probable cases of scurvy. Likewise, non-adult remains are difficult to diagnose due to their developing nature and it is not always possible to distinguish between normal bone growth and pathological growth. SUGGESTIONS FOR FURTHER RESEARCH: Future applications of biomolecular studies will help illustrate changes in diet that may have contributed to vitamin deficiencies.

Osteological evidence of metabolic diseases from a post medieval North Italy archaeological site.

Skeletal lesions related to metabolic diseases in children have been systematically investigated in paleopathological literature only in recent years. This work presents an infant pathological specimen from the post-medieval cemetery of the St. Mary's Nativity church (15th-18th centuries, Segno, Trento, Trentino, Northeast Italy). The bones belonged to an individual of 9 ± 3 months of age, estimated upon an assessment of the stage of dental eruption. Metabolic diseases were diagnosed with paleopathological criteria according to previous literature. Differential diagnosis of the osteological evidence indicates a disease that might be caused by the lack of vitamin D or C. Comorbidity of vitamin C and D deficiency has been widely studied in clinical literature, particularly in children between 3 months and 5 years of age. The study of ancient osteoarchaeological materials allows us to improve our knowledge on diseases' effects on bone development in children and, in this case, it represents additional evidence of the presence of metabolic diseases in a rural contest of the Italian post-medieval period.

Paleopathological rigor and differential diagnosis: Case studies involving terminology, description, and diagnostic frameworks for scurvy in skeletal remains.

Diverse pathological processes can produce overlapping or even indistinguishable patterns of abnormal bone formation or destruction, representing a fundamental challenge in the understanding of ancient diseases. This paper discusses increasing rigor in differential diagnosis through the paleopathological study of scurvy. First, paleopathology's use of descriptive terminology can strive to more thoroughly incorporate international standards of anatomical terminology. Second, improved observation and description of abnormal skeletal features can help distinguish between anemia or vitamin C deficiency. Third, use of a structured rubric can assist in establishing a more systematic, replicable, and precise decision-making process in differential diagnosis. These issues are illustrated in the study of two new cases of suspected scurvy from northern Peru. From this, it appears possible that ectocranial vascular impressions may further examined as a morphological marker of scurvy in the skeleton. Also, increased paleopathological attention to pellagra is long overdue, especially as it may produce generally comparable lesions to scurvy. This paper reflexively speaks to the process of paleopathological problem solving and the epistemology of our discipline-particularly regarding the ways in which we can continuously improve description and the construction of diagnostic arguments.

Scurvy at the agricultural transition in the Atacama desert (ca 3600-3200 BP): nutritional stress at the maternal-foetal interface?

Studies of contemporary populations have demonstrated an association between decreased dietary diversity due to resource scarcity or underutilization and an increase in diseases related to poor micronutrient intake. With a reduction of dietary diversity, it is often the women and children in a population who are the first to suffer the effects of poor micronutrient status. Scurvy, a disease of prolonged vitamin C deficiency, is a micronutrient malnutrition disorder associated with resource scarcity, low dietary diversity, and/or dependence on high carbohydrate staple-foods. The aim of this paper is to assess the potential impact of nutritional transition on the prevalence of diseases of nutritional insufficiency in an archaeological sample. Here, we report palaeopathological findings from an Early Formative Period transitional site located in coastal Northern Chile (Quiani-7). The subadult cohort from this site is composed of four perinates who exhibit a number of non-specific skeletal changes suggestive of a systemic pathological condition. One of these is associated with an adult female exhibiting diagnostic skeletal lesions of scurvy. We argue that the lesions exhibited by these perinates may represent maternal transmission of vitamin C deficiency but acknowledge that there are difficulties in applying current diagnostic criteria for scurvy to individuals this young.

Basilar portion porosity: A pathological lesion possibly associated with infantile scurvy.

Recent analysis of the juvenile (≤12 years) human remains from a 19th century site in Wolverhampton, England revealed a relatively high level of nutritional deficiency diseases within the population. Indeed, 41.7% of the 48 juvenile skeletons analysed exhibited a combination of porous and proliferative bone lesions consistent with the pathological alterations associated with nutritional stress. This paper describes a pathological lesion on the inferior surface of the basilar portion of the occipital bone, not previously reported in association with infantile scurvy, but which was exhibited by 90% (N=9) of the 10 scorbutic individuals identified during this study.

The role of scurvy in Scott's return from the South Pole.

Scurvy, caused by lack of vitamin C, was a major problem for polar explorers. It may have contributed to the general ill-health of the members of Scott's polar party in 1912 but their deaths are more likely to have been caused by a combination of frostbite, malnutrition and hypothermia. Some have argued that Oates's war wound in particular suffered dehiscence caused by a lack of vitamin C, but there is little evidence to support this. At the time, many doctors in Britain overlooked the results of the experiments by Axel Holst and Theodor Frølich which showed the effects of nutritional deficiencies and continued to accept the view, championed by Sir Almroth Wright, that polar scurvy was due to ptomaine poisoning from tainted pemmican. Because of this, any advice given to Scott during his preparations would probably not have helped him minimise the effect of scurvy on the members of his party.

Scurvy in the Great Irish Famine: evidence of vitamin C deficiency from a mid-19th century skeletal population.

Scurvy has increasingly been recognized in archaeological populations since the 1980s but this study represents the first examination of the paleopathological findings of scurvy in a known famine population. The Great Famine (1845-1852) was a watershed in Irish history and resulted in the death of one million people and the mass emigration of just as many. It was initiated by a blight which completely wiped out the potato-virtually the only source of food for the poor of Ireland. This led to mass starvation and a widespread occurrence of infectious and metabolic diseases. A recent discovery of 970 human skeletons from mass burials dating to the height of the famine in Kilkenny City (1847-1851) provided an opportunity to study the skeletal manifestations of scurvy-a disease that became widespread at this time due to the sudden lack of Vitamin C which had previously almost exclusively been provided by the potato. A three-scale diagnostic reliance approach has been employed as a statistical aid for diagnosing the disease in the population. A biocultural approach was adopted to enable the findings to be contextualized and the etiology and impact of the disease explored. The results indicate that scurvy indirectly influenced famine-induced mortality. A sex and stature bias is evident among adults in which males and taller individuals displayed statistically significantly higher levels of scorbutic lesions. The findings have also suggested that new bone formation at the foramen rotundum is a diagnostic criterion for the paleopathological identification of scurvy, particularly among juveniles.

[History of scurvy therapy and the injustice done to Dr. Maksim Nikolic-Miskovicev of Sremski Karlovci in the 19th century]. / Istorijat lecenja skorbuta i nepravda ucinjena Karlovcanu Dr Maksimu Nikolicu-Miskovicevom u XIX veku.

This paper reviews historical aspects regarding medical knowledge on scurvy, vitamin C deficiency, and its etiological factors. This disease used to affect naval-crews on long lasting sea voyages, soldiers during times of war and the poor. Although efficient therapy of scurvy (fresh vegetables, lemon juice) was known in the mid-18th century, its etiology was not known. It was believed to be caused by the cold, moist winds, unhealthy evaporations, malnutrition and it was called "alkaline disease". It was established that acid substances like lemon juice, had beneficial effects on the disease. However, it was soon generally accepted that it was caused by deficient diet. In 1830, Dr. John Elliotson, Professor of Medicine at London University supported this opinion. In 1928, Albert Szent Gyordyi, professor of Chemistry and Biochemistry at Szeged and Budapest Universities, isolated vitamin C from green pepper, vegetable proved to be rich with vitamin C. Due to this discovery, and some discoveries regarding biological processes, he was awarded the Nobel Prize for medicine and physiology in 1937. Back in 1864, a military doctor in Belgrade, Dr. Maksim Nikolic-Miskovicev from Sremski Karlovci, wrote to Ministry of Defence of the Serbian Principality. He informed the authorities about a successful, quick and cheap cure for scurvy-pepper juice. A medical board headed by Dr. Vladan Dordevic was formed to evaluate his discovery. Dr. Nikolic-Miskovicev was underestimated and laughed at, and his discovery was completely forgotten. The aim of this paper was to correct injustice done to Dr. Maksim Nikolic-Miskovicev.

Captain Cook's beer: the antiscorbutic use of malt and beer in late 18th century sea voyages.

The custom of allowing British seamen the regular use of fermented liquor is an old one. Ale was a standard article of the sea ration as early as the fourteenth century. By the late eighteenth century, beer was considered to be at once a food (a staple beverage and essential part of the sea diet), a luxury (helping to ameliorate the hardship and irregularity of sea life) and a medicine (conducive to health at sea). In particular, beer and its precursors, wort and malt, were administered with the aim of preventing and curing scurvy. This paper examines the use of malt and beer during late eighteenth century British sea voyages, particularly their use as antiscorbutic agents, focusing on James Cook's three voyages during the period 1768-1780. Cook administered sweet wort (an infusion of malt), beer (prepared from an experimental, concentrated malt extract), and spruce beer (prepared mainly from molasses), among many other items, in his attempts to prevent and to cure scurvy. Despite the inconclusive nature of his own experiments, he reported favourably after his second voyage (1772-1775) on the use of wort as an antiscorbutic sea medicine (for which purpose it is now known to be useless). Cook thereby lent credibility to erroneous medical theories about scurvy, helping to perpetuate the use of ineffective treatments and to delay the discovery of a cure for the disorder.

[Axel Holst and Theodor Frolich--pioneers in the combat of scurvy]. / Axel Holst og Theodor Frølich--pionerer i bekjempelsen av skjørbuk.

Axel Holst (1860-1931), professor of hygiene and bacteriology at the University of Oslo and paediatrician Theodor Frølich (1870-1947) became interested in a disease termed "ship beriberi" which afflicted the crews of sailing ships, and which showed an uncanny likeness to scurvy. They suspected a nutritional deficiency, and established an animal model that allowed systematic study of factors that led to disease as well as the preventive value of different substances. The choice of the guinea pig as the experimental animal for these studies was one indeed fortuitous, as that species has been shown to be among the very few mammals incapable of endogenous synthesis of ascorbic acid. They found that the guinea pigs developed distinctly scurvy-like symptoms when fed a diet consisting of various types of grain either whole or baked into bread, and that these symptoms were prevented when the diet was supplemented with known antiscorbutics like fresh cabbage or lemon juice. Their findings were published in 1907 in the Journal of Hygiene, but caused scientific uproar since the concept of nutritional deficiencies was a novelty at the time. The crucial factor, Vitamin C, was discovered in 1930 by Albert Szent-Györgyi, for which he was rewarded the Nobel Prize. No prizes or proper recognition were awarded Holst and Frølich at the time. It took some 60 years before they due acclaim was given to them; the 1907 paper by Holst and Frølich is now considered the most important single contribution to elucidating the aetiology of scurvy.

Nutritional research in World War 2: the Oxford Nutrition Survey and its research potential 50 years later.

To investigate the nutritional status of the population of the UK during the Second World War, nutritional surveys were commissioned in 1941. These included surveys of two groups of pregnant women: the first comprised 120 working-class women who were studied in the spring of 1942, and a second group of 253 women in 1944. Both groups were followed up until after delivery. Detailed biochemical assessments were performed on each subject. Our statistical analysis of the haematological data showed that nearly 25% of women from the 1942 group were deficient in protein, over 60% were deficient in Fe and vitamin A, and over 70% had severe vitamin C deficiency. The findings were reported to the Ministries of Health and Food who instigated a food supplementation policy at the end of 1942 that entitled pregnant women in the UK to extra rations of fruit, dairy produce and to a supply of cod-liver-oil tablets. A second group of 253 pregnant women were studied 15 months later which enabled the effects of this programme to be investigated. Supplementation reduced the proportion of women with vitamin A concentrations below the normal range from 63% to 38%, and vitamin C from 78% to 20%, but protein and Fe concentrations were not increased but actually declined. These findings continued to exert an influence over government food policy for pregnant women until the abolition of rationing in 1954.

[Correlations between cribra orbitalia, archeometric findings on the skeleton and habitat conditions]. / Zusammenhänge zwischen Cribra orbitalia, archäometrischen Befunden am Skelett und Habitatbedingungen.

The interpretation of cribra orbitalia as an isolated skeletal lesion is mainly based on malnutrition, in particular in terms of iron deficiency or vitamin C deficiency. A chronic iron deficiency anemia should result in both a reduced iron content of the skeleton and an underhydroxylation of the amino acid proline with the consequence of a less stable collagen matrix of the bone. The latter holds also for a vitamin C deficiency. Trace element and amino acid analyses were independently applied to subsamples of two early medieval human skeletal series to test whether a relation between cribra orbitalia and skeletal iron content and amino acid hydroxylation was detectable. For one of these series (Nusplingen, district Balingen, Schwäbische A1b), habitat specific properties have already been assumed to be responsible for an insufficient iron supply of the inhabitants. Both archaeometric approaches led to a verification of the malnutrition hypothesis, but for advanced states of the skeletal lesion only. Less affected individuals did not reveal any of the expected relationships. Possible adaptive subsistence strategies are discussed which might compensate for such unfavourable living conditions.