Differential diagnosis of metabolic disease in a commingled sample from 19th century Hisban, Jordan.

OBJECTIVE: This research attempts a differential diagnosis of skeletal lesions in a commingled sample from Hisban, Jordan, focusing on non-adults in the assemblage. MATERIALS: 2,883 well-preserved skeletal elements and 9 relatively complete skulls representing an MNI of 32 non-adults (<18 years old). METHODS: All skeletal elements were observed macroscopically and pathophysiological processes underlying any lesions or other anomalies were assessed, followed by a comparative approach to rule out potential diagnoses. RESULTS: The skeletal lesions observed were caused by inflammation due to chronic hemorrhaging, marrow hyperplasia due to an increase in hemopoiesis, rapid bone growth, and the impact of biomechanical strain on poorly mineralized elements. Rickets, scurvy, and acquired anemias best fit this pattern of lesions, although inflammation from other sources such as trauma or infection could not be definitively ruled out. CONCLUSIONS: The in utero and postnatal environments at Hisban were conducive to the development of vitamin C and D deficiencies from birth until 2 years of age. The analysis of commingled remains requires an ontological shift in the importance of the individual to the population in paleopathology. SIGNIFICANCE: This investigation demonstrates the efficacy of a combined biological and comparative approach in differential diagnosis in complicated commingled collections. In addition, it emphasizes the importance of the mother-infant dyad in understanding metabolic disease. LIMITATIONS: Histological and radiographic analyses were not included in this diagnostic study due to COVID-19 travel restrictions. SUGGESTIONS FOR FURTHER RESEARCH: Isotopic analysis to investigate childhood diet and histological and radiographic analyses to assess survival of deficiencies.

Scottish soldiers from the Battle of Dunbar 1650: A prosopographical approach to a skeletal assemblage.

After the Battle Dunbar between English and Scottish forces in 1650, captured Scottish soldiers were imprisoned in Durham and many hundreds died there within a few weeks. The partial skeletal remains of 28 of these men were discovered in 2013. Building on previous osteological work, here we report wide-ranging scientific studies of the remains to address the following questions: Did they have comparable diet, health and disease throughout their lives? Did they have common histories of movement (or lack of movement) during their childhoods? Can we create a collective biography of these men? Strontium and oxygen isotope analysis of tooth enamel investigated childhood movement. Carbon and nitrogen isotope analysis of incrementally sampled dentine addressed childhood diet and nutrition. Metaproteomic analysis of dental calculus investigated oral microbiomes and food residues; this was complemented by microscopic analysis of debris in calculus from ingested materials. Selected individuals were examined for dental microwear. The extent of hydroxylation of proline in collagen was examined as a potential biomarker for scurvy. An osteobiography for each man was created using the full range of data generated about him, and these were synthesised using an approach based on the historical method for a collective biography or prosopography. The childhood residences of the men were primarily within the Midland Valley of Scotland, though some spent parts of their childhood outside the British Isles. This is concordant with the known recruitment areas of the Scottish army in 1650. Their diets included oats, brassicas and milk but little seafood, as expected for lowland rather than highland diets of the period. Childhood periods of starvation or illness were almost ubiquitous, but not simultaneous, suggesting regionally variable food shortages in the 1620s and 1630s. It is likely there was widespread low-level scurvy, ameliorating in later years of life, which suggests historically unrecorded shortages of fruit and vegetables in the early 1640s. Almost all men were exposed to burnt plant matter, probably as inhaled soot, and this may relate to the high proportion of them with of sinusitis. Interpersonal violence causing skeletal trauma was rare. Based on commonalities in their osteobiographies, we argue that these men were drawn from the same stratum of society. This study is perhaps the most extensive to date of individuals from 17th century Scotland. Combined with a precise historical context it allows the lives of these men to be investigated and compared to the historical record with unprecedented precision. It illustrates the power of archaeological science methods to confirm, challenge and complement historical evidence.

Navegación e historia de la ciencia: La vida a bordo: los hombres de la mar en el siglo XVI / Navigation and history of science: life on board: men of the sea in the 16th Century

El objetivo del presente trabajo fue sintetizar los aspectos básicos de la vida a bordo de los marineros españoles del siglo XVI. Dado el tiempo que pasaban navegando, el barco era la verdadera residencia del marinero, residencia mejor o peor según el rango de la tripulación. Pero si la vida en el barco era dura, muchos de los embarcados estaban en la gloria si se comparaba con sus penurias en tierra, en el barco, al menos, se comía. Horas y horas de trabajo se paliaban con cierto ocio a base de juego, algunas lecturas religiosas y sexo a bordo, que también había. Naufragios, incendios, epidemias, batallas y otros sustos diversos entretenían a los intrépidos marineros, buscavidas de la época. Todo ello en medio de unas lamentables condiciones higiénico-sanitarias, eso sí, no mucho peores que las que se ofrecían en tierra firme

The objective of this study was to synthesize the basic aspects of the Spanish sailors' life on board in the 16th century. Given the time they used to spend sailing, the ship was the sailors' main residence, a better or worse "house" depending on the range of the crew. But if life on board was hard, many of those sailors were in glory when compared with their hardships on land, at least they could eat on the ship. To many hours of work were palliated with some leisure based on games, some religious readings and sex on board, which they also had. Shipwrecks, fires, epidemics, battles and other diverse scares "entertained" the intrepid sailors, a sort of hustlers of the time. All this in the midst of unfortunate hygienic-sanitary conditions, which were not much worse than those offered on the mainland

Scurvy-Characteristic Features and Forensic Issues.

Scurvy is a multisystem condition that arises from vitamin C deficiency. As humans cannot synthesize vitamin C, serum and tissue levels depend on bioavailability, utilization, and renal excretion. Deficiencies result in defective collagen formation with swelling of gums, leg ulceration, and bleeding manifestations. Death most often results from infection and hemorrhage. In a forensic context, scurvy may mimic inflicted injuries and may be responsible for sudden death by mechanisms that remain unclear. Cardiac failure and rhythm disturbances with chest pain, hypotension, cardiac tamponade, and dyspnea are associated with vitamin C deficiency. In addition, syncope and seizures may occur. Although far less common than in previous centuries, scurvy is still present in high-risk populations that include alcoholics, isolated elderly individuals, food faddists, institutionalized patients, those with mental illness, and those who have had bariatric surgery or with underlying gastrointestinal conditions. Scurvy should therefore be a diagnosis to consider in medicolegal cases of apparent trauma and sudden death.

Johann Bachoven von Echt (1515-1576) and his work on scurvy: An omen of Vesalius' death?

A discussion is given of the figure of Johann Bachoven von Echt and his family, and on his work on scurvy. The disease is evaluated as a possible cause of the death of Andreas Vesalius. Echt's relationship with Jan Wier and his connections with Vesalius and Metellus are illustrated. A historical overview of the literature on scurvy is provided highlighting the importance of the work of Echtius and Ronsse for the early knowledge of that disease. A report by Metellus on the circumstances of Vesalius' death is added.

Macroscopic features of scurvy in human skeletal remains: A literature synthesis and diagnostic guide.

The past two decades have seen a proliferation in bioarchaeological literature on the identification of scurvy, a disease caused by chronic vitamin C deficiency, in ancient human remains. This condition is one of the few nutritional deficiencies that can result in diagnostic osseous lesions. Scurvy is associated with low dietary diversity and its identification in human skeletal remains can provide important contextual information on subsistence strategy, resource allocation, and human-environmental interactions in past populations. A large and robust methodological body of work on the paleopathology of scurvy exists. However, the diagnostic criteria for this disease employed by bioarchaeologists have not always been uniform. Here we draw from previous research on the skeletal manifestations of scurvy in adult and juvenile human skeletal remains and propose a weighted diagnostic system for its identification that takes into account the pathophysiology of the disease, soft tissue anatomy, and clinical research. Using a sample of individuals from the prehistoric Atacama Desert in Northern Chile, we also provide a practical example of how diagnostic value might be assigned to skeletal lesions of the disease that have not been previously described in the literature.

Juvenile scurvy from Late Medieval Knin, Croatia.

In this study, we examine the scurvy associated skeletal lesions among juveniles from the late Medieval site Uzdolje-Grablje in Croatia. The study aims to establish a demographic pattern of scurvy using existing diagnostic criteria. The sample consists of 16 well-preserved and fairly complete juveniles, excavated from a cemetery dating to 1420-1920. Skeletal remains were analyzed macroscopically for signs of porosity and new bone formation. Scurvy is diagnosed using the "Ortner criteria" of cranial and postcranial lesions. Depending on the location of the lesions, individuals were diagnosed with either scurvy or possible scurvy. Half of the individuals in our sample are diagnosed with scurvy, with additional 25% being diagnosed with possible scurvy. Along with porotic lesions, all individuals diagnosed with scurvy/possible scurvy showed new bone formation on at least one skeletal element. The occurrence of lesions associated with scurvy in our sample is unusually high. Instead of focusing solely on diet and insufficient intake of the vitamin C, a more likely explanation lies in the synergy between diet, exposure to infections, and the environment.

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.

Health research and safeguards: The South African journey.

Health research, as a social good, needs to be conducted in the interests of the common good. Because of the unfortunate exploitation of research participants globally, safeguards for protections are necessary. Most international codes and guidelines originated as responses to the abuse and mistreatment of research subjects. By the 1890s, antivivisectionists were already calling for laws to protect children, as a result of the increasing numbers of institutionalised children being subjected to vaccine experiments in Europe and the USA. Just after the turn of the century, the first attempt to test a polio vaccine was thwarted after the American Public Health Association condemned the programme. In South Africa, medical scientists were busy with discoveries and innovations as far back as the 1800s. In December 1967, the historic first human heart transplant was undertaken in Cape Town. Although it is unclear how much research preceded this procedure, there is no doubt that the operation was done in a research setting, and it had a far-reaching impact.

James Lind and the disclosure of failure.

Though James Lind is renowned as a pioneer of the clinical trial, he records the 1747 trial aboard the Salisbury in passing, never followed up on it, never campaigned for clinical trials as a means of medical discovery, and eventually pronounced scurvy an insoluble enigma. The case can be made that in confessing his lack of an unfailing remedy for scurvy and his trouble making sense of the disease's behaviour, Lind did medicine a greater service than by conducting his now-famous trial. At the time, medical progress was hindered by the all-too-common practice of proclaiming success and concealing failure. With his ethos of candour Lind challenged this practice by example; he may have been among the first to do so. Within a few years of the publication of the third and final edition of his A Treatise of the Scurvy, medical tracts began to appear in which the authors (some of whom knew Lind's treatise) took issue with the practice of concealing failure. A concerted attack on the suppression of evidence vivified the concept of evidence itself. Today, with the selective publication of findings distorting the medical literature, Lind's story of admitted failure holds great meaning.

Pharmacology in a Cup of Coffee The Virtue of Coffee and Vitamins Learned from the History of Scurvy and Dropsy.

Scurvy, a vitamin C deficiency, was rampant during the age of discovery in Europe. In the mid-17th century, "Pasqua Rosée," the first coffee house in London, put an ad in the newspaper "Publick Adviser" clearly stating, "It (coffee) is excellent to prevent and cure dropsy, gout, and scurvy." A Netherlands trade merchant carried the information to Nagasaki, Japan, along with coffee beans harvested in the Netherlands' new territory, Java Island. A Japanese physician in Nagasaki, Dr. Kai Hirokawa, translated the information into Japanese in his new book, "Dutch Medicines," published in 1803. According to the ancient documents stored in Wakkanai City, Japan, the coffee beans were distributed to Tsugaru Clan soldiers who were guarding the northern coastline from 1855 to 1856. The purpose of the distribution was the prevention of scurvy and dropsy. As the result, none of the soldiers died from scurvy during the winter of 1855-1856. This paper discusses the pharmacological relationship between coffee micronutrients and vitamin deficiency syndrome.