Ancient Egyptian health: the prevalence of anemia at the origins of agriculture and state level society.

Ancient Egyptians experienced a vast increase in population size following the Neolithic Revolution. Nomadic hunter-gatherer groups gradually adopted agriculture as their primary food subsistence strategy. Analyses of human societies shifting from foragers to farmers have provided evidence which suggests this transition is linked with an increase in disease and allostatic load. This paper presents an examination of cribra orbitalia and porotic hyperostosis prevalence in Predynastic and Dynastic Egyptians using public health evidence as a means to interpret the skeletal findings. The sample included 219 individuals from the regions of Naga-ed-Dêr, Mesheikh, Giza, and potentially El-Ahaiwah. The aim of this study was to identify significant differences of cribra orbitalia and porotic hyperostosis across time and sex. Application of a Fisher-Freeman-Halton's test indicated there were no differences in prevalence of cribra orbitalia or porotic hyperostosis between the Predynastic and Dynastic, nor were there differences between the sexes. The results of this study did not produce any evidence for an epidemiological shift to have occurred in post-agricultural Egypt. Further, the most likely explanation of the pattern of disease stems from a parasitic model of infection.

The History of Arachne Through Historic Descriptions of Meningiomas with Hyperostosis: From Prehistory to the Present.

BACKGROUND: Intracranial meningiomas are brain tumors that have probably been known the longest, largely because of the occasional production of grotesque cranial deformities that have attracted the attention and interest of humankind. Because of the tendency of some intracranial meningiomas to cause skull deformation and thickening, these tumors have given rise to various speculations and theories related to their origin, starting in prehistoric times up to the present. METHODS: From the Steinheim skull and "pharaonic meningiomas" to the first meningioma monograph and the first explanations of Harvey Cushing regarding the mechanism of hyperostosis, this review aims to weave again the story of Arachne. We identify the main contributors who have tried to understand and explain the tendency of some of these tumors to cause hyperostosis or other skull bone involvements. CONCLUSIONS: The contribution of neurosurgeons or pathologists over the centuries is of undeniable importance and is the basis for understanding future molecular mechanisms.

Infant and juvenile growth in ancestral Pueblo Indians.

The present study examines patterns of infant and juvenile growth in a diachronic sample of ancestral Pueblo Indians (AD 1300-1680) from the American Southwest. An assessment of growth patterns is accompanied by an evaluation of pathological conditions often considered to be indicators of nutritional deficiencies and/or gastrointestinal infections. Growth patterns and the distribution of pathological conditions are interpreted relative to culturally relevant age categories defined by Puebloan rites of passage described in the ethnographic literature. A visual comparison of growth distance curves revealed that relative to a modern comparative group our sample of ancestral Pueblo infant and juveniles exhibited faltering growth beginning soon after birth to about 5 years of age. A comparison of curves describing growth relative to adult femoral length, however, indicated reduced growth occurring later, by around 2 years of age. Similar to previous studies, we observed a high proportion of nonsurvivors exhibiting porotic cranial lesions during the first 2 years of life. Contrary to expectations, infants and juveniles without evidence of porotic cranial lesions exhibited a higher degree of stunting. Our study is generally consistent with previous research reporting poor health and high mortality for ancestral Pueblo Indian infants and juveniles. Through use of a culturally relevant context defining childhood, we argue that the observed poor health and high mortality in our sample occur before the important transition from young to older child and the concomitant initial incorporation into tribal ritual organization.

Health of the non-elites at Tombos: Nutritional and disease stress in New Kingdom Nubia.

During the New Kingdom period, Egypt succeeded in occupying most of Nubia. Colonial towns were built, which served as centers of government and redistribution. This paper uses a bioarchaeological approach to address the effects of this cultural contact on non-elites. Skeletal remains from the site of Tombos (N = 100), a cemetery in Upper Nubia dating to this important time, are analyzed, in addition to 1,082 individuals from contemporaneous Egyptian and Nubian sites, in order to shed light on the social, political, and economic processes at play and to determine how the people at Tombos were affected during this transitional period. In many ways, the Tombos population appears to have been affected by similar stressors as the other populations under study. However, a few small differences in the subadult frequencies of pathological lesions, especially remodeling rates, are significant in the overall picture of health at Tombos. These analyses suggest that, although the people of Tombos may have been integrated into the Egyptian colonial network, the additional resources they may have obtained could not protect them from nutritional and disease stress. A lower childhood survival through bouts of ill health at Tombos is suggested. While status may have played a role in the differences seen in the comparative populations, it is likely that parasites and/or other infections led to childhood illness and death.

[Life in imperial Rome: new data from recent excavations in Suburbium]. / Vivere a Roma in eta imperiale: evidenze antropologiche da recenti scavi nel Suburbio.

One of the goals of the anthropological research of the Anthropological Service of the Archaeological Superintendence of Rome is to reconstruct the hygienic-environmental living conditions of the ancient populations in Imperial Age. We considered some not specific pointers of stress in four necropolis, that are excavated in the last years in the Suburbium. In particular Harris's lines, porotic hyperostosis and enamel hypoplasia are been considered. Two shape of research have been lead: (a) an analysis of the frequencies of the three factors on the data from a single necropolis and (b) a comparison between enamel hypoplasia and porotic hyperostosis. The distributions of such alterations indicates the presence of light stresses.

Harvey Cushing's Meningiomas text and the historical origin of resectability criteria for the anterior one third of the superior sagittal sinus.

The search for the origin of the commonly held principle in current neurosurgery regarding the resectability of the anterior one third of the superior sagittal sinus unravels the many fascinating developments that occurred in neurosurgery during the early 20th century. All these occurrences can be traced back to, and are uniquely contextualized in, Harvey Cushing's seminal text, Meningiomas, Their Classification, Regional Behaviour, Life History, and Surgical End Results. Written with Louise Eisenhardt and published in 1938, Meningiomas is a monograph of incredible description and detail. The meticulous categorization of meningiomas, their presentation, clinical outcome, and surgical therapies are even further supplemented by Cushing's personal commentary, questions, and recollections. Cushing's genius was evident in his ability not only to make insightful clinical observations, but also to synthesize these ideas within the neurosurgical context of his era. As he says in Meningiomas, "Thus the pathological curiosity of one day becomes in its proper time a commonplace... most of which are one and the same disorder--had, for their interpretation, to await the advent of the Neurosurgeon."

[Cribra orbitalia (Porotic hyperostosis) in a prehistoric population of Parana Medio]. / Criba Orbitalia (hiperostosis porótica) en una población prehistórica del Paraná medio.

The observation of porotic hyperostosis in the orbits (criba orbitalia) in bone remains of a funeral site at the north of the Santa Fe province strongly suggests the occurrence of severe anemia among dwellers. Intestinal parasitosis (by Ancylostoma duodenalis or Necator americanus) is deemed the most likely cause of the anemia.

Criba Orbitalia (hiperostosis porótica) en una población prehistórica del Paraná medio / [Cribra orbitalia (Porotic hyperostosis) in a prehistoric population of Parana Medio]

The observation of porotic hyperostosis in the orbits (criba orbitalia) in bone remains of a funeral site at the north of the Santa Fe province strongly suggests the occurrence of severe anemia among dwellers. Intestinal parasitosis (by Ancylostoma duodenalis or Necator americanus) is deemed the most likely cause of the anemia.

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

Porotic hyperostosis, characterized by small and localized perforations on the surface of cranial bones, is considered a good indicator for assessing the health and nutritional status of past human populations. The most widely accepted theory at present indicates that anemias, either acquired or of genetic origin, are responsible for the bony lesions described as porotic hyperostosis. In this paper, the prevalence of these lesions in two skeletal samples from Latium (central Italy) was used to evaluate health and life conditions in Italy after the collapse of the Roman Empire. One sample belongs to the Roman Imperial Age (1st-3rd centuries A.D.) rural town of Lucus Feroniae; the other comes from the 7th century A.D. Lombard necropolis of Selvicciola. The prevalence of cribra orbitalia and cribra cranii was quite similar in the two samples but slightly more frequent in the Medieval community. Differential diagnosis suggested iron deficiency anemia in early childhood as the causative agent of the hyperostotic lesions in both samples. These results may be interpreted in light of previous examinations of same samples and according to their respective historical and socio-economical characteristics.

Diachronic patterns of dental hypoplasias and vault porosities during the predynastic in the Naqada region, Upper Egypt.

The diachronic pattern of the frequencies of linear enamel hypoplasias and porotic hyperostosis was studied in temporally separated samples of adult predynastic Egyptian remains from the Naqada region, Upper Egypt. The samples covered a period of increasing population density and social complexity as well as decreasing Nile flooding in Egypt. First and second molars were evaluated for hypoplasias in material from the Naqada I, II, and III periods; sample sizes were 13, 30, and 25, respectively, for the first molar, and 11, 28, and 24 for the second molar. Cranial vaults were examined for porotic hyperostosis using several approaches; sample sizes were 26, 66, and 51 for Naqada I, II and III, respectively. Linear regression showed a decreasing trend for several variables: for the individual frequency of first molar hypoplasias (rho = 0.025), the vault porosity score, which indicates the severity of the lesions (rho < 0.001), and the extent score, which indicates the number of superior vault bones having porosities (rho < 0.001). Logistic regression showed a temporal decline in the percentage of crania per sample having any vault porosities and only higher grade lesions (rho < 0.012 and rho < 0.003, respectively). Lesions of the second molar showed no directional trend. The results contrast with the common observation that these skeletal markers usually increase in contexts of increasing population density and social complexity.

Etiopathogenesis of skeletal hyperostosis. A study of a European population that lived 7700 years ago.

The prevalence of hyperostosis meeting the criteria developed by Arlet and Mazières in skeletons from two of the oldest European necropolises of neolithic farmers was about 10%, i.e., similar to that in a medieval population of comparable demographic structure. This similarity over a greater than 6600-year period suggests that hyperostosis is related to genetic factors.

Developmental, diachronic, and demographic analysis of cribra orbitalia in the medieval Christian populations of Kulubnarti.

Previous analysis of cribra orbitalia in the medieval populations of Kulubnarti focused only on the presence or absence of the lesion relative to age, sex, and cultural period. Demographic consideration of the lesion was limited to a gross comparison of lesion frequencies and probabilities of dying by age group. The scope of the earlier work has been expanded in the present research to include the consideration of cribra orbitalia from a developmental, demographic, and diachronic perspective. The sample consisted of the same 334 crania analyzed by Van Gerven et al. ([1981] J. Hum. Evol. 10:395-408). All skulls showing the lesion were dichotomized as active or healing, and separate life tables were constructed for those with lesions and those without. The results demonstrate that active lesions are confined entirely to infancy and childhood with formation beginning as early as six months and ending by the twelfth year. This childhood pattern is consistent with the iron deficiency anemia hypothesis proposed by Carlson et al. ([1974] J. Hum. Evol. 3:405-410). Among young adults (16-40), healing lesions occur more frequently in males than females. In the older age categories, however, females exhibit a higher frequency of partially healed lesions than males. A life table comparison of those with and those without cribra orbitalia reveals a dramatic reduction in mean life expectancy for those with the lesion across the formative childhood years (birth-16). This reduction peaks at age 5 where 78% of the children exhibit lesions and where they, as a group, have a mean life expectancy 15.5 years below those without the lesion.

[Evaluation of diagnostic criteria for hyperostotic diseases on a series of skeletons. Epidemiological implications]. / Evaluation sur une série de squelettes de critères diagnostics de la maladie hyperostosique. Implications épidémiologiques.

Three sets of diagnostic criteria for diffuse idiopathic skeletal hyperostosis were evaluated in 78 medieval skeletons from subjects aged 30 years or more at the time of death. Prevalence of the disease ranged from 7.6 to 11.5% according to the criteria used. Gross examination of skeletons was consistent with hyperostosis in 16.6% of cases. The lesions observed are described. A new set of criteria is suggested: 1) involvement of three vertebras (bridging of two intervertebral spaces) at the lower thoracic spine; 2) involvement of four vertebras (bridging of three intervertebral spaces) at any level; 3) flowing ossification along the anterolateral aspect of at least two contiguous vertebras; 4) enthesopathies without remodeling of the cortex symmetrically involving the posterior calcanei, olecranons, and upper patellas. Decreased disk height in elderly subjects and para-articular bony bridging of the sacroiliac joints do not rule out the diagnosis. The diagnosis is definite in patients with criteria 1 or 2, probable in patients with criteria 3 and 4, and possible in patients with criterion 3 or criterion 4.

Patterns of anemia and infection from medieval York, England.

An assessment of the presence and patterns of porotic hyperostosis and periosteal reactions in the skeletal population (n = 1,014) from St. Helen-on-the-Walls, York, are used to examine health and disease in urban medieval England. The analyses of these two lesions indicate that 58% of the population display evidence of porotic hyperostosis and that 21.5% of the population display periosteal reactions. Through differential diagnosis it is asserted that porotic hyperostosis is associated with iron-deficiency anemia, and that periosteal reactions may be the result of endemic treponematosis and/or non-specific infection, including parasitic infestation. An association between the presence of remodeled lesions and adulthood is noticeable for both porotic hyperostosis and periosteal reactions, as is a pattern of increased average age at death for those displaying both conditions.

Palatine torus in the Greenlandic Norse.

Physical anthropologists have long been intrigued by the distinctive oral tori expressed by the medieval Norse populations of Iceland and Greenland. To assess the temporal and spatial variation of one form of oral tori, palatine torus, observations were made on all available Greenlandic Norse skeletons, as well as on samples of medieval Icelanders and Norwegians. In terms of temporal variation, 12th to 14th century (medieval) Greenlanders from the Eastern and Western settlements exhibited higher frequencies and more pronounced expressions of palatine torus compared with early 11th century Greenlanders. The early Greenlandic sample closely approximated the medieval Icelandic and Norwegian samples for total torus frequency, although the Norwegians exhibited the trait to a less pronounced degree. As degree of expression is the most distinctive aspect of torus variation among the Norse, some combination of environmental factors, including increased masticatory stress and chronic undernutrition, probably accounts for most of the difference between settlement period and medieval Greenlanders. Although palatine torus may be hereditary in part, environmental factors play a significant role in the expression of this trait.

Porotic hyperostosis: a new perspective.

Porotic hyperostosis is a paleopathologic condition that has intrigued researchers for over a century and a half. It is now generally accepted that anemia, most probably an iron deficiency anemia, is the etiologic factor responsible for lesion production. Although there can be a number of factors involved in the development of iron deficiency anemia, a dietary explanation has often been invoked to explain the occurrence of porotic hyperostosis in past human skeletal populations. In fact, porotic hyperostosis has been referred to as a "nutritional" stress indicator. Traditionally those groups with a higher incidence of porotic hyperostosis have been considered to be less successful in adapting to their environment or more nutritionally disadvantaged than other groups. A new perspective is emerging that is challenging previous views of the role of iron in health and disease, thus having profound implications for the understanding of porotic hyperostosis. There is a new appreciation of the adaptability and flexibility of iron metabolism; as a result it has become apparent that diet plays a very minor role in the development of iron deficiency anemia. It is now understood that, rather than being detrimental, hypoferremia (deficiency of iron in the blood) is actually an adaptation to disease and microorganism invasion. When faced with chronic and/or heavy pathogen loads individuals become hypoferremic as part of their defense against these pathogens, thus increasing their susceptibility to iron deficiency anemia. Within the context of this new perspective porotic hyperostosis is seen not as a nutritional stress indicator, but as a indication that a population is attempting to adapt to the pathogen load in its environment.

A medieval example of meningiomatous hyperostosis.

An archaeologically retrieved skeleton, a female aged 35-50 years, from medieval Rochester, displays osseous changes which are considered to be diagnostic of meningiomatous hyperostosis. The dry bone findings are supported by X-ray and CT scan evidence. A search of the palaeopathological literature reveals only seven other convincing examples.