Research Article
Analysis of nutritional disease in prehistory: The search for scurvy in antiquity and today

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Highlights

  • Analysis of nutritional disease in prehistory provides a review of the search for scurvy in archeological populations.

  • Current macroscopic methodologies allow for determining scurvy in the skeletons of children, but diagnosis in adult skeletons remains complex.

  • The search for scurvy in adult archeological specimens is comprised by interaction of vitamin C deficiency and iron metabolism.

  • Broader anthropological perspectives are warranted in further researching scurvy.

Abstract

In this paper, we discuss the issues surrounding the study of scurvy, or vitamin C deficiency, in paleopathology, and highlight the work of Donald Ortner in advancing this area of research. This micronutrient deficiency impacts collagen formation and results in damage to a variety of bodily tissues. While clinical manifestations are observed routinely, the lack of specific signatures on bone makes paleopathological diagnosis difficult. Rapid growth in infants, children, and subadults provides abundant remodeled tissue and an increase in vascularization that makes identification possible in younger segments of the population. However, diagnosis of scurvy in adults remains problematic, given that diagnostic lesions are strikingly similar to those associated with rickets, osteomalacia, and other conditions. We argue that this confounding factor underscores the need for a broader anthropological approach to scurvy research that expands beyond differential diagnosis to include more accurate reconstruction of diets and available resources, greater consideration of the possibility – even likelihood – of multiple nutrient deficiencies simultaneously affecting an individual, and the patterning of these deficiencies along lines of status, sex, and age.

Introduction

“Circumstantial evidence is a very tricky thing,” answered Holmes thoughtfully. “It may seem to point very straight to one thing, but if you shift your own point of view a little, you may find it pointing in an equally uncompromising manner to something entirely different.” (Doyle, 1891, p. 402)

We have three objectives in this essay: to describe the history of the search for markers of scurvy and similar diet-related pathologies, to celebrate Donald J. Ortner's1 role in unraveling the role of nutritional deficiencies in the adaptation and well-being of human populations, and to suggest broader anthropological perspectives useful in the study of these deficiencies. Over the course of his long and productive career, Ortner investigated tooth mutilation (Ortner, 1966), osteon remodeling (Ortner, 1975), hypothyroidism (Ortner and Hotz, 2005), carcinomas (Ortner et al., 1991), and nutritional diseases such as scurvy, rickets (Ortner and Mays, 1998), and iron deficiency anemia (Von Endt and Ortner, 1982). While we note limitations in the descriptive and diagnostic tradition of paleopathology that might limit more meaningful study of an elusive skeletal condition like scurvy, we also review the progress that has been made in scurvy diagnosis and highlight encouraging directions in broader anthropological research on this condition in antiquity.

Section snippets

Contextual background

Donald Ortner was a major force in the development of methodological and theoretical issues in paleopathology (Ortner, 1991, Ortner, 2002, Ortner, 2009, Ortner and Aufderheide, 1991). Ortner and Arthur C. Aufderheide organized a symposium held at the International Congress of Anthropological and Ethnological Sciences in Zagreb, Yugoslavia in July, 1988 that reviewed the then-current state of paleopathology with an eye to future developments. The proceedings of the conference, Human

The scurvy enigma

Almost all animals, except for Homo sapiens, higher primates, fruit bats, bulbul birds, guinea pigs, and fish metabolically synthesize the enzyme l-gulonolactone oxidase that is required to convert glucose to vitamin C. Without the enzyme, vitamin C must be consumed from food sources. Vitamin C, a simple water-soluble molecule, is found in many plants, with especially high concentrations in citrus, tomatoes, potatoes, cabbages, and green peppers (García-Closas et al., 2004). This vitamin is

Paleopathological approaches to studying scurvy

A combination of lesions (Brickley and Ives, 2008, Brown and Ortner, 2011, Ortner et al., 1999), assessed using a weighted system of diagnostic criteria based on clinical and paleopathological features (Brickley and Ives, 2006), provide the basis for a scurvy diagnosis in skeletal remains. Fragmentary remains that are common features of the archeological record make diagnosis difficult, which may contribute to an under-representation of the disease in prehistory (Geber and Murphy, 2012).

Theoretical issues in the paleopathology of scurvy

The complexity of describing and interpreting lesions indicative of scurvy is due, in part, to issues of comorbidity and the fact that lesions may remain confined to soft tissues without skeletal presentation. However, this complexity has also been due to a historical trend in paleopathology whereby pathological conditions were described and diagnosed without fully standardizing descriptive criteria. Ortner highlighted the considerable variability that exists in the quality of observations,

Toward an anthropological study of ancient scurvy

The preceding pages center primarily on Ortner's first question as it pertains to scurvy; in order to study what it is, one must first find and describe it. In turning our attention to the second question, of what scurvy means, we argue that it is as important to push ourselves in thinking about the implications of scurvy in ancient populations, as it is to move forward in developing new diagnostic techniques. If the skeletal signs of scurvy are ambiguous or absent, a broader anthropological

Conclusion

Solutions to the scurvy enigma may soon be within reach, given the advancements in specific diagnostic tools for studying subtle changes in collagen structure, identifying microscopic variation in bony reactions to different deficiencies. In the future, it may be possible to differentiate between collagen amino acid profiles in affected versus unaffected individuals and better identify divergence in the cellular and molecular processes associated with different conditions. However, it is argued

Acknowledgements

We would like to thank Haagen Klaus, John Crandall, and an anonymous reviewer for their helpful and insightful comments on earlier versions of this manuscript. We would also like to thank Don Ortner and his students for their immeasurable contributions to paleopathology and biological anthropology.

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