Research ArticleAnalysis of nutritional disease in prehistory: The search for scurvy in antiquity and today
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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2019, International Journal of PaleopathologyCitation Excerpt :6524.102 was affected by this disease. Scorbutic bones commonly display periosteal lesions (Brickley and Ives, 2005: 56–57, Armelagos et al., 2014). Key-features of scurvy, including porosity at the greater wing of the sphenoid, hard palate and mandibular ramus, however, were absent (Table 3).
Juvenile scurvy from Late Medieval Knin, Croatia
2018, HOMOCitation Excerpt :Hemorrhage, the hallmark sign of scurvy (Levine et al., 1996), usually occurs in later stages of the disease, causing spots on the skin, swollen joints accompanied with muscular pain, and periodontal bleeding. If left untreated for a prolonged period, scurvy can cause death (Fain, 2005; Hodges et al., 1971; Hirschmann and Raugi, 1999; for a summary of diagnostic features of scurvy see Armelagos et al., 2014: Table 1). In juveniles (all individuals from birth until biological maturity), scurvy related signs tend to occur after approximately 6–10 months of insufficient intake of vitamin C (Algahtani et al., 2010; Jaffe, 1972), although they can occur as early as 2–4 months (Tamura et al., 2000).
Paleopathological rigor and differential diagnosis: Case studies involving terminology, description, and diagnostic frameworks for scurvy in skeletal remains
2017, International Journal of PaleopathologyCitation Excerpt :The interface between subsistence behavior and metabolic disease in the human past represents a principal concern of paleopathological research. Scurvy, or vitamin C deficiency, provides particularly important perspectives (Ortner, 2003; Brickley and Ives, 2008; Armelagos et al., 2014; Crandall and Klaus, 2014a). Not only is scurvy quite challenging to diagnose in human skeletal remains, it has additionally been a “neglected” skeletal condition in paleopathology until carefully composed diagnostic criteria emerged in the late 1990s (Ortner and Eriksen, 1997).
Basilar portion porosity: A pathological lesion possibly associated with infantile scurvy
2017, International Journal of PaleopathologyCitation Excerpt :Despite approximately 80% of scorbutic cases developing musculoskeletal alterations, and a myriad of historical literature attesting to its high prevalence, the disease remains a relative rarity within palaeopathology (Stark, 2014). It is likely that this discrepancy is due to the skeletal manifestations of scurvy being subtle and common to many other disease processes, as well as the often fragmentary nature of archaeological remains making a definitive diagnosis difficult (Geber and Murphy, 2012; Armelagos et al., 2014). In addition to this, the frequent co-morbidity of other pathological disorders with scurvy may mask its presence within the skeletal remains (Roberts and Manchester, 2010; Ortner, 2003; Waldron, 2009).