Cribra orbitalia and porotic hyperostosis in Greek skeletal remains have typically been attributed to a genetic anaemia, most notably thalassemia due to the presence of endemic malaria in the Mediterranean region. This paper reports the results of an analysis of cribra orbitalia and porotic hyperostosis in a Greek colonial population (5th to 3rd centuries BC) from the Black Sea. Archaeological evidence, stable isotopic data, and other skeletal indicators of physiological stress are examined to determine the most likely cause(s) of these lesions. While the possibility that some of the colonists of Apollonia suffered from thalassemia cannot be entirely discounted, the skeletal evidence examined in this study is not consistent with a diagnosis of thalassemia. We must therefore be cautious in assuming that cribra orbitalia and porotic hyperostosis in Greek skeletal remains, and indeed skeletal remains from any region where malaria was endemic in the past, is always indicative of this condition. Nutritional deficiencies and exposure to infectious diseases probably played an equally, if not more, important role in the development of these lesions.
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