Evidence of probable scurvy in subadults from archeological sites in North America

Abstract

The authors surveyed subadult human skeletons from Native American archeological sites in the United States for evidence of skeletal lesions associated with scurvy. Geographic regions surveyed include the Midatlantic area, the Southeast (Florida), the Southwest, and the Plains. The prevalence of probable subadult scurvy ranged from zero in the Plains samples to 38% in a small sample from Florida. These data indicate the likelihood that scurvy was a significant childhood disease in many Native American groups. Reasons for variation in prevalence remain speculative but include regional and seasonal variation in food types and abundance, cultural patterns of storage and utilization, periodic food shortages, and the relative importance of corn in the diet. These factors are part of a nutritional complex that is related to disease prevalence which can be studied through evidence seen in archeological human remains.

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

“…Using both anatomical (Ortner & Ericksen, 1997) and archaeological samples of non‐adult remains (Ortner et al, 1999, 2001) these authors have identified a suite of macroscopic bony lesions which they argue can be intuitively linked to the hemorrhagic effects of scurvy, specifically low‐grade bleeding due to the effects of minor muscular actions—such as masticatory movements—on weakened vasculature. The scorbutic lesions proposed by Ortner et al, as well with their anatomical associations and hypothesized mechanisms of formation, are outlined in Table 1 and described in detail in section ten.…”

“…The scorbutic lesions proposed by Ortner et al, as well with their anatomical associations and hypothesized mechanisms of formation, are outlined in Table 1 and described in detail in section ten. The majority of these are cranial, consisting of clustered, fine cortical porosity and are argued to be the result of bleeding of vasculature associated with the muscles of mastication, such as the temporalis and pterygoids (Ortner et al, 1999, 2001; Ortner & Ericksen, 1997). Capillary proliferation is part of the inflammatory response to the presence of extravascular blood; these new vessels act as a delivery system for phagocytic cells of the innate immune system to aid in the removal of hemorrhagic material (Browder, Folkman, & Pirie‐Shepherd, 2000).…”

“…Capillary proliferation is part of the inflammatory response to the presence of extravascular blood; these new vessels act as a delivery system for phagocytic cells of the innate immune system to aid in the removal of hemorrhagic material (Browder, Folkman, & Pirie‐Shepherd, 2000). Ortner & others argue that this hypervascular (angiogenic) response to extravasated blood will result in fine (<1 mm across) abnormal porosity at sites of subperiosteal hemorrhage as new capillaries create pathways through the bony cortex (Klaus, 2017; Ortner et al, 2001; Figure 1). Once sufficient levels of vitamin C are restored for osteoid formation, islands of porous new bone may be deposited at these sites of subperiosteal bleeding (Ortner et al, 1999, 2001; Riepe et al, 2001; Figure 2).…”

“…This proliferation of research began with the identification by Donald Ortner and colleagues of a suite of dry bone lesions which the authors argue can be intuitively linked to the unique pathophysiology of this disease (Ortner, Butler, Cafarella, & Milligan, 2001; Ortner & Ericksen, 1997; Ortner, Kimmerle, & Diez, 1999). Subsequent researchers have expanded on this work, both by extending Ortner's logical process of lesion identification to osseous changes at other sites in the skeleton and by integration of clinical radiographic and histological features of scurvy (Brickley & Ives, 2008; Geber & Murphy, 2012; Maat, 2004; Mays, 2008; Moore & Koon, 2017; Stark, 2014).…”

“…As such, identification of scorbutic individuals in the archeological record can contribute significantly to studies of the paleoenvironment, subsistence transitions such as agricultural intensification, and even cultural practices involving resource allocation and social inequality (Buckley et al, 2014; Crandall, 2014; Snoddy, Halcrow, Buckley, Standen, & Arriaza, 2017). Although many studies have contributed to methodological development (Brickley & Ives, 2006, 2008; Buckley et al, 2014; Maat, 2004; Ortner et al, 1999, 2001), and theoretical frameworks for the study of scurvy in the past have begun to emerge (Armelagos, Sirak, Werkema, & Turner, 2014; Stark, 2014), a comprehensive literature synthesis and diagnostic guide for the identification of scurvy in humans is still needed. This article provides a review of the paleopathological literature on the diagnosis of scurvy in adult and juvenile (0–15 years) human skeletal remains, a critical evaluation of the clinical basis of diagnostic macroscopic skeletal lesions, and a case‐study demonstrating a new approach to the establishment of diagnostic features is presented.…”