Skeletal manifestations of infantile scurvy

Abstract

Recent investigations of human skeletal material from the historic St. Martin's cemetery, England, found a range of abnormal lesions in six infants that are almost certainly related to scurvy. Porous and proliferative bone lesions affecting the cranial bones and scapulae were found, and this paper presents images obtained using both macroscopic and scanning electron microscope examination of the lesions. Previous work on infantile scurvy (Ortner et al., 1997-2001) relied heavily on changes at the sphenoid, which is often missing in archaeological bone, so the identification of changes attributable to scurvy on other cranial bones and the scapulae is encouraging. The ability to recognize changes related to scurvy on a range of bones will ensure an enhanced potential for recognition of this disease in future research involving archaeological bone. Research on historical documents from Birmingham dating to the eighteenth and nineteenth centuries, combined with the probable cases of scurvy identified, supports the view that the paucity of cases of infantile scurvy from the archaeological record reflects a lack of understanding and recognition of bone manifestations, rather than a lack of occurrence in this period. Changes linked to scurvy were only found in infants from the poorer sections of the community from St. Martin's, and this is almost certainly linked to patterns of food consumption and may be related to shortages of potatoes, due to blight, experienced during this period.

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

“…This feature has been noted in a large body of paleopathological work (Brickley & Ives, 2006; Klaus, 2014; Ortner et al, 2001; Ortner & Ericksen, 1997). …”

“…Porous subperiosteal new bone has since been described at this location in a large body of paleopathological work (Brickley & Ives, 2006; Brown & Ortner, 2011; Buckley et al, 2014; Geber & Murphy, 2012; Halcrow, Harris, Beavan, & Buckley, 2014; Ortner et al, 1999, 2001). …”

“…However, a systematic approach to the diagnosis of this disease in skeletal remains and an exploration of the assignment of the diagnostic weight of individual lesions is needed in order to avoid over‐diagnosis. Although much has been done in terms of methodological advancement over the last two decades (Brickley & Ives, 2006, 2008; Ortner et al, 1999, 2001), the application and diagnostic weight given to osseous features attributed to this disease has not always been uniform. Some researchers consider particular lesions (e.g., porosity of the greater wing of the sphenoid) pathognomonic or strongly diagnostic for this condition (Ortner et al, 1999, 2001; Ortner & Ericksen, 1997), while others do not recognize any strongly diagnostic osseous features (Brickley & Ives, 2008) or simply list all lesions exhibited which have been shown to have any association with the disease (Wrobel, 2014).…”

“…Radiographs or SEM (Brickley & Ives, 2006) should be employed wherever possible to confirm the subperiosteal nature of the new bone.…”

“…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.…”