aapa symposium 2009

7/25/2019 AAPA Symposium 2009

http://slidepdf.com/reader/full/aapa-symposium-2009 1/14

The collaborators in theThe collaborators in the

Global History of HealthGlobal History of HealthProjectProject

dedicate this symposium to the memory of dedicate this symposium to the memory of

Phillip L. WalkerPhillip L. Walker

July 22, 1947July 22, 1947-- February 6, 2009February 6, 2009

Without his tremendous work and enthusiasm thisWithout his tremendous work and enthusiasm this

symposium would not have been possible.symposium would not have been possible.

Global History of Health Project Logo: Designed by Phil Walker 2Global History of Health Project Logo: Designed by Phil Walker 2 009009



The European Project:

Introduction to Goals, Materials, and Methods

Auth ors : R.H. Steckel, C.S. Larsen, P.L. Walker, C. Roberts, J. Blondiaux, G. Grupe, R. Jankauskas, G. Maat, G. McGlynn, A. Papathanasiou, M. Teschler-Nicola, U. Wittwer-Backofen, A. Agnew, S. Assis,Z. Bereczki, B. Bertrand, T.K. Betsinger, S. Boulter, C. Bourbou, A. Boylston, M. Brickley, L. Bürli, C. Cooper, A. Coppa, J. Coughlan, A. Drozd, E. During, J. Eng, F. Engel, S. Fox, M. Furtado, G. Gerhards,

K. Haebler, K. Harkins, P. Holck, M. Holst, G. Hotz, H. Justus, K. Kaminska, A. Kjellström, C.J. Knüsel, T. Kozlowski, A. Lagia, C. Lopes, S. Manolis, A. Marcsik, C. Marques, C. Moenke, Ioanna Moutafi, C.

Niel, S.A. Novak, F. Novotny, J. Peck, I. Potiekhina, B. Rega, R . Richman, F. Rijpma, J. Rose, J. Rui z, P. Sannen, P. Sciulli, A. Soficaru, M. Spannagl, R. Storm, M.E. Subirà, D . Swales, V. Tritsaroli, E.

Tyler, S. Ulrich-Bochsler, S. Vatteoni, Nuria Villena-Mota, R. Wiggins, and L.L. Williams

Acknow ledgements: Supported by the U.S. National Science Foundation (BCS-0527658, SES-0138129, BCS-0117958). Special thanks to Kimberly Williams for her assistance in the development of this

research, and Ohio State University for continued institutional and facilities support.

AAPA Symposium

Reconstructing Health and Disease in Europe:

The Early Middle Ages through the Industrial

Period

MethodsMuch information about the project is available from thefollowing web site: http://global.sbs.ohio-state.edu. Here

one can find the codebook, description of specialized

software and copies of grant proposals. Briefly, over 70collaborators in a trans-Atlantic consortium have agreed to

code skeletal data, most of which are from previouslyanalyzed collections. We are also collecting contextual

information about the sites, including the size of the

community and a variety of ecological variables available

from GIS databases.Beginning with a project organizational meeting at Ohio

State University in June of 2001, various project conferences

advanced the agenda at the European PPA meetings in

Coimbra in 2002. We held additional gatherings at various

AAPA meetings in the U.S. and in Rome (2005), Athens(2006), Munich (2008) and Douai (2009). Early meetings

improved the codebook, and subsequent gathering

emphasized the software for coding skeletal remains; criteria

for coding sites; aspects of project administration; andultimately, results.

The Database

Various criteria influenced the choice of skeletal collections

to be coded, including state of preservation and the quantityand quality of contextual information that was available.

Everyone on the project agreed on the need for temporal

and geographic diversity. Some regions are missing, such

as Southern France and much of Spain, but subsequent

efforts will attempt to obtain data from these areas. On the

right, in an evolving list, we acknowledge the work of peoplewho have contributed to or are currently contributing to the

project.

BackgroundThis project stems from a smaller, more focused effort on

the Western Hemisphere that originated in 1988, when

Richard Steckel and Jerome Rose began to organize

physical anthropologists, economists and historians in aretrospective study of health centering on the quincentennial

of 1492. Building upon ideas in Paleopathology at theOrigins of Agriculture, they organized planning conferencesat Ohio State University, which would pool skeletal data on

the following health indicators: stature (from long bonelengths); dental health; degenerative joint disease; signs of

anemia (cribra orbitalia and porotic hyperostosis); linear

enamel hypoplasias; trauma; and skeletal infections.

Eventually they and numerous collaborators assembled acombined database of 12,520 individuals, who had lived at

65 localities in the Western Hemisphere from approximately

5000 BC to the early twentieth century, a research effort

published as The Backbone of History: Health and Nutrition

in the Western Hemisphere.

ObjectivesThe frequency and severity of skeletal lesions in the

Western Hemisphere database correlates with a variety of

ecological or environmental variables such as settlementsize, elevation, topography, and subsistence patterns. The

responsiveness or sensitivity of health to the environment in

these data suggested there would be great potential for

understanding the long-term evolution of human health by

gathering and analyzing skeletal and environmental datafrom other areas of the world.

The European project substantially exceeds the Western

Hemisphere project in size, scope and complexity. By

creating several large databases, investigators andcollaborators are able to reinterpret the history of human

health from the late Paleolithic era to the early twentieth

century. During this period, human health and welfare weretransformed enormously by the transition from foraging to

farming; the rise of cities and complex forms of social andpolitical organization; European colonization; and

industrialization. With a trans-Atlantic network of

collaborators, the project undertakes large-scale

comparative studies of the causes and health consequences

of these and other dramatic changes in arrangements forwork, living, and human interaction.

Country Site name Funding Excavation Curation facility Coders from skeletons Coders to GGH format Other contributors

Austria Gars-Thunau Austrian Academyof SciencesUniversity of Vienna,Departmentfor PrehistoryandMedieval Archaeology (1965 -ongoing) Natural History MuseumVienna F.Novotny,M. Spannagl, K.Wiltschke-Schrotta, M.Teschler-Nicola F.Novotny,M. Spannagl

C.Huemer,T. Prohaska(Strontium-isotope ratio);P.Stadler, E.Wild(Radio-carbon dating);E.Wild,K. Rumpelmaier(C- andN-isotopesfordietaryreconstruction)

Austria PottenbrunnUniversity of Vienna,Departmentfor Prehistory andMedieval Archaeology (1965/66,1973/74)) Natural History MuseumVienna S.Reuer-Fabrizii,E.Reuer,K. Harkins,M.Teschler-Nicola, R.Pinhasi K.Harkins S.Steiner,(Endocranialfeatures); D.Schamall(Mucopolysaccaridose)

Austria ZwoelfaxingNatural History MuseumVienna,Departments forPrehistorya nd A nt hr op ol og y ( 19 54 /5 9, 1 97 4) N at ur al H is to ry M us eu m Vi en na J . Sz il va ss y, M . S pa nn ag l, F . N ov ot ny , M. T es ch le r- Ni co la , R . P in ha si M . Sp an na gl , F . N ov ot ny

Cyprus Pasydy Despo Pilides Wiener Lab Sherry C. Fox, Ioanna Moutafi Sherry C. Fox, Ioanna Moutafi Eleni Anna Prevedorou (cleaning)

F ra nc e S ai nt -A mé C EE ( FO DE S) , R ég io n No rd -P as d e Ca la is , V il le d e Do ua i.Direction de l'ArchéologiePréventivedela Communautéd'Agglomérationdu Douaisis

Direction de l'Archéologiedela Communautéd'Agglomérationdu D ouais is. Ben oit Ber tr and, Soph ie Vat teon i Ben oit Ber tr an d, Soph ie Vat teon i Pier re Dem olon (s it edi rect or ), Et ienn eL ouis ( arc hae olo gist r es pons ibl e)

France Les Rues des Vignes DRAC 59-62 Bernard Florin CEPN Joël Blondiaux Joël Blondiaux

France Amiens IlôtdesBoucheries INRAP Eric Binet CEPN Joël Blondiaux Joël Blondiaux

Germany Grossmehring State Anja Ledderose SAPM Gisela Grupe K. Haebler

Poland Poznań- Śródka Paweł Pawłak,Poznań Archaeological Museum MarekPolcyn,FirstPiastsMuseum,Dziekanowice Tracy Betsinger Tracy Betsinger

Poland Garbary Paweł Pawłak,Poznań Archaeological Museum Paweł Pawłak,Poznań Archaeological Museum Tracy Betsinger Tracy Betsinger

Poland Wodna Paweł Pawłak,Poznań Archaeological Museum Paweł Pawłak,Poznań Archaeological Museum Tracy Betsinger Tracy Betsinger

UnitedKingdom

France Duisans Arras City Alain Jacques CEPN Joël Blondiaux Joël Blondiaux

France Haudricourt INRAP Etienne Mantel CEPN Joël Blondiaux Joël Blondiaux

France Hamage SACAD Etienne Louis SACAD Nuria Villena-Mota, Joël Blondiaux Joël Blondiaux

France Saint Laurent Blangy Arras City Alain Jacques CEPN Joël Blondiaux Joël Blondiaux

G er ma ny L au ch he im A rc he ol og ic al S ta te O ff ic e Ba de n- Wu er tt em be rg A rc he ol og ic al S ta te O ff ic e Ba de n- Wu er tt em be rg A rc he ol og ic al S ta te O ff ic e Ba de n- Wu er tt em be rg M an fr ed K un te r, A le xa nd ra A lt , U rs ul a W it tw er -B ac ko fe n F el ix E ng el

Germany Minoritenweg State Heyse Co. SAPM Kristin Haebler, George McGlynn K. Haebler

Germany Schleswig State Claus von Carnap-Bornheim Schleswig-Holsteinisches Landesmuseum Gisela Grupe K. Haebler

AppleDown ChichesterDistrict Museum T. Jakob T. Jakob Mike Griffiths and Associates Limited

Germany Unterigling State Bayerisches Landessamt für Denkmalpflege SAPM Gisela Grupe K. Haebler

Germany Etting-Sandfeld State ProArch GmbH Ingolstadt SAPM Gisela Grupe K. Haebler

Germany Volders City Alexander Zanesco, Stadtarchaeologie Hall in Tirol SAPM George McGlynn K. Haebler

Germany Wenigumstadt State Eva Strauch SAPM Kristin Haebler K. Haebler

Germany Bachlechnerplatz City Alexander Zanesco, Stadtarchaeologie Hall in Tirol SAPM George McGlynn K. Haebler

Germany Altdorf State Paeffgen SAPM Andrea Grigat Andrea Grigat

Greece Kastella13th Ephorateof ByzantineAntiquities,BSA CentenaryBursaries L. Starida 13th Ephorate of Byzantine Antiquities C. Bourbou C. Bourbou M.P. Richards (stable isotope analysis)

Greece MesseneWienerLaboratory,American Schoolof Classical Studies at Athens (ASCSA);CostopoulosFoundation P.Themelis Archaeological Museumof Mavromati-AncientMessene C.Bourbou C.Bourbou M.P.Richards,B.Fuller (stable isotopeanalysis,in progress)

Greece Sourtara Wiener Laboratory (ASCSA), Dumbarton Oaks A. Tsilipakou 11th Ephorate of Byzantine Antiquities C. Bourbou C. Bourbou M.P. Richards, B. Fuller (stable isotope analysis)

G re ec e T hi va i (T he be s) T he AG L ev en ti s Fo un da ti onCharisKoilakou,1st Ephorateof ByzantineAntiquities at Athens

1st Ephoreia of Byzantine Antiquities Paraskevi Tritsaroli Paraskevi Tritsaroli

Greece Spata UNESCOEleniGini-Tsofopoulou,1stEphorateof ByzantineAntiquitiesat Athens

1st Ephoreia of Byzantine Antiquities Paraskevi Tritsaroli Paraskevi Tritsaroli

Greece Xironomi Wiener Laboratory (ASCSA)CharisKoilakou,1stEphorateof Byzantine Antiquitiesat Athens

23rd Ephoreia of Byzantine Antiquities Paraskevi Tritsaroli Paraskevi Tritsaroli

Greece Alepotrypa Wiener Laboratory (ASCSA) George Papathanassopoulos Neolithic Museum of Diros Anastasia P apathanasiou Anastasia P apathanasiou

Greece Franchthi Cave Wiener Laboratory (ASCSA) Thomas Jackobsen, K.D. Vitelli 4th Ephorate of Prehistoric and Classical Antiquities Anastasia Papathanasiou Anastasia Papathanasiou

Greece Proskynas Ministry of Culture Eleni Zachou 14th Ephorate of Prehistoric and Classical Antiquities Anastasia Papathanasiou Anastasia Papathanasiou

Greece Spaliareika Ministry of Culture Michail Petropoulos 6th Ephorate of Prehistoric and Classical Antiquities Anastasia Papathanasiou Anastasia Papathanasiou

Greece Sykia Ministry of Culture Joanna Efstathiou 5th Ephorate of Prehistoric and Classical Antiquities Anastasia Papathanasiou Anastasia Papathanasiou

Greece Athens Collection University of Athens, Wiener Laboratory (ASCSA), Biology Department, University of Athens Anna Lagia, Costas Eliopoulos Costas Eliopoulos, Velissaria Vanna Sotiris Manolis (curat or)

H un ga ry D es zk -O la jk út U ni ve rs it y of S ze ge d, D ep ar t me nt o f An th ro po lo gy M ór a Fe re nc M úz eu m Sz eg ed , Hu ng ar y, O t tó T ro gm ay er U ni ve rs it y of S ze ge d, D ep ar t me nt o f An th ro po lo gy A nt ón ia M ar cs ik , Er ik a Mo ln ár , Zs ol t Be re cz ki Z so lt B er ec zk i

H un ga ry B ék és -P ov ád zu g U ni ve rs it y o f S ze ge d, D e pa rt me nt o f A nt hr op ol og y M ór a Fe re nc M úz eu m Sz eg ed , Hu ng ar y, O t tó T ro gm ay er U ni ve rs it y of S z eg ed , D ep ar t me nt o f A nt hr op ol og y A nt ón ia M ar cs ik , E ri ka M ol ná r, Z so lt B er ec zk i Z so lt B er ec zk i

HungaryKiskundorozsma-D ar uh al om U ni ve rs it y o f S ze ge d, D e pa rt me nt o f A n th ro po lo gy M ór a Fe re nc M úz eu m Sz eg ed , Hu ng ar y, C s ab a Sz al on ta i U ni ve rs it y o f S ze ge d, D e pa rt me nt o f A n th ro po lo gy A nt ón ia M ar cs ik , E ri ka M ol ná r, Z so lt B er ec zk i Z so lt B er ec zk i

H un ga ry H om ok mé gy -S zé ke s U ni ve rs it y o f S ze ge d, D ep ar tm en t of A nt hr op ol og y V is ki K ár ol y Mú ze um Ka lo cs a, H un ga ry , Zs ol t Ga ll in a U ni ve rs it y o f S ze ge d, D ep ar tm en t of A nt hr op ol og y Z so lt B er ec zk i Z so lt B er ec zk i

H un ga ry N ag yl ak -H at ár sá v U ni ve rs it y o f S ze ge d, D ep ar tm en t of A nt hr op ol og y M ór a Fe re nc M úz eu m Sz eg ed , Hu ng ar y, J án os O rm án dy U ni ve rs it y o f S ze ge d, D ep ar tm en t of A nt hr op ol og y Z so lt B er ec zk i Z so lt B er ec zk i

Hungary Szőreg-Téglagyár University of Szeged, Departmentof AnthropologyMóraFerencMúzeumSzeged,Hungary,JánosReizner-JánosKotormány-Dezs ő Csallány University of Szeged, Department of Anthropology Zsolt Bereczki Zsolt Bereczki

Latvia Doma laukums Andris Caune; Silvija Tilko University of Latvia, Institute of Latvian History Guntis Gerhards Guntis Gerhards

Latvia St. Peters Roberts Spirgis University of Latvia, Institute of Latvian History Guntis Gerhards Guntis Gerhards

Latvia Selpils Anna Zarina University of Latvia, Institute of Latvian History Guntis Gerhards Guntis Gerhards

Lithuania Bernardinai Lithuanian State Vidas Daminaitis, 1992 Vilnius University Rimantas Jankauskas, Agnius Urbanavicius, Zydrune Miliauskiene Agnius Urbanavicius

Lithuania Mindaugo Private contractors Vidas Daminaitis, 2000 Vilnius University Rimantas Jankauskas, Agnius Urbanavicius, Zydrune Miliauskiene Agnius Urbanavicius

Lithuania Latako Lithuanian State Gediminas Gendr ėnas, 1981 Vilnius University Rimantas Jankauskas, Agnius Urbanavicius, Zydrune Miliauskiene Agnius Urbanavicius

Lithuania Pranciskonu Lithuanian State Andrius Vaicekauskas, 1994-1997 Vilnius University Rimantas Jankauskas, Agnius Urbanavicius, Zydrune Miliauskiene Agnius Urbanavicius

Lithuania Pranciskonu sventorius Lithuanian State Andrius Vaicekauskas, 1993-1994 Vilnius University Rimantas Jankauskas, Agnius Urbanavicius, Zydrune Miliauskiene Agnius Urbanavicius

Lithuania Subaciaus Private contractors Andrius Vaicekauskas, 1998 Vilnius University Rimantas Jankauskas, Agnius Urbanavicius, Zydrune Miliauskiene Agnius Urbanavicius

Lithuania Katedra Lithuanian State Albertas Lisanka, 1984-1986 Vilnius University Rimantas Jankauskas, Agnius Urbanavicius, Zydrune Miliauskiene Agnius Urbanavicius

Lithuania Kriveikiskis Lithuanian S tate Gintautas Vėliu s, 19 94 -1997 ,1999 ,200 0 V ilniu s U niver sit y R im ant as Jan kau sk as, Agnius Ur ban av iciu s, Zydr une Mil iaus ki ene Agn ius Ur ban avic ius

Lithuania Leipalingis Lithuanian State Eugenijus Svetikas, 1982 Vilnius University Rimantas Jankauskas, Agnius Urbanavicius, Zydrune Miliauskiene Agnius Urbanavicius

Lithuania Siaures miestelis Lithuanian State Justina Poškienė, 2002VilniusUniversity(selectedcasesof pathologyonlypr eser ved ) R im ant as Jankau sk as, Agniu sU rban av iciu s, Zyd ru ne Mil iaus ki ene Agn ius Ur ban avic ius

Lithuania Panevezys Lithuanian S tate Daina Stankevičiūtė, 2005 Reburied Rimantas Jankauskas, Agnius Urbanavicius, Zydrune Miliauskiene Agnius Urbanavicius

Lithuania Rukliai Lithuanian State Dalius Ribokas, 1989-1991, 1993-1998 Vilnius University Rimantas Jankauskas, Agnius Urbanavicius, Zydrune Miliauskiene Agnius Urbanavicius

Lithuania Plinkaigalis Lithuanian State Eugenijus Jovaiša, Vytautas Kazakeviči us , 19 77 -1 98 4 V il ni us U ni ve rs it y R im an ta s Jan ka us ka s, A gn iu s Ur ba na vi ci us , Zy dr un eM il ia us ki en e A gn iu s Ur ba na vi ci us

Lithuania Aguonu Private contractors Robertas Žukovskis, 2006-2007 Reburied Rimantas Jankauskas, Agnius Urbanavicius, Zydrune Miliauskiene Agnius Urbanavicius

Lithuania Boksto Private contractors Rytis Jonaitis, 2007 Reburied Rimantas Jankauskas, Agnius Urbanavicius, Zydrune Miliauskiene Agnius Urbanavicius

Lithuania Klaipeda Private contractors Gintautas Zabiela, 2006 Klaipeda University Rimantas Jankauskas, Agnius Urbanavicius, Zydrune Miliauskiene Agnius Urbanavicius

L it hu an ia D ub in gi u pi li av ie te L it hu an ia n S ta teRimvydasLaužikas,AlbinasKuncevičius,DainaStankevičiūtė,G in ta ut as S tr iš ka , 20 03 -2 00 7 V il ni us U ni ve rs it y ( pa rt ia ll y re bu ri ed ) R im an ta s Ja nk au sk as , Ag ni us U r ba na vi ci us , Zy dr un e Mi li au sk ie ne A gn iu s Ur ba na vi ci us

LithuaniaKernaveformer c hu rc hy ar d L it hu an ia n S ta te

AdolfasJankauskas,GintautasKarnatka,AleksiejusLuchtanas,1989-1991 Vilnius University Rimantas Jankauskas, Agnius Urbanavicius, Zydrune Miliauskiene Agnius Urbanavicius

Lithuania Zveju Lithuanian State Robertas Žukovskis, 1996 Vilnius University Rimantas Jankauskas, Agnius Urbanavicius, Zydrune Miliauskiene Agnius Urbanavicius

Lithuania Alytus, near church Lithuanian State Zenonas Baubonis, Vida Kliaugaitė, 20 03- 2004 V ilniu s U niver sit y R im ant as Jan kau sk as, Agnius Ur ban av iciu s, Zydr une Mil iaus ki ene Agn ius Urban avic iu s

NetherlandsBreda (ValkenbergBegijnhof) Guido van der Eynde The community of Breda F.E. Rijpma and G.J.R. Maat F.E. Rijpma

NetherlandsDordrecht(Minderbroedersklooster) H. Sarfatij RACM, Amersfoort R.W. Mastwijk and G.J.R. Maat F.E. Rijpma

Poland Giecz (Gz4) Slavia Foundationlead by TeresaKrysztofiak,KingaMonczak-Zamelska, Amanda Agnew,andHedyJustus RezerwatArchaeologicznyGrodPiastowskiwGieczu AmandaAgnew,HedyJustus AmandaAgnew,HedyJustus

Poland Kaldus

Grants fromthe Polish Ministryof ScienceandPolishMinistry of Culture;Funded by Allianz and Nicolaus

Copernicus University

WojciechChudziakandNicolausCopernicus University

I ns ti tu te o f A rc ha eo lo gy T ea m N ic ol au s Co pe rn ic us U ni ve rs it y, D ep ar tm en t of A nt hr op ol og y T om as z Ko zl ow sk i, A li cj aD ro zd T om as z Ko zl ow sk i

Prof.ElzbietaZadzinska, Headof Departmentof Anthropology,Lodz Univ.(accesstoskeletons),Dr. BeataBorowska,Lecturer in Departmentof Anthropology,LodzUniv.,(preparedthebonefor transport). 50 skeletons fromKalduscoded to theGHHP wereexcavation in 1956 by Kaszewska,curationfacility of theseskeletons

is Department of Anthropology, Lodz University

P ol an d G ru cz no F un ded by N ic ol au sC op er ni cu s U ni ve rs it y G ui do K ri es el , Ry sz ar d Bo gu wo ls ki N ic ol au s Co pe rn ic us U ni ve rs it y, D ep ar tm en t of A nt hr op ol og y K at ar zy na Ka mi ns ka , T om as z K oz lo ws ki T om as z Ko zl ow sk i

Polan d Plonk ow o F unded by R oj ew oD is tr ic t O f fic e M algor zat aGr up a N icol aus Coper nic us Uni ver sit y, D epar tment of An thr opol ogy N at al ia Glo wac ka, Magdal ena Kr aje wsk a, Tomas zK ozl ows ki To mas zKozl ow sk i

Polan d Kamion ki DuzeFundedby Agency of Construction of Motorways and Roads( Po la nd ) W oj ci ec h Ch ud zi ak , O la K uj aw a (a s f ie ld d ir ec to r) N ic ol au s Co pe rn ic us U ni ve rs it y, D ep ar t me nt o f A nt hr op ol og y M ag da le na K ra je ws ka , Na ta li a Gl ow ac ka , To ma sz K oz lo ws ki T om as z Ko zl ow sk i

Poland PienGrants fromPolish Ministry of Science; FundedbyDabrowaC he lm in sk a Di st ri ct O ff ic e D ar iu sz P ol in sk i, A li cj a Dr oz d, A nd rz ej J an ow sk i N ic ol au s Co pe rn ic us U ni ve rs it y, D ep ar tm en t of A nt hr op ol og y A li cj a Dr oz d, T om as z Ko zl ow sk i T om as z Ko zl ow sk i

PolandKwidzyn(CatedralC hu rc h) F un ded by K wi dz yn M un ic ip al A ut ho ri ty A nt on iP aw lo ws ki , To ma sz Ko zl ow sk i, " Od kr yw ca "T ea m N ic ol au s Co pe rn ic us U ni ve rs it y, D ep ar tm en t of A nt hr op ol og y T om as z Ko zl ow sk i T om as z Ko zl ow sk i

Portugal Silveirona Department of Anthropology, University of Coimbra Célia Lopes Célia Lopes

Portugal Santa Clara-a- Velha Entity: IPPAR Coimbra Convento de Santa Clara -a -Velha, Coimbra, Portugal Célia Lopes Célia Lopes

Portugal Rua 1º de Dezembro Entity: Ecomuseu do Seixal Ecomuseu do Seixal, Portugal Célia Lopes Célia Lopes Dr. Jorge Raposo (archaeologist)

Portugal Constância Câmara Municipal de Constância Archaeologist: Joana Garcia Department of Anthropology, University of Coimbra Sandra Assis Sandra Assis

Portugal Cacela Velha Câmara Municipal de Vila Real de Sant oAntónio Archaeologist :Cristina Garcia D epartment of Anthropology, University of Coimbr a Francisco Curate Sandra Assis

P or tu ga l C on ve nt o do C ar mo Archaeologist:AntónioMarques.Entity: Divisãode MuseusePalácios da Cidade de Lisboa Department of Anthropology, University of Coimbra Vanda Benisse Vanda Benisse

Portugal São João de Almedina Department of Anthropology, University of Coimbra Eugénia Cunha Marta Furtado

PortugalConventodeSãoFrancisco Archaeologist :Maria Ramalho, Car la Lopes Department of Anthropology, University of C oimbr a Ana Maria Silva, Cláudia Umbelino, Teresa Ferreir a Marta Furt ado

R om an ia S la va R us a R om an ia n M in is tr y fo r C ul tu re , C ul ts , an dN at io na lH er it ag e E co -M us ea m Re se ar ch I ns ti tu te , T ul ce aC ou nt y F r. J. R ai ne r In st it ut e o f A nt hr op ol og y A nd re iD or ia nS of ic ar u A nd re i Do ri an S of ic ar u

Romania Mangalia Romanian Ministry f or Culture, Cults, and Nat ional Heritage Callatis Museum, Constanta County Fr.J. Rainer Institute of Anthropology Andrei Dorian Sof icaru Andrei Dorian Soficaru

R oman ia I st ri a R om ani an M ini st ry f or C ult ur e, C ult s, and Nat ion al Her it age V. Par van Ins tit ut eof Ar ch aeolo gy, Bu ch ares t Fr .J. Rain er Ins ti tut e of Ant hr opology An dr ei Dor ian Sof icar u An drei Dor ian Sof ic ar u

Spain Agustins

Serveid'Arqueologiai Paleontologia-Generalitatde

Catalunya Anna Colet Oriol Saula M.E. Subirà, J. Ruiz M.N. Marín, L. Capilla

Spain RoquetesServeid'Arqueologiai Paleontologia-GeneralitatdeCatalunya Anna Colet Oriol Saula M.E. Subirà, J. Ruiz M.N. Marín, L. Capilla

Sweden Sigtuna Berit Wallenbergs Stiftelse Sigtuna Museum Sigtuna Museum Anna Kjellström Anna Kjellström

Switzerland Barfüsserkirche Barfüsserkirche 1975/6 Lucia Buerli and Dr. Gerhard Hotz Lucia Buerli and Dr.Gerhard Hotz

Switzerland Theodorskirchplatz Theodorskirchplatz 1984/33 Dr. Gerhard Hotz and Liselotte Meyer Dr. Gerhard Hotz and Liselotte Meyer

S wi tze r la n d Obe rbü ren -Ch i lch ma tt

University of Bern, ArchäologischerDienstdes Kantons

Bern Archäologischer Dienst des Kantons Bern Naturhistorisches Museum Bern Annette Heigold-Stadelmann, Susi Ulrich-Bochsler Christine Cooper Sara Toggweiler (data input)

S wi tze r la n d B ern -Gro sse S cha n zeUniversity of Bern, ArchäologischerDienstdes KantonsBern Archäologischer Dienst des Kantons Bern Naturhistorisches Museum Bern Christine Cooper, Susi Ulrich-Bochsler Christine Cooper Jacqueline Lauper (data input)

S wi tze r la n d B ern -B u n de sga sse

University of Bern, ArchäologischerDienstdes Kantons

B ern Ar chäolog is cher Di ens tdes Kant on sBer n N at ur his tor is ch es Mus eum Ber n Su si Ul ric h- Boc hs ler ,C hr ist ine Co oper , D omen ic Rü tt im ann C hri st in eC ooper , Dom enic Rüt ti mann Jac que line Laupe r( dat a input )

Tu rkey C at alh oyu k

Grants fromPolish Ministry of Science, FundedbyUniversity of Poznan, Universityof Gdansk,Polish Academyof Science Arkadiusz Marciniak, Lech Czerniak, TeamPoznan Catalhoyuk, Turkey Tomasz Kozlowski Tomasz Kozlowski

U ni te d Ki ng do m T ow to n N or th Y or ks hi re C ou nt y C ou nc il

LyndaIsaac,JenniferJanzen,Mark Jeffries, Jason Mayer,Rebecca Norman,LynneRace, Amanda Simpson TimSutherland.

Departmentof ArchaeologicalSciences,University ofBradford Anthea Boylston, Shannon N ovak, Malin Holst, Jen C oughlan Rebecca Storm

U ni te dK in gd om B la ck fr ia rs C it y E xc av at io n U ni t, G lo uc es te r C it y E xc av at io n U ni t, G lo uc es te r Departmentof ArchaeologicalSciences,University ofBradford

Charlotte Roberts,AntheaBoylson,Rebecca Wiggins (recordedtheskeletonsoriginallyto provide thedata forStorm) Rebecca Storm

United Kingdom 10 Bowling Green Lane Marldon Ltd AOC Archaeology AOC Archaeology/Museum of London Rachel Ives, Heather Applegate, Cat GibbsRachelIves,Melissa Melikian,ArnieRamirez,CatGibbs

U ni te d Ki ng do m S t. M ar ti n' s T he B ir mi ng ha m Al li an ce

BirminghamUniversityField Archaeology Unit (Birmingham Archaeology) Reburied Helena Berry, Gaynor Western Martin Smith, Jenna Morgan

U ni te d Ki ng do m B la ck ga te N ew ca st le U po n Ty ne C it y Co un ci l

John Nolan (nowof Northern Counties Archaeological Servicebutexcavated on behalf of theformerNewcastle City Archaeological Unit),BarbaraHarbottleand MargaretEllison(former Newcastle City Excavation Unit) Department of Archaeology, University of Sheffield Diana Swales

Dr.D.A.Lake,Departmentof Oral Anatomy, University of Newcastle upon Tyne,with assistancefrom JGColes and DonaldWright,SueAnderson,Centre forField Archaeology,Musselburgh,Scotland,Beth Rega, Western University,Pomona,SueBoulter, MandyMarlo

United Kingdom Trentolme Drive, York L.P. Wenham Natural History Museum of London Joshua J Peck

United Kingdom Butt Road, Colchester Colchester Castle Museum Joshua J Peck Stephanie Pinter-Bellows (initial osteological monograph)

UnitedKingdomDane's Graves, EastYorkshire Natural History Museum of London Joshua J Peck

United Kingdom Fishergate House, York Shepherds Homes Field Archaeology Associates Ltd, York Department of Archaeology, Durham University Malin Holst Jaime Jennings

Ukraine Kiev-Patorzhinskogo National Academy of Sciences of Ukraine I.Movchan Institute of Archaeology, NAS Ukraine, Kiev Inna Potekhina Inna Potekhina O.Kozak (paleopathological data and histological analysis in Medieval collections)

Ukraine Kiev-Shchekavitsa National Academy of Sciences of U kraine I.Movchan Institute of A rchaeology, N AS Ukraine, Kiev Inna Potekhina Inna Potekhina O.Kozak (paleopathological data and histological analysis in M edieval collections)

Ukraine Kiev-Stajki National Academy of Sciences of Ukraine A.Petrauskas, I.Gotun Institute of Archaeology, NAS Ukraine, Kiev Inna Potekhina Inna Potekhina

Ukraine Uspenski Cathedral National Academy of Sciences of Ukraine G.Ivakin Reburied Inna Potekhina Inna Potekhina

UkraineMykhailovskyGoldenCathedral National Academy of Sciences of Ukraine V.Kharlamov, V.Kozubovski Institute of Archaeology, NAS Ukraine, Kiev Inna Potekhina Inna Potekhina

Ukraine Kiev-Patorzhinskogo National Academy of Sciences of Ukraine I.Movchan Institute of Archaeology, NAS Ukraine, Kiev Inna Potekhina Inna Potekhina O.Kozak (paleopathological data and histological analysis in Medieval collections)

Ukraine Kiev-Shchekavitsa National Academy of Sciences of U kraine I.Movchan Institute of A rchaeology, N AS Ukraine, Kiev Inna Potekhina Inna Potekhina O.Kozak (paleopathological data and histological analysis in M edieval collections)

Ukraine Kiev-Stajki National Academy of Sciences of Ukraine A.Petrauskas, I.Gotun Institute of Archaeology, NAS Ukraine, Kiev Inna Potekhina Inna Potekhina

Ukraine Uspenski Cathedral National Academy of Sciences of Ukraine G.Ivakin Reburied Inna Potekhina Inna Potekhina

UkraineMykhailovskyGoldenCathedral National Academy of Sciences of Ukraine V.Kharlamov, V.Kozubovski Institute of Archaeology, NAS Ukraine, Kiev Inna Potekhina Inna Potekhina

Acknowledgments



Contextual and Socio-cultural

Variables DatabasesSocio-cultural variables are being studied from

archaeological evidence and historical documents,

summarized for each sample: absolute chronology,

settlement size and type, density, size of cultural

interaction (trade, migration), structural

heterogeneity, housing type and pattern, fortification,

drainage, sanitation and water supply systems,

technologies for food acquisition and processing,

transportation, subsistence, social organization

(economics, occupation, health care), and socialidentity.

Classification according to the above listed

sociocultural variables is somewhat arbitrary, as

each period of time in Europe provides data for

significantly varying subsistence (from foragers to the

beginnings of civilization, from early agriculture to

developed urban communities, from early

industrialization to autarchic agricultural communities

existing contemporaneously in different locations)

(Figure 4). In this case, sites were subdivided

according to longitude and latitude (Figure 5).

Contextual Dimensions of European Health and Lifestyle:

The Archaeological and Historical Record

AAPA Symposium



Period

Auth ors : R. Jankauskas, C. Roberts, R.H. Steckel, C.S. Larsen, P.L. Walker, J. Blondiaux, G. Grupe, G. Maat, G. McGlynn, A. Papathanasiou, M. Teschler-Nicola, U. Wittwer-Backofen, A. Agnew, S. Assis,Z. Bereczki, B. Bertrand, T.K. Betsinger, S. Boulter, C. Bourbou, A. Boylston, M. Brickley, L. Bürli, C. Cooper, A. Coppa, J. Coughlan, A. Drozd, E. During, J. Eng, F. Engel, S. Fox, M. Furtado, G. Gerhards,


Niel, S.A. Novak, F. Novotny, J. Peck, I. Potiekhina, B. Rega, R. Richman, F. Rijpma, J. Rose, J. Ruiz, P. Sannen, P. Sciulli, A. Soficaru, M. Spannagl, R. Storm, M.E. Subirà, D. Swales, V. Tritsaroli, E.


Acknow ledgements: Supported by the U.S. National Science Foundation (BCS-0527658, SES-0138129, BCS-0117958). Special thanks to Kimberly W illiams for her assistance in the development of this


I would like to write about the history of those tribes,

but I am held back by the thought that they did not have any history,

and if I would do so I would be guilty for imposing my own mindset

on their descendants who were greedily grasping for any kind of mythology.

Czeslaw Milosz. Piesek przydrozny, 1997

Material and Methods

Global History of Health Project members have

selected skeletons representing 83 European sites

dating from Antiquity/Prehistory (<500 BC) to the

early Modern period (after 1501 AD) (Table 1 and

Fig. 2) for analysis in order to maximize the quality

of both the skeletal and available contextual

information; the total number of skeletons included

for this analysis is 10,969. The sample will

inevitably increase as the Project progresses.

Introduction

Skeletal evidence from archaeological sites is

interesting from biological and historical points of

view. Concerning biomedical aspects, the

possibilities of hypothesis testing under extreme

physiological conditions in contemporary medicine

are severely limited. However, as the history of

humanity in Europe had already created such

conditions that cannot be reproduced in any

experiment, skeletal remains can be of value for

biomedicine, for example by exploring human

adaptation and the development of pathologicalchanges without the impact of modern treatments.

Concerning history, the study of human remains

from archaeological sites facilitates the

understanding and interpretation of the quality of

past lives.

By themselves, skeletal remains tell us little

about the history of human health and its

determinants; although they can show signs of

Figure 1: Regina Europa. From CosmographiaUniversalis, book 7. Basel: Sebastian

Müntzer, 1550-1554

disease, methodological

difficulties complicate the

interpretations.

Contextual informationabout the natural and

sociocultural

environments people

inhabited is necessary to

draw meaningful

conclusions about how

these impacted health.

The aim of this

presentation is to

introduce the scope and

the design of this large

ongoing study.

Recording of Skeletons All project members coded skeletal variables

according to a uniform system (available from the

project website http://global.sbs.ohio-state.edu). Sex

and age determination was established according to

the criteria listed in the database. Health indicators

selected are easily recorded and do not require

sophisticated diagnostic equipment. These include

skeletal measurements to estimate stature and

robusticity, dental traits such as linear enamel

hypoplasia, dental caries and antemortem tooth loss;

cribra orbitalia and porotic hyperostosis, signs ofscurvy and rickets, specific (TB, leprosy,

trepanematosis), and non-specific infectious

diseases, or periosteal reactions, trauma, and

degenerative joint disease. A pilot analysis (on-line

personal diagnostic quiz for participants) revealed no

significant inter-observer biases. The total sample

recorded by country is illustrated in Figure 3.

Contextual variables for each site available include

latitude and longitude, altitude, soil types, vegetationzone, precipitation, and length of growing period.

Extensive use of Geographic Information Systems

databases from a variety of sources are being used

to reconstruct the ecosystems inhabited by the

people whose remains are being studied. These

databases contain information pertaining to climatic

variation and key variables of socio-economic

importance such as growing season length, patterns

of annual precipitation, water availability, local

topographical relief, etc.

Figure 3: Distribution by country of the total sample encoded

Preliminary Results and Prospects

for the Future

Studies of these European data in the following

posters provide a unique opportunity to explore

correlations between health, geographic,

environmental and socio-cultural contexts. We also

plan to refine the chronological framework for

analysis through the selective use of radiocarbon

dating.

For example, we have found that a considerable

proportion (48%) of the variance in estimated adultheight (a parameter that has been shown to be an

excellent summary of quality of life index) can be

explained by a simple multiple regression model

that incorporates such local ecological variables

(see, the Body Size and Femoral length poster).

However, our goal is not to use such environmental

data to create deterministic models. Instead, we are

using deviations from the predictions they produce

to identify the socio-cultural factors that are the key

determinants of the health history of the European

population.

Figure 5: Sizeand geographicalareas of four

regional samples

Figure 2: Site locations and names using latitude and longitude imported into googleearth

Period

Dates

(B.C/A.D)

Dates

(B.P.)

Begin End Begin End

Antiquity/Prehistoric <500 B.C. 500 B.C. <2450 2450

Classical Antiquity 800 B.C. 500 A.D. 2750 1450

Early Middle Ages 501 A.D. 1000 A.D. 1449 950

High Middle Ages 1001 A.D. 1300 A.D. 949 650

Late Middle Ages 1301 A.D. 1500 A.D. 649 450

Modern 1501 A.D. 1950 A.D. 449 0

Table 1: Chronological subdivisions used in the poster analyses

Figure 4: East-westfault lines in Europe.From Davis N.

Europe: a history.London: Pimlico,1997.



Peasants, Elite, Paupers and City Folk :

A Prel iminary Analysis of Stable C and N Isotopes

across Europe

Auth ors : G. McGlynn, G. Grupe, R.H. Steckel, C.S. Larsen, P.L. Walker, P. Sciulli, H.D. Klaus, J. Blondiaux, R. Jankauskas, G. Maat, A. Papathanasiou, C. Roberts, M. Teschler-Nicola, U. Wittwer-Backofen, A. Agnew, S. Assis, Z. Bereczki, B. Bertrand, T.K. Betsinger, S. Boulter, C. Bourbou, A. Boylston, M. Brickley, L. Bürli, C. Cooper, A. Coppa, J. Coughlan, A. Drozd, E. During, J. Eng, F. Engel, S.

Fox, M. Furtado, G. Gerhards, K. Haebler, K. Harkins, P. Holck, M. Holst, G. Hotz, H. Justus, K. Kaminska, A. Kjellström, C.J. Knüsel, T. Kozlowski, A. Lagia, C. Lopes, S. Manolis, A. Marcsik, C. Marques,

M. Melikian, C. Moenke, Ioanna Moutafi, C. Niel, S.A. Novak, F. Novotny, J. Peck, I. Potiekhina, B. Rega, R. Richman, F. Rijpma, J. Rose, J. Ruiz, P. Sannen, A. Soficaru, M. Spannagl, R. Storm, M.E.

Subirà, D. Swales, V. Tritsaroli, E. Tyler, S. Ulrich-Bochsler, S. Vatteoni, Nuria Villena-Mota, R. Wiggins, and L.L. Williams



AAPA Symposium



Period

Methods

• Collagen extraction was conducted at theLudwig-Maximilians-University in Munich

according to Ambrose (1993).

• Mass spectrometry was performed with an

elemental analyser (Carlo-Erba1110) connected

online to a ThermoFinnigan Delta Plus

masspectrometer. All carbon isotope values are

reported in the conventional δ-notation in permil

relative to V-PDB (Vienna-PDB). Nitrogen isotope

ratios are reported in per mil (‰) relative to

atmospheric N2. Accuracy and reproducibility of

the analyses were checked by replicate analyses

of international standards (see data sheet: e.g.USGS 24, USGS 40, IAEA N1, IAEA N2).

Measurement error does not exceed 0.15o/oo.

Introduction

The dynamics of health are intrinsically bound to

nutrition and significantly impact the socio-economic

state of a group or population. Precise indicators ofcultural attributes such as nutrition, migration, and

social stratification over space and time are made

possible by stable isotope analysis. The European

Module of the Global History of Health Project for the

first time is processing large quantities of skeletal

data from all parts of the European continent and

has created the potential for detecting varying

patterns in health and disease (Fig. 1).

In this present study the analysis of stable

isotopes of C and N in bone collagen is conducted to

Objectives

• Comparison of δ15N ratios between the socially

privileged and commoners in early medieval

society to assess nutritional differences.

• Determining values characteristic for various

geographical locations ranging from Alpine to

coastal regions.

Aust ria: an early medieval Alpine farming population Adult δ15N ratios exhibit a very high degree of

variability, which is remarkable for a presumably

agrarian based population. A number of individuals

are separated by a full trophic level (Fig. 5). The

δ15N values for adults ranged between 7.78‰ and

11.91‰. Overall, there was no significant difference

between males and females, but, it is interesting to

note that 15 of the lowest 20 nitrogen ratios

belonged to males and 13 of the highest 20 alsobelonged to males. The δ13C outlier may have

augmented his diet with fish from the nearby river.

Schleswig: a Viking coastal trading center in

northern Germany

Although the site is situated in close proximity to the

sea, and the assumption of a marine-based diet

might be given, C and N stable isotopes show that

the individuals buried here subsisted on terrestrial

foods (Fig. 3).

Anal ys is in Prog ress:• Minoritenweg, a high medieval poorhouse

cemetery in Regensburg, Germany: Were the

needy, sick, or otherwise handicapped individuals

recovered from poorhouse cemeteries chronicallyundernourished, and how large were the

catchment areas of such pre-industrial institutions?

• Altdorf, a 19th-20th C. northern German skeletal

series from the Late Industrial Age, a period with

little dietary isotope data.

• Three sites in Poland including Kaldus, an 11th-12th

C. urban series, Kamionki, a 17th-18th C. rural

series, and 16th-19th C. Pien.

• Blackgate, Newcastle upon Tyne, skeletons from a

late medieval non-European mainland seaport.

Germany, cont.

Palaeodietary analyses of four early medieval

socially stratified separated burial sites in southern

Germany (Etting-Sandfeld, Unterigling-

Loibachanger, Grossmehring, Kelheim), do not

generally confirm the hypothesis that the socially

privileged were necessarily better nourished than the

common people (Fig. 2). High trophic levels may

prove misleading, since the consumption of “cheaply

acquired” animal products like milk, cheese, and

eggs can result in consumer δ15N values more

elevated than those produced through the

consumption of “expensive” meat. Consequently,

poorer people can exhibit higher δ15N ratios

compared to wealthy individuals.

Lithuania: two urban burial sites

Collagen ratios were determined from a random

sample originating from two different sites,Kriveikiskis dated to the 13th to 15th C. and Vilnius

dating from the 15th to 17th C. Although the present

sample is not large enough to draw serious

conclusions, this preliminary study, illustrated in Fig.

6, indicates the possible presence of sex based

differences where females appear to have higher

δ15N values.

Figure 2:Comparison of

δ15N values

originating frombulk and

separatedgraves from thefour different

burial sitesagainst baselinebovine valueswhich are set to

zero.

Figure 4: δ15N and δ13C values from both Swiss burial sites.

Figure 5: Scatter plot of collagen values from Volders.

Figure 6: Preliminary C and N analysis fromLi thuania.

Figure 3: δ13Cand δ15N ratios from Schleswig.

2

4

6

8

10

12

14

16

18

20

-29 -27 -25 -23 -21 -19 -17 -15 -13 -11

13C[‰]

1 5 N [ ‰ ]

HerbivoreterrestrischOmnivore terrestrischCarnivoreterrestrisch

AquatischBrackwasser MarinRMfrühErwachseneRMfrühKinder RMspätErwachseneRMspätKinder SC ErwachseneSC Kinder

aquatic

terrestrial

Brackwasser

marine

Humans

Figure 1: Map of Europe with site with completed sampling in redand green forthose presently in progress.

elucidate aspects

of nutrition.

Differences in the

intake of protein-

rich foods can

result in a

pronounced

trophic level

effect which isreflected in δ15N

values (Ambrose

et al. 1997,

Minagawa &

Wada 1984).

Case Studies

Germany: a separate burial groundIt is a common conception that socially privileged

individuals are better nourished and therefore

healthier, taller and have a potentially longer life

expectancy than their non-privileged

contemporaries.

Switzerland: upper crust and lower class, urban

laborers

Two different 17th-18th C. sites in Bern were

examined: the Bundesgasse churchyard, in which

the town’s wealthier citizenry was interred, and the

Grosse-Schanze burial ground located outside of the

city boundaries, comprised primarily of lower-class,

urban dwellers called “Hintersassen”, literally “those

sitting in the back”. Statistically, C and N analysis

revealed no significant differences between the two

groups or between males and females, underlining

the results found at the aforementioned Germansites (Fig. 4).



Body Size and Femur Length

Auth ors : G. Maat, R.H. Steckel, C.S. Larsen, P.L. Walker, J. Blondiaux, G. Grupe, R. Jankauskas, G. McGlynn, A. Papathanasiou, C. Roberts, M. Teschler-Nicola, U. Wittwer-Backofen, A. Agnew, S. Assis,Z. Bereczki, B. Bertrand, T.K. Betsinger, S. Boulter, C. Bourbou, A. Boylston, M. Brickley, L. Bürli, C. Cooper, A. Coppa, J. Coughlan, A. Drozd, E. During, J. Eng, F. Engel, S. Fox, M. Furtado, G. Gerhards,





research, and Ohio State University for continued institutional and facilities support

AAPA Symposium



Period

Methods

Of course, we cannot observe stature

directly from the skeleton but several

studies establish that height is highly

correlated with femur length. In the

1950s, Trotter and Gleser measured

the femur lengths (and other long

bones) of American troops who died

and were buried with identification

bracelets that enabled them to

compare bone lengths with heights

measured at enlistment. We use

their equation to estimate average

height, but some analyses are based

on femur length alone.

The codebook for the Europeanproject specifies that maximum femur

length be coded to the nearest

millimeter using an osteometric

board. It is defined as the distance

from the most superior point on the

head of the femur to the most inferior

point on the distal condyles.

Obviously this requires a fused

femur, which defines an adult in our

procedures.

Background

Social scientists have long been developing and

analyzing measures of social performance, a

generic term that refers to well-being. Scholarshave devised a large number of measures such as

life expectancy at birth, income per person, and

socioeconomic inequality. Most of these measures

are available for no more than one or two centuries

into the past, which considerably limits our

understanding of the evolution of the human

condition.

Human biologists and medical anthropologists

know that average stature is an excellent measure

of net nutritional conditions in childhood. One may

think of the body as a biological machine that

consumes fuel (calories, protein, vitamins and so

forth) in basal metabolism, work or physical activity

and fighting infection or disease. Physical growth

has a low priority under conditions of physiological

stress, and persistent malnutrition leads to stunting

by as much as 10 to 20 centimeters, depending

upon duration and severity. Therefore average

height is a useful measure of population health and

well-being.

Objectives

We seek to measure average stature over time,

across space, and by sex, to establish baseline

patterns against which more recent evidence can

be evaluated. We will test the null hypothesis that

no differences existed over time, across space, or

by sex. Ultimately we will draw comparisons with

the Western Hemisphere database, which showed

that physical growth was retarded in urban areas

and in upland environments where food was

relatively sparse.

Figure 1

Variation by Sex and Time Period

Whereas rates of cranial trauma were rising among

men during the Middle Ages (see trauma poster),

average stature of both men and women wasdeclining (Fig. 1). The stature decline agrees with

that reported by Steckel (2004; 2005) based on

published studies. Possibly the two patterns are

related in that socioeconomic stress could have

contributed to both malnutrition and violence.

Steckel suggests, and the project will investigate,

whether the onset of the Little Ice Age in the late

Middle Ages led to deteriorating diets. Other

sources of stress may have emerged from the

growth of interregional trade and urbanization,

which both led to the spread of communicable

disease.

Regional Variation

Various cross-country studies of height in modern

Europe report a north-south gradient, with the

Dutch and the Scandinavians being the tallest and

the Mediterranean populations of Portugal, Spain

and Greece the shortest (Schmidt et al. 1995).

Interestingly, this pattern also existed a thousand

years earlier (see Fig. 2), which may lead one to

think genetic factors were involved. The Dutch,

however, were relatively short in the mid-nineteenth

century and are now the tallest in the world, whichdiscounts the role of genes.

The modern pattern is consistent with a north-

south income gradient. Both measures of social

performance are converging such that southern

Europeans are growing faster and getting richer

relative to the north. A millennium ago, however,

southern Europe was richer than the north

(Cameron and Neal, 2003). Quite possibly the

trade and commerce that made southern Europe

rich during the Middle Ages also led to the

formation of inequality and the spread of disease

that stunted growth. The project will investigatethese ideas in future publications.

Sexual Dimorphism

Several studies of growth by human biologistsreport that women and girls are more resistant to

deprivation than are men and boys (Eveleth and

Tanner, 1976; 1990). As a result, the heights of

men tend to rise relative to those of women if

nutritional conditions improve.

Although the pattern is a bit jagged, the data in

Figure 4 confirm this relationship. As average

stature declined during the Middle Ages, the

heights of men fell faster than those of women,

such that the ratio of their heights diminished.

140

150

160

170

180

M e a n H e i g h t ( c m )

35 40 45 50 55

Latitude

Men

Women

Slope=0.34

Slope=0.12

Figure 2

Figure 3

Regional Variation, con t.It is well known that cities were less healthy than

rural areas prior to the advent of public health

measures in the late nineteenth century. Therefore

it is unsurprising that heights of men and women

were generally taller in the countryside compared

with the cities (Fig. 3). Notably heights declined

faster in rural than urban areas during the Middle

Ages.

Figure 4

Figure 1: Images fromthe codebook for theEuropean project,

indicating long bonemeasurements.Codebook available at

http://global.sbs.ohio-state.edu/new_docs/Codebook-06-28-06.pdf

Life in Venice in 1553 Rural life. From 'The Book of Hours'Flemish c. 1500. Fitzwilliam

Museum, Cambridge.



Rural-Urban Differences in LEHWith regard to settlement type – rural/village or

town/city – LEH data suggest that developmental

disruption in children living in rural areas increases

between Classical Antiquity to the Late Middle Ages.

Children who grew up in an urban area, in contrast,show an initial increase in LEH between Classical

Antiquity and the Early Middle Ages, but than a

conspicuous decline through modern times. Only for

the Early Middle Ages is there a statistically

significant rural-urban difference (chi-square=30.3,

p<0.0001, see Fig. 5). In this period the rural areas

might have provided better living conditions to those

of densely populated cities with their inadequate

hygiene and the higher risk of infectious diseases.

The History of Growth Disruption in European Children:

Evidence from Hypoplastic Teeth

Auth ors : M. Teschler-Nicola, A. Marcsik, R.H. Steckel, C.S. Larsen, P.L. Walker, J. Blondiaux, G. Grupe, R. Jankauskas, G. Maat, G. McGlynn, A. Papathanasiou, C. Roberts, U. Wittwer-Backofen, A. Agnew, S. Assis, Z. Bereczki, B. Bertrand, T.K. Betsinger, S. Boulter, C. Bourbou, A. Boylston, M. Brickley, L. Bürli, C. Cooper, A. Coppa, J. Coughlan, A. Drozd, E. During, J. Eng, F. Engel, S. Fox, M.

Furtado, G. Gerhards, K. Haebler, K. Harkins, P. Holck, M. Holst, G. Hotz, H. Justus, K. Kaminska, A. Kjellström, C.J. Knüsel, T. Kozlowski, A. Lagia, C. Lopes, S. Manolis, C. Marques, C. Moenke, Ioanna

Moutafi, C. Niel, S.A. Novak, F. Novotny, J. Peck, I. Potiekhina, B. Rega, R. Richman, F. Rijpma, J. Rose, J. Ruiz, P. Sannen, P. Sciulli, A. Soficaru, M. Spannagl, R. Storm, M.E. Subirà, D. Swales, V.

Tritsaroli, E. Tyler, S. Ulrich-Bochsler, S. Vatteoni, Nuria Villena-Mota, R. Wiggins, and L.L. Williams



AAPA Symposium



Period

Methods

The sample investigated for LEH included a total of

5,782 adult individuals.

Since transverse linear hypoplastic lesions occur

most often on the anterior teeth, we examined the

incisors (either I1 or I2) and canines exclusively. We

investigated primarily the teeth on the left side of the

(upper and lower) jaws. In cases where the left tooth

was not preserved, the right one was used as a

substitute. Teeth which have lost more than 50% of

the crown height due to wear or other causes were

excluded or scored as “unobservable”.

The scoring scheme for enamel hypoplasia

considered three degrees of development: 1= no

LEH or very mild (Fig. 1), 2= one LEH (more

Background

Over many decades palaeopathologists have

investigated disturbances in dental development, in

particular the abnormal quality of teeth, which inprinciple may affect all tissues of a tooth. The most

common is deficient enamel development,

expressed as pits or linear grooves. Such

hypoplastic lesions relate to developmental stress

caused by various conditions, among them

infectious diseases (e.g., congenital syphilis,

tuberculosis), malnutrition (rickets, anemia, dietary

shift at weaning), genetic causes and other factors

(e.g., toxins, trauma). Within this project we scored

only transverse linear hypoplasias (LEH). They

provide an index of (non-specific) developmental

stress and shed light on an, up to now,

epidemiologically insufficiently recorded and

investigated feature for the reconstruction of past

European children’s lives.

Objectives• Draw inferences about stress in early childhood

as indicated by mild and severe LEHs in relation

to sex, period and region.

• Test the hypothesis that the settlement type

(rural/urban) in relation to the time period affected

the stress level of children in Europe.

Temporal and Regional Variation

To investigate possible geographical and/or climatic

influences in LEH formation, we divided the

European sites into four main areas (Northeast,

Northwest, Southeast and Southwest). Considering

the region as well as the time period, an increase of

LEH (in general) through time in western Europe

and a decline through time in eastern European

sites was observed (Fig. 6). This trend is of great

interest, but will be discussed and re-investigated

following a re-definition of the geographic areas and

consideration of the significance of other relevant

variables (sex, rural/town).

Period Absent Mild Severe Total

%

Mild

%

Severe

Ancient/Prehistoric 43 27 7 77.0 35.1 9.1

Classical Antiquity 710 239 93 1042.0 22.9 8.9

Early Middle Ages 1,572 939 290 2801.0 33.5 10.4

High Middle Ages 371 162 69 602.0 26.9 11.5

Late Middle Ages 293 142 84 519 27.4 16.2

Modern 456 172 113 741 23.2 15.2

Total 3,445 1,681 656 5,782 29.1 11.3

Figure 2

Figure 1

LEH by Sex and Age

Males (N=2591) exhibited significantly more

hypoplastic lesions than females (N=2046) (41.6% :

37.6%, chi-square=7.4, p=0.007). This result mayreflect that male individuals in the past were more

prone to stress in early childhood than females. In

this regard, it is of interest that recent clinical studies

pointed out males are more prone to infectious

diseases (e.g., malaria) than females, suggesting a

correlation between sex hormones and susceptibility

or protection.

The frequency of people with hypoplastic defects

decreases significantly with increasing age at death

(this is observable in males and in females): people

older than 60 years exhibited LEH less often. The

average age at death of people (both sexes

included) with LEH was 34.3 years. and lacking

LEH was 35.7 years; this is significantly different

(t=2.8, d.f.=5641, p=0.005; (Fig. 3), indicating that

less physiological stress during childhood leads to

a longer life.

Temporal Variation of Mild/Severe

LEHBased on a sample of 5,782 individuals, 29.1%

exhibited mild LEH and 11.3% had severe LEH

(Table 1). However, the results are not consistent

when compared to the frequency of burials with

mild and severe linear enamel hypoplasia by period

(Fig. 4). Whereas mild forms decrease impressively

from the Early Middle Ages to modern time, the

severe forms increase continuously until the Late

Middle Ages.

Table 1: Temporal Variation in LEH

pronounced), so

that it can be

identified by running

the fingernail across

the tooth; 3= two or

more LEHs (Fig. 2).

All examinations

were carried out

macroscopically.

0

5

10

15

20

25

30

35

40

Classical

Antiquity

Early

Middle

Ages

High

Middle

Ages

Late

Middle

Ages

Modern

%

o f B u r i a l s w i t h L i n e a r E n a m e

l H y p o p l a s i a

Mild

Severe

Figure 4

0

10

20

30

40

50

60

Classical

Antiquity

Early

Middle Ages

High

Middle

Ages

LateMiddle

Ages

%

w i t h L E H

Rural/Village

Town/City

Figure 5

10

15

20

25

30

35

40

45

50

Classical

Antiquity

Early Middle

Ages

High Middle

Ages

LateMiddle

Ages

%

o f B u r i a l s w i t h L i n e a r E n a m e l H y p o p l a s i a

Northeast

Northwest

Southeast

Southwest

Figure 6

0

5

10

15

20

25

30

35

40

1 0- <2 0 20 -< 30 3 0- <4 0 4 0- <5 0 5 0- <6 0 6 0+

Age Group

% o

f b u r i a l s w i t h L E H

Males

Females

Figure 3

Th Hi f E O l H l h



The History of European Oral Health:

Evidence from Dental Caries, Dental Abscesses,

Antemortem Tooth Loss

AAPA Symposium



Period

Auth ors : U. Wittwer-Backofen, F. Engel, R.H. Steckel, C.S. Larsen, P.L. Walker, J. Blondiaux, G. Grupe, R. Jankauskas, G. Maat, G. McGlynn, A. Papathanasiou, C. Roberts, M. Teschler-Nicola, A. Agnew,S. Assis, Z. Bereczki, B. Bertrand, T.K. Betsinger, S. Boulter, C. Bourbou, A. Boylston, M. Brickley, L. Bürli, C. Cooper, A. Coppa, J. Coughlan, A. Drozd, E. During, J. Eng, S. Fox, M. Furtado, G. Gerhards,



Tyler, S. Ulrich-Bochsler, S. Vatteoni, Nuria Villena-Mota, V. Villar, R. Wiggins, and L.L. Williams



Discussion and Outlook• Spatial analysis has shown a distinct development

in Central Southeast Europe that contrasts with otherregions. Caries and antemortem tooth loss

frequencies peak here considerably earlier and

subsequently decrease towards the late Middle

Ages; this runs against all trends elsewhere. Further

analysis will concentrate on possible factors for this

shift. While economy may explain diachronic

developments, geographic and climate factors are

more likely to illustrate regional disparities.

• Sugar consumption obviously had moderate

effects on caries and tooth loss until the modern

period. If the import of cane sugar was relevant, this

would have been expected to be exhibited earlier incoastal regions than in Central Southeast Europe.

The sharp increase of caries and antemortem tooth

loss in the modern period in the Mediterranean might

indicate a change in consumption following the

introduction of beet sugar.

• The decline in oral health from the Northwest to the

Northeast might reflect general climatic factors

causing adverse living conditions in the east.

• A major difference between the sexes could not be

found.

• While these results are based on an

unprecedented amount of data, further analyses areneeded to complete the picture. For example, the

Mediterranean sample needs to be increased to gain

better spatial and diachronic coverage. Data for the

modern period are also needed for Northwest and

Central Southeast Europe to determine whether a

deterioration of oral health similar to that witnessed

in the Mediterranean can also be found there.

Additionally, the inclusion of earlier periods would

allow for tracing the history of oral health from the

major impact of the Neolithic transition to 'modern'

sugar consumption.

Regional Trends

Figure 2 presents diachronic trends in caries

frequency by regions. In general, frequencies are

higher in Northeast and Central Southeast Europe

than in the Northwest and the Mediterranean. While

the latter shows a marked increase towards the

modern period (based on a small sample) a similar

trend could not be verified for Northwest and Central

Southeast Europe due to lack of data. It is absent,however, from the Northeastern sample.

Central Southeast Europe differs from the other

regions in that caries frequencies peak during the

High Middle Ages followed by a considerable drop

towards the Late Middle Ages. Otherwise an opposite

pattern prevails with a rise of caries frequency

towards the Late Middle Ages.

Caries and Tooth Loss

Severe carious lesions ultimately lead to

antemortem tooth loss. Such cases consequently

do not appear in caries statistics; therefore these

missing data do not reflect the full impact on a

population. For a more accurate assessment caries

and antemortem tooth loss frequencies have been

summed (Fig. 3).

These figures confirm the general patterns already

discussed for caries frequencies in Figure 2 at a

higher level. The higher caries rate in Northeast

Europe is connected to a high rate of tooth loss.

Results

Age-relat edness As expected, caries affliction increases with age.

This steady trend is little influenced by other factors.

Additionally, the increase is linear, i.e. the

increments are similar both for older and younger

ages.

Materials and MethodsDental data is available from 10,003 individuals

within the data base and have been explored for

chronological trends, regional variance, age-

relatedness and sex differences. To avoid shifts in

caries and antemortem loss frequencies due to

different age distributions in time periods and

regions, we used standardized decade age groups

starting above 20 years of age. Only sites

represented by more than 100 observable teeth

have been considered to avoid bias by small samplesizes.

Spatial analyses were based on a subdivision of

Europe into four regions with distinct climatic

conditions (Fig. 1) following long-established

schemes (Kottek et al. 2006). These regions are also

known to be archaeologically distinct for long periods

of time.

Background

Oral health is an important indicator of diet, economy

and quality of life. Most accessible indices are those

derived from the observation of carious lesions,antemortem tooth loss and alveolar abscesses. This

contribution focuses on the first two of these sources.

Introduction

Dental caries is closely connected to diet, especially

high intake of carbohydrates. An essential turning

point in Central European dietary habits was the shift

from hunting and gathering to agriculture during the

Early Neolithic (Wittwer-Backofen & Tomo 2008),

featuring high correlations between the consumption

of carbohydrates, wheat grinding techniques and

caries intensity (Roberts & Cox 2003).

Further increases in caries frequency can beexpected with the introduction of cane sugar from

colonial trading around 1500 AD and the extraction

of sugar from beets starting in the early 19th century.

Poor hygiene, a lack of certain trace elements or

highly abrasive food particles may also promote

caries.

Severe lesions often result in antemortem tooth

loss or alveolar abscesses, which are serious, and

potentially fatal, restrictions on the quality of life.

Differences in caries frequencies between males

and females have been observed both in modern

(Alvarez-Arenal et al. 1996) and Neolithicpopulations (Larsen 1998, Lukacs 1996).

Figure 1: Climatic regionswithin Europe used for the

spatial analysis of oralhealth data and referred toin other graphs (Kottek et

al. 2006; Neef aspresented in Dierke2008).

Left: :"Der Zahnbrecher” ('The tooth breaker’) 1568.Right: “The old German tooth breaker. Which excruciates - or should I say cures - the hypocriticaldishonest swanks and eaters of confectionery (because they have developed b lack, stinking, worm-

eaten, bad teeth by it) according to fashion and better than any charlatan”. 1632.

Sex Differences

In Northeast Europe females are more strongly

afflicted by caries and antemortem tooth loss than

men. However, this trend is not very pronounced and

not at all universal.

Figure 2: Diachronic trends in caries frequencies according to region. The cumulative curvelabeled 'both sexes' includes skeletons for which sex could not be determined. These are notrepresented in the 'male' and 'female' curves. All data has beenstandardized for each age group

to avoid bias through varying age distributions.

Figure 3: Diachronic trends in caries and premortem tooth loss frequencies according to region.The values were added up taking into account that the frequencies for caries and premortemtooth loss are calculated drawing on different totals (number of teeth vs. number of tooth

positions observed). Where data for either caries or premortem tooth loss was not available novalue has been given. The cumulative curve labeled 'both sexes' includes skeletons for whichsex could not be determined. These are not represented in the 'male' and 'female' curves. All

data has been standardized for each age group to avoid bias through varying age distributions.

Th Hi t f A i d R l t d N t iti l



AAPA Symposium



Period

Analysis of the mortality profiles of people dying

with and without cribra orbitalia and porotic

hyperostosis suggest that the conditions producing

these lesions have a negative effect on

survivorship (Figs. 1 and 2). The difference in

mortality rate is especially clear for cribra orbitalia

for older children and adolescents. The agedistributions of burials with cribra orbitalia and

porotic hyperostosis are similar, which suggests

similar etiologies. There is a steep drop in the

prevalence of the lesions among people dying

during the first decade of life and then a gradual

rise among adults into the fifth decade. After that,

their frequency decreases significantly with few

people who reach an elderly age.

Age Variation and Survivorship

The average age at death of people lacking cribra

orbitalia was 35.8 years, versus 22.5 years for

people with the condition (Table 1). For porotichyperostosis, the age differential was somewhat

less with people lacking it having an average age at

death of 32.7 years and people with it an average

age at death of 27.5 years. The average age at

death of people having both conditions (22.1 years)

is not significantly (t = 0.4207, p≤0.6) younger than

that of people having only cribra orbitalia (22.7

years).

The History o f Anemia and Related Nutritional

Deficiencies in Europe:

Evidence from Cribra Orbitalia and Porotic Hyperostosis

Aut hors: A. Papathanasiou, P.L. Walker, R.H. Steckel, C.S. Larsen, J. Blondiaux, G. Grupe, R. Jankauskas, G. Maat, G. McGlynn, C. Roberts, M. Teschler-Nicola, U. Wittwer-Backofen, A. Agnew, S. Assis,Z. Bereczki, B. Bertrand, T.K. Betsinger, S. Boulter, C. Bourbou, A. Boylston, M. Brickley, L. Bürli, C. Cooper, A. Coppa, J. Coughlan, A. Drozd, E. During, J. Eng, F. Engel, S. Fox, M. Furtado, G. Gerhards,



Tyler, S. Ulrich-Bochsler, S. Vatteoni, Nuria Villena-Mota, V. Villar, R. Wiggins, and L.L. Williams

Ack now ledgements: Supported by the U.S. National Science Foundation (BCS-0527658, SES-0138129, BCS-0117958). Special thanks to Kimberly W illiams for her assistance in the development of this


Methods

Using the following standardized recording system,

6,697 of the individuals in the Global History of

Health Project European sample for cribra orbitalia

and 7,702 individuals for porotic hyperostosis werescored.

Cribra Orbitalia: The porosity/pitting of the roof

areas of the eye orbits was assessed for cribra

orbitalia when at least one eye orbit was present.

The scoring of the condition was as follows: No

orbits present for observation (score=0); pitting

absent with at least one observable orbit (score=1);

presence of pitting on at least one orbit (score=2);

gross lesion with excessive expansion and exposed

diploë (score=3).

Background

Porous lesions on the outer table of the cranial

vault (porotic hyperostosis) and orbital roof (cribra

orbitalia) are among the most common pathologicallesions seen in ancient human skeletal collections.

These conditions are frequently associated with

substandard living conditions. They can be a result

of marrow expansion associated with both acquired

and inherited hemolytic and megaloblastic

anemias.

Cribra orbitalia and porotic hyperostosis, given

their prevalence and etiology, are a key indicator

for assessing past quality of life. This project

records and interprets variation by age and sex,

geographical region, and natural and cultural

contexts, which is highly informative for overall

quality of life and its fluctuations through broadcultural periods of European history.

Objectives• Assess the relationship between living

conditions and survivorship through time and

across different regions of Europe over the last

10,000 years, following the major cultural shifts

of human history.

• Test the hypothesis that cultural developments

improved human living conditions.

• Shed light on the genetic and acquired origins of

anemia, and account for the observed variation.

Porotic hyperostosis from AlepotrypaCave, Greece.

Cribra orbitalia from Alepotrypa Cave, Greece.

Porotic Hyperostosis

Cribra Orbitalia Absent Present

Absen t Mean Age at Death 35.8 32.7N 4654 266

Present Mean Age at Death 22.5 22.1

N 1011 215

Table 1: Age Distributions with and without cribraorbitalia and porotichyperostosis.

Methods, cont .

Porotic Hyperostosis: The pitting on the

squamosal portions of the occipital and the parietal

bones was assessed for porotic hyperostosis. The

scoring of the condition was as follows: No parietals

present for observation (score=0); pitting absent

with at least one observable parietal (score=1);

presence of pathological pitting (score=2); gross

lesion with excessive expansion and exposed

diploë (score=3).

Temporal Variation

There is a considerable decrease in the prevalence

of both conditions as time progresses with a

notable reversal during the High Middle Ages (Fig.

3). A clear temporal trend is visible in the

prevalence of both cribra orbitalia and porotic

hyperostosis with time for all sites and individuals

combined, suggesting overall improved living

conditions, consistent with the hypothesis that

cultural developments had a positive impact on

living conditions.

Sex Variation

There were also sex differences in these conditions.

• Women are more likely to have cribra orbitalia

than men (χ2=10.6, p≤0.005) and• Men are more likely to have porotic hyperostosis

than women (χ2=14.9, p≤0.001).

Regional and Environmental

Variation

Logistic regression indicates that

• people living in rural villages and eastern Europe

(χ2=57.7, p ≤0.00001) are much more likely to have

cribra orbitalia (χ2=30.9 p ≤0.00001) than people

living elsewhere.• porotic hyperostosis is more common among

people in eastern Europe than in western Europe

(χ2=126.5, p ≤ 0.0001).

• cribra orbitalia and porotic hyperostosis are rare

among medieval European communities associated

with the boreal forest (subtaiga) vegetation region

(χ2=176.6699, p ≤ 0.0001)

• both conditions seem to be somewhat more

frequent near the coast, but the relationship is not

very strong.

Figure 3

0

5

10

15

20

25

% o

f B u r i a l s

10 20 30 40 50 60 70 80

Age at Death

With

Without

Age Distribution of Burials with & Without Cribra OrbitaliaFigure 2

0

5

10

15

20

25

% o

f B u r i a l s

10 20 30 40 50 60 70 80

Age at Death

With

Without

Age Distribution of Burials with & Without Porotic HyperostosisFigure 1



Socio-culturally Mediated Disease:

Rickets and Scurvy

Auth ors : M. Brickley, T. Kozlowski, R.H. Steckel, C.S. Larsen, P.L. Walker, J. Blondiaux, G. Grupe, R. Jankauskas, G. Maat, G. McGlynn, A. Papathanasiou, C. Roberts, M. Teschler-Nicola, U. Wittwer-Backofen, A. Agnew, S. Assis, Z. Bereczki, B. Bertrand, T.K. Betsinger, S. Boulter, C. Bourbou, A. Boylston, L. Bürli, C. Cooper, A. Coppa, J. Coughlan, A. Drozd, E. During, J. Eng, F. Engel, S. Fox, M.

Furtado, G. Gerhards, K. Haebler, K. Harkins, P. Holck, M. Holst, G. Hotz, H. Justus, K. Kaminska, A. Kjellström, C.J. Knüsel, A. Lagia, C. Lopes, S. Manolis, A. Marcsik, C. Marques, C. Moenke, Ioanna





AAPA Symposium



Period

Spatial Relationship of Cases of

Rickets and Scurvy A relationship was found between latitude and

vitamin D deficiency (Fig. 7). Although the generalpattern observed demonstrated cases of rickets

increase markedly above 45° degrees, some sites did

not follow this trend e.g. Xironomi, Greece (26%) and

Çatalhöyük, Turkey (8%), both located at 38°. Here a

range of social and cultural practices that impacted

on vitamin D were present. GIS data show that levels

of rickets are higher in environments where large

urban settlements are likely to be found.

The relationship between scurvy and latitude was

less clear, indicating that a wide range of foods

containing vitamin C were used across the climaticregions investigated (Fig. 8). Although some cases

of scurvy were recorded from rural areas, many of the

sites with higher levels were urban.

Future Directions/Research

Data analysis is on-going, particularly for later

periods. Once complete it will be possible to examine

the temporal relationship between rickets and scurvy,and the link to latitude and urban settlements, as well

as links between these conditions and other stress

indicators.

ConclusionsResults are preliminary, but a broad link between

complex urban communities and deficiency diseases

is suggested.

Figure 8

Figure 7

Introduction : Vitamin C and Scurvy

Humans need to obtain vitamin C from dietary

sources, and regular supplies are required. Vitamin

C is present in a wide range of fruits and vegetables,and smaller amounts are found in milk, meat and fish.

Storage, preparation and cooking practices affect the

vitamin C content.Foods containing

vitamin C are present at

all latitudes, but will be

more plentiful and less

seasonally dependent

at lower latitudes. A

wide range of social

and cultural factors

influence the types of

foods eaten, and theirvitamin content.

Skeletal Changes

Haemorrhagic

manifestations due

to impairedcollagen formation

are the primary

bone change.

Scurvy causes

depressed

osteoblastic activity and a virtual cessation of bone

formation; formation occurs rapidly once vitamin C is

obtained. The full range of changes is discussed by

Brickley and Ives (2008). Examples of skeletal

changes associated with scurvy are shown in Figures

1 and 2.

Vitamin D deficiency is primarily

caused by a prolonged lack of

exposure to sunlight and/or

dietary deficiency of foodstuffs

containing vitamin D. Sunlight

exposure varies between

geographic latitudes (Holick &

Adams, 1998).

Levels of vitamin D deficiency can

provide an important indicator of

socio-economic, cultural,environmental and nutritional

conditions in the past.

Skeletal Changes

Vitamin D is required during the

mineralization of osteoid and,

during deficiency, areas of

unmineralised osteoid will develop

throughout the skeleton.

Examples of changes associated

with rickets are shown in Figures

3 and 4.

Introduction: Vitamin D and Rickets

Figure 1: Lateral view of the skull of a 19th centuryinfant with scurvy. Porous bone is visible on the

greater wing of the sphenoid bone from the Ortner database. Main Image by D. Ortner. The inset showsthe greater wing of the sphenoid bone (left side) withprobable scurvy from Çatalhöyük, Turkey (post

mediaeval period).

Figure 2: Medial view ofthe tibia of a 3-4 year old

child excavated fromWorcestershire, England.Metaphysealporosity

thought to be linked toscurvy is present alongwith a small area of new

bone formation. Thischild must have obtainedsome vitamin C before

death allowing the boneformation to take place.

Image by D. Ortner.

Figure 3: Comparison of thepattern of bending observed in thefemur in an active case of rickets

in a juvenile and residual changeslinked to rickets in an adult. Bothbones show a ‘kink’ at the proximal

end of the anterior shaft. Bothbones from disarticulated bonerecovered during excavation at

post mediaeval site of St. Martin’s.

Co-occurrence of Scurvy and Rickets

Diagnosis of scurvy is complicated by the co-

occurrence of vitamin D deficiency, but 29 individuals

show signs of both conditions (Fig. 6). There was a

significant correlation between cases of rickets and

scurvy being present at a site (r=0.3308, p=0.0112).

Results and Discuss ion

• Lesions suggestive of scurvy were identified in

1.37% of the individuals analyzed.• Lesions suggestive of rickets (active and healed)

were identified in 1.40% of the burials analyzed (see

Fig. 5). For most periods the prevalence of those

rickets is lower for adults than those aged <20 years.

Methods

During recording if any pathological changes linked to

scurvy were present the individual was recorded as

having scurvy. Both rickets (term used whereunfused growth plates present) and residual changes

associated with rickets (see Brickley et al., in press),

were recorded. If either of these changes was

present the individual was coded as having rickets.

For this analysis, individuals aged 20+ were

considered to have ‘healed’ rickets and younger

individuals ‘active’ rickets, providing a good overall

indication of numbers who survived periods of

deficiency.

Figure 4: View of the frontal bone of skull of a post mediaeval infant

from Çatalhöyük, Turkey, with rickets. Deposits of woven bone arepresent along with some areas of abnormal porosity.

Figure 6

Figure 5

Individual vitamin C requirements vary depending on

age, and factors such as pregnancy. Symptoms of

scurvy frequently occur when no vitamin C has been

ingested for 90 days, but once obtained recovery is

rapid; significant improvements have been noted

clinically after 48 hours.

Understanding the Impact of Infectious Disease on



Understanding the Impact of Infectious Disease on

European Populations: Contributions from the

Global History o f Health Project

Auth ors : C. Roberts, T.K. Betsinger, R.H. Steckel, C.S. Larsen, P.L. Walker, J. Blondiaux, G. Grupe, R. Jankauskas, G. Maat, G. McGlynn, A. Papathanasiou, M. Teschler-Nicola, U. Wittwer-Backofen, A. Agnew, S. Assis, Z. Bereczki, B. Bertrand, S. Boulter, C. Bourbou, A. Boylston, M. Brickley, L. Bürli, C. Cooper, A. Coppa, J. Coughlan, A. Drozd, E. During, J. Eng, F. Engel, S. Fox, M. Furtado, G.

Gerhards, K. Haebler, K. Harkins, P. Holck, M. Holst, G. Hotz, H. Justus, K. Kaminska, A. Kjellström, C.J. Knüsel, T. Kozlowski, A. Lagia, C. Lopes, S. Manolis, A. Marcsik, C. Marques, C. Moenke, Ioanna





AAPA Symposium



Period

Background

Today we are seeing emerging and re-emerging

infectious disease plaguing both developing and

developed societies around the world

(http://www.who.int/en/). The emergence of

agriculture, the development of urbanism and the

rise of industrial societies have all impacted the

frequency of infectious disease documented in

historical writing and art and in skeletal remains

from archaeological sites through time.

Bioarchaeology, in particular has documented a

rise in infections with increasing complexity (e.g.,

see Cohen & Crane-Kramer 2007). One could

argue that, of all measures of health in the past,

infectious disease allows us to explore in detail a

whole range of factors within people’s environments

that could have contributed to their quality of life.

Rises in population density, poverty and poor diet,

contact with animals (Fig. 1), particular occupations

(Fig. 2), and the mobility of people have all

contributed to this increase. In Europe, especiallystarting in the Roman period, all these factors could

have contributed to exposure to infections. This

poster documents the frequency of leprosy (L) and

tuberculosis (TB) as seen in the skeletal data from

the Project dating from the prehistoric to modern

periods. Treponemal disease was rarely recorded

(12 of 7732 individuals) and is not discussed here,

although 10 date to pre AD 1500.

Hypothesis

The hypothesis to be

tested was that themycobacterial

diseases increased

through time with

increasing social

complexity.

Figure 1: Human contact with animals through animal husbandry Image from the 'The Book of Hours'

Flemish c. 1500. Fitzwilliam Museum, Cambridge ; Figure 2: Corn reaping

Figure 3: Kyphoticspine due to collapse

of vertebral bodies from TB.

Results: Temporal and Regional

Variation

Data were recorded from 83 sites located in Austria,

France, Germany, Greece, Hungary, Italy, Latvia,

Lithuania, Netherlands, Poland, Portugal, Romania,

Switzerland, Turkey, the UK and Ukraine. Only

eight cemetery sites were unusual contexts

(battlefields, monasteries, a nunnery, and a militaryhospital).

Accepting that around 3-5% of untreated people

with these infections develop bone changes, the

following was observed:

TB: 1.1% of individuals with observable vertebrae

(73 of 6560) had suggestive lesions of TB on at

least one thoracic or lumbar vertebra. Pleural

periostitis was seen in 1.15% of ribs (375 of

32,485). Twenty-eight individuals had both vertebral

and rib changes, but rib changes are not

pathognomonic for TB (Roberts and Buikstra 2003).

Leprosy: 0.79% of individuals with observablenasopharyngeal areas (36 of 4571), 0.21% with

observable foot bones (11 of 5213), and 0.06% with

observable hand bones (3 of 5347) displayed

suggestive leprous changes. Most individuals were

only affected in the nasopharyngeal area, and very

few in the hands or feet, a feature common for

skeletons from non-leprosy hospital cemeteries.

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

2

A n c i e

n t / P r e h i s t o

r i c

C l a s s i c

a l A n

t i q u i t

y

E a r l y

M i d d l e A

g e s

H i g h

M i d d l e A

g e s

L a t e

M i d d

l e

A g e s

M o d

e r n

% o f B u r i a l s W i t h L y t i c V e r t e b r a l L e s i o n s

Figure 4: Nasopharyngeal lesions

associated with leprosy.

Context of Sites

TB: The earliest example was dated to 2500-2400

BP (Iron Age Italy). More individuals in Classical

Antiquity (1.9%) and the Early Middle Ages (1.3%)were affected than in the later periods (Fig. 6) – this

is unusual when the global evidence is considered

(Roberts & Buikstra 2003), but may reflect the

nature of the samples examined. Pleural periostitis

was seen most frequently in the Early Middle Ages

(EMA) (2.2% of ribs observed) – (Fig. 7). Those

with vertebral changes derived from both urban and

rural sites but the EMA is dominated by rural sites

which is expected since that period is dominated by

rural living (e.g., see Hills 1999).

Figure 6

Context of Sites, cont.

Leprosy: Leprosy is first documented in theClassical Antiquity period, increasing into the Early

Middle Ages and then declining until the early

modern period (Fig. 8). Leprosy today is noted to be

a rural disease, consistent with rural living in the

EMA. A decline in leprosy and an increase in TB

from the 14th century AD in Europe has been noted

by many (e.g., see Manchester 1984, but also see

Wilbur et al. 2002 on clinical data), but the GHHP

data here also show a decline in TB. Those with

nasopharyngeal changes derived from both urban

and rural sites but urban sites dominate in the Late

Middle Ages; no individuals derived from leprosyhospital sites.

Conclusions and Future Research

The mycobacterial diseases are present in the data

collected from the 10, 969 skeletons examined.

Some of the data support previous observations on

leprosy and TB in Europe (e.g., a decline in leprosy

into the Late Middle Ages), but others do not (e.g., a

decline in spinal TB in the Middle Ages). Increases

in population density and close contact with animalswith urbanism in the high and Late Middle Ages,

necessary for the transmission of TB, are

suggested to cause a rise in TB, as is the rise of

industrial societies associated with poverty,

unhealthy work practices and increased mobility.

Additional data collected for the GHHP will refine

our understanding of the impact of both infections

on European populations, as will a more nuanced

exploration of the epidemiological factors affecting

frequency.

0

0.2

0.4

0.6

0.8

1

1.2

A n c i e


r i c

C l a s s i c

a l A n

t i q u i t

y

E a r l y

M i d d l e A

g e s

H i g h

M i d d l e A

g e s

L a t e

M i d d

l e

A g e s

M o d

e r n

% o f B u r i a l s W i t h N a s o

‐ P h a r y n g e a l L e s i o n s

Figure 8

0.00

0.50

1.00

1.50

2.00

2.50

A n c i e


r i c

C l a s s i c

a l A n

t i q u i t

y

E a r l y

M i d d l e A

g e s

H i g h

M i d d l e A

g e s

L a t e

M i d d

l e

A g e s

M o d

e r n

% o f A d u l t R i b s w i t h P l e u r a l L e s i o n s

Males

Females

Figure 7

Figure 5: Periostitison visceral surface of ribs.

Materials and Methods

Skeletal evidence for leprosy and tuberculosis from

10,969 skeletons dating from <500 BC to 1950 AD

were recorded using standard diagnostic criteria

(http://global.sbs.ohio-state.edu); these followaccepted methods previously described in the

bioarchaeological literature. Lytic lesions of the

vertebral bodies, especially in the lower thoracic

and lumbar spine (TB), nasopharyngeal lesions,

hand and foot bone destruction and remodeling (L),

and visceral surface rib periostitis (possibly TB)

were observed and recorded (Figs. 3-5).

The majority of skeletons observed for these

conditions (7582 or 69%) dated to the medieval

period (501-1500AD) and, of those, 2638 skeletons

(35%) date to AD1000-1500.



Periosteal Lesions:

A Non-spec if ic Index of the History o f Health in Europe

Auth ors : C. Marques, J. Blondiaux, C.S. Larsen, R.H. Steckel, P.L. Walker, G. Grupe, R. Jankauskas, G. Maat, G. McGlynn, A. Papathanasiou, C. Roberts, M. Teschler-Nicola, U. Wittwer-Backofen, A. Agnew, S. Assis, Z. Bereczki, B. Bertrand, T.K. Betsinger, S. Boulter, C. Bourbou, A. Boylston, M. Brickley, L. Bürli, C. Cooper, A. Coppa, J. Coughlan, A. Drozd, E. During, J. Eng, F. Engel, S. Fox, M.

Furtado, G. Gerhards, K. Haebler, K. Harkins, P. Holck, M. Holst, G. Hotz, H. Justus, K. Kaminska, A. Kjellström, C.J. Knüsel, T. Kozlowski, A. Lagia, C. Lopes, S. Manolis, A. Marcsik, C. Moenke, Ioanna





AAPA Symposium



Period

Methods• A sample of (N = 7896) adult individuals were

surveyed for the presence of periosteal bone

formation on long bones.

• The severity of PL was scored using an ordinalscale (see Table 1).

Background

Proliferative periosteal lesions on long bones are

commonly reported on ancient skeletal remains, from

diverse chronological periods and geographic sites.Many events may stimulate the periosteum, such

as mechanical injury (e.g. trauma, leg ulceration),

metabolic or neoplastic conditions, circulatory

insufficiency or infectious processes (Weston, 2008).

In most cases, the underlying pathological process

causing proliferative periosteal lesions (PL) is not

easily established, but these lesions are most

commonly attributed to the impact of infection or

trauma (Larsen, 2002; Ortner, 2003).

Although these pathological changes are not

pathognomonic for a particular disease, they suggest

a health disruptive process often as an outcome of

environmental constraints. Therefore, this parameter

is of great importance in the assessment of the

health history of Europe and can be used as an

indirect and non-specific health indicator.

The scarcity of large-scale bioarchaeological

analysis of PL often precludes a full understanding of

its role in exploring living conditions of past

populations. Consequently, analysis of the Global

History of Health Project (GHHP) data can be an

important tool for establishing general prevalence as

well as geographical and chronological trends.

Objectives

• Evaluation of the prevalence of periosteal lesions

(PL) in the GHHP European sample, serving as a

non-specific index of temporal-spatial variation in the

health status of European populations.

Results and Discussion, cont.Despite the scarcity of studies addressing this

observed anatomical pattern, different physiologicaland anatomical factors can concomitantly be involved

in tibial PL predominance, such as differences in

circulatory flow, soft tissue mass involvement, and

the location of the bone closer to the skin (Ortner,

2003). The lower leg also suffers more physical

trauma. Significant sex differences were only

observed for the fibula (χ2=4.5411, p=0.03) and more

strongly the tibia (χ2= 16.1158, p<0.0001), with

higher rates in males (Fig. 1).

Differences observed can reflect both a more

effective immune response of women to pathogens,

and differences in activity patterns between sexes.

Periosteal Lesions Temporal Trends

• A marked decrease in PL prevalence was observed

from Classical Antiquity to the Early Middle Ages

(EMA) with a subsequent rise after this period (Fig.

2). These two shifts are statistically significant

(χ2=31.4, p<0.0001 and χ2=19.0, p=0.0001). Lower

frequency is seen for the EMA, with Classical

Antiquity, the High Middle Ages and Late Middle Ages presenting steady frequencies (18.2%, 17.6%,

and 17.3%, respectively).

• Inferences about the marginal values for the

Prehistoric and Modern periods are limited due to

sample constraints.

• The chronological pattern is mainly the result of

variations in the lower limb rates (χ2= 84.5,p<0.0001), specially the tibia. The upper limb

maintains a uniformity of PL values through time

(χ2=4.5, p=0.474) (Fig. 2, Fig. 3).

Conclusions and Future ProspectsOverall, chronological variation in periosteal lesions

in skeletons from the GHHP can be related to

demographic trends and changing social, cultural,

economic and environmental factors. Future

comparisons of these data with other health

indicators from the GHHP, and a more in-depth

scrutiny of the patterns of periosteal lesions, will help

clarify questions raised by this preliminary analysis

and consequently improve our health assessment of

European populations through history.

Figure 4: Possible skeletal lesions ofhypertrophic osteoarthropathy, in both tibiae.From Amiens, France.

Figure 5: Localized bone changes on a tibia,possibly as a result of a leg ulcer. From ISCMB,

Portugal.

Chronological fluctuation in lower limb lesion

frequency raises the questions: 1) why don’t upper

limb lesions frequencies also change, and 2) to what

extent is temporal fluctuation in tibial PL indicative of

major health changes? The answer is notstraightforward and further scrutiny of the data is

necessary.

Moreover, the temporal prevalence of PL may

reflect a close synergistic interaction between

hypertrophic osteoarthropathy (Fig. 4) and specific

disease (e.g. tuberculosis), and also trauma to limbs

or leg ulcers (Fig. 5).

One of the most important outcomes of the PL

analysis is that these skeletal data reflect an

important historical shift, the transition between

Classical Antiquity and the EMA. This period is

generally characterized by demographic, economic

and socio-cultural changes after the collapse of the

Roman Empire, and was also accompanied by

famines and epidemics (e.g. the Justinian plague).

We can hypothesize that the spread of acute

deadly epidemics could reflect a decrease in skeletal

signs of long standing chronic diseases, associated

with other factors such as a steep population decline

and more rural living during the EMA. This contrasts

with the higher population density and urbanization

of Classical Antiquity and the High Middle Ages.

Additionally, changing patterns of warfare, mobility,

provision of labor (extensive slave labor and military

involvement during Classical Antiquity), and changesin economic systems (Scheidel, 2007; Woods, 2007;

Davis & McCormick, 2008)could also have played an

important role.Table 1: Standards for scoring periosteallesions (from the GHHP Codebook).

Results and DiscussionOverall Frequency

• Signs of PL were present in 15.3% of the adult

individuals studied.

• Bones of the lower limb were far more affected by

PL than the bones of the upper limb, with highest

values obtained for the tibia (18.4% in males) and

lowest for the clavicle (0.3% in females) (Fig. 1).

Figure 1: Percent of individuals with periosteallesions on long bonesaccording to sex.

Figure 3: Number of individuals with periosteallesions on

one or more long bones by time period.

Figure 2: Percent of individuals with periosteallesions on the upperand lower limb by chronological period.

Hi t i l P tt f T ti I j d AAPA S i



Historical Patterns of Traumatic Injury and

Violence in Europe

Auth ors : P.L. Walker, R.H. Steckel, C.S. Larsen, J. Blondiaux, G. Grupe, R. Jankauskas, G. Maat, G. McGlynn, A. Papathanasiou, C. Roberts, M. Teschler-Nicola, U. Wittwer-Backofen, A. Agnew, S. Assis,Z. Bereczki, B. Bertrand, T.K. Betsinger, S. Boulter, C. Bourbou, A. Boylston, M. Brickley, L. Bürli, C. Cooper, A. Coppa, J. Coughlan, A. Drozd, E. During, J. Eng, F. Engel, S. Fox, M. Furtado, G. Gerhards,






AAPA Symposium



Period

MethodsThe European database, which is described in the

introductory poster, records trauma for the following

skeletal elements: cranial vault; nasal bones; non-

nasal facial bones; long bones; other post-cranial

bones; and weapon wounds on any bone. As part

of the procedure, the coder also noted whether the

lesion was well-healed, partially healed or occurring

at death, the last coded as positive only if there was

clear and convincing evidence of a perimortem

injury.

Background

Social scientists have long sought to understand

the origins of conflict, violence, and physical injury.

Today various agencies collect relevant information

from police reports, court records, emergency room

admissions, special surveys, and so forth.

Unfortunately written sources are often thin for the

recent historical past and frequently unavailable for

more distant eras. Nevertheless, pressing social

questions remain over humankind’s predilections

for conflict and aggression, which are best studied

across diverse socioeconomic settings. The near

and distant past therefore provide an excellent

laboratory for studying precursors or determinants

of aggression. Physical anthropologists have

learned that skeletal remains provide a valuable

biological record for measuring trauma, for whichdata are available deep into the human past.

Objectives

We seek to measure rates of trauma over time,

across space, and by age and sex, to establish

baseline patterns against which twentieth-century

evidence can be evaluated. We will test the null

hypothesis that no differences existed over time,

across space, or by age and sex. Ultimately we will

draw comparisons with the Western Hemisphere

database, which showed that rates of trauma were

independent or uncorrelated with the frequencies of

other types of pathological lesions.


Broken bones in the wrists and ankles often result

from accidental falls, and occur more frequently in

uneven terrain. Cranial injuries, on the other hand,

are a barometer of deliberate interpersonal

violence.

Figure 2 shows that these injuries were several

times more likely among men compared to women,

a pattern found in the Western Hemisphere and in

modern evidence. Indeed the male-female contrast

is so common that one might doubt the quality of

the skeletal evidence if it was not observed.

As the Middle Ages unfolded the rate of cranial

vault injury among men rose dramatically,

increasing nearly three fold. No such patternexisted among the women, for whom the trend was

flat, and even declined in the late Middle Ages. At

this point we can only speculate as to the causes,

but this was an era in which cities were fortified with

walls, and fortresses were built to house

professional soldiers. A surge in population and

growing scarcity of land may have contributed to

strife.

Figure 3 shows that the rate of cranial injuries

varied systematically by region, with the southwest

most prone and the northwest the least prone to

this type of trauma. Considering the four

quadrants, one can see that the highest rates

occurred along the southwest-northeast corridor

and the lowest rate existed along the northwest-

southeast diagonal. Note that the bulk of the data

come from the Middle Ages. Until we conduct

additional analysis of this interesting pattern we are

withholding speculation on its possible causes.

Age and Sex Var iat ion

Figure 1 gives a frequency distribution of non-

weapon injuries for males and females by age atdeath. Relatively few injuries occurred among

children under age 10 but the curve rose steeply in

the teens and twenties, reaching a peak in the

thirties. The age pattern of injury resembles that

found in the Western Hemisphere data and in

modern epidemiological evidence. The rapid

decline in the forties, also found in the Western

Hemisphere, may reflect selective elimination

(death) of the violent or the accident prone.

Figure 3: Regional Differences in the effective number of male and female burials with cranialvault injuries

Methods, cont .Because trauma frequencies depend upon the

completeness of the skeleton and the age of the

individual, it is important to standardize. We did

this by using data collected on the completeness(percent present or observable) of each major

skeletal element. This information was then

converted into full skeleton equivalents. For

example, if two individuals had cranial vaults that

were 40 and 60 per cent complete, together they

make the equivalent of one complete cranium. The

procedure requires an assumption that portions of

bone are missing at random, or at least that trauma

had no systematic relationship to the portions of

bones observable or unobservable. To obtain

frequencies, the number of traumas (in a category

such as the site, region or time period) was dividedby the number of skeletal equivalents for that

category.

Because skeletal injuries tend to accumulate as

people age (shown below), one may also adjust

(divide) results further by the sum of years lived by

the population or group under study. In the cause

of cranial trauma, for example, the final result is the

number of injuries per effective cranial vault year

lived. This equals the number of injuries (in the

numerator) divided by the effective number of

vaults times the number of years lived (the sum ofages at death). Because the age distribution of

deaths was similar across categories used in the

analysis, however, the age-adjusted results are

similar.

Cranial depression in a medieval skeleton from Winchester,England. Image by D. Ortner.

Figure 2: Cranial Injuries/Effective Vaults by Time Period

Unhealed sword wounds in a cranium from Nieder, Switzerland.Image by D. Ortner.

Figure1: Age distribution of non-weapon injuries by decade of death

History of Degenerative Joint Disease in Europe: AAPA Symposium



History of Degenerative Joint Disease in Europe:

Inferences about Li festyle and Activity

Auth ors : C.S. Larsen, P.L. Walker, R.H. Steckel, P. Sciulli, H.D. Klaus, J. Blondiaux, G. Grupe, R. Jankauskas, G. Maat, G. McGlynn, A. Papathanasiou, C. Roberts, M. Teschler-Nicola, U. Wittwer-Backofen, A. Agnew, S. Assis, Z. Bereczki, B. Bertrand, T.K. Betsinger, S. Boulter, C. Bourbou, A. Boylston, M. Brickley, L. Bürli, C. Cooper, A. Coppa, J. Coughlan, A. Drozd, E. During, J. Eng, F. Engel, S.

Fox, M. Furtado, G. Gerhards, K. Haebler, K. Harkins, P. Holck, M. Holst, G. Hotz, H. Justus, K. Kaminska, A. Kjellström, C.J. Knüsel, T. Kozlowski, A. Lagia, C. Lopes, S. Manolis, A. Marcsik, C. Marques,

C. Moenke, Ioanna Moutafi, C. Niel, S.A. Novak, F. Novotny, J. Peck, I. Potiekhina, B. Rega, R. Richman, F. Rijpma, J. Rose, J. Ruiz, P. Sannen, A. Soficaru, M. Spannagl, R. Storm, M.E. Subirà, D.

Swales, V. Tritsaroli, E. Tyler, S. Ulrich-Bochsler, S. Vatteoni, Nuria Villena-Mota, R. Wiggins, and L.L. Williams



AAPA Symposium



Period

Figure 1

The development of

DJD is more rapid in

males than females, in

general and for all

specific joints (Fig. 4).

The sex differences aresignificant for the

shoulder, elbow, and

hip. For the seventh

decade, females

exceed or are the same

for males for all joints

except the elbow.

Figure 4

Women show greater DJD right-left asymmetry

than men for all joints except the hip. This difference

reaches statistical significance for the elbow (t-test;

p<0.05). This pattern suggests differences in use of

the upper limb, especially involving the elbow and

associated functions (Fig. 3).

Figure 3

Males have significantly more DJD than females

(chi-square; p<0.05; Fig. 2). This pattern suggests a

conflation of level of activity (or behaviors) in later

adulthood of men and women.

Reflecting the use of the upper limb for non-

ambulatory activities using the hands and arms for

lifting, throwing, and other activities, there is

statistically-significant difference between the left

and right sides (right side score – left side score) for

the shoulder, elbow, and wrist/hand, and not for thehip, knee, and ankle/foot (t-test, p<0.05).

Figure 2

Age and Sex Var iat ion

Consistent with progressive age-associated DJD,

there is a clear increase in prevalence with age for

all sites and individuals combined. The age effect is

especially pronounced for proximal joints (shoulder

and hip), intermediate for knee, elbow, and

wrist/hand, and least for the ankle/foot (Fig. 1).

Figure 5

Figure 6

Significant regional differences existed in this

trend. Prior to the High Middle Ages, age-corrected

osteoarthritis is significantly lower in southern

European populations than in northern European

populations. Beginning in the Early Middle Ages,

DJD begins to increase among Europeans living inthe Mediterranean region (Fig 6).

Figure 7


The most profound pattern of variation is documented

in the temporal reduction of DJD, based on the mean

residual of DJD total score from age regression in

order to correct for age (Fig. 5). The finding is

consistent with the hypothesis that, overall,

technology has alleviated articular degeneration

during the Medieval period.

These changes affected men and women

differently with notable Medieval declines in DJD

among Northern European Females and increase

among Mediterranean (Fig. 7).

Methods

• All major upper and lower limb articular joints or

joint groups were assessed: shoulder, elbow, hip,

knee, wrist/hand, ankle/foot for both right and left

sides. All available elements of a joint were

assessed, but only one element had to display

degenerative changes in order to indicate

presence of DJD. Each joint was scored: no

evidence of DJD (score=0); slight marginal lipping

(score=1); severe marginal lipping, commonly with

porosity and/or eburnation on joint surface

(score=2); complete or near complete destruction

of joint surface, often accompanied by ankylosis

(score=4); joint fusion (score=5). Summary joint

scores were calculated: (right side score + leftside score)/2.

• All cervical, thoracic, and lumbar vertebrae were

scored separately, with focus exclusive to the

vertebral body surface and margin: no DJD

(score=0); slight to moderate marginal lipping on

at least one body (score=2); extensive marginal

lipping, with or without intervertebral body surface

degeneration (e.g., Schmorl’s nodes) (score=3).

Background

Anthropologists and other social scientists have long

had an interest in quality of life as it relates to

workload, lifestyle, and activity. An important tool for

addressing this general topic is degenerative joint

disease, articular joint modifications largely owing to

wear-and-tear over the course of life.

In addition to differences by joint, variation in age

and sex is highly informative about the behavioral

and life experiences of a population as it relates to

workload and activity. This project documents and

interprets temporal and other patterns derived from

the Global History of Health Project in order to

characterize the history of activity in a broad sense

for Europe.

Objectives• Draw inferences about activity in relation to key

shifts in settlement, technology, and other

factors that influence lifestyle in the last 10,000

years of human evolution.

• Test the hypothesis that technological

innovation occasioned a decline in workload

and activity.

Medieval men and women reaping and shearing.

From the Très Riches Heures du Duc de BerryDJD of the lumbar vertebrae. Male, 13 th-16th c.

Chichester, England. Image by D. Ortner.

Summary Measurement of Health and Wellbeing: AAPA Symposium



Summary Measurement of Health and Wellbeing:

The Health Index

Auth ors : R.H. Steckel, A. Kjellström, J. Rose, C.S. Larsen, P.L. Walker, J. Blondiaux, G. Grupe, R. Jankauskas, G. Maat, G. McGlynn, A. Papathanasiou, C. Roberts, M. Teschler-Nicola, U. Wittwer-Backofen, A. Agnew, S. Assis, Z. Bereczki, B. Bertrand, T.K. Betsinger, S. Boulter, C. Bourbou, A. Boylston, M. Brickley, L. Bürli, C. Cooper, A. Coppa, J. Coughlan, A. Drozd, E. During, J. Eng, F. Engel, S.

Fox, M. Furtado, G. Gerhards, K. Haebler, K. Harkins, P. Holck, M. Holst, G. Hotz, H. Justus, K. Kaminska, C.J. Knüsel, T. Kozlowski, A. Lagia, C. Lopes, S. Manolis, A. Marcsik, C. Marques, C. Moenke, C.

Niel, S.A. Novak, F. Novotny, J. Peck, I. Potiekhina, B. Rega, R. Richman, F. Rijpma, J. Ruiz, P. Sannen, P. Sciulli, A. Soficaru, M. Spannagl, R. Storm, E. Subirà, D. Swales, V. Tritsaroli, E. Tyler, S. Ulrich-

Bochsler, S. Vatteoni, Nuria Villena-Mota, R. Wiggins, and L.L. Williams



AAPA Symposium



Period

Methods

Ideally we would have information on both mortality

and morbidity. Unfortunately mortality rates are

difficult to estimate from skeletal remains because

some individuals, especially children, may have

been missed in excavation. Moreover, the age

distribution of deaths is influenced by fertility and by

migration. Therefore it is difficult to determine the

population at risk, which is required to calculate

mortality rates.

Skeletal remains do provide useful measures ofmorbidity. Pathological lesions such as linear

enamel hypoplasias reflect physiological stress

associated with malnutrition and/or illness.

Our procedure is based on the health index,

which is explained in chapter 2 of The Backbone of

History. The index includes 7 dimensions: LEH;

femur length; cribra orbitalia and porotic

hyperostosis; periosteal reactions; trauma;

degenerative joint disease; and dental health. In

the European project we added an 8th dimension

consisting of 5 specific conditions: TB, leprosy;

scurvy; treponemal infections; and rickets.

Importantly, the health index adjusts orcompensates for the age distribution of deaths by

converting morbidity to age-specific rates, which in

turn are weighted by the relative number of person

years lived in a reference population. This

procedure removes differences in mortality from the

index, which is a regrettable limitation made

necessary by lack of data. Then the results are

scaled for each component from 0 (worst) to 100

(no deficiency), and averaged together to form the

overall index.

Background

Health is an important aspect of a society’s well-

being and standard of living. All scholars who

study demography realize there are numerous

measures of health, which fall into two main

categories: mortality and morbidity. The first can

be expressed by age-specific death rates, which in

turn can be summarized by life expectancy at birth

(or at other ages such as age 10 or 20). Morbidity

refers to illness or disability that limits functional

capacity. It can take many forms such as acute

infections, degenerative joint disease, broken

bones that limit mobility, and so forth.

Objectives

Our goals are to measure and analyze health ascan be learned from skeletal remains. Specifically

we wish to know how societies of the past

compared with each other and with populations

today. Thus we require a broad measure that

incorporates conditions in childhood as well as

degenerative processes associated with aging. In

combination with contextual information on sites

where people lived we can analyze or try to explain

why some populations were healthier than others,

and thus uncover influences on health in today’s

world.

Temporal Variation

From Figure 1, one can see that average health as

depicted by the health index declined over time

from the ancient prehistoric to the modern periods,

although one should note that only two sites are

available for ancient/prehistoric period. Stature and

LEH (not shown) showed the strongest downward

association with time, whereas infections actually

moved in the opposite direction over time. Trauma

and dental disease had weak associations with

time. DJD followed an M-shape as the centuries

unfolded. Hence it is important to use multiple

indicators to arrive at a general characterization of

health.

Latitude

The charts arranged by quadrant and by latitude

reveal strong effects on overall health. Stature

showed a strong association with latitude, which is

indicated here but in a nonlinear form (Fig. 2). The

healthiest individuals on average lived at the

northern and southern parts of Europe. At thispoint it is difficult to tell what forces might have

created this pattern, but it will be under

investigation in the future.

ElevationOne can see from the scatter diagram (Fig. 3) that

the health index varied a great deal at given levels

of elevation. That said, a clear pattern also

emerged, whereby the health index varied little

within the range of 0 to 250 meters and then rose

steadily to approximately 1000 meters. Note that

the Western Hemisphere project generally found

the opposite pattern, in that the healthiest sites

were found along the coast and a low elevations.

The possible sources of this pattern are under

investigation.

Concluding Remarks

Our measure of health assembled from skeletal

remains compresses information on 7 variables into

a single number. It adjusts for the age distribution

of deaths and imposes the same age pattern of

mortality on all sites. It has the virtue of

incorporating child as well as old age indicators of

health.

Strong geographic patterns of health were found

across Europe, notably by elevation. In addition,

health deteriorated over time from the classical tothe modern periods.

We have only just begun to explore the possible

pathways by which geography and time imposed

their effects on health as seen through skeletal

remains. We have found, however, patterns that

differ considerably from those observed in the

Western Hemisphere.

It is plausible that health in Europe was affected

by a complex process. In any event, we look

forward to this exciting journey of discovery.

Figure 1: Health Index by Time Period: 1= ancient/prehistory; 2= classical; 3= early

Middle Ages; 4 = high Middle Ages’5 = late Middle Ages; 6 = modern

Figure 2: Health Index by Latitude

Figure 3: Health Index by Elevation (meters)

The European Project Health Index includes both DJD and, unlike the Western Hemisphere Health Index,diseases like leprosy and TB. Left: DJD of the elbow in male from Chicester, England; Image by D.

Ortner. Right: The Medieval Leper and his Bell, from 14th C. Manuscript. Image by P. Richards.

aapa symposium 2009

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