aapa symposium 2009
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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
7/25/2019 AAPA Symposium 2009
http://slidepdf.com/reader/full/aapa-symposium-2009 2/14
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
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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
Reconstructing Health and Disease in Europe:
The Early Middle Ages through the Industrial
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,
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, 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 W illiams for her assistance in the development of this
research, and Ohio State University for continued institutional and facilities support.
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.
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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
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
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
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).
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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,
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, 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 W illiams 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
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.
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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
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
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
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
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The History of European Oral Health:
Evidence from Dental Caries, Dental Abscesses,
Antemortem Tooth Loss
AAPA Symposium
Reconstructing Health and Disease in Europe:
The Early Middle Ages through the Industrial
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,
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, 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, V. Villar, 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 W illiams for her assistance in the development of this
research, and Ohio State University for continued institutional and facilities support.
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
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AAPA Symposium
Reconstructing Health and Disease in Europe:
The Early Middle Ages through the Industrial
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,
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, 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, 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
research, and Ohio State University for continued institutional and facilities support.
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
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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
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
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
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
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
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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
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
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
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
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
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 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
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 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.
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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
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
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
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
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
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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,
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, 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 W illiams 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
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.
Temporal and Regional Variation
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
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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
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
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
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
Temporal and Regional Variation
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
7/25/2019 AAPA Symposium 2009
http://slidepdf.com/reader/full/aapa-symposium-2009 14/14
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
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
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
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.
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