High infant mortality versus low number of diseases in paleopathological literature:
the cases from S. Bartolomeu necropolis (Aljustrel, Portugal)
Liliana Serrano1 ([email protected]), Ana Luísa Santos1,2
1Department of Life Sciences 2Centro de Investigação em Antropologia e Saúde (CIAS), Universidade de Coimbra
INTRODUCTION
MATERIAL AND METHODS
In 1981/2, an archaeological emergency excavation was developed at the S. Bartolomeu
necropolis, related to the pyrite mining site of Aljustrel (Beja, Portugal).
A set of 23 fetuses/newborns individuals among a MNI (minimum number of individuals)
of 35 non-adult (23/35=65.7%).
The remains identified covered a chronological spectrum, from the Middle Ages to Modernity.
The estimation of age of death was based on the maximum length of long bone
diaphyses1.
This area is also known as Vipasca, the Roman designation of this cooper extraction center. The
majority of the human remains studied are from non-adult individuals, which are relevant to the
aims of the study:
All osteological remains were subjected to morphological and morphometric analysis and
differential diagnosis.
• To question the living conditions, particularly of infants and women during pregnancy;
´´
• To discuss the difficulty of paleopathology to interpret infant mortality based on bone lesions.
RESULTS AND DISCUSSION
New bone formation and porosity:
- Skeleton well preserved from a fetus/newborn - on both pars lateralis, pars petrosa, pars
basilaris, right clavicle, right ischium (left bones are absent) and in some long bones (see red
circles in the skeletal sketch).
- Commingled bones belonging to a MNI of 7 individuals aged less than 1 y. o. (8/23=35%).
No bone lesions were identified on the remaining individuals (15/23=65%).
Pars basilaris
Greater wing of the sphenoid
Long bone diaphyses
Ilium
Rickets is, likewise, suggested by severe mechanic deformities that occur during growth,
particularly between the 6 and 24 months of age, rare in children with less than 4 months. This
condition is caused by the transference of vitamin D from the mother to the fetus/newborn during
the gestational period, through the placenta4, which is accumulated in the nursling’s liver and, after
birth, by breastfeeding11. Vitamin D deficiencies during pregnancy may have long-term
consequences in the bone health of the offspring, especially in adulthood12.
The differential diagnosis includes conditions
such as anaemia, rickets, trauma or
infections2 and the coexistence of them is
possible too.
The distribution pattern and characteristics
of the bone lesions suggests a metabolic
etiology.
Anaemia is generally associated with cribra orbitalia and porotic hyperostosis13. These lesions are
not pathognomonic of iron deficiency and could indicate other conditions such as hypovitaminosis
B 14. Up until the 3-4 months of age, the newborns have sufficient iron reserves to meet their
needs15. Amongst the consequences of a malnourished mother is the high risk of abortion,
premature birth, birth complications raised by the physical and mental weakening of the mother,
pre-natal mortality and morbidity, low birth weight, deficient immunity of the infant and higher risk
of infections, caused by an inferior volume of breast milk16.
In the individual found in articulation the
lesions are bilateral and among the
commingled bones are greater wings of
sphenoid affected, a pathognomonic
indicator of scurvy2-4.
Avitaminosis is in the core of the most
common childhood diseases in Europe up
until the 18th century3, generally related
with an unvaried diet, unbalanced in
proteins. The mining environment should
also be considered as a potential factor to
unhealthy living conditions5. The pathologic
lesions visible in so young individuals also
reflect the nutritional deficiencies of the
mothers6-7.
Pregnant
women
with
hypovitaminosis C are not known for giving
birth to children with scurvy8. In addition,
breast milk contains high levels of ascorbic
acid8. Although this pathology is commonly
associated with non-adults9, especially
younger infants10, vitamin C deficiency rarely
occurs in infants younger than 4 months4.
Mandible
Malnutrition results in an increased risk of illness and death among
pregnant women and newborns17. Although it compromises the
development of the fetus, it rarely is the direct cause of death,
contributing, nevertheless, to neonatal mortality by increasing the risk of
asphyxia at birth and infections (sepsis, pneumonia and diarrhea)18.
These causes of death are present in World Health Organization data19,
along with congenital abnormalities.
The pathologies caused by hypovitaminosis are the most common
between 1 and 4 years of age, whereas infections and parasitosis are
responsible for the majority of deaths in infants under 1 year20.
Distribution of scurvy in the non-adults. Black
indicates most commonly affected areas; hatched
lines
indicate
areas
of
less
frequent
involvement11:128. Red circles indicates bones with
lesions in the articulated skeleton from Aljustrel.
The data provided by the scientific literature are insufficient to establish a
clear connection between the possible causes of death in foetuses
/newborns and the lesions identified in the bones. As has been noted20-21
in bioarchaeological studies, the causes of morbidity and mortality in
children have been neglected.
FINAL COMMENTS
The presence of infants skeletons is archaeological/historical samples is common due to the high mortality found in this age group. However, many skeletons do not show macroscopic lesions
to allow a paleopathological diagnosis. In opposition, in this study 35 % of the individuals presents new bone formation in some of their bones.
The characteristic and pattern of the lesions were considered in the differential diagnosis of conditions such as rickets, scurvy, anemia or infections suggesting a metabolic etiology, most
probably scurvy. Both paleopathological and clinical literatures highlight the rarity of such conditions during breastfeeding, even in severely malnourished mothers. Even so, a weak health
status associated with poor hygiene and nutrition indirectly influenced the risk of stillbirth.
Commingled bones are particularly challenging for paleopathological diagnosis and to age at death estimation. The growth pattern in the past may have been different from modern
populations from which methods were developed and thus there is a risk of misestimation, namely of age underestimation.
Moreover, paleopathology faces huge difficulties to interpret infants mortality based in a few number of diseases known to leave bone lesions, particularly during the first months of life.
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