Skeletal manifestations of infantile scurvy in a late medieval anthropological series from Hungary

Abstract

This study provides a review of the skeletal manifestations of infantile scurvy and presents four cases observed in the Bácsalmás-Óalmás series (247 subadults and 234 adults; 126 males, 113 females, 242 unknown sex) dating from the 16-17th centuries AD. In the case of these four infants (aged 6 months-3 years) bilateral porous bone lesions were found on the external surface of the cranial bones. In three cases, these features were associated with porous new bone formations and/or abnormal blood vessel impressions in the internal surface of the skull. Moreover, porotic alterations of the long bones occurred in all cases and were mostly symmetrically developed. In order to confirm the origin of the observed features, the lesions were investigated using microscopic techniques. Analyses of the cross sections provided similar results in each case: newly built bone formations were visible on the external bone surfaces. These new bone layers are only found externally to the original bone surfaces. Thus, the original bone substance was not affected. On the basis of the characteristics of the observed lesions and their topographic distribution in the skeleton, and, additionally, by the use of microscopic analyses, we can state that the most likely diagnosis is scurvy. Furthermore, the co-occurrence of anaemia was also confirmed in one case. Up to now, there has been no archaeological evidence of scurvy in Central Europe in this time period, although on the basis of historical sources, the occurrence of this disease was expected. Additionally, besides these four cases, there are numerous other possible cases of infantile scurvy in this population, which suggests that the diet of the examined individuals was probably poor in vegetables and fruits.

Did Children in Medieval and Post‐medieval Poland Suffer from Scurvy? Examination of the Skeletal Evidence

“…However, the idea that genetic factors contributed to scurvy development in the examined samples is rather unlikely, because of their European Slavic origin. Because the most common cause of scurvy is insufficient dietary intake of vitamin C, most cases of scorbutic lesions in archaeological samples are attributed to an inadequate diet (Lovász et al ., ; Halcrow et al ., ), with a possible strong influence of religious and child‐rearing practices (Lewis, ). Although scurvy has historically occurred under diet‐restriction circumstances, such as long sea voyages (Aufderheide & Rodríguez‐Martín, ; WHO, ; Maat, ; Brown & Ortner, ), it seems that vitamin C deficiency occurred quite frequently in the past (Ortner et al ., ; Brickley & Ives, ) and remains common today (Maat, ; Fain, ).…”

Knee Ankyloses Associated with Tuberculosis from the Medieval Hungary - Differential Diagnosis Based on Medical Imaging Techniques

“…Posterior tibial subluxation or dislocation, and the other pathological changes documented in this skeleton (endocranial and orbital changes) may also appear associated with TB (Spiegel et al ., ; Hershkovitz et al ., ; Lovász et al ., ).…”

Growth and health status of children and adolescents in medieval Central Europe

“…It appears that the vitamin C status in the Polish territories was generally inadequate and improved only with the widespread consumption of potatoes starting in the 19th century (Leszczyński 2012 Table 2). Because the most common cause of scurvy is insufficient dietary intake of vitamin C, most cases of scorbutic lesions in archaeological samples are attributed to an inadequate diet (Lovász et al 2013;Halcrow et al 2014), with a possible strong influence of religious and child-rearing practices (Lewis 2010). Melikian and Waldron (2003) claim that scurvy was likely to have shown considerable seasonal variation in the past, being most prevalent in the seasons with least available fresh fruit and vegetables.…”