Compounding vulnerabilities: Syndemics and the social determinants of disease in the past

Objective: This article explores the theory and utility of a syndemic approach for the study of disease in the past. Syndemic principles are examined alongside other theoretical developments within bioarchaeology. Two case studies are provided to illustrate the efficacy of this approach: Tuberculosis and vitamin D deficiency in 18th and 19th century England, and malaria and helminth infections in Early Medieval England. Materials: Public health studies of present syndemics, in addition to published bioarchaeological, clinical and social information relating to the chosen case studies. Methods: The data from these two historical examples are revisited within a syndemic framework to draw deeper conclusions about disease clustering and heterogeneity in the past. Results: A syndemic framework can be applied to past contexts using clinical studies of diseases in a modern context and relevant paleopathological, archaeological, and historical data. Conclusions: This approach provides a means for providing a deeper, contextualised understanding ancient diseases, and integrates well with extant theoretical tools in bioarchaeology Significance: Syndemics provides scholars a deep-time perspective on diseases that still impact modern populations. Limitations: Many of the variables essential for a truly syndemic approach cannot be obtained from current archaeological, bioarchaeological, or historical methods. Suggestions for further research: More detailed and in-depth analysis of specific disease clusters within the past and the present, which draws on a comprehensive analysis of the social determinants of health

The Children of the Reformation: Childhood Palaeoepidemiology in Britain, ad 1000–1700

CHILDHOOD IS A TIME of rapid biological growth and development, and a stage of the life course during which bodies are particularly sensitive to social and environmental stressors. As a consequence, events which may impact upon a child’s care and treatment can become physically embodied within their bones and teeth. The skeletal remains of children have been neglected within archaeological discourse until recently, but they are, in fact, a particularly important demographic for understanding the impact of social processes on past population health. This research examines the prevalence of skeletal disease in children (≤16 years) in Britain (England, Wales and Scotland) between ad 1000 and 1700. Data for a total of 4,626 children from 95 sites were collated from published and unpublished skeletal reports and analysed for evidence of skeletal changes reflecting disease. A biocultural approach was adopted in which the evidence was interpreted in relation to ecological, social, economic and environmental conditions. It was observed that childhood levels of skeletal stress did increase significantly after 1540. It was noted that during the Reformation sociocultural and economic factors added to stressors in the ecology of the medieval child. The effects of the Reformation were found to be the greatest aggravator in the rise of morbidity prevalence over seven centuries. Differences in morbidity patterns between non-adult age categories indicated that a state of ‘childhood’ existed until at least eleven years of age, after which there appears to have been a gradual transition into adolescence and adulthood

Alloparenting Adolescents: Evaluating the Social and Biological Impacts of Leprosy on Young People in Saxo-Norman England (9th to 12th Centuries AD) through Cross-Disciplinary Models of Care

The majority of historical sources describe past attitudes towards people with leprosy as negative, focussing on ostracism and damnation, and this is thought to have impacted on the care that sufferers received. More recent historical and archaeological evidence challenges this longstanding perspective, portraying a very different view of care for those with this potentially debilitating and disfiguring disease (Roberts 2002; Rawcliffe 2006; Roberts 2013; Roberts 2018). This paper aims to explore the social and biological impacts of adolescents with leprosy in SaxoNorman England (9th – 12th centuries AD). The intersection of youth, chronic infection, aspects of care (inclusive of medical, surgical, and daily support), and cultural identity has only been tangentially explored in the past (e.g see Redfern and Gowland 2011; Roberts and Bernard 2015; Lewis 2017). Studies that integrate these entwined themes can, however, provide a more holistic view of societal responses to wider encultured disease identities. This study utilises multiple lines of evidence for medical care and social treatment to evaluate the validity of dominant historical narratives about leprosy, i.e. that people in the past with leprosy were not cared for or treated well. In order to achieve this, the notion of past requirements of care and treatment through an alloparental model will be introduced. This is followed by a review of the existing historiographical evidence for medical care for young people in the medieval period to better understand systems of care provision and parental reactions to their sick children at this time. Discussions of leprosy in young people in the present and past will help contribute to longitudinal views of the biological impacts of leprosy and help the necessity for care in relation to certain pathological responses (i.e. the manifestation of lepromatous leprosy). To apply this framework to the past, palaeopathological and archaeological evidence from adolescent individuals excavated from the North Cemetery of St. Mary Magdalen leprosy hospital will be analysed. The presence of both leprosy and alloparental care for adolescents in the Saxo-Norman transition at this hospital is demonstrated. Finally, the construction of a theoretical model of required clinical care and provisions, such as the Index of Care framework, helps interpret the evidence for care in alloparental institutions such as leprosaria. The treatment of people with leprosy in the medieval period is often cited as a justification for the continuing stigma and community expulsion of family members with leprosy in some parts of the world (World Health Organization 2015). Therefore, it is worth examining the social milieu of this disease in which young people with leprosy in the past lived, and the models of care and treatment that may be interpreted from these data in order to dispel this longstanding stigma

Sex determination of human remains from peptides in tooth enamel

The assignment of biological sex to archaeological human skeletons is a fundamental requirement for the reconstruction of the human past. It is conventionally and routinely performed on adults using metric analysis and morphological traits arising from postpubertal sexual dimorphism. A maximum accuracy of ∼95% is possible if both the cranium and os coxae are present and intact, but this is seldom achievable for all skeletons. Furthermore, for infants and juveniles, there are no reliable morphological methods for sex determination without resorting to DNA analysis, which requires good DNA survival and is time-consuming. Consequently, sex determination of juvenile remains is rarely undertaken, and a dependable and expedient method that can correctly assign biological sex to human remains of any age is highly desirable. Here we present a method for sex determination of human remains by means of a minimally destructive surface acid etching of tooth enamel and subsequent identification of sex chromosome-linked isoforms of amelogenin, an enamel-forming protein, by nanoflow liquid chromatography mass spectrometry. Tooth enamel is the hardest tissue in the human body and survives burial exceptionally well, even when the rest of the skeleton or DNA in the organic fraction has decayed. Our method can reliably determine the biological sex of humans of any age using a body tissue that is difficult to cross-contaminate and is most likely to survive. The application of this method will make sex determination of adults and, for the first time, juveniles a reliable and routine activity in future bioarcheological and medico-legal science contexts

Broken childhoods: rural and urban non-adult health during the industrial revolution in Northern England

During the eighteenth and nineteenth centuries England underwent a period of rapid urbanization and industrialization. The detrimental effects of urban living conditions and child factory labor on the health of children during this time has been the subject of considerable debate and investigation by historians. It is generally understood that growing up in a rural environment was more conducive to healthy growth and development than within an industrial town. This study presents the first direct comparison of the bioarchaeological evidence for non-adult health from contemporaneous urban and rural sites from the north of England. Rural skeletal assemblages from this period are rare and most published studies are biased towards urban sites in the south of the country. Contrary to expectations, results revealed equal prevalence rates of metabolic and dental disease at both sites, but skeletons from the rural site had greater evidence of growth disruption and respiratory disease. Evidence for specific infectious disease and medical care in response to trauma were also identified. Our interpretations of rural/urban health during this period must take into account the dire consequences of social inequalities and economic migration. There is a tendency for the latter to be characterized as uni-directional ‒ from country to town ‒ without due consideration of rural industry and child migrant workers

Towards a best practice for the use of active non-contact surface scanning to record human skeletal remains from archaeological contexts

Active surface scanners emit light or a laser stripe to record the exterior surface of an object or landscape, providing results in three dimensions. The use of active surface scanners to record anthropological and archaeological contexts has increased within the last few years, creating a number of sub-contexts within these disciplines, and allowing a further development of certain applications, such as quantitative analysis, the use of replicas in education and museums, and the creation of digital databases archived in institutions. However with guidance, this paper aims to assess the advantages and disadvantages of active surface scanning and the potential for research with regards to the recording and analysis of human skeletal remains. The key advantages and uses identified include: quantitative digitisation, geometric morphometric studies, conservation, preservation, documentation, and reconstruction. However, surface scanning also has some limitations, including: cost, technological expertise, the need for a power source, computing requirements, and data size. Overall, the application of active surface scanning technology to archaeological skeletal remains will provide a vital digital archive that will serve to preserve the integrity of this fragile and finite resource for future generations. This is particularly important within the current developer-funded environment in which many skeletal collections, including those yielding unique or unusual pathological or morphological features, are re-buried, with only very limited time for analysis

Creating communities of care: Sex estimation and mobility histories of adolescents buried in the cemetery of St. Mary Magdalen leprosarium (Winchester, England)

Objectives This study examines the biological sex and geographical origins of adolescents buried at the St Mary Magdalen leprosarium (Winchester, UK). The data are combined with archaeological and palaeopathological evidence to broaden the understanding of mobility and its relationship to leprosy and leprosaria in Medieval England. Materials and Methods Nineteen individuals (~10–25 at death) with skeletal lesions diagnostic of leprosy were analyzed using standard osteological methods. Amelogenin peptides were extracted from five individuals whose biological sex could not be assessed from macroscopic methods. Enamel samples were analyzed to produce 87Sr/86Sr and δ18O values to explore mobility histories. Results Amelogenin peptides revealed three males and two females. Tooth enamel samples provided an 87Sr/86Sr ratio range from 0.7084 to 0.7103 (mean 0.7090, ±0.0012, 2σ). δ18OP values show a wide range of 15.6‰–19.3‰ (mean 17.8 ± 1.6‰ 2σ), with corresponding δ18ODW values ranging from −9.7‰ to −4.1‰ (mean −6.3 ± 2.4‰ 2σ). Discussion Amelogenin peptide data reveal the presence of adolescent females with bone changes of leprosy, making them the youngest confirmed females with leprosy in the archaeological record. Results also show at least 12 adolescents were local, and seven were from further afield, including outside Britain. Since St. Mary Magdalen was a leprosarium, it is possible that these people traveled there specifically for care. Archaeological and palaeopathological data support the notion that care was provided at this facility and that leprosy stigma, as we understand it today, may not have existed in this time and place

At the world's edge: Reconstructing diet and geographic origins in medieval Iceland using isotope and trace element analyses

Objectives A multi‐isotope study was conducted on individuals buried at Skriðuklaustur monastery (AD 1493–1554) to investigate their geographic origins and dietary composition. Comparative material from individuals excavated from Skeljastaðir, an inland farm site was also analyzed. Materials and methods Bone collagen was extracted from 50 humans (Skriðuklaustur and Skeljastaðir) and 25 animals (Skriðuklaustur) and analyzed for δ13C, δ15N, and δ34S. Dental enamel samples from 31 individuals (Skriðuklaustur) were also analyzed for 87Sr/86Sr, δ18O, δ13C, and trace elements (Pb, Sr, Zn, Ba). Results The mean value determined from individuals from Skriðuklaustur (n = 36) was δ13C = −18.7 ± 0.8‰, δ15N = 12.8 ± 1.1‰, and δ34S = 9.0 ± 1.6‰, whereas at Skeljastaðir (n = 14), it was δ13C = −20.5 ± 0.8‰, δ15N = 7.8 ± 0.9‰, and δ34S = 9.4 ± 1.6‰. At Skriðuklaustur, human dental enamel samples (n = 31) provided a 87Sr/86Sr range of 0.7060–0.7088, δ18Ophosphate from 13.9 to 16.1‰ and δ13Ccarbonate from −16.6 to −12.9‰. Inferred drinking water (δ18Odw) values range from −12.3 to −8.9‰. Sr concentrations range from 25.8 to 156.7 ppm, Ba from 0.11 to 0.81 ppm, Zn from 43.8 to 145.8 ppm, and Pb from 0.13 to 9.40 ppm. Discussion A combination of results indicates that the people from Skriðuklaustur were born in Iceland, but some lived inland during childhood while others lived closer to the coast. Since Skriðuklaustur was a hospital, these individuals may have sought medical treatment at the monastery. The δ13C and δ15N values determined from bone collagen indicate that the people residing at Skriðuklaustur consumed a diet high in marine protein, while those residing at Skeljastaðir exhibit values more consistent with terrestrial resources.This research was financed by Fornminjasjóður (the Archaeology Fund), Háskólasjóður Eimskipafélags Íslands (the Eimskip University Fund), and the Stable Isotope Biogeochemistry Laboratory (SIBL).Peer Reviewe

The genetic architecture of the human cerebral cortex

The cerebral cortex underlies our complex cognitive capabilities, yet little is known about the specific genetic loci that influence human cortical structure. To identify genetic variants that affect cortical structure, we conducted a genome-wide association meta-analysis of brain magnetic resonance imaging data from 51,665 individuals. We analyzed the surface area and average thickness of the whole cortex and 34 regions with known functional specializations. We identified 199 significant loci and found significant enrichment for loci influencing total surface area within regulatory elements that are active during prenatal cortical development, supporting the radial unit hypothesis. Loci that affect regional surface area cluster near genes in Wnt signaling pathways, which influence progenitor expansion and areal identity. Variation in cortical structure is genetically correlated with cognitive function, Parkinson's disease, insomnia, depression, neuroticism, and attention deficit hyperactivity disorder