Sub-Adult Non-Specific Indicators of Stress: Introduction and Some Resources

The study of health in non-adults is critical to understanding the health of the entire community. There are a variety of skeletal lesions that can be used in order to do this, but for purposes of this post we will be looking specifically at non-specific stress indicators. Non-specific stress indicators can be used for diagnosing a wide range of diseases and deficiencies, but are used overall to show the stress that placed on the individual. Lewis (2000:39) proposes that “the health and survival of the offspring indicate the level to which a population has adapted to the environment in which it lives”. There are numerous studies that use sub-adult data to extrapolate total population health. In order to understand overall health in the medieval England, Ribot and Roberts (1996) look at a combination of childhood growth and indicators of non-specific stress. They argue that children represent the most sensitive indicator in judging a population’s ability to adapt to stress. Oxenham et al. (2008:204) conduct a similar study in a population from Late Neolithic Vietnam, arguing that the poor health of the sub-adults can be attributed to the stressful shift of the entire community to agriculture. Children are a reflection on adult health as well, since the insults suffered in childhood can potentially leave lasting manifestations on the individual as an adult. In their study of dental indicators of stress, Palubeckaite et al. (2002) found that age at death in adults was closely related to the stress they suffered as children. Kamp (2001:10) discusses the hypothesis that “adults who have been severely stressed as children may have lower fertility, capacity for work, or adult health”. Perry (2006) proposes that the study of childhood health can reveal important social information about the community including health, quality of life, and the experience of different stages such as birth, weaning, or puberty.

In order for the study of pathology in sub-adults to be useful and valid, a detailed analysis of all the data must be taken. Studying sub-adult health can be difficult, due to confusion between growth and pathology, and the multifactorial nature of many pathological manifestations (Lewis and Roberts 1997:584).The solution offered by Lewis and Roberts (1997) is that archaeologists must be explicit in their criteria for diagnosis and offer alternative etiological explanations.  Lewis (2007:104) in regards to non-specific indicators of stress argues that it is “essential to understand their aetiology and manifestation of these lesions before assumptions about health and nutrition in the past can be made”.

There are a number of indicators of stress which are used by bioarchaeologists to create more robust interpretations of past health. Below is a quick review of a few of these, including linear enamel hypoplasia, cribra orbitalia, vault porosities, and non-specific bone build-up.

Linear enamel hypoplasia manifests as furrows of decreased enamel on teeth due to interruption during development. They are attributed to times of high metabolic stress, such as periods of malnutrition, but can also be due to trauma or chronic illness (Roberts and Manchester 2005:75). Enamel hypoplasia is extremely useful in discerning risk to disease, and therefore it is important to calculate the ages that hypoplasias have manifested. Palubeckaite et al. 2002 found that the age and frequency of hypoplasia formation varied among populations, revealing different periods and types of high stress that reflect differences in the communities.

Cribra orbitalia is seen as being a symptom of numerous diseases, rather than a condition itself, and the specific manifestation of it is important to note (Lewis 2007). Since cribra orbitalia is often a symptom of vitamin deficiencies, parasitic infection or infectious disease, it is necessary to examine the specific manifestation of this pathology. Obertova and Thurzo (2008) argue that cribra orbitalia is a non-specific indicator of stress caused by inadequate sanitation and high pathogen load.

Vault porosities are a primarily a sign of vitamin deficiencies like rickets, anemia and scurvy.  While each of these vitamin deficiencies does produce different types of vault lesions it can be difficult to separate them based on cranial traits alone without microscopic analysis (Larsen 1997:33). Brickley and Ives (2008:57, 103) describe rickets cranial lesions as being speculated irregular plaque formation, and scurvy as abnormal external porosity. Anemia is identified by the expansion of the diploe and penetrating porosity by Schultz et al. 2007. They propose that it can be caused by diet or possibly parasitic infection. All of these point to malnutrition, and poor health. However, diagnosis of each requires acknowledgement of all skeletal elements, as these three can easily be confused and often occur at the same time (Ortner 2003).

Like orbital and vault porosity, periostitis and osteomyelitis are caused by general infection, have varying aetiologies, and can result in both bone formation and destruction. These can be difficult to discern due to growing bone often having a similar appearance, but are critical in looking at overall health. It can be caused by trauma, abuse, malnutrition, or a number of diseases such as syphilis. Osteomyelitus is most common when sub-adults suffer from complex fractures that are infected or heal incorrectly.

Sub-adults are critical towards creating a full demographic profile of a population, and can be key to understanding adult health. However, careful attention must be paid to the pattern of pathologies in order to determine what they were afflicted by. This is important to all studies of pathology, but in sub-adults it is even more important due to the common confusion of growth and pathology.

Selection of Resources on Sub-Adult Bioarchaeology and Paleopathology

Brickely and Ives 2008. The Bioarchaeology of Metabolic Disease. Oxford: Academic Press.

Chapeskie, A.  2006. Sub-Adults in the Bioarchaeological Record. In Nexus 19:32-51.

Goodman, Alan H. and George J. Armelagos 1989. Infant and Childhood Morbidity and Mortality Risks in Archaeological Populations. In World Archaeology 21(2):225-243.

Kamp, K. 2001 Where Have All the Children Gone?: The Archaeology of Childhood. In Journal of Archaeological Method and Theory 8(1):1-34.

Larsen, C. 1997. Bioarchaeology: interpreting behavior from the human skeleton. Cambridge: Cambridge University Press.

2002 Bioarchaeology: The Lives and Lifestyles of Past People. In Journal of Archaeological Research 10(2): 119-166.

Lewis, M. 2000 Non-Adult Paleopathology: Current Status and Future Potential. In Human Osteology: In Archaeology and Forensic Science. M. Cox and S. Mays, eds. London: Greenwich Medical Media Ltd. Pp. 39-58.

2004 Endocranial Lesions in Non-Adult Skeletons: Understanding their Aetiology. In International Journal of Osetoarchaeology 14:82-97.

2007 The Bioarchaeology of Children. Cambridge: Cambridge University Press.

Lewis, M. and C. Roberts 1997. Growing Pain: the Interpretation of Stress Indicators. In International Journal of Osteoarchaeology 7:581-586.

Mays, S., M. Brickley and R. Ives 2009. Growth and Vitamin D Deficiency in a Population from 19th century Birmingham, England. In International Journal of Osteoarchaeology 19:406-415.

Obertova, Z, and M. Thurzo 2008. Relationship between Cribra Orbitalia and Enamel Hypoplasia in the Early Medieval Slavic Population at Borovce, Slovakia. In International Journal of Osteoarchaeology 18:280-292.

Ortner, Donald J. 2003. Identification of Pathological Conditions in Human Skeletal Remains. London: Academic Press.

Oxenham, M., H. Matsumura, K. Domett, N. Kim Thuy, N. Dung, N. Cuong, D. Huffer, and S. Muller 2008. Health and the Experience of Childhood in Late Neolithic Vietnam. In Asian Perspectives 47(2):190-209.

Palubeckaite, Z., R. Janakauskas, and J. Boldsen 2002. Enamel Hypoplasia in Danish and Lithuanian Late Medieval/Early Modern Samples: a Possible Reflection of Child Morbidity and Mortality Patterns. In International Journal of Osteoarchaeology 12:189-201.

Perry, M. 2006 Redefining Childhood through Bioarchaeology: Toward an Archaeological and Biological understanding of Children in Antiquity. In Archaeological Papers of the Americna Anthropological Association 15:89-111.

Ribot, I. and C. Roberts 1996. A Study of Non-Specific Stress Indicators and Skeletal Growth in Two Medieval Subadult Populations. In Journal of Archaeological Science 23:67-79.

Roberts, Charlotte, and Keith Manchester 2005 The Archaeology of Disease. Ithaca: Cornell University Press.

Schultz, M., U. Timme, and T.H. Schmidt-Schultz 2007. Infancy and Childhood in the Pre-Columbian North American Southwest- First Results of the Paleopathological Investigation of the Skeletons from the Grasshopper Pueblo, Arizona. In International Journal of Osteoarchaeology 17:369-379.

Walker, P., R. Bathurst, R. Richman, T. Gjerdrum, and V. Andrushko 2009. The Causes of Porotic Hyperstosis and Cribra Orbitalia: A Reappraisal of the Iron-Deficiency Anemia Hypothesis. In American Journal of Physical Anthropology 139:109-125.

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