Some spinach a day keeps the doctor away
Eating nutritious food has always been important to
good health. If we don’t get enough nutrients in our early years or if our diet
is too samey, we can develop deficiency diseases that, at worst, can leave
traces on our bones. There are several such marks that are relatively common
when making osteological analyses, some of which can be seen in the material
housed in the anatomical collection at KI’s Medical History and Heritage
Unit.
Common signs of deficiency disease
Starting with the skull, malnourishment often manifests itself as visible changes in the orbital roof,
where tiny holes and porosities form that in severe cases can suspend like peat
moss. The condition is called cribra orbitalia, and has
traditionally be interpreted as a sign of iron deficiency anaemia. Anaemia has
several different aetiologies. Low birth weight can make an individual more
precociously susceptible. Diarrhoea, haemorrhaging and intestinal parasites are
other possible causes. Similar hole patterns can also be seen on the top of the
skull, where they are called porotic hyperostosis. This kind of
skeletal change is most common in children, as it generally heals in adults.
This is because young individuals have a great deal of red bone marrow, which
more readily reacts with this type of lesion. In recent years, researchers have
looked into if it might be caused by a deficiency in something other than iron,
such as vitamin B-12. Since the most sensitive time is childhood, physiological
stress can leave traces in the form of visible, even ridged horizontal stripes
that appear mainly on the incisors. This condition is called enamel
hypoplasia and develops while the teeth are developing. It is possible
to calculate at which age the stripes appeared; if they are on the milk teeth,
it means the child suffered stress while still in the womb – i.e. that the
mother suffered stress or some kind of deficiency while pregnant. While it is
not fully known what causes the striping effect, researchers have been
interrogating the possibility that it is a result of stress related to
childbirth, malnutrition/stunted growth, imprisonment or other kinds of social
stress. Other stripes that can appear on the long tubular bones are
discoverable by X-ray and are called Harris lines.They too
can be caused by disease or trauma and appear when growth is suspended, but
whether this suspension is natural, given that growth can stop and spurt in
different periods, is a moot point.
Scurvy
These days, we know that scurvy is caused by vitamin C deficiency, and most people know that sailors
could lose their teeth when they were at sea for long periods of time with no
access to fresh fruit or vegetables. For some sailors, vitamin C deficiency
could be so severe as to prove fatal. Vitamin C, or ascorbic acid, helps to
build a strong immune system as well as cartilage and bone tissue, but cannot
be produced by the body. Scottish navy doctor James Lind (1716-1794) discovered
that the juice of citrus fruits could help the complaint and started to work on
prophylactic measures. Lind had several predecessors, but it was his work that
led to the discovery. Thanks to Lind, many hygiene and sanitation improvements
were made to life on board. He was the first person to make a thorough and
documented medical study on humans. At the Hagströmer Library, we have copies
of the first French edition of Lind’s Traité de scorbut. It was
published in 1756 and is thought to be as rare and prized as the first English
edition A treatise of the scurvy from 1753.
The critical component of vitamin C was not discovered until 1927 through the
work of the Hungarian biochemist Albert Szent-Györgyis (1893-1986), whose
research went on to earn him the Nobel Prize in 1937.
Traces of vitamin C deficiency are seldom found in archaeological bone matter
since it expresses itself in swollen mucosa, bleeding in the skin, periosteum
and gums and periodontitis, the causes of which are many. Vitamin C also helps
the body to absorb iron. This deficiency was probably more uncommon before the
introduction of agriculture when hunter-gatherers would eat more fresh and
unrefined food, such as berries, fruit and vegetables. Part of the vitamin is
destroyed during cooking and boiling. Maize, which was introduced to Europe by
Columbus, has often been associated in archaeological studies with a
deterioration in public health. It is high in sugar and starch and has been
shown to impact on both dental health and iron absorption. However, the plant
has been a food staple for centuries in other parts of the world. The conclusion
can be drawn that the advent of agriculture contributed to a slow decline in
human health. Very much on account of the increase in wheat and maize in the
diet but also of settlement, the consequence of which was the more rapid spread
of disease, with the accumulation of waste and stagnant water aggravating
bacterial growth and animal husbandry aiding the transmission of zoonoses.
Both lactose and gluten intolerance appeared after the arrival of
agriculture, although the pattern is complex and the changes gradual. For
instance, in Southeast Asia and Japan, where the staple food is rice, caries
has not increased since its introduction. It’s always hard to compare
hunter-gather societies and modern agriculture with the early agrarian
societies. Archaeologist Charlotte Roberts stresses that one must also factor
genetics and environment into understanding how the human body reacts to
different conditions.
Rachitis or the “English disease”
Once, rachitis was mainly common in children. The
condition is more commonly known as rickets and is caused by severe vitamin D
deficiency, which eventually gives rise to soft bones, a condition that in
adults is called osteomalacia. This softness is especially evident
in the long tubular bones of the arms and legs, which become bent under load.
The disease can also cause deformities in the pelvis, which can later lead to
life-threatening complications during childbirth. The KI collection houses a
couple of examples of babies who died of the disease before the age of 2,
probably from a combination of infection (maybe TB) and muscle weakness. In
Sweden, folk traditions were once rife about rickets and how it could be cured.
Protective amulets were common as a prevention, while it was thought a special
tree with a natural crevice or looped branch large enough to pull the sick
child through (known as a vårdbundet or “care-bound” tree)
possessed curative powers. A photograph of this practice (called smörjning)
can be seen in the Digital museum. Dr Nils Rosén von Rosenstein (1706-1773)
wrote a long account of childhood rickets, claiming that “the disease shows
itself when the child starts to teethe. Should it then proceed to become
emaciated, should the skin start to slacken and the belly to swell,
particularly on the right, the head to grow large, the face to become puffy and
pale with large veins in the neck, and the bone around the joints to become
enlarged: it thus already has a strong touch of this disease.” The description
continues in the same style. He also warns that “Women who have or have had
this ailment should think well before marrying. If their pelvis has become too
narrow they will either have difficult deliveries and tend to produce stillborn
babies or will die in childbirth.” According to Rosén von Rosenstein the
English disease had several causes, but usually the blame was placed on the
parents, who had brought the disease upon the child through their advanced age
or promiscuity; or on the baby having been raised in a “low-lying, damp and
marshy place”. He thought that children with rickets had too much acid in the
body. In the 19th and early 20th centuries, Henrik Berg’s (1858-1936) Läkarbok was
a standard medical work. Berg recommended, amongst other things, fresh air and
sunshine, saline baths, horse-hair mattresses, dry-rubbing with wool and
washing with salted aquavit. Potatoes and farinaceous food was to be reduced in
favour of fresh milk, eggs, good quality bread, grain-based soups, meat soups,
gruel, wholemeal bread, rusks, fruit, berries and vegetables – a diet that
wasn’t always so easy for a poor family. Rickets often went hand in hand with
tuberculosis.
Rickets was, as its popular epithet implies, a common disease in English
industrial towns, where buildings were densely packed and very little light was
let in between the houses and the factories. Many English doctors looked into a
possible cause. One theory was that the muscles grew more slowly than the
bones, which thus became curved. In was only in the 1700s that doctor Thomas
Percival (1740-1804) discovered that cod liver oil was an effective
prophylactic, but it was not until the 1900s that scientists began to
understand the relationship better. In the 1930s, after further research, Nobel
laureate Adolf Windhaus (1876-1959) was able to demonstrate that the substance
ergosterol was converted into vitamin D when the skin was exposed to sunlight.
Eventually, children started to be given fish liver oil, then vitamin A/D – and
these days only vitamin D drops. In Sweden, dairy products have been fortified
with vitamin D since the 1960s. Nowadays we know much more about the body’s
vitamin D needs. Ninety per cent of essential vitamin D (which is actually a
prohormone) is produced in the skin through exposure to the sun. The primary
function of the vitamin is to regulate the amount of calcium and phosphor in
the blood to ensure effective bone mineralisation. It also helps the body to
absorb calcium from the gut. It is not that common to find curved long tubular
bones amongst osteological material or in anatomical collections, for even if a
child is affected by the disease, the bones can remould themselves and regain
their strength later in life. In today’s society, the disease is sometimes
found in people who cover themselves for religious reasons and thus deprive
their skin of sunlight. Symptoms can be a pricking sensation in the hands or
muscle cramp. Pregnant and nursing women are particularly vulnerable. A
correlation can also be seen with diets that are low in dairy products and high
in fibre. A child also risks suffering vitamin D deficiency if its mother had
low vitamin D levels during pregnancy; elderly and sick people who spend
lengthy periods of time inside either in hospital or at home without access to
the outdoors are in the risk zone. A moderate amount of sunlight is therefore
vital for everyone. Many people take vitamin D supplements during the winter,
and research continues on what the long-term effects of vitamin D deficiency
might be.
Ann Gustavsson, 22 January 2019
Illustrations:
Title page from Traité de scorbut by James Lind, 1756. From
the Hagströmer Library collections.
Close-up of the orbital roof with cribra orbitalia. KI’s anatomical
collection.
Photos: Anna Lantz and
Ann Gustavsson.
Bibliography:
Aufderheide, A.C. & Rodríguez-Martin, C.The Cambridge
encyclopedia of human paleopathology. Cambridge, 2011:
305-314.
Berg, H. Läkarebok. Nya omarbetade och tillökade upplagan. Del
3-4. Göteborg, 1919.
Brickley, M, Ives, R.The bioarchaeology of metabolic bone disease.
Oxford, 2008: 41-74, 75-150.
Larsen, C.S. Bioarcheology. Interpreting behavior from the human
skeleton. Cambridge, 1997: 29ff, 45-46.
Ortner D.J. Identification of pathological conditions in human
skeletal remains. San Diego, 2003: 383-401.
Roberts, C. & Manchester, K. The archaeology of disease.
Gloucestershire, 2010: 234ff.
Roberts, C. & Manchester, K. What did agriculture do for us? In
G. Barker & C. Goucher (Eds.), The Cambridge World History 2015: 55-92.
Rosén von Rosenstein, N. Underrättelser om Barn-Sjukdomar och deras
Bote-Medel; Tillförene styckewis utgifne uti de små Almanachorna, nu samlade
och förbättrade. Stockholm, 1764.
(Nyutgåva: Jägervall M. Nils
Rosén von Rosenstein och hans lärobok i pediatrik. Lund,
1990.)
Uddenberg, N. Lidande & läkedom I. Medicinens historia fram
till 1800. Stockholm, 2015: 13, 261, 285, 291,325, 327f.
Uddenberg, N. Lidande & läkedom II. Medicinens historia från
1800 till 1950. Stockholm, 2015: 148, 149f, 150f.
Learn more:
Vitamin D deficiency in modern society.
The Smörjning folk cure.
Ann Gustavsson is an archivist/curator at Karolinska Institutet’s Medical
History and Heritage Unit. She has a master’s degree in archaeology and another
in osteoarcheology. With a background in cultural studies, she went on to read
ancient history and archival science. Her speciality is pathological lesions in
bone. Ms Gustavsson is currently inventorying, analysing and digitalising
Karolinska Institutet’s anatomical skull collection.
Translation: Neil Betteridge