Summary:
The shift in current bioarchaeological research focuses on new interpretative
synthesis on the identity of the Greek prehistory and how it is shaped through
the processes of phenomena during the Holocene, a chronological period (10000
B.C.-today) which signs the biocultural microevolution of societies. The
Neolithic period (~7000-3200 B.C.) has been a field of hot debate, as the
critical stage of the beginning of the agricultural economy with the consequent
biological and socioeconomic implications, from the hunting-gathering stage of
the preceding Mesolithic period (~9000-7000 B.C.) to the advent and
intensification of farming and the development of the civil structures during
the Bronze period (~3200-1200 B.C.). Within that conceptual framework, a
significant number of scholars support the major impact of the Neolithic
structures on the health status of societies due to the shift from the
nutritious animal protein intake of the Mesolithic hunters to the low
nutritional quality of carbohydrates and the lack of microelements of the
Neolithic farmers, furthermore related to severe demographic events. Porotic
hyperostosis and cribra orbitalia have been investigated as the most popular
disorders in prehistoric archaeological samples identified as the
epidemic/endemic events in the Neolithic period. The iron-deficiency anemia, as
the cause agent of those diseases due to dietary behavioral patterns, has been
established as the most popular theory in both Greek and European area.
However, new data from the examination of archaeological collections and the
revising of the sociocultural models in prehistoric contexts dispute the
prevailing paradigm. Therefore, the established methodology of the traditional
archaeology is tested to new experimental methods through an interdisciplinary
approach and a logical dialectism in bioarchaeology. The present project aims
to build up the clinical, biocultural and biogeographic profile of a disease
group, that is, the porotic hyperostosis and cribra orbitalia with the
occasionally co-occurring pathological finds in the endocranium and the
postcranial skeleton. They are developed as porotic lesions in different
degrees of severity and morphology on the cranial and orbital areas with
occasional co-occurrence of endocranial and postcranial lesions. From 14
excavated prehistoric sites-units of various environmental and geomorphological
settings in Greece, developing a stratigraphic sequence with chronological
diachrony, human remains of 230 individuals, mainly of young ages (<30), were
studied. In comparison to the routine macroscopic and radiological analysis,
new analytical laboratory methods were applied such as, endoscopy, scanning
electron microscopy-SEM and microscopic-histological analysis applying adjusted
alternative technical protocols. The main objective of that attempt is to
construct the clinical picture of those diseases using reliable methods for
differential diagnosis and possible paleoepidemiological research in
combination with the introduction of “know how” in order to build up a database
of diseased ancient bone. As reference control groups, samples from prehistoric
and medieval sites in central and northern Europe, Levant and northern America
were examined both macroscopically and microscopically. By applying the new
analytical laboratories techniques, the main variables of the outer table, the
diploe and the inner table of both cranial and orbital regions entered in the
database include: the morphology of pitting/porosis, the frequency distribution
pattern per anatomical area, the stage of severity of porosity, the morphology
and pattern of angiosis/hypervascularity, osteoblastic and osteoclastic
processes, features of lamellar and woven bone, the morphology and changes in
the architecture and size of diploic trabeculae and lamellae, striation
patterns, hypertophic and proliferate organizational zones of bone reaction,
islands of remodeling and mixed structures, contact areas of the bone tissue,
structures and stages of healing processes. The statistical analysis used raw
data and categorical variables (chi-square) to assess significance of
correlation of groups and variables. The testing of the selected parameters in
the macroscopic examination did not provide either a consistent morphotype or a
pattern of the distribution or stages of severity and prevalence of the
lesions, except from the few cases exhibiting an advanced stage of porotic
lesions. There was assessed a broad spectrum of variability in the relation of
the variables with chronological period. Furthermore, no correlation between
the prevalence of the lesions and age/gender was observed, while a significant
variability on intra-, and inter-site level was evaluated. In contrast to the
results from the macroscopic analysis, the combination of the new analytical
methods provided sound criteria to enter to the database, to apply protocols
and attain a reliable differential diagnosis, yet of major disease groups. Very
few cases of porotic hyperostosis and cribra orbitalia were diagnosed as anemic
episodes, yet of a mild degree and in a successfully healing process. The same
finds stand for scurvy lesions which are identified in few individuals in a
mild stage and/or a remodeling process of healing. The percentage of lesions on
the outer table diagnosed as cranial periostitis and of the endocranial ones as
non-specific infections, meningitis, leptomeningitis, pachymeningitis,
tubercular meningitis, hemorrhagic events caused either from localized trauma
or epidural, subdural hematoma or scurvy, mixed structures of
inflammation-hemorrhage or hemorrhage-inflammation compose the clinical picture
and differential diagnosis of porotic hyperostosis and cribra orbitalia,
evaluated as morphological features of a multifactorial etiology. In a
significant number of specimens the histological examination diagnosed the
porotic lesions as diagenetic, identified as pathological in the macroscopic
analysis. The statistical analysis of categorical variables showed a
relationship of the prevalence of the lesions with the type of physical
environment but it is not possible to assess a causal link per se. Furthermore,
the epidemiological profile of the syndromes under investigation is not
documented considering the continuous population movements in Greek prehistory
with the genetic impact on their demographic profile. In the interpretative
synthesis, the current research, under the new findings of the genetic
background and polymorphism of the iron-deficiency anemia, megaloblastic anemia
and scurvy, beyond their dietary cause, and the anemia of inflammation, needs
to be incorporated. It is expected that some individuals may have suffered from
different categories of anemias, with or without hyperplasia of marrow, such
as, the genetic anemias, autosomal anemias, the sideroblastic anemias, the
hemolytic anemias, the megaloblastic anemias, the anemia related with chronic
leukemia, the anemia of chronic heart defects, hypoxia anemias, anemia of lead
poisoning, idiopathic anemias of unidentified cause without the involvement of
any erythropoietin dysfunction. In combination with the paleohistological
examination, molecular and biochemical analysis for tracing immunological
dysfunctional proteins on genetic anemias and scurvy, methods already
successfully tested on ancient bone disease, will contribute to more reliable
diagnosis. Furthermore, the application of spectroscopic techniques for the
quantification and bioelementary analysis of porosis will provide new variables
to the database and research on diagenesis, a new developing field in
paleopathology
