Metabolic Disease and Trauma in the Children From Late Roman Dorchester, Dorset

Life and Death in a Civitas Capital: Metabolic Diseaseand Trauma in the Children from Late RomanDorchester, Dorset

Mary E. Lewis*

Department of Archaeology, School of Human and Environmental Studies, University of Reading,Reading, Berkshire RG6 6AB, UK

KEY WORDS Poundbury Camp; rickets; scurvy; rib fractures; anemia; urbanization

ABSTRACT The impact that ‘‘Romanization" and thedevelopment of urban centers had on the health of theRomano-British population is little understood. A re-examination of the skeletal remains of 364 nonadultsfrom the civitas capital at Roman Dorchester (Durno-varia) in Dorset was carried out to measure the health ofthe children living in this small urban area. The cemeterypopulation was divided into two groups; the first buriedtheir dead organized within an east–west alignment withpossible Christian-style graves, and the second with morevaried ‘‘pagan’’ graves, aligned north–south. A higherprevalence of malnutrition and trauma was evident in thechildren from Dorchester than in any other publishedRomano-British group, with levels similar to those seenin postmedieval industrial communities. Cribra orbitaliawas present in 38.5% of the children, with rickets and/or

scurvy at 11.2%. Twelve children displayed fractures ofthe ribs, with 50% of cases associated with rickets and/orscurvy, suggesting that rib fractures should be consideredduring the diagnosis of these conditions. The high preva-lence of anemia, rickets, and scurvy in the Poundburychildren, and especially the infants, indicates that thiscommunity may have adopted child-rearing practices thatinvolved fasting the newborn, a poor quality weaningdiet, and swaddling, leading to general malnutrition andinadequate exposure to sunlight. The Pagan groupshowed no evidence of scurvy or rib fractures, indicatingdifference in religious and child-rearing practices but thatboth burial groups were equally susceptible to rickets andanemia suggests a shared poor standard of living in thisurban environment. Am J Phys Anthropol 000:000–000,2010. VVC 2009 Wiley-Liss, Inc.

This study explores the health of an urban‘‘Romanized’’ population living in Dorchester through theexamination of the children buried at the cemetery ofPoundbury Camp. The health of the inhabitants ofRoman Britain is little understood, and population stud-ies that integrate skeletal evidence with archaeologicaland environmental data are few. Many questions remainabout what impact the introduction of urban centers andthe gradual economic decline at the end of the RomanEmpire had on the local population. Some Roman schol-ars argue that ‘‘Romanization" brought about improve-ments to the health of the people (Mattingly, 2006, p323), with the writing of Roman architects such as Vitru-vius conjuring up images of planned Roman cities, withmarbled surfaces and flowing water, providing extensivefacilities for the comfort and health of the inhabitants(Morley, 2005). Diametrically opposed is the argumentthat urbanization widened the divide between the richand the poor, with many suffering hardships of poverty,social unrest, and subservience to the conquering popu-lation. The city of Rome itself is seen as overcrowdedand filthy, with dogs and muggers prowling the streets,whereas the archaeological evidence calls into questionthe organization of the water supply and levels of sanita-tion, with latrines discovered near kitchen areas (Lau-rence, 1997; Morley, 2005). Garnsey (1999) has hypothe-sized that undernutrition was endemic in the urbancommunities of the Greco-Roman world, but there is lit-tle osteological evidence to support or dispute this con-troversial theory. Although the importance of the skele-tal remains has been acknowledged, these data are still‘‘marginalized’’ in discussions of Romano-British archae-

ology (Gowland, 2003, p 137). Although, for the firsttime, Roberts and Cox (2003) have drawn together allthe current osteological evidence for health in RomanBritain, we still have little concept about what life inRomano-British urban centers was like, and how itaffected the health of the general population.Nonadult remains provide an effective measure of pop-

ulation fitness, as the ability of a society to keep theirmost vulnerable members alive, and in good health,attests their ability to adapt to their environment(Lewis, 2007). Research on nonadult skeletons fromindustrial areas has demonstrated the impact a poorenvironment has on the health of the children (Lewis,2002). Previous studies of children in Roman Britainhave focused on the aspects of their burial, infanticide,and the life course, and there is a growing interest inexamining the remains for evidence for diet and disease(Mays, 1993; Gowland, 2001; Gowland and Chamberlain,

Grant sponsor: AHRC (‘‘Diasporas, Migration and Identities’’research programme).

*Correspondence to: Mary E. Lewis, Department of Archaeology,School of Human and Environmental Studies, University of Read-ing, Reading, Berkshire RG6 6AB, UK.E-mail: [email protected]

Received 18 May 2009; accepted 23 October 2009

DOI 10.1002/ajpa.21239Published online in Wiley InterScience

(www.interscience.wiley.com).

VVC 2009 WILEY-LISS, INC.

AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 000:000–000 (2010)

2002; Redfern, 2007, 2008). In understanding the fea-tures of Roman society that may have impacted on thehealth of children, we face certain challenges. Documen-tary evidence from Roman Britain is scarce, and any in-formation on weaning, child rearing, education, health,marriage, and employment of children comes mainlyfrom the Mediterranean. Arguments surrounding theextent to which ‘‘Roman" culture was adopted by thenative population in Britain are still ongoing, withthe idea of Romanization, whether conceptualized interms of imperially imposed acculturation or native emu-lation (Millett, 1990), gradually being replaced by themodels such as creolization (Webster, 2001). There is anincreasing awareness of the diversity of the responses to‘‘Roman" influence and the multitude of identitiesexpressed in the material culture and social practice(Mattingly, 2002, 2006).The children excavated from the late-Romano-British

cemetery of Poundbury Camp (3rd–5th century AD) re-present the largest sample of nonadult skeletons datingfrom the period. This work reports on the recent re-examination of the 364 nonadults from Poundbury Campand focuses on new evidence for high levels of rickets,scurvy, and trauma in the children. The reasons behindthe pathology in this nonadult group are discussedwithin the context of urbanization in Roman Britain.

MATERIALS

The cemetery at Poundbury Camp in Dorset was exca-vated between 1966 and 1982 and is located at the footof an Iron Age hillfort, overlooking the River Frome(Green, 1987). More than 1,400 graves were identified,with 1,200 burials recovered. The cemetery first servedthe Durotrigian Iron Age hillfort (1st century BC–1stcentury AD), before becoming incorporated into a smallrural Romano-British settlement (1–3 centuries AD),with both groups burying their dead on the slopes of thehillfort (see Fig. 1). By the end of the 3rd century AD,Poundbury Camp had become the main burial locationfor the people living in Durnovaria (modern Dorchester)immediately to the east, a relatively small civitas capital(town) originally created for the Durotriges of Dorset(Wacher, 1992). Little is understood about the living con-ditions within this urban settlement, and this lack ofknowledge about what occupations people carried out,how they sourced their food and materials, and the den-sity and identity of urban sites is a common and well-recognized problem within Roman archaeology (Jones,1991a; Burnham et al., 2001). However, extensive exca-vations at Greyhound Yard (in the center of Durnovaria)show the development of the town from timber buildingsto extensive stone houses in the 4th century. By the endof the Roman period, these were often subdivided intoseveral living spaces, with adjacent-aisled buildings sug-gesting accommodation for tenants, laborers, and slaves.Bronze working and iron smithing may also have beencarried out (Woodward et al., 1993). The presence of pig,dog, cat, and raven bones indicates a build-up of refuseat the site that attracted scavengers to middens. It islikely that the inhabitants of Durnovaria followed a typi-cal diet of meat (ox, sheep, goat, pig, chicken, red, androe deer), marine and freshwater fish and diary prod-ucts, with plums, cabbages, and pears being introducedto the area by the Romans (King, 1991; Smith, 1993;Cool, 2006). Evidence for imported foods such as wine,olive oil, figs, dates, grapes, corn, and chamomile has

also been found in the south of Britain during this pe-riod, as the result of extensive trade networks betweenBritain and Europe (Jones, 1991b; Gale, 2003).The skeletal sample comprised 796 adults and 404

nonadults. The children, including perinates, wereevenly distributed throughout the cemetery (see Fig. 2),suggesting that they underwent the same burial treat-ment as the adults. There were no clusters of particularage groups, with the exception of a group of infants tothe east of the cemetery, buried within a smithy (R14).In the original report, the cemetery was divided into sixseparate burial areas to aid in the analysis (see Fig. 2).The ‘‘Main" cemetery area comprised the majority of bur-ials (n 5 1,028) organized in neat rows, typical of manyRomano-British urban cemeteries (Cleary, 1992). Most ofthese burials were aligned east–west and contained sin-gle inhumations. This area of the cemetery included 11mausolea, thought to be reserved for the burial of high-status individuals and their families (including theirslaves), as well as wooden, lead and stone coffins, andburials packed with gypsum or plaster (Molleson, 1989).There was a distinct lack of gravegoods. Burials, show-ing these characteristics were assigned to study Group1. The other cemetery areas comprised graves that werealigned north–south with a variety of grave inclusionsand a lack of coffins and hobnails (Group 2).The meaning behind these two seemingly contempora-

neous burial types is still a matter of debate. The formalalignment of the Group 1 graves has been suggested tobe the result of ‘‘managed" Christian cemeteries, wherethe mode of burial and east–west alignment was dictatedby the ‘‘Romanized" elite (Philpott, 1991; Sparey-Green,2004).The Group 2 burials included five prone burials, and

the only late Roman crouched burial at the site. Gravegoods included glass and jet beads, bone pins and brace-lets, and copper alloy brooches, and the three cremationburials in this section of the cemetery indicates a smallsegment of the population who continued to practice tra-ditional burial rites, whereas the general mode of burialwas undergoing change (Farwell and Molleson, 1993,p 30). It is also possible that these burials reflect areintroduction of ancient burial practices at the end ofRoman occupation. Food offerings and hobnails arethought to represent the pagan tradition of furnishingfor the afterlife and the journey across the Styx (Clarke,1979; Baldwin, 1985). The similarity in the burial orien-tation and gravegoods suggests that the burials in Group2 represent individuals that shared a similar identitythat was different from those of the general populationin Group 1.The differences in burial rite between these two

groups provide a useful tool for comparing child healthbetween two potentially contrasting sections of Romano-British society.

METHODS

The sample comprised 364 nonadults (\17 years).Age-at-death estimates were obtained using standards ofdevelopment for the deciduous and permanent dentitionpublished by Moorrees et al. (1963a,b) and tabulated bySmith (1991). Where no teeth were present, diaphyseallengths and skeletal maturation were used to assign anage (Ubelaker, 1989). Perinates were aged using Britishstandards developed by Scheuer et al. (1980) based ondiaphyseal lengths. The skeletons were divided into

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American Journal of Physical Anthropology

seven age categories, with individuals in the last age cat-egory (14.5–17.0 years), estimated to be older than 17.0years when the root of the third molar was complete(Rc 5 16.9) but the apex open (Moorrees et al., 1963b).These biological ages are a useful tool for examininghealth within key stages of a developing child’s life (i.e.,at birth, during infancy, and adolescence), but do not

necessarily coincide with the cultural concepts of child-hood within the Roman period, where girls as young as12 could be married, and males may not have beenviewed as fully adult until they were 25 years of age(Revell, 2005, p 50). Vitamin D deficiency (rickets andosteomalacia) was diagnosed using the criteria set outby Ortner and colleagues (Ortner and Ericksen, 1997;

Fig. 1. Map showing the location of Poundbury and Dorchester (‘‘Durnovaria’’). After Farwell and Molleson (1993, p 3).

Fig. 2. Distribution of child graves (shaded) within the Poundbury Camp cemetery (adapted from Farwell and Molleson, 1993).[Color figure can be viewed in the online issue, which is available at www.interscience.wiley.com.]

3CHILD HEALTH AT ROMANO-BRITISH POUNDBURY CAMP


Ortner and Mays, 1998) and Brickley and Ives (2006).Rickets denotes the effect of vitamin D deficiency on thechondroblasts of the growth plate in children, whereasosteomalacia refers to the more general changes result-ing from the disruption to the osteoblasts (Pettifor,2003). Cribra orbitalia was graded using the scheme byStuart-Macadam (1991, p 109) and an active and remod-eled lesions recorded (Mensforth et al., 1978). Porotichyperostosis can occur in rickets, scurvy, and anaemiaand so was recorded in relation to other pathologies onthe skeleton. Although traditionally considered to be in-dicative of iron-deficiency anaemia (Ortner, 2003), theexact aetiology of cribra orbitalia and porotic hyperostosisis still in question, and, recently, it has been suggestedthat the marrow expansion typical of these lesions is theresult of megalobalstic anemia due to vitamin B12 defi-ciency and gastrointestinal infections (Walker et al.,2009). Other pathologies were recorded according tostandard published criteria (Buikstra and Ubelaker,1994; Ortner, 2003). All three conditions, iron deficiency,vitamin D, and vitamin C deficiency, are likely to haveoccurred together in a malnourished child, and we shouldexpect to see skeletal manifestations of each of these con-ditions in a single skeleton. Osteopenia (loss of bonemass) may also be expected as, while rickets affects ossifi-cation and scurvy the production of osteoid (Brickley andIves, 2008, p 48), a malnourished child is also likely to beimmobile, exacerbating the skeletal changes, and leadingto increasingly fragile bones. Osteopenia was identifiedmacroscopically when there was evidence of a thinnedcortex, sparse cancellous bone, and reinforced vertical tra-beculae, known as sclerotic atrophy (Ortner, 2003, p 411).

RESULTS

Age-at-death

Of the 364 nonadults from the late Romano-Britishperiod, the majority came from the ordered cemeteryarea (Group 1, 89%), with four (1.1%) located withinMausolea (two perinates and two children aged 10.6–14.5 years) and six (1.6%) from high-status graves andlead-lined coffins. Group 2 comprised 39 (11%) of thenonadult burials (Table 1, Fig. 3a). Only 331 skeletonswere complete enough to be placed within an age cate-gory. Infants (i.e., 0.0–1.0 years) made up the largestgroup (87 or 24%) with perinates (under 41 weeks) andthe 2.6–6.5-year-olds making up the second largest agecategories. Perinates occurred in both Groups, however,there were significantly more in Group 2 (38%; X2 518.57; P 5 0.001, d.f.1). In addition, Group 2 had thelargest number of adolescents (i.e., 14.6–17.0 years; Fig.3b), but this was not statistically significant.

Metabolic disease

Of the 200 nonadults with orbits preserved, 77 (38.5%)had cribra orbitalia (Table 2), with Grades 2 and 3 form-

ing the majority of lesions. Fifteen (19%) children hadthe most severe forms of cribra orbitalia (Grades 4 and5). These results are only slightly higher than the 36.4%reported by Stuart–Macadam (1991). The five mostsevere cases of cribra orbitalia (Grade 5) were fromGroup 1 (see Fig. 4), and in all age categories (from 0.0to 14.5 years), active lesions (n 5 42) significantly out-weighed healed lesions (n 5 25; X2 5 7.64; P 5 0.01,d.f.1). Between the ages of 0.0–1.0 years, all the caseswere active (n 5 11).Of the 248 children with postcranial bones (Table 2),

31 (12.5%) had definite evidence for vitamin D (n 5 12or 4.8%), vitamin C (n 5 12 or 4.8%), or combined vita-min D and C deficiency (n 5 7 or 2.8%). A further 20(8%) children had changes indicative of deficiency dis-ease, but the lack of a temporal or sphenoid bone or poorpreservation of the ends of ribs or long-bones made anyspecific diagnosis impossible. Ten children (4%) had sur-viving cranial vaults with porotic hyperostosis present-ing as layers of active new bone on the ectocranium, sug-gestive of vitamin C or D deficiency over anemicchanges, but again, the lack of any postcranial bonesmeant a specific diagnosis was not possible. Hence,although 11% of the children at Poundbury are recordedas having a specific metabolic disease, the true preva-lence in this sample is probably much higher. Infantswere most commonly affected by rickets and/or scurvy(54%), with nearly all cases of metabolic disease (90% ofthe 31 individuals affected) coming from Group 1 (Table2, Fig. 5). It is also notable that scurvy was only evidentin this ordered part of the cemetery, but this trendproved not to be statistically significant (X2 5 0.83; P 50.01, d.f.1) and probably results from the small samplesize of Group 2. Scurvy was the only condition to persistafter 2.6 years. Lesions associated with rickets, andosteomalacia showed a range not usually recorded innonadult material. For example, one skeleton demon-strated folding of the unfused iliac crest, more often seenin adult osteomalacia (Brickley et al., 2005). Parrot boss-ing of the skull (see Fig. 6) and extensive new bone for-mation in the orbits (see Fig. 7) in scurvy was alsoobserved, suggesting a more advanced form of the condi-tion than pitting alone (Ortner et al., 2001). There werealso two cases of premature suture closure (in childrenaged 2 and 12 years), a reported complication of rickets(Wang et al., 2007). A striking feature of the remainsfrom Poundbury Camp was the degree of osteopenia inthe affected group (see Fig. 8), with 11 individuals dem-onstrating thin and friable bones with thickened trabec-ulae macroscopically. In each case, all the survivingbones were affected (long bone shafts, skull, pelvis, andribs), suggesting a systemic condition such as severemalnutrition and possibly that these children had re-stricted movement and poor muscle tone. Further quan-titative analysis into the bone mineral density of thePoundbury sample in relation to nutritional stress isneeded.

TABLE 1. Age at death and burial location of the Poundbury Camp nonadults

Perinate 0.0–1.0 1.1–2.5 2.6–6.5 6.6–10.5 10.6–14.5 14.6–17.0 Age Totalb

Group 1 40 (12)a 79 (27) 45 (98) 50 (15) 38 (12) 34 (10) 10 (3) 30 (9) 325 (89)Group 2 15 (38) 8 (20.5) 1 (2) 5 (13) 3 (8) 0 (0) 3 (8) 3 (8) 39 (11)Total 55 (15) 87 (24) 46 (13) 55 (15) 41 (11) 34 (9) 13 (3.5) 33 (9) 364 (

a The number in parenthesis is the rounded % of the total for each group.b The number in parenthesis in this column is the rounded % of the total nonadults.

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Trauma

Single and multiple rib fractures were recorded in 12children (5.4% with ribs), with a total of 20 fracturedribs (Table 3). All were located in Group 1. The agesranged from perinate to c.7 years of age. Where the ribscould be identified, the majority were right mid ribs,with between two and five ribs affected in some individu-als, and a mix of healed and healing lesions (see Fig. 9).One child, aged around 1.5 years, had a possible healedfracture of the first rib, while another in the same age

group had a fractured left second rib. Six of these chil-dren also had evidence for other pathology on their skel-eton (i.e., rickets, porotic hyperostosis, or periostitis). Inaddition to fractures of the ribs, a child aged around 7months from Group 1 presented a bucket-handle frac-ture of the distal metaphyses of the right tibia (see Fig.10) conforming to the Salter–Harris Scheme B (Salterand Harris, 1963). Only one other case of child trauma,a possible bowing deformity at Cannington (Brothwelland Powers, 2000) has ever been reported in nonadultremains from a Romano-British site.

Fig. 3. A: Number of nonadults in each age category for the site and for each burial group. B: Percent distribution of nonadultsin each age category, by burial group.



DISCUSSION

The aim of this study was to re-examine the skeletalremains of the children from Poundbury Camp toexplore the health of a community living in an urbansettlement during the Romano-British period. The divi-sion of the cemetery into two groups, the first which bur-ied its dead organized within an east–west alignment(Group 1, ‘‘Christian’’), and the second with more variedgraves aligned north–south (Group 2 ‘‘pagan"), was car-ried out in an attempt identify any possible differencesin the life styles of the two groups. Statistically signifi-cant differences between the two groups were not

evident with both showing a high prevalence of ricketsand anemia. Although the ‘‘pagan" group did not haveany cases of rib fractures, this may be a result of thesmaller sample size. The lack of scurvy in the secondgroup may hint at differences in childhood diet, but thisstudy has not provided any conclusive evidence that thedifferent burial practices at Poundbury Camp reflect adifferent way of life for these two groups.That Poundbury may represent a rather unusual pop-

ulation in Roman Britain has been suggested by Cool(2006), who argues that the adoption of Christianity mayhave resulted in the women of Poundbury Camp practic-ing an extreme form of fasting. Although it is hard to

TABLE 2. Number and percent metabolic disease in the nonadults, by cemetery location

Location Cribra orbitalia Porotic hyperostosis Vitamin D deficiency Vitamin C deficiencyVitamin C and D

deficiency

Group 1Observed Affected Observed Affected Observed Affected Observed Affected Observed Affected

Perinate 16 0 ( 34 0 ( 35 0 (0)a 35 0 ( 35 1 (3)0.0–1.0 33 2 (6) 71 5 (7) 43 7 (16) 43 3 (7) 43 4 (9)1.1–2.5 44 14 (32) 39 6 (15) 36 3 (8) 36 4 (11) 36 2 (5.5)2.6–6.5 52 18 (35) 48 3 (6) 37 0 ( 37 2 (5) 37 0 (6.6–10.5 50 19 (38) 33 2 (6) 29 0 ( 29 1 (3) 29 0 (10.6–14.5 44 17 (39) 33 0 ( 29 0 ( 29 1 (3) 29 0 (14.6–17.0 8 1 (12.5) 0 0 ( 8 0 ( 8 0 ( 8 0 (Nonadult 0 0 ( 15 2 (13) 3 0 ( 3 1 (75) 3 0 (Total G1 176 71 (40) 273 18 (6.5) 220 10 (4.5) 219 12 (5) 219 7 (3)

Group 2Observed Affected Observed Affected observed Affected Observed Affected Observed Affected

Perinate 10 0 ( 13 0 ( 13 0 ( 13 0 ( 13 0 (0.0–1.0 3 0 ( 8 4 (50) 5 2 (40) 5 0 ( 5 0 (1.1–2.5 1 0 ( 1 0 ( 1 0 ( 1 0 ( 1 0 (2.6–6.5 4 1 (25) 4 0 ( 3 0 ( 3 0 ( 3 0 (6.6–10.5 2 2 (100) 3 0 ( 1 0 ( 1 0 ( 1 0 (10.6–14.5 0 0 ( 0 0 ( 0 0 ( 0 0 ( 0 0 (14.6–17.0 3 2 (75) 0 0 ( 3 0 ( 3 0 ( 3 0 (Nonadult 1 1 (100) 0 0 ( 2 0 ( 2 0 ( 2 0 (Total G2 24 6 (25) 29 4 (14) 28 2 (7) 28 0 ( 28 0 (Total 200 77(38.5) 302 22 (7) 248 12 (4.8) 248 12 (4.8) 248 7 (2.8)

a The number in parenthesis is the rounded % of the total for each group.

Fig. 4. True prevalence rate (TPR) of cribra orbitalia in the nonadults by burial group and severity of lesion.

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substantiate such theories, the level of malnutrition inthe Poundbury Camp children is notable, and some casesmay be related to maternal health during pregnancy.Most studies that report cribra orbitalia in the

Romano-British samples provide crude prevalence rates(percent of total individuals affected) that are fairly low,ranging from ‘‘probably less than 5%’’ in the EasternCemetery in London (Conheeney, 2000, p 285) to 22.5%at Ancaster (Cox, 1989). The true prevalence rate (basedon the number of children with orbits present) of 38.5%at Poundbury Camp is high in comparison and is moresimilar to those seen on the Continent where prevalencerates range from 85% to 28% (Salvadei et al., 2001; Fac-chini et al., 2004; Cucina et al., 2006). Results from else-

where in the Roman Empire suggest that the high levelof cribra orbitalia at Poundbury Camp is not unusual forchildren in the Roman period, but the rates from Dor-chester, to date, are the highest reported in Britain.In the original Poundbury Camp report, only three

possible cases of nonadult rickets were identified basedon the appearance of bowed bones and, apart from theevidence for anemia, no other nutritional diseases werenoted (Farwell and Molleson, 1993, p 179). Advances inpalaeopathological diagnosis now mean that we are moreaware of the subtle changes related to rickets and/orscurvy in the nonadult skeleton, such as pitting of thesternal ends of ribs, metaphyseal fraying and friable,and undermineralized diaphyses (Lewis, 2007). In thepast, such signs were probably interpreted as poor pres-ervation, compounding the commonly held assumptionsthat nonadult skeletons do not preserve well in the bur-ial environment. Many of the bones of the children, suf-fering from rickets and scurvy in the Poundbury Campsample, were extremely fragile, and without knowledgeof the appearance of poorly ossified bone, they wouldappear to be damaged postmortem. In this study, 31

Fig. 5. True prevalence rate (TPR) of children displaying metabolic disease in each burial group.

Fig. 6. Classic ‘‘parrot bossing" of the skull of PC1096. Indic-ative of scurvy.

Fig. 7. Active new bone formation on the orbits of PC1308.These lesions are thought to be the result of bleeding into theorbits in scurvy.



(11%) of the Poundbury children were diagnosed as hav-ing a specific metabolic disease. A literature review ofother Romano-British samples revealed only three casesof rickets, and one possible case of infantile scurvy, fromsites in London (Conheeney, 2000; Mackinder, 2000).This may be the result of differences in the methodsused to identify the conditions in these earlier reports,rather than a true difference in the health patterns ofthese samples. Once again, the rates at PoundburyCamp are more similar to those reported from sites inpostmedieval England, where Brickley and colleagues

Fig. 8. Osteopenia of the right ilium, ischium, and pubis of PC558. Note the porosity and thinning of the cortex (A) and thick-ened trabeculae (B) on the ilium that is separate to the postmortem damages at the edges of these bones (C).

TABLE 3. Rib fractures divided by age and cemetery location

Age category Group 1 Group 2

Perinate 30 1 (3)a 9 00.0–1.0 43 6 (17) 7 01.1–2.5 34 4 (12) 1 02.6–6.5 35 0 ( 2 06.6–10.5 27 1 (4) 3 010.6–14.5 29 0 ( 0 014.6–17.0 7 0 ( 3 0Total 205 12 (100) 25 0

a The number in parenthesis is the rounded % of the total foreach group.

Fig. 9. Left rib of PC210 demonstrating a transverse ribfracture and callus formation.

Fig. 10. Bucket-handle fracture of the right distal tibia ofPC1180. Note the extension of the left aspect of distal metaphy-sis beyond the level of the metaphyseal surface.

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(2006) provide a true prevalence rate of 13% rickets and10.5% scurvy in the infants from industrial Birmingham.

Child-rearing practices

We have no documentary evidence from Britain toindicate whether Roman feeding practices were adoptedby the Iron Age population, but these methods may gosome way in explaining the level of malnutrition in theyoungest children from Poundbury Camp. Writing in theearly 2nd century AD, Soranus of Ephesus provides adisturbing account of infant-feeding practices where chil-dren were starved for the first 2 days of their lives,denied colostrum, and often fed honey and goat’s milk asa breastmilk substitute (Jackson, 1988; Temkin, 1991).This diet would have left the child susceptible to dysen-tery and, as nonhuman protein causes irritation toimmature intestines, anemia (Jelliffe and Blackman,1962). The gradual introduction of solid foods was recom-mended after 6 months of age (Temkin, 1991). Prowseand co-workers (2008) caution that, as medical textswere addressed to the wealthier members of society, orto wet nurses charged with feeding slaves or foundlings,they should not be seen to reflect the wide variety ofpractices that might be expected across the Empire. Iso-topic evidence from Roman Egypt (Dupras et al., 2001)and Italy (Prowse et al., 2004, 2007, 2008) indicates thatweaning was complete by 3 years. This is reflected inthe carbon and nitrogen isotope evidence from Queen-sford Farm in England (Fuller et al., 2006) where a com-plete cessation of breastfeeding seemed to occur between3 and 4 years. However, solid foods appear to haveentered the diet later than Roman medical texts suggestat 1.5 years of age.That rickets was a health problem in Roman Italy

may be inferred by the comments Soranus makes aboutchild rearing. Once the child is released from their swad-dling clothes, mothers are warned not to let the childrenwalk so quickly as their legs ‘‘. . . may become distortedin the region of the thighs . . . the ground being too hard,causing the bones to give a little, since the bones havenot yet become strong" (Temkin, 1991, p 116). It is possi-ble that the practice of swaddling, limiting the skin’saccess to ultraviolet light, sporadic access to breastmilk,and early weaning resulted in the high prevalence ofrickets in the infants from Dorchester. The widespreaddistribution of vitamin D deficiency throughout the cem-etery site, and in both Groups, indicates that this was asystemic problem in the community. Such high levels ofrickets in later populations are usually attributed to airpollution in an urban or industrial environment (Lewis,2002; Brickley et al., 2006).Ascorbic acid is accessible to infants through mother’s

breastmilk and in their fetal stores. If children are notbreastfed (Shorbe, 1953) or breastfeeding mothers aredeficient in vitamin C (Fain, 2005), then infantile scurvymay occur. Scurvy normally occurs in infants between 8and 11 months (Brickley and Ives, 2006), and clinicalmanifestations can appear after the child have lackedthe vitamin for as little as 2–4 months (Tamura et al.,2000). Because of rapid growth in infancy, there is agreater chance that they will develop defective blood ves-sels and show more obvious skeletal manifestations ofthe condition than adults (Brickley and Ives, 2006). AtPoundbury Camp, seven infants had evidence of scurvy,and this persisted in the children aged between 2.6 and

10.5 years, with 11 cases. It is difficult to understandwhy the older children in urban Dorchester should havebeen denied access to vitamin C, as fruit and vegetablesin the summer months should have been plentiful.Although scurvy is most common during the wintermonths of January and February (Brickley and Ives,2008), other sources such as cabbage and root vegetablesshould have been accessible. Perhaps, the conditionreflects problems with a limited childhood diet, religiousdietary constraints, or food production, as vitamin Cwould be destroyed in heated milk or stewed fruit(Brickley and Ives, 2008, p 42–44). Scurvy has beenlinked to other acute illnesses or infectious disease(Follis et al., 1950), and it is possible that these childrenwere already chronically ill, and scurvy developed duringtheir convalescence. Whatever the cause, cases of scurvyoccur throughout the organized cemetery, in both theMausolea and coffin burials of Group 1, but no caseswere noted in Group 2. It is possible that the diet of thechildren from the ‘‘pagan" group differed to the rest ofthe population when it came to access to fresh fruit andvegetables, despite their shared susceptibility to ricketsand anemia.In 1882, Cheadle noted the coexistence of scurvy and

rickets in cases where children lacked access to freshfruit and were given boiled milk (Cheadle, 1882). Ane-mia, caused by the presence of scurvy, has also been dis-cussed in the literature, either as the result of bleedinginto the tissues or the direct effect of ascorbic acids onthe production of red blood cells (Goldberg, 1963). Diag-nosis of the coexistence of rickets and scurvy is challeng-ing if the skull and long bones are not both present, asthe cranial bones are needed to identify the early pittedchanges in vitamin C deficiency (Mays, 2008). It is alsolikely that any sign of ossified haematomas in childrenwith both conditions would be absent due to the natureof rickets, which hinders ossification. The presence ofboth rickets and scurvy in the children from Group 1(seven cases) indicates a lack of fresh fruit and vegeta-bles, in addition to poor quantities of sunlight, and per-haps a vitamin-deficient mother.The recent suggestion by Walker et al. (2009) that the

marrow hypertrophy demonstrated in cribra orbitalia ismore likely to be the result of megloblastic anemia dueto deficiencies in vitamins B12 and B9 (folic acid) is alsorelevant. If mothers were denied access to animal prod-ucts rich in vitamin B (i.e., fish, shellfish, beef, lamb,eggs, and cheese) either through famine or religiouspractices, they would pass this deficiency on to theirnewborn children, whose weaning diet would provide lit-tle of this nutrient. Poor-weaning foods, if coupled withthe unsanitary conditions of an urban environment,could lead to diarrheal diseases, exacerbating the ane-mia and ultimately causing the death of the child. Sucha scenario would explain the high levels of cribra orbita-lia in the young children at Poundbury Camp.

Trauma

The prevalence of rib fractures in the children fromPoundbury Camp is remarkable. Although rib fracturesare the most commonly recorded type of fracture in Brit-ish archaeological material (Brickley, 2006), they arerarely considered in nonadults. In modern clinical medi-cine, rib fractures are commonly associated with physicalchild abuse. Also, diagnostic is spiral and metaphysealfractures of the humerus, femur, and tibia (Brogdon,



1998; Resnick and Goergen, 2002). Fractures of the firstrib and pelvis, in particular, are considered to representthe most severe injuries in a child (Wilber and Thomp-son, 1998; Starling et al., 2002) brought about by com-pression forces, shaking or slamming the child downonto a hard surface (Strouse and Owings, 1995). In asurvey of 165 postcranial fractures from suspected childabuse cases, Kleinman and colleagues (1995) identifiedrib fractures in 31 (51%) cases. However, Glass et al.(2002) caution that rib fractures can also result fromgeneralized bone dysplasia, metabolic diseases, tumors,and in infants with rickets, rib fractures due to generalosteopenia may be the first clinical sign of this disease(Pettifor and Daniels, 1997). Kopcsanyi and colleagues(1969) discuss rib fractures associated with whoopingcough or any other chest infection associated with mal-nutrition and were seen in 50% children with rickets intheir sample. All the children with rib fractures atPoundbury came from Group 1, and 50% also had evi-dence for rickets and/or scurvy and, in some cases, osteo-penia. It is possible that the simple act of lifting thesechildren, perhaps while they were swaddled, caused frac-tures to the chest. That rib fractures in individuals withrickets have not been previously reported in the archaeo-logical literature may illustrate the severity of the condi-tion at Poundbury Camp. In one case, rib lesions wereassociated with extensive porotic hyperostosis andchanges to the facial bones, which suggest thalassaemiaintermedia as a cause for the rib changes, rather thantrauma (Lewis, Forthcoming).Secondary rib fractures as the result of metabolic dis-

ease may explain some of the trauma at the site, but itdoes not explain the presence of fractured ribs in theother six children. Three of the children were too poorlypreserved to identify any other pathology, but three(aged c. 44 weeks, 2 years, and 7 years) had rib fracturesunrelated to metabolic disease. Combined with thebucket handle fracture on the tibia in a 7-month-oldchild, this indicates a certain level of acute trauma inthis group, possibly as the result of physical abuse or, inthe older children, through corporal punishment, roughgames, or accidents. Modern cases of physical abuse areseen to reflect a high level of stress within the commu-nity as the result of overcrowding or parental consump-tion of alcohol, and the cases of infant trauma may dem-onstrate this tension. However, evidence for abuse in thearchaeological record is rare and needs to be put intocontext (Lewis, 2007, p 181–182). Roman society relishedviolent sports; and attitudes to child rearing reportedlyinvolved the use of physical punishment that membersof Roman society would not have recognized as ‘‘abuse"(Rawson, 2003, p 176).

CONCLUSIONS

The impact that urban centers had on the health ofthe Romano-British population has been a matter ofdebate for many years. The lack of comparative skeletalstudies and a paucity of documentary evidence for thispart of the Roman Empire means that we are unsurewhich aspects of Roman culture were adopted by thegeneral population after the conquest. Evidence from thechildren buried at Poundbury Camp shows that therewas a high level of malnutrition in the sample, withmany children suffering from anemia, rickets, scurvy,and general osteopenia. Suggestions that PoundburyCamp is in some way unusual for Roman Britain are yet

to be substantiated and stem from a lack of data on thehealth of individuals, and especially children, from con-trasting sites from this period. However, levels of cribraorbitalia are similar to those seen from urban centersfrom the rest of the Roman Empire, and the prevalenceof rickets and scurvy is comparable to children living inpostmedieval England.Several suggestions have been made for the high level

of anemia and vitamin deficiencies in this group. Itseems likely that child-rearing practices that involvedstarving the newborn, denying them colostrum, andswaddling led to general malnutrition, infections, andinadequate exposure to sunlight. Rib fractures may haveresulted from minor pressure being placed on fragilebones as the swaddled child was picked up. If cribraorbitalia and porotic hyperostosis are indeed the resultof vitamin B deficiency in the population, then a mater-nal and infant diet of limited animal protein may be thecause. Scurvy may also reflect this overall pattern ofmalnutrition, with a lack of access to fresh fruit and veg-etables in the childhood diet. That scurvy and rib frac-tures were only evident in Group 1 may suggest thatthese individuals adopted a different lifestyle to those inthe ‘‘pagan" burial area, perhaps including religiouspractices such as fasting and corporal punishment. Butboth groups were equally susceptible to rickets and ane-mia, suggesting a shared polluted and unsanitary urbanliving environment.In conclusion, it seems that life in the civitas capital of

Durnovaria was detrimental to the health of the childrenliving there, with high levels of malnutrition and possi-ble evidence for physical abuse. However, more work onthe health of nonadults from contrasting Roman environ-ments (i.e., rural areas, villa sites, and military com-munities) is needed before we can establish whether anurban environment was the cause.

ACKNOWLEDGMENTS

I thank Drs. Robert Krusynski and Margaret Clegg(Natural History Museum, London) for access to thePoundbury Camp material, and permission to photo-graph the specimens, Edeltraud Asopeck for help withFigure 2, and the Editor and anonymous reviewers fortheir comments on the original manuscript. Dr. HellaEckardt and Prof. Mike Fulford provided thoughtful andconstructive comments on earlier drafts of this work forwhich I am grateful.

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