Bioarchaeological Perspectives on Stress and Disease with a Focus on Scurvy

The article "Frontiers in the Bioarchaeology of Stress and Disease: Cross-Disciplinary Perspectives From Pathophysiology, Human Biology, and Epidemiology" by Haagen D. Klaus (2014) looks at different aspects of a cross-disciplinary view. Klaus talks about three main ideas: pathophysiology, human biology, and epidemiology. He shows how they all fit together (Klaus, 2014). Each of these perspectives is unique, but they can be super helpful when combined because more info is always better than not enough.

Klaus says that pathophysiology helps us understand what changed or damaged bones mean, where diseases come from, and what observable pathological characteristics are (2014). New bone growth from inflammation, shown in Klaus's article (2014), is a sign of biological stress when related to infection. Another finding he mentions is that osteoarthritic changes happen because the body can't keep up with joint maintenance (Klaus, 2014). This pathophysiology angle adds depth to our understanding of many issues (Klaus, 2014). Think of it like climbing a ladder; each step gets you closer to fully grasping these attributes.

Klaus (2014) also discusses human biology, one of the three key perspectives. He explains how human biology interacts with pathophysiology and epidemiology (Klaus, 2014). He notes that stress and disease effects from an epigenetic angle often don't show up on skeletons (Klaus, 2014). Stress in early life can cement damage to one's biological makeup, making them more prone to stress, lowering their immune system, and leading to earlier death (Klaus, 2014).

Stress markers on skeletons have their limits in how they can be measured (Klaus, 2014). This is where Klaus (2014) suggests using epidemiology tools to help bioarchaeologists analyze and understand these markers. One tool he mentions is the odds ratio, which helps determine if prevalence differs between two samples (2014). Essentially, the odds ratio shows the likelihood of something happening in one sample compared to another (Klaus, 2014).

The main point Klaus keeps returning to is that combining these perspectives can give us a much clearer picture of how stress affects health and other factors (2014). Using these ideas and tools together can raise our understanding to higher levels, as each provides different but compatible information.

Epidemiology of Scurvy

There are many diseases that can harm a person. They fall into categories like infectious, metabolic, and epigenetic diseases, among others. Scurvy, a metabolic disease, is caused by a lack of vitamin C. You can find vitamin C in citrus fruits like oranges and grapefruits. Humans can't make their own vitamin C, so almost all of it must come from the food we eat (Baradhi, Vallabhaneni, & Koya, 2018). Vitamins are generally easy to find in well-developed places like the USA or China (Wijkmans & Talsma, 2016). Grocery stores and food stands are everywhere, and some people even have citrus plants in their yards. But in poorer places, fresh fruits and veggies with essential vitamins can be really hard to get. This lack of vitamins can lead to diseases like scurvy.

When people think of scurvy, they often imagine it as a disease from the past (Golriz, Donnelly, Devaraj, Krishnamurthy, & Donnelly, 2017). That's because, in developed countries, scurvy is rare (Wijkmans & Talsma, 2016). It's usually overlooked when diagnosing patients because such a vitamin C deficiency is uncommon (Golriz et al., 2017). When a child has scurvy, other factors or diseases often contribute to the lack of vitamin C, which is another reason it's often missed (Golriz et al., 2017). Times have changed, and other diseases are more common in developed societies, though modern practices for preventing scurvy are in place.

Presentation of Scurvy

Scurvy, like many diseases, can cause serious problems if untreated. In adults, it can be life-threatening (Ortner, 2003). But scurvy in infants wasn't seen as serious until later (Ortner, 2003). Maybe it wasn't noticeable enough before. When it does show up in infants, it affects the fastest-growing bones (Ortner, 2003). Chronic scurvy can mess with new bone growth, and since infants have faster metabolisms, it's more noticeable (Ortner, 2003). The new bone formations caused by scurvy in infants can appear on long bone shafts, skull vaults (both inside and outside), the femur's metaphysis, some arm bones, and the jaw (Ortner, 2003). Since these areas grow rapidly, signs of vitamin C deficiency can be clear. Infants under four weeks old are unlikely to have a vitamin C deficiency because they'd get it from their mothers (Ortner, 2003).

A lack of vitamin C in older kids can be seen in soft tissue and bones. Large blood collections, or hematomas, can appear on bones like the femur and tibia (Ortner, 2003). These bones bear a lot of weight, which is why large hematomas can form. In less advanced stages of scurvy, there might be unusual bleeding, but the periosteum won't be as damaged (Ortner, 2003). In adults, bleeding gums or tooth loss are other signs of scurvy (Ortner, 2003). Porosity in parts of the sphenoid and temporal bones is likely due to scurvy (Ortner, 2003). Transverse fractures on ribs in adults are also a result of little to no vitamin C intake (Ortner, 2003). In children, rickets may occur alongside scurvy or other nutritional diseases, likely because both are due to nutritional deficiencies.

Overall, curing scurvy is simple: just get enough vitamin C in your diet. Ideally, you should also get all the other necessary nutrients. Scurvy is one of the easiest diseases to cure; you just need to add the missing vitamin C to the person's diet (Cole, Warthan, Hirano, Gowen, & Williams, 2011).

Historical Overview

In the past, scurvy was a big problem for long sea voyages (Hoorn, 2018). It caused the deaths of millions of sailors (Hoorn, 2018). The link between vitamin C intake and scurvy wasn't clear until around the 20th century (Hoorn, 2018). This discovery was crucial for preventing the disease during long trips. Before, people thought keeping clean and exercising were better ways to prevent scurvy than eating fresh produce (Hoorn, 2018).

James Lind is often associated with scurvy research (Magiorkinis, Beloukas, & Diamantis, 2011). He was the first to test scurvy cures through clinical trials (Magiorkinis et al., 2011). He concluded that eating citrus fruits helped recover from scurvy (Magiorkinis et al., 2011). When he published his findings, he suggested making a citrus syrup (Magiorkinis et al., 2011). However, from a modern perspective, his solution wouldn't work well (Magiorkinis et al., 2011). Boiling something with nutritional value can reduce its nutrients (Magiorkinis et al., 2011).

Later, one of the earliest scurvy epidemics on land occurred in prisons (Magiorkinis et al., 2011). A lack of potatoes and onions among some prisoners led to scurvy (Magiorkinis et al., 2011). During the potato famine, scurvy became more common on land (Magiorkinis et al., 2011). While scurvy is often linked with sailors, there's no reason it should only be a travel-related disease.

A case study by Nina Vaezipour and Kurt Leibundgut involved treating scurvy symptoms in a young girl (Vaezipour & Leibundgut, 2018). They gave her high doses of vitamin C supplements (Vaezipour & Leibundgut, 2018). This helped for a while, but after stopping the supplements, her symptoms returned (Vaezipour & Leibundgut, 2018). Stopping the supplements might have caused the symptoms to come back. It's unclear if they gradually reduced her doses of vitamin C. Overall, her health improved quickly with vitamin C intake but worsened when she stopped taking it.

Prevalence and Prevention of Scurvy

In modern society, scurvy isn't very common. In the U.S., it's less than 10%, while in India, it's around 70% (Maxfield & Crane, 2019). The rate of scurvy depends on how developed the area is. People with a higher risk of scurvy include low-income individuals, alcoholics, and men, among other factors (Maxfield & Crane, 2019). Women need less vitamin C than men, so men are at higher risk (Wijkmans & Talsma, 2016).

Around the 19th century, parents started giving their kids juices from fruits and vegetables (Fomon & Fomon, 2001). This greatly reduced the number of infants with scurvy (Fomon & Fomon, 2001). Today, scurvy is found in malnourished people. Solutions for homeless or low-income people include soup kitchens and food pantries. While these places may not offer the best options, they still provide much-needed nutrients.

Conclusion

Overall, a vitamin C deficiency affects metabolism, so scurvy is a metabolic disease. Another disease often seen with scurvy is rickets. Nutritional deficiencies can cause many health problems. Fresh produce is easy to find in well-off areas but not in impoverished ones, leading to deficiencies (Wijkmans & Talsma, 2016). Excessive bleeding, hematomas, and tooth loss are visible in soft tissue (Ortner, 2003). Skeletal signs include transverse fractures and cranium porosity (Ortner, 2003). Scurvy is known as a sailor's disease for long voyages (Hoorn, 2018). Looking at scurvy through multiple lenses could deepen our understanding (Klaus, 2014). Using biology, pathophysiology, and epidemiology together can help in preventing and controlling this disease (Klaus, 2014). Scurvy is serious in both infants and adults. Treating it as soon as symptoms show up, and ideally preventing it, is crucial.