Bioarchaeological Perspectives on Stress and Disease with a Focus on Scurvy

The article called “Frontiers in the Bioarchaeology of Stress and Disease: Cross-Disciplinary Perspectives From Pathophysiology, Human Biology, and Epidemiology” by Haagen D. Klaus (2014) reviews a few different aspects of a cross-disciplinary view. He describes three different ideas including pathophysiology, human biology, and epidemiology and gives examples of how they interlock with each other (Klaus, 2014). These three perspectives are different in their own ways but when put together they could be insanely useful in that more information is always better than a lack of information.

Klaus explains that pathophysiology helps to provide deeper understandings of the meaning of changed or damaged bone, among origination of diseases, and lastly observable pathological characteristics (2014). New bone formation due to inflammation is shown in the article by Klaus (2014) to be a symptom of biological stress when it is in the context of infection. Another finding that is stated by the author when talking about pathophysiology is that osteoarthritic disturbances or changes are caused by the loss of ability to keep up with joints that are in good condition (Klaus, 2014). The pathophysiology aspect of this cross-disciplinary approach serves to add to the depth of information and cause of many different things (Klaus, 2014). This example can be compared to rungs in a ladder as it is just one step up to reach a higher understanding of the meanings of attributes in this approach.

Klaus (2014) talks about different characteristics of the human biology feature in the article as its one of only three important perspectives that he goes over. He explains how human biology interacts with the other perspectives, pathophysiology, and epidemiology (Klaus, 2014). Including that the resulting detrimental features of stress and disease from an epigenetic standpoint are not often able to be seen on the skeleton (Klaus, 2014). In the early life of an individual if stress occurs this could result in the cementation of damage to their biological make up according to Klaus (2014). In response to that he explains that it could result in making them susceptible to stress, drops their immune system and leads to loss of life at an earlier age (Klaus, 2014).

The signs of stress on a skeleton have limitations in the ways that they can be measured (Klaus, 2014). This is where Klaus (2014) comes in and proposes that the different tools that are used in epidemiology can be used to help bioarchaeologists in their tasks of analyzing and understanding the different markers. One of the tools in epidemiology that Klaus talks about is called odds ratio, this helps to find out if prevalence is different between two different samples (2014). Essentially, odds ratio shows how likely whatever someone is measuring is going to happen in one sample in comparison to an additional or second sample (Klaus, 2014).

The main idea that Klaus keeps coming back to in the article is that these different perspectives can be combined to create an even more thorough understanding of how stress affects health among other things (2014). Each of these ideas and tools can be used in tandem to rise to higher levels of comprehension as they each work in their own ways to find different and yet compatible information.

Epidemiology of Scurvy

There are many different types of diseases or conditions that have detrimental effects on a person. These can be grouped in different categories such as infectious, metabolic, and epigenetic diseases, among others. As a metabolic disease, scurvy is caused by a lack of vitamin C in someone's diet. Vitamin C can be found in many things such as any type of citrus fruit like oranges or grapefruit. Humans are not able to create their own vitamin C and therefore just under one hundred percent of consumption needs to come from surrounding fruits and vegetables (Baradhi, Vallabhaneni, & Koya, 2018). Vitamins in general are also not hard to come by in a well developed area such as the United States of America or China (Wijkmans & Talsma, 2016). This is because there are grocery stores or food stands around every corner and citrus plants in people’s backyards in these areas. On the contrary, in underdeveloped or poverty stricken areas fresh fruit and vegetables with important vitamins and nutrients can oftentimes be severely hard to come by. This lack of vitamins can eventually lead to diseases such as scurvy.

When people think of the disease scurvy, they think of it as being centralized around the past (Golriz, Donnelly, Devaraj, Krishnamurthy, & Donnelly, 2017). The main reason being is that in developed countries it is often rare to have a case of scurvy (Wijkmans & Talsma, 2016). It is generally overlooked when evaluating a patient because it’s not common to have such a deficit of vitamin C (Golriz et al., 2017). Oftentimes when a child has scurvy there are other factors or other diseases that contribute to the lack of vitamin C, which is an additional reason that it is often left unnoticed (Golriz et al., 2017). Times have changed and there are other diseases that are more prevalent in developed societies, though modern practices for preventing scurvy are underway.

Presentation of Scurvy

Scurvy, like many other diseases can cause detrimental things to happen if it is left unchecked. In adults, there is a very high chance of loss of life and therefore its seen as a serious disease (Ortner, 2003). Although scurvy in infants was not looked at as being serious until later on (Ortner, 2003). This could be because it did not manifest enough to where it was noticed. Although, when it does manifest in infants it shows up in the bones that grow the fastest (Ortner, 2003). The reason for this is that chronic scurvy can affect the new bone formations and as infants’ metabolisms are higher this tends to be more noticeable (Ortner, 2003). The recently developed bone formations caused by scurvy in infants can be found on long bone shafts, the skull vault including endocranial and ectocranial areas, the metaphysis of the femur and some bones of the arm, and lastly the area of the jaw (Ortner, 2003). As some of these are areas that rapidly grow, the signs of vitamin C deficiency can be apparent. In infants that are less than four weeks old it is unlikely to find a vitamin C deficiency among them because the mother would have had to pass it to the child (Ortner, 2003).

In addition, a lack of vitamin C in subadults can be visible in soft tissue as well as skeletal areas. A large collection of blood, also called a hematoma can be found on bones such as the femur and tibia (Ortner, 2003). These bones are ones that tend to hold a lot of weight, hence why large hematomas are able to occur on them. In not as progressed stages of scurvy it may appear in that there's atypical bleeding in areas, but the periosteum will not be as damaged (Ortner, 2003). In living adult patients gums that bleed regularly or even the loss of teeth is another sign of scurvy (Ortner, 2003). Porosity of cortical bone of a part of the sphenoid and temporal bones are found to most likely be caused by scurvy (Ortner, 2003). Transverse fractures on the ribs in adults is an effect of having little to no vitamin C intake (Ortner, 2003). It is also likely that in children rickets occurs along with scurvy or any other nutritional disease. Mainly because, they are both due to nutritional deficiencies, therefore one is likely to come with the other.

Overall, the cure for scurvy is a very simple one. Which is to get a regular intake of vitamin C into a person's diet. Also, ideally that along with all the other nutrients that are needed in cases with not only scurvy but rickets as well. This may be because of the lack of nutrients in a diet in general. Scurvy is seen to be one of the simplest ways to cure a disease as you are just adding vitamin C that they did not have to their diets (Cole, Warthan, Hirano, Gowen, & Williams, 2011).

Historical Overview

In the past, scurvy was a huge debilitation of traveling overseas for a large period of time (Hoorn, 2018). This disease is responsible for the deaths of millions of seamen (Hoorn, 2018). The intake of vitamin C was not directly linked to scurvy until around the twentieth century (Hoorn, 2018). This link was the most important thing in order to not become sick when journeying on long voyages. Previously, it was thought that having clean areas and getting exercise while traveling was a better thing to do to prevent scurvy than consuming fresh produce (Hoorn, 2018).

In addition, James Lind is often connected to the research of scurvy (Magiorkinis, Beloukas, & Diamantis, 2011). He was the first to test cures for scurvy by holding clinical trials (Magiorkinis et al., 2011). He later went on to conclude that consuming citrus fruits is linked with recovering from scurvy (Magiorkinis et al., 2011). When he published his findings, he stated that his solution involved the making of a citrus syrup (Magiorkinis et al., 2011). Although, looking at his solution with a modern take it would not be feasible (Magiorkinis et al., 2011). This is because altering something with nutritional value that is needed by boiling will diminish the nutrients within it (Magiorkinis et al., 2011).

Later on, one of the earliest scurvy epidemics on land occurred in prisons (Magiorkinis et al., 2011). This was found to be because of a lack of potatoes and onions in some prisoners resulted in scurvy (Magiorkinis et al., 2011). Farther down the road, when the potato famine hit scurvy showed up on land more often (Magiorkinis et al., 2011). While scurvy is known to be linked with sailors there is not any reason that it would solely be a traveling disease.

There is a case study by Nina Vaezipour and Kurt Leibundgut that involves the treatment of symptoms of scurvy in a young girl (Vaezipour, & Leibundgut, 2018). They ended up giving her regular high doses of vitamin C supplements (Vaezipour, & Leibundgut, 2018). This helped for a while but after stopping the supplements she reverted back to having symptoms (Vaezipour, & Leibundgut, 2018). Cutting off the supplements may have had an effect on her resuming symptoms. It is not specified if they gradually reduced her doses of Vitamin C or not. Overall, the intake of vitamin C rapidly increased her health and when she stopped them it reverted back.

Prevalence and Prevention of scurvy

In a modern society scurvy is not very abundant. In the United States its less than 10% while in India it is around 70% (Maxfield, Crane, 2019). Depending on how developed the area is the rate of scurvy varies. Individuals with a higher risk of getting scurvy can include low-income, alcoholics, and men among other factors (Maxfield, Crane, 2019). Women do not need as much vitamin C as men do and therefore men can be at higher risk than women (Wijkmans & Talsma, 2016).

Around the 19th century, parents started to supplement their children's diets with different juices from vegetables and fruits (Fomon, & Fomon, 2001). This served to reduce the number of infants with scurvy by a large amount (Fomon, & Fomon, 2001). Nowadays, scurvy is apparent in malnourished people and a solution to people that are homeless or in poverty is soup kitchens and food pantries. Although, these places may not offer the best options they still offer much needed nutrients.

Conclusion

Overall, a vitamin C deficiency is connected to the metabolism and therefore it is classified as a metabolic disease. Another disease that falls into this category and is often occurring at the same time as scurvy is rickets. Nutritional deficiencies can cause many health problems to happen. Fresh produce is easy to come by in modern areas that are well off. Though it is the opposite in impoverished areas, which may lead to nutritional deficiencies among the population (Wijkmans & Talsma, 2016). Excess bleeding, hematomas and loss of teeth are apparent on soft tissue (Ortner, 2003). While the skeletal manifestations include but are not limited to transverse fractures and porosity of the cranium (Ortner, 2003). Scurvy is known to be a disease that sailors get when traveling over a long amount of time (Hoorn, 2018). If scurvy was looked at with a combination of different aspects, this would lead to a higher understanding of the disease (Klaus, 2014). Using the biology, pathophysiology, and epidemiology aspects will only help the knowledge of this disease and be useful in prevention and control of it (Klaus, 2014). Diseases such as scurvy are serious in both infants and adults. It is ideally important to treat them as soon as the symptoms occur, and preferably prevent them before they even manifest.