A study of cribra orbitalia over time and space in the ancient Nile Valley Nicole E. Smith Department of Anthropology, University of Arkansas Introduction Methods Results Discussion & Conclusions Acknowledgments A great deal of credit is owed to my advisor, Jerry Rose, for coming up with the idea for this project, guiding me through the design, and helping me understand the results. Additional thanks go to Mike Plavcan for his advice regarding the statistical analysis of data gathered for this study. Literature Cited Bianucci R, Mattutino G, Lallo R, Charlier P, Jouin-Spriet H, Peluso A, Higham T, Torre C, Rabino Massa E. 2008. Immunological evidence of Plasmodium falciparum infection in an Egyptian child mummy from the Early Dynastic Period. Journal of Archaeological Science 35:1880–1885. Gowland RL, Western AG. 2012. Morbidity in the marshes: Using spatial epidemiology to investigate skeletal evidence for malaria in Anglo-Saxon England (AD 410–1050). American Journal of Physical Anthropology 147:301–311. Rabino Massa E, Cerutti N, Marin A, Savoia D. 2000. Malaria in Ancient Egypt: Paleoimmunological investigation on predynastic mummified remains. Chungará 32:7–9. Sallares R, Bouwman A, Anderung C. 2004. The spread of malaria to Southern Europe in antiquity: new approaches to old problems. Medical History 48:311–328. Steckel RH, Rose JC (eds). 2002. The backbone of history: health and nutrition in the Western Hemisphere (Vol. 2). Cambridge: Cambridge University Press. Walker PL, Bathurst RR, Richman R, Gjerdrum T, Andrushko VA. 2009. The causes of porotic hyperostosis and cribra orbitalia: A reappraisal of the iron-deficieŶcy-anemia hypothesis. American Journal of Physical Anthropology 139:109–125. For further information Please contact nes003@uark.edu http://uark.academia.edu/NicoleSmith Cribra orbitalia (CO) is one of the most common skeletal lesions noted in ancient human skeletal remains excavated from the Nile Valley. Long thought to be a sign of iron-deficiency anemia, CO is now indicated to be triggered in fact by megaloblastic and hemolytic anemia (Walker et al 2009). Results showed generally high CO rates between 10.8% and 78.7% of the total population affected, with an overall mean of 42.8%. Figure 3 shows the greater overall rates of CO in the Nile Valley sample compared with other global CO meta-analyses. Interestingly, the Nile Valley CO distribution only overlaps slightly with the English sample associated with P. vivax malaria infection. The gradual increase in CO over space and time that was hypothesized for this study was not confirmed by the results. Rates of CO in the Nile Valley are generally high throughout time and space when compared with New World samples, and showed no association with location, estimated date, proportion of subadults, social status, or date of report publication. From these results, the following interpretations can be made: • Contrary to small-scale comparisons between sites, CO does not increase or decrease in frequency, but stays prominent over time throughout the Nile Valley. • The failure to associate CO frequency with social status or age suggest that the main cause of the high CO rates is not class- specific or age-specific (like diet, exposure to parasitic worms, or nutritional stress caused by weaning). • Assuming that CO is indicative of malaria infection, this disease must have been endemic in the Nile Valley long before Dynastic Egypt. This interpretation is supported by aDNA evidence, and pushes back the date for theoretical models of ŵalaria’s spread out of Africa. This study has shed new light on the patterns of health in the ancient Nile Valley by providing a holistic view of anemia present throughout time and space. Through comparison with Gowland aŶd WesterŶ’s ;ϮϬϭϮͿ EŶglish ŵalarial saŵple, this study has also potentially provided the first interspecific malarial comparison through large-scale CO frequencies. Due to uncertainties surrounding the etiology of CO, further research is needed to fully understand the processes involved in causing these skeletal lesions. Future directions for this project will involve an in-depth investigation into the link between CO and malaria infection through clinical comparisons. This study surveyed CO frequencies tallied in site reports from 29 ancient Nile Valley sites, representing 4,760 individuals ranging from prehistoric to Christian periods (4400 BC – 1500 AD) and situated between upper Nubia and the Nile delta. See handout for the sources of data used in this meta-analysis. Analysis of the data consisted of: • Exclusion of samples of n<15, as well as sites reporting poor skeletal preservation. • Comparison of overall distribution of the data to other existing CO meta- analyses. • Determination of associations through SpearŵaŶ’s raŶk aŶd KeŶdall’s tau correlatioŶs. One of the main causes of acquired hemolytic anemia is malaria infection. Evidence supporting the link between CO and malaria infection include the following: • CO present in 92% of skeletons testing positive for Plasmodium falciparum DNA (Rabino-Massa et al 2000). • Higher rates of CO lesions on skeletons buried near locations of greater Anopheles mosquito distribution and known malaria infection from historical records (Gowland & Western 2012). Some theoretical models have pointed to the Nile Valley as the pathway of malaria from Africa to Europe within the time frame of Dynastic Egypt (Sallares et al 2004). Through aDNA analysis of EgyptiaŶ ŵuŵŵies, direct evideŶce of ŵalaria’s preseŶce iŶ the Nile Valley dates as far back as 2820 BC (Bianucci et al 2008); however, we do not know the prevalence, spread, or endemic/epidemic status of the disease in this region in antiquity. The objectives of the present study were as follows: • To test the theoretical Dynastic Egyptian time frame for the spread of malaria up the Nile Valley and out of Africa. • To use variability in levels of CO present on ancient Egyptian and Nubian remains to track the spread of malaria. • To test a hypothesized increasing trend in CO frequency over time from South to North in the Nile Valley. Figure 1. Cribra orbitalia present on the left orbit of a skull from Amarna, Egypt. Photo credit: Amarna Project. As shown in figures 4 and 5, the data showed no significant correlation over time and geographical location, suggesting that high levels of hemolytic anemia affected individuals in the Nile Valley equally from pre-dynastic to Christian periods. No association was found between the frequency of CO present at the sites and proportion of subadults in the sample, social status of the cemetery, or year of report publication. Figure 2. Google map image showing the location of the sites used for the present study. N Figure 4. Scatterplot showing no trend in cribra orbitalia rate over site location in the Nile Valley. Figure 5. Scatterplot showing no trend in cribra orbitalia rate over time in the Nile Valley. Figure 3. Boxplot showing cribra orbitalia frequency distributions for each location, with the horizontal line representing the median, red box representing 50% of the data, and vertical lines extending to 95% confidence interval limits. The dots represent outliers.