Anemia and Childhood Mortality: Latitudinal Patterning Along the Coast of Pre-Columbian Peru Deborah E. Blom, 1 * Jane E. Buikstra, 2 Linda Keng, 3 Paula D. Tomczak, 4 Eleanor Shoreman, 5 and Debbie Stevens-Tuttle 6 1 Department of Anthropology, University of Vermont, Burlington, Vermont 05405 2 Department of Anthropology, University of New Mexico, Albuquerque, New Mexico 87131 3 Department of Anthropology, University of Houston, Houston, Texas 77204 4 Department of Anthropology, University of New Mexico, Albuquerque, New Mexico 87131 5 Department of Anthropology, Vanderbilt University, Nashville, Tennessee 37235 6 Department of Neurology, University of Vermont, Burlington, Vermont 05405 KEY WORDS paleopathology; porotic hyperostosis; skeletal biology; Andes; parasites ABSTRACT Hrdlic ˇka ([1914] Smithson. Inst. Misc. Collect. 61:1– 69) reported that pre-Columbian skeletal material from the coastal lowland Andean region exhib- ited a high frequency of porotic hyperostosis, a patholog- ical condition of bone that generally is thought to indicate childhood anemia. While subsequent studies tended to reinforce this conclusion, factors implicated in the condi- tion have yet to be fully explored in the region as a whole. This study explores regional and intravalley variation as one step in establishing biocultural variables that in- crease the apparent risk of childhood anemia. The study sample includes 1,465 individuals: 512 from Peruvian col- lections housed at the Field Museum of Natural History, and 953 from systematically excavated contexts from Mo- quegua, Peru. Environmental stressors, such as parasites and disease, rather than specific dietary practices were found to be more likely associated with childhood anemia in these coastal Andean samples. The study supports cri- bra orbitalia as an earlier expression of porotic hyperos- tosis and suggests that porotic hyperostosis, as recorded here, cannot be easily dismissed as a result of cranial shape modification. No clear temporal patterns were ob- served. Finally, the study establishes that comparing data for children and adults can reveal the relative association between childhood anemia and mortality. Childhood mor- tality associated with anemia was elevated where the presence of tuberculosis or tuberculosis-like conditions was more common and the presence of water-borne patho- gens was negligible. In contrast, those buried at lower altitudes, closer to the coast, and consuming mainly ma- rine resources were less likely to die in childhood with anemia than in the other contexts studied. Am J Phys Anthropol 127:152–169, 2005. © 2004 Wiley-Liss, Inc. The archaeological record of coastal Peru is excep- tionally rich. Human remains, organic artifacts, and diverse remnants of human subsistence are well- preserved due to extreme aridity in archaeological sites that date back at least 10,000 –11,000 years. Consequently, archaeologists and collaborative sci- entists have been unlocking various aspects of the rich pre-Columbian archaeological record in Peru and the broader Andean region for more than 100 years. Working with an extensive human osteologi- cal sample of 3,400 individuals from Andean sites such as Chan Chan and Pachacamac, Hrdlic ˇka (1914) first noted that pre-Columbian Andean skel- etal material from the coast exhibits a high fre- quency of porotic hyperostosis, a pathological condi- tion of bone generally thought to indicate childhood anemia. More recent work reaffirmed the presence of porotic hyperostosis in additional Andean con- texts (e.g., El-Najjar, 1976; Allison, 1984; Fouant, 1984; Benfer, 1990; Williams, 1990; Ubelaker, 1992; Verano, 1992, 1997; Burgess, 1999; Tung, 2003; Far- num, 2002). The present study extends this research by incorporating a large sample of human remains from coastal archaeological sites to examine regional patterning in ancient Peruvian porotic hyperostosis. Porotic hyperostosis (also termed cribra cranii ex- terna, symmetrical osteoporosis, osteoporotic pit- ting, and spongy hyperostosis) is an increase in the cranial diploe ¨ at the expense of the outer table, resulting in a thinning and porosity of the cortex (Moseley, 1966; Steinbock, 1978; Ortner and Put- schar, 1985; Stuart-Macadam, 1985; Walker, 1985; Hershkovitz et al., 1997). It is characterized on ra- diographs by a “hair-on-end” appearance, and can also take the form of cribra orbitalia, i.e., orbital roof *Correspondence to: Deborah E. Blom, Department of Anthropol- ogy, University of Vermont, Williams Hall 508, Burlington, VT 05405- 0168. E-mail: Deborah.Blom@uvm.edu Received 17 December 2002; accepted 16 September 2003. DOI 10.1002/ajpa.10431 Published online 19 November 2004 in Wiley InterScience (www. interscience.wiley.com). AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 127:152–169 (2005) © 2004 WILEY-LISS, INC.