RESUMO
The past two decades have seen a proliferation in bioarchaeological literature on the identification of scurvy, a disease caused by chronic vitamin C deficiency, in ancient human remains. This condition is one of the few nutritional deficiencies that can result in diagnostic osseous lesions. Scurvy is associated with low dietary diversity and its identification in human skeletal remains can provide important contextual information on subsistence strategy, resource allocation, and human-environmental interactions in past populations. A large and robust methodological body of work on the paleopathology of scurvy exists. However, the diagnostic criteria for this disease employed by bioarchaeologists have not always been uniform. Here we draw from previous research on the skeletal manifestations of scurvy in adult and juvenile human skeletal remains and propose a weighted diagnostic system for its identification that takes into account the pathophysiology of the disease, soft tissue anatomy, and clinical research. Using a sample of individuals from the prehistoric Atacama Desert in Northern Chile, we also provide a practical example of how diagnostic value might be assigned to skeletal lesions of the disease that have not been previously described in the literature.
Assuntos
Paleopatologia/métodos , Escorbuto , Adulto , Arqueologia , Osso e Ossos/patologia , Criança , Chile , Diagnóstico Diferencial , Dieta , História Antiga , Humanos , Lactente , Maxila/patologia , Escorbuto/diagnóstico , Escorbuto/história , Escorbuto/patologiaRESUMO
Diverse pathological processes can produce overlapping or even indistinguishable patterns of abnormal bone formation or destruction, representing a fundamental challenge in the understanding of ancient diseases. This paper discusses increasing rigor in differential diagnosis through the paleopathological study of scurvy. First, paleopathology's use of descriptive terminology can strive to more thoroughly incorporate international standards of anatomical terminology. Second, improved observation and description of abnormal skeletal features can help distinguish between anemia or vitamin C deficiency. Third, use of a structured rubric can assist in establishing a more systematic, replicable, and precise decision-making process in differential diagnosis. These issues are illustrated in the study of two new cases of suspected scurvy from northern Peru. From this, it appears possible that ectocranial vascular impressions may further examined as a morphological marker of scurvy in the skeleton. Also, increased paleopathological attention to pellagra is long overdue, especially as it may produce generally comparable lesions to scurvy. This paper reflexively speaks to the process of paleopathological problem solving and the epistemology of our discipline-particularly regarding the ways in which we can continuously improve description and the construction of diagnostic arguments.
Assuntos
Osso e Ossos/patologia , Paleopatologia/métodos , Escorbuto/história , Escorbuto/patologia , Fatores Etários , Anemia/história , Anemia/patologia , Deficiência de Ácido Ascórbico/história , Deficiência de Ácido Ascórbico/patologia , Remodelação Óssea , Osso e Ossos/fisiopatologia , Criança , Pré-Escolar , Diagnóstico Diferencial , História Antiga , Humanos , Peru , Porosidade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Escorbuto/fisiopatologiaRESUMO
A Maya burial of a late adolescent (Burial 98-3) found in the rockshelter entrance of Actun Uayazba Kab (AUK), Belize, displays a combination of lesions that is consistent with scurvy. Signs include large, active lesions on the posterior surfaces of maxilla; relatively mild porotic hyperostosis along the midline of the skull on the parietals and occipital; cribra orbitalia; potential pinprick lesions on the greater wings of sphenoid and temporal; reactive lesions on the palate, temporal lines of frontal and parietals, and external and internal surfaces of zygomatics; small lesions on the popliteal surfaces of both femora; and periodontal disease. Identification of scurvy at AUK potentially informs the analysis of other primary burials and scattered bone found there and at other nearby sites, which often reveal evidence of nonspecific lesions that are usually attributed to anemia and infection, but that are also consistent with scurvy. The social and ecological context of this Protoclassic (0-AD 300) individual, who lived in a rural agricultural community with no evidence of complex social hierarchy, contrasts with typical discussions of disease among the Maya, which tend to focus on the degrading effects of overcrowding and resource deficiencies. While scurvy has been largely overlooked in the Maya area, this study supports earlier arguments for its presence that were based largely on clinical and ethnographic analogies and suggests the need to incorporate scurvy into broader synergistic models of ancient health.
Assuntos
Osso e Ossos/patologia , Escorbuto/patologia , Adolescente , Adulto , Antropologia Física , Belize , Sepultamento , Feminino , Humanos , Indígenas Centro-Americanos , Masculino , Adulto JovemRESUMO
Se relata el caso de una paciente de sexo femenino, de 21 años de edad que se autoprovocó Escorbuto. Tubo severas manifestaciones articulares y hematológicas que exigieron el diagnóstico diferencial con Lupus Eritematoso Sistemico. Se le administró Acido Ascórbico con lo que presentó regresión total de su sintomatológía.