March 29, 2012

Leprosy in an Imperial Roman Child

There's an interesting article that's just been accepted for publication in the International Journal of Osteoarchaeology on possible leprosy in a 4- to 5-year-old child from the Imperial-era Roman suburbium.  It's by Mauro Rubini and Paola Zaio (who previously published evidence of a leper warrior from Italy), Mark Spigelman and Helen Donoghue (who have published on aDNA evidence of leprosy), and Yilmaz Erdal (who seems to have provided the sample from Turkey) -- "Palaeopathological and molecular study on two cases of ancient childhood leprosy from the Roman and Byzantine Empires."

The gist of the article is that evidence of leprosy in children is quite rare in the palaeopathological literature, possibly because the characteristic bony changes seen in the disease - rhinomaxillary syndrome or facies leprosa - are more often identified as pathological in adults, whose skulls have fully formed.  So the authors are presenting information on two subadults with bone changes to the skull - one from Imperial-period Italy and one from Byzantine-era (8th-9th century AD) Turkey.

Skeletons from Martellona
The ancient Roman child comes from the necropolis of Martellona, a site that was located along the via Tiburtina, quite close to Tivoli in the Roman suburbium.  Rubini reports that there are over 400 excavated graves and that the cemetery was in use from the 6th century BC through the 4th century AD.  For the most part, burials were in cappuccina style, and "the site shows an economy substantially agricultural and very poor."  The child in question dates to the 2nd-3rd centuries AD according to grave goods (two nearby burials were carbon dated to 193 AD +/- 25 years), and all that remains of the skeleton are the cranium, mandible, left clavicle, and first and second left ribs.  Unlike the Byzantine cemetery, where two males and one female in addition to the infant showed pathognomonic characteristics of leprosy, the Roman cemetery did not present any other evidence of leprosy in the population.

Bony changes in the skull of the Roman child are considerable.  There is erosive activity in the maxilla, including resorption of the area where the right central and lateral incisors would have been, and erosive activity and remodelling of the anterior nasal spine, the inferior portion of the nasal aperture, and both inferior nasal conchae.  The forehead slopes backward, and there is pitting and a cloaca in the hard palate.  The Byzantine child, on the other hand, has no signs of leprous lesions other than porosity of the occipital and parietals endocranially.

In their differential, the authors rule out lupus, actinomycosis, mucormycosis, sarcoidosis, treponemal disease, and noma.  For the Roman child, the authors conclude that:
Fig. 4 from Rubini et al. 2012
Important osteological changes are present in the rhinomaxillary region.  The resorption of the anterior nasal spine, the enlargement and rounding of the piriform aperture and erosion of the alveolar margin accompanied by the loss of the front teeth shown in our case are the classic changes seen in leprosy referred to as facies leprosa. [...] Furthermore, the perforation of the hard palate is present.  This last change is strongly pathognomonic in leprosy diagnosis.  An initial examination of the Martellona sample for M. leprae DNA in the Jerusalem laboratory was unsuccessful (data not shown).
So, the bony evidence in the Roman child is suggestive of the leprous changes we normally see in adults, but the DNA test was negative.  In the Byzantine child, there were no lesions indicative of leprosy, but a DNA test was positive for M. leprae.  That's odd.

The findings in this study are interesting, but there are several questions that I would have raised had I reviewed this article:
  • What is the context of the Roman child?  There are no published data from Martellona, either osteologically or archaeologically, even though it was excavated over a decade ago according to this brief mention of the cemetery.  I'd never heard of the cemetery until today (which isn't surprising, since there is a considerable amount of Italian bioarchaeological literature published in ways that are hard to find in a web or library search in this country), but there are also no citations to this cemetery anywhere in the article.
  • Why was the Byzantine child tested for leprosy?  I suspect that the association with other leprous individuals in the cemetery and the curious porosity on the endocranial surface of the skeleton led researchers to suspect leprosy.  But this is not specifically remarked on in the paper.  It does seem that the three adults with pathognomonic lesions were subject to DNA testing and at least one was positive for M. leprae.  The case for the presence of leprosy in the Byzantine population as a whole is much stronger than the case for leprosy in the Roman population, although little is mentioned about the Byzantine population in the article.
  • How do we know that facies leprosa is the same in subadults as in adults?  The authors note that "Today there are no literature or hospital reports on children under 4-5 years with lepromatous leprosy that show such an involvement of the bones, even in underdeveloped countries where the medical control is difficult."  They further note that "studies on leprosy sufferers in the absence of drug therapy show changes in the rhinomaxillary skeletal region only after about 7-10 years from the likely date of infection. Therefore, this is the most likely reason why today children under 14 years of age with leprosy do not show significant changes in the facial bones."  The Roman child has significant bony changes to the face, suggesting advanced leprosy -- so the child would have to have been infected very young, even in utero -- and still the time-frame is off.  Of course, it's possible that leprosy (or this particular form) was more aggressive than it is today, but now we're just guessing.
I'm disappointed that the Roman skeleton did not provide DNA evidence of leprosy because, as the authors note, "the case of Martellona is the first case in Italy (and possibly the world) of a child under 5 years of age with a clear rhinomaxillary syndrome." And so I'm skeptical about Rubini and colleagues' conclusions with respect to the Roman child because:
  • The skeleton is incomplete.  After all, it was just a head.  Who knows what lesions may have been on the postcranial skeleton and how those lesions may have affected a differential diagnosis?
  • There is a complete lack of contextual information about the population.  Did other skeletons have evidence of leprosy?  Tuberculosis?  Other conditions considered in the differential?
  • There is no DNA evidence of M. leprae.
The Byzantine case is a bit more straightforward, though, leading the authors to write:
The case from Kovuklukaya displays no pathognomonic bone changes for leprosy but the palaeopathology is consistent with a chronic inflammatory response and specific PCR is positive for M. leprae DNA.  We believe that this is the youngest individual in the world known to have had leprosy in the past.  In sum, this study suggests that skeletal changes on young children must be analyzed in detail and aDNA analysis should be applied on subadult individuals, especially those who have non-specific infectious lesions, who are in populations with adult individuals with pathognomonic lesions of leprosy.
This conclusion is very interesting, and I think Rubini and colleagues are right to suggest that, with the current availability of biochemical analysis, testing subadults in a population with known evidence of leprosy is a key path forward in understanding the prevalence of the disease in the past.  I'm not convinced yet that this Roman child had leprosy -- the differential didn't sell me on that diagnosis -- but I'm also not an expert on the disease.

I hope to hear more about the Martellona cemetery, particularly what sorts of pathologies other individuals in the population suffered from, in the future.  It could be a very interesting comparison site to the Imperial-era cemeteries that have been published from the Roman suburbium.

Rubini, M., Erdal, Y., Spigelman, M., Zaio, P., & Donoghue, H. (2012). Paleopathological and Molecular Study on two Cases of Ancient Childhood Leprosy from the Roman and Byzantine Empires International Journal of Osteoarchaeology DOI: 10.1002/oa.2242

Rubini, M., & Zaio, P. (2011). Warriors from the East. Skeletal evidence of warfare from a Lombard-Avar cemetery in Central Italy (Campochiaro, Molise, 6th–8th Century AD) Journal of Archaeological Science, 38 (7), 1551-1559 DOI: 10.1016/j.jas.2011.02.020

Spigelman M, & Donoghue HD (2001). Brief communication: unusual pathological condition in the lower extremities of a skeleton from ancient Israel. American Journal of Physical Anthropology, 114 (1), 92-3 PMID: 11150055

Further Reading
Thanks to Jeff Becker and Mitch Fraas, who pointed me at these two brief reports on the necropolis at Martellona:  Di Sante, S., Presen, G., 2002. Guidonia: nota di scavo in località Martellona. Notiziario Archeologico (Associazione Nomentana di Storia e Archeologia), Annali 2002, pp. 88–101.  Moscetti, E., ed.  2003. Guidonia Montecelio Localita Martellona (don Uva). Necropoli. Notiziario Archeologico (Associazione Nomentana di Storia e Archeologia), Annali 2003, pp. 152-4.

March 28, 2012

Who needs an osteologist?

One of the stocks-in-trade over here at Powered by Osteons is featuring photographs of skeletons laid out incorrectly.  Since this isn't just a one-off event, I'm going to rechristen the series with the rhetorical question, "Who needs an osteologist?"

Some may say that I'm being needlessly picky.  But one of my pet peeves is presenting incorrect information to the public.  Even if an osteologist can't be found, a medical doctor should remember enough of her training to consult on the layout of a skeleton.  If a doctor cannot be found, there are anatomy books that can work much like the picture on the box of a puzzle yet to be put together.  And if an anatomy book can't be procured, well, there's the internet.

Back to today's episode, which takes place in Italy.  As far as I can tell, this skeleton is going to be put on display at the Museo delle Grotte.  I hope that museum staff consult an osteologist before showing this to the public:
Roman skeleton from Grotte di Toirano (credit)
I'll leave it to you to figure out what's wrong with the skeleton.  Feel free to discuss in the comments!  (And if you happen to come across a skeleton you want featured on "Who needs an osteologist?", drop me an email.)

For previous episodes of "Who needs an osteologist?" check out:
Speaking of Bones, it returns next week.  Have you caught up on all my reviews?

March 20, 2012

From Birth to Burial: the Curious Case of Easter Eggs

Ever wonder why the humble egg is the focus of the most important Christian holiday?  The egg is ubiquitous and cheap today, often the product of backyard coops managed by hipsters keen on urban farming.  But this incredible, edible source of protein was, millennia ago, a potent religious symbol.

Earth and Sun at the Equinoxes (credit)
It all started with the spring or vernal equinox (which, this year, is today).  During the equinox, the sun is directly over the equator, and sunlight is (basically) evenly distributed between the north and south hemispheres.  Numerous cultures around the world have celebrations for the beginning of spring.  For example, in Japan, today is a national holiday, Vernal Equinox Day, where families visit graves of their ancestors and hold reunions. Prior to 1948, the day was celebrated as a Shinto holiday, Koreisai, a time to pray for a successful growing season and a time to venerate the ancestors.  And modern Egyptians today celebrate the national holiday of Sham el-Nessim, going on picnics and eating lettuce and onions, foods that were customarily offered to the ancient Egyptian gods for Shemu, or the start of the third Egyptian season, a holiday that dates back to around 2700 BC.

So spring is the start of a new growing season, a rebirth of crops that have been dormant through the winter and the beginning of a time of plentiful food, a time that was crucially important for the yeomen of antiquity who lived perpetually on the edge of famine.  The relationship between the start of spring and the return of crops can also be seen in ancient Roman culture.  The month of March was named for the Roman god Mars, who - in addition to his role as the god of war - was also a god of fertility; sacrifices for the health of one's cattle were often made to Mars Silvanus (Cato, de Agricultura LXXXIII).  And it was Julius Caesar who established the date of the spring equinox in his calender reform of 45 BC, fixing it as March 25 (a date that was later changed to March 20/21 through the vagaries of leap days in the first few centuries AD).

The spring equinox has long been important in reckoning time in the political sense - from the ancient Iranian calendar, which began on the vernal equinox, to the Julian calendar.  But it's also quite important in reckoning time in the religious sense.  In Jewish tradition, Passover was originally intended to track the vernal equinox, although reforms in the Hebrew calendar in the fourth century AD mean the celestial event doesn't determine the date of Passover anymore.  And in Christian tradition, Easter falls on the first Sunday after the first full moon on or after the vernal equinox.  In fact, our word Easter comes from an Old English word referring to the month of April, named after the pagan goddess of the dawn.  (In other modern languages, Easter is called a variant of Paschal, a word that can refer to either Easter or to Passover, demonstrating the strong link between these two Judeo-Christian celebrations.)  Spring is a time to celebrate - whether it's the start of the year, the season for sowing, the release of slaves from Egypt, or the resurrection of a savior, spring means starting anew.  

Chocolate Eggs (credit)
But back to eggs.  Most of us take for granted the association of eggs with Easter, particularly when that association involves the words Cadbury, Kinder, or Reese's.  But before the egg became firmly linked to Christianity, it was a symbol of life dating back at least 2,500 years.

Our first historical records of egg symbolism in religion date to about 500 BC.  In the Achaemenid period, the Iranian calendar was influenced by Zoroastrianism, and the spring equinox - the first day of their calendar year - became a holiday.  Called Nowruz, this holiday is often celebrated today by decorating, sharing, and eating eggs, and may have been celebrated similarly in the past, as a carved relief from Persepolis (dating to around 500 BC) seems to depict noblemen carrying colored eggs:

Relief from Persepolis (credit: Encyclopaedia Iranica)

But it's not clear that the Persians had much of an influence on early Christianity.  To see the beginnings of the egg as a Christian symbol, then, we have to look at the Roman world.  In pagan times, eggs were part of the Bacchic or Dinoysian mysteries, possibly a chthonic symbol (Macrobius, Saturnalia 7.16); they could be used to cast spells and, conversely, to offer protection (Clarke 1979).  A fortified castle was built in the 15th century in the Bay of Naples, but legend has it that the poet Virgil (1st c BC) buried an egg on the site for protection, hence the modern name of the structure: Castel dell'Ovo

Hatchling (credit)
The symbolic uses of the egg varied in the Roman world, but the link between eggs and birth is fairly straightforward. The Romans had plenty of species of birds, and most people probably would have observed chickens, pigeons, or other fowl laying eggs out of which new life hatched.  Roman medicine was greatly influenced by the Hippocratic treatises (c. 400 BC), which sometimes used egg-hatching as comparanda for human birth.  In de Natura Pueri (29.1-3), a human baby breaking out of the confines of the womb is described in direct analogy to a chick breaking out of its shell (Hanson, 2008).  

But by the early Imperial period (1st c AD), we get the association of eggs with burials.  There aren't that many examples of these burials in the bioarchaeological record, though.  At Colchester, York, and Winchester in Roman Britain, eggs have been found in or near cremation urns and inhumation burials (Pollexfen 1867, Wenham 1968, Clarke 1979), and eggs are sometimes depicted on Roman sarcophagi (Nilsson 1907), suggesting they were a symbol for all social classes.  Eggshells are fairly thin, so archaeological excavation techniques prior to about 1980 might very well have missed additional examples of eggs in Roman burials.  Two cases of burial with an egg have been found recently in Rome, though.  

At the site of Castellaccio Europarco, whose skeletons I studied for my dissertation, Tomb 31 was the burial of a 3- to 4-year-old child, dating to roughly 50-175 AD.  The archaeologists note that: "under the left hand of the deceased is a chicken egg, which in a funeral context is probably not only a material offering of food, but perhaps also an allusion to eschatological renaissance (rebirth).  Besides the presence of the egg, the method of disposition of the child is interesting: s/he presents on his/her stomach. This position is very rare in the context of Roman cemeteries" (Buccellato et al., 2008:18-19 [translation mine]).  And in the Vatican necropolis under the via Triumphalis, a child a little less than a year old was found buried with an egg.  This burial dates to around the same time as the Castellaccio child, about 50-150 AD, although this child was buried facing up and had additional grave goods.  Excavators write that the egg is most likely "a symbol of rebirth, a new life balancing the injustice of a premature end" (Liverani et al., 2010; 229 [translation mine]).

Figure 74 from Liverani et al. (2010)
It is possible that these two children represent early Christian burials, as the egg has been strongly wedded to the idea of rebirth since the life, death, and resurrection of Jesus.  The egg "is an apparently animate and inert substance which carries within itself a potent principle of life, and that which has a special vital power must perforce awake or enhance the vital powers of those to whom it is offered" (Nilsson 1907, quoted in Alcock 1980: 56).  This could explain the association: the dormant egg, like the tomb of Jesus, contains new life within it.  The eggshell is the rock that sealed the tomb of Christ.  

Historical evidence of eggs being linked to Jesus, though, is kind of uncertain.  There is surprisingly little in the Bible about eggs - we get passages about eggs as food (Job 6:6) and a few passages using an egg in an analogy (Luke 11:12, Isaiah 10:14).  Eastern Orthodox tradition has it that Mary Magdalene was bringing cooked eggs to Jesus' tomb; the eggs turned bright red - the color of blood - when she saw that Christ had risen.  In a similar vein, another story holds that when Mary Magdalene went to Tiberius, the emperor of Rome, to tell him that Christ had risen, he insisted that "Christ has no more risen than that egg is red," after which the egg turned bright red.  But these are just traditions handed down, possibly apocryphal or used to retroactively justify the tradition of dyeing and eating Easter eggs.
Mary Magdalene with
Red Egg (credit)

Dyed and Decorated Easter Eggs (credit)

Egg on End (credit)
Yet two millennia later, we're still buying up Paas dye kits and hiding delicious treats in plastic eggs to the delight of our kids (and those of us who are kids at heart).  One of my fondest memories of Easter, though, was the year that I was allowed to stay up really late.  I was maybe 8 or 9, and my father explained that some people believed the spring equinox meant that there were special gravitational forces on this day, which would let us do something amazing: balance an uncooked egg on its end.  After many attempts (and a broken egg or two), we finally got one to stand, and I went to bed happy.  The next morning, the egg was still standing, and it continued to stand for a couple days until we had to toss it out.  Turns out, this business about special gravitational forces is an urban legend, but it shows that even in the 21st century, we're still linking eggs with the vernal equinox.

So, why do we gobble up anything ovoid at this time of year, from Pancake Day before Lent to chocolate eggs on Easter?  Pretty simply: the egg has long been associated with rebirth and renewal, first applied to the beginning of spring and then adopted as a symbol of Christianity.  The egg is a handy way of visualizing the circle of life that starts - for many plants and animals - in spring.

Happy equinox... happy Easter... and happy eating!

Further Reading:


J.P. Alcock (1980). Classical religious belief and burial practice in Roman Britain. Archaeological Journal, 137, 50-85.

A. Buccellato, P. Catalano, & W. Pantano (2008). Le site et la nécropole de Castellaccio. Les Dossiers d'Archéologie, 330 (Nov-Dec), 14-19.

G. Clarke (1979).  The Roman Cemetery at Lankhills.  New York: Clarendon Press.

A.E. Hanson (2008). The gradualist view of fetal development. Histoire des Doctrines de l'Antiquité Classique, XXXVIII, 95-108. [PDF]

P. Liverani, G. Spinola, & P. Zander, eds. (2010). Le Necropoli Vaticane: La Città dei Morti di Roma.  Musei Vaticani: Libreria Editrice Vaticana.

M. Nilsson (1907). Das Ei im Totenkult der Alten. Archiv für Religionswissenschaft, 49, 530-546.

J.H. Pollexfen (1867-70).  Excavations at Colchester.  Proceedings of the Society of Antiquaries, 4, 271-3.

L.P. Wenham (1962).  The Roman British Cemetery at Trentholme Drive, York.  London: HMSO.

Note: Thanks to Jeff Becker for helping me gain access to the Alcock 1980 article.

This post was chosen as an Editor's Selection for

March 13, 2012

Childbirth and C-Sections in Bioarchaeology

Basically since we started walking upright, childbirth has been difficult for women.  Evolution selected for larger and larger brains in our hominin ancestors such that today our newborns have heads roughly 102% the size of the mother's pelvic inlet width (Rosenberg 1992).

Yes, you read that right. Our babies' heads are actually two percent larger than our skeletal anatomy.
Fetal head and mother's pelvic inlet width
Photo credit:
Obviously, we've also evolved ways to get those babies out.  Biologically, towards the end of pregnancy, a hormone is released that weakens the cartilage of the pelvic joints, allowing the bones to spread; and the fetus itself goes through a complicated movement to make its way down the pelvic canal, with its skull bones eventually sliding around and overlapping to get through the pelvis.  Culturally, we have another way to deliver these large babies: the so-called caesarean section.

Up until the 20th century, childbirth was dangerous.  Even today, in some less developed countries, roughly 1 maternal death occurs for every 100 live births, most of those related to obstructed labor or hemorrhage (WHO Fact Sheet 2010).  If we project these figures back into the past, millions of women must have died during or just after childbirth over the last several millennia.  You would think, then, that the discovery of childbirth-related burial - that is, of a woman with a fetal skeleton within her pelvis - would be common in the archaeological record.  It's not.

Archaeological Evidence of Death in Childbirth

Two recent articles in the International Journal of Osteoarchaeology start the exact same way, by explaining that "despite this general acceptance of the vulnerability of young females in the past, there are very few cases of pregnant woman (sic) reported from archaeological contexts" (Willis & Oxenham, In Press) and "archaeological evidence for such causes of death is scarce and therefore unlikely to reflect the high incidence of mortality during and after labour" (Cruz & Codinha 2010:491).

The examples of burials of pregnant women that tend to get cited include two from Britain (both published in the 1970s), four from Scandinavia (published in the 1970s and 1980s), three from North America (published in the 1980s), one from Australia (1980s), one from Israel (1990s), six from Spain (1990s and 2000s), one from Portugal (2010), and one from Vietnam (2011) (most of these are cited in Willis & Oxenham).  Additionally, I found some unpublished reports: a skeleton from Egypt, a body from the Yorkshire Wolds in England, and a skeleton from England.

The images of these burials are impressive: even more than child skeletons, these tableaux are pathos-triggering, they're snapshots of two lives cut short because of an evolutionary trade-off.

The wide range of dates and geographical areas illustrated in the slideshow demonstrates quite clearly that death of the mother-fetus dyad is a biological consequence of being human.  But what we have from archaeological excavations is still fewer than two dozen examples of possible childbirth-related deaths from all of human history.

Where are all the mother-fetus burials?

As with any bioarchaeological question, there are a number of reasons that we may or may not find evidence of practices we know to have existed in the past.  Some key issues at play in recovering evidence of death in childbirth include:
  • Archaeological Theory and Methodology.  From the dates of discovery of maternal-fetal death cited above, it's obvious that these examples weren't discovered until the 1970s.  Why the 70s?  It could be that the rise of feminist archaeology focused new attention on the graves of females, with archaeologists realizing the possibility that they would find maternal-fetal burials.  Or it could be that the methods employed got better around this time: archaeologists began to sift dirt with smaller mesh screens and float it for small particles like seeds and fetal bones.
  • Death at Different Times.  Although some women surely perished in the middle of childbirth, along with a fetus that was obstructed, in many cases delivery likely occurred, after which the mother, fetus, or both died.  In modern medical literature, there are direct maternal deaths (complications of pregnancy, delivery, or recovery) and indirect maternal deaths (pregnancy-related death of a woman with preexisting or newly arisen health problems) recorded up to about 42 days postpartum.  An infection related to delivery or severe postpartum hemorraging could easily have killed a woman in antiquity, leaving a viable newborn.  Similarly, newborns can develop infections and other conditions once outside the womb, and infant mortality was high in preindustrial societies.  With a difference between the time of death of the mother and child, a bioarchaeologist can't say for sure that these deaths were related to childbirth.  Even finding a female skeleton with a fetal skeleton inside it is not always a clear example, as there are forensic cases of coffin birth or postmortem fetal extrusion, when the non-viable fetus is spontaneously delivered after the death of the mother.
  • Cultural Practices.  Another condition of being human is the ability to modify and mediate our biology through culture.  So the final possibility for the lack of mother-fetus burials is a specific society's cultural practices in terms of childbirth and burial.  In the case of complicated childbirth (called dystocia in the medical literature), this is done through caesarean section (or C-section), a surgical procedure that dates back at least to the origins of ancient Rome.
Cultural Interventions in Childbirth

It's often assumed that the term caesarean/cesarean section comes from the manner of birth of Julius Caesar, but it seems that the Roman author Pliny may have just made this up. The written record of the surgical practice originated as the Lex Regia (royal law) with the second king of Rome, Numa Pompilius (c. 700 BC), and was renamed the Lex Caesarea (imperial law) during the Empire.  The law is passed down through Justinian's Digest (11.8.2) and reads:
Negat lex regia mulierem, quae praegnas mortua sit, humari, antequam partus ei excidatur: qui contra fecerit, spem animantis cum gravida peremisse videtur.
The royal law forbids burying a woman who died pregnant until her offspring has been excised from her; anyone who does otherwise is seen to have killed the hope of the offspring with the pregnant woman. [Translation mine]
Example of Roman gynaecological equipment: speculum
From the House of the Surgeon, Pompeii (1st c AD)
Photo credit: UVa Health Sciences Library
There's discussion as to whether this law was instituted for religious reasons or for the more practical reason of increasing the population of tax-paying citizens.  In spite of this law, though, there isn't much historical evidence of people being born by C-section.  Many articles claim the earliest attested C-section as having produced Gorgias, an orator from Sicily, in 508 BC (e.g., Boley 1991), but Gorgias wasn't actually born until 485 BC and I couldn't find a confirmatory source for this claim.  Pliny, however, noted that Scipio Africanus, a celebrated Roman general in the Second Punic War, was born by C-section (Historia Naturalis VII.7); if this fact is correct, the earliest confirmation that the surgery could produce viable offspring dates to 236 BC.

This practice in the Roman world is not the same as our contemporary idea of C-section.  That is, the mother was not expected to survive and, in fact, most of the C-sections in Roman times were likely carried out following the death of the mother.  Until about the 1500s, when the French physician François Rousset broke with tradition and advocated performing C-sections on living women, the procedure was performed only as a last-ditch effort to save the neonate.  Some women definitely survived C-sections from the 16th to 19th centuries, but it was still a risky procedure that could easily lead to complications like endometritis or other infection.  Following advances in antibiotics around 1940, though, C-sections became more common because, most importantly, they were much more survivable.

Caesarean Sections and Roman Burials

Roman relief showing a birthing scene
Tomb of a Midwife (Tomb 100), Isola Sacra
Photo credit: magistrahf on Flickr
In spite of the Romans' passion for recordkeeping, there's very little evidence of C-sections.  It's unclear how religiously the Lex Regia/Caesarea was followed in Roman times, which means it's unclear how often the practice of C-section occurred.  Would all women have been subject to these laws?  Just the elite or just citizens?  How often did the section result in a viable newborn?  Who performed the surgery?  It probably wasn't a physician (since men didn't generally attend births), but a midwife wouldn't have been trained to do it either (Turfa 1994).

Whereas we can supplement the historical record with bioarchaeological evidence to understand Romans' knowledge of anatomy, their consumption of lead sugar, or the practice of crucifixion, this isn't possible with C-sections - the surgery is done in soft tissue only, meaning we'd have to find a mummy to get conclusive evidence of an ancient C-section.

We can make the hypothesis, though, that because of the Lex Regia/Caesarea, we should find no evidence in the Roman world of a woman buried with a fetus still inside her.  This hypothesis, though, is quickly negated by two reported cases - one from Kent in the Romano-British period and one from Jerusalem in the 4th century AD. The burial from Kent hasn't been published, although there is a photograph in the slide show above.

Interestingly, the Jerusalem find was studied and reported by Joe Zias, who also analyzed the only known case of crucifixion to date.  Zias and colleagues report on the find in Nature (1993) and in an edited volume (1995), but their primary goal was to disseminate information about the presence of cannabis in the tomb (and its supposed role in facilitating childbirth), so there's no picture and the information about the skeletons is severely lacking:
We found the skeletal remains of a girl (sic) aged about 14 at death in an undisturbed family burial tomb in Beit Shemesh, near Jerusalem.  Three bronze coins found in the tomb dating to AD 315-392 indicate that the tomb was in use during the fourth century AD.  We found the skeletal remains of a full-term (40-week) fetus in the pelvic area of the girl, who was lying on her back in an extended position, apparently in the last stages of pregnancy or giving birth at the time of her death... It seems likely that the immature pelvic structure through which the full-term fetus was required to pass was the cause of death in this case, due to rupture of the cervix and eventual haemorrhage (Zias et al. 1993:215).
Both Roman-era examples involve young women, and it is quite interesting that they were already fertile.  Age at menarche in the Roman world depended on health, which in turn depended on status, but it's generally accepted that menarche happened around 14-15 years old and that fertility lagged behind until 16-17, meaning for the majority of the Roman female population, first birth would not occur until at least 17-19 years of age (Hopkins 1965, Amundsen & Diers 1969).  These numbers have led demographers like Tim Parkin (1992:104-5) to note that pregnancy was likely not a major contributor to premature death among Roman women.  But the female pelvis doesn't reach skeletal maturity until the late teens or early 20s, so complications from the incompatibility in pelvis size versus fetal head size are not uncommon in teen pregnancies, even today (Gilbert et al. 2004).

More interesting than the young age at parturition is the fact that both of these young women were likely buried with their fetuses still inside them, in direct violation of the Lex Caesarea.  So it remains unclear whether this law was ever prosecuted, or if the application of the law varied based on location (these young women were both from the provinces), social status (both young women were likely higher status), or time period.  Why wasn't medical intervention, namely C-section, attempted on these young women?  It's possible that further context clues from the cemeteries and associated settlements could give us more information about medical practices in these specific locales, but neither the Zias articles nor the Kent report make this information available.

Childbirth - Biological or Cultural?

Childbirth is both a biological and a cultural process.  While biological variation is consistent across all human populations, the cultural processes that can facilitate childbirth are quite varied.  The evidence that bioarchaeologists use to reconstruct childbirth in the past includes skeletons of mothers and their fetuses; historical records of births, deaths, and interventions; artifacts that facilitate delivery; and context clues from burials.  The brief case study of death in childbirth in the Roman world further shows that history alone is insufficient to understand the process of childbirth, the complications inherent in it, and the form of burial that results.  In order to develop a better understanding of childbirth through time, it's imperative that archaeologists pay close attention when excavating graves, meticulously document their findings, and publish any evidence of death in childbirth.

Further Reading:

This post was chosen as an Editor's Selection for ResearchBlogging.orgD.W. Amundsen, & C.J. Diers (1969). The age of menarche in Classical Greece and Rome. Human Biology, 41 (1), 125-132. PMID: 4891546.

J.P. Boley (1991 [1935]). The history of caesarean section. Canadian Medical Association Journal, 145 (4), 319-322. [PDF]

S. Crawford (2007). Companions, co-incidences or chattels? Children in the early Anglo-Saxon multiple burial ritual.  In Children, Childhood & Society, S. Crawford and G. Shepherd, eds.  BAR International Series 1696, Chapter 8. [PDF]

C. Cruz, & S. Codinha (2010). Death of mother and child due to dystocia in 19th century Portugal. International Journal of Osteoarchaeology, 20, 491-496. DOI: 10.1002/oa.1069.

W. Gilbert, D. Jandial, N. Field, P. Bigelow, & B. Danielsen (2004). Birth outcomes in teenage pregnancies. Journal of Maternal-Fetal and Neonatal Medicine, 16 (5), 265-270. DOI: 10.1080/14767050400018064.

K. Hopkins (1965). The age of Roman girls at marriage. Population Studies, 18 (3), 309-327. DOI: 10.2307/2173291.

E. Lasso, M. Santos, A. Rico, J.V. Pachar, & J. Lucena (2009). Postmortem fetal extrusion. Cuadernos de Medicina Forense, 15 (55), 77-81. [HTML - Warning: Graphic images!]

T. Parkin (1992).  Demography and Roman society.  Baltimore: Johns Hopkins University Press.

K. Rosenberg (1992). The evolution of modern human childbirth. American Journal of Physical Anthropology, 35 (S15), 89-124. DOI: 10.1002/ajpa.1330350605.
J.M. Turfa (1994). Anatomical votives and Italian medical traditions. In: Murlo and the Etruscans, edited by R.D. DePuma and J.P. Small. University of Wisconsin Press.

C. Wells (1975). Ancient obstetric hazards and female mortality. Bulletin of the New York Academy of Medicine, 51 (11), 1235-49. PMID: 1101997.

A. Willis, & M. Oxenham (In press). A Case of Maternal and Perinatal Death in Neolithic Southern Vietnam, c. 2100-1050 BCE. International Journal of Osteoarchaeology, 1-9. DOI: 10.1002/oa.1296.

J. Zias, H. Stark, J. Seligman, R. Levy, E. Werker, A. Breuer & R. Mechoulam (1993). Early medical use of cannabis. Nature, 363 (6426), 215-215. DOI: 10.1038/363215a0.

J. Zias (1995). Cannabis sativa (hashish) as an effective medication in antiquity: the anthropological evidence. In: S. Campbell & A. Green, eds., The Archaeology of Death in the Ancient Near East, pp. 232-234.

Note: Thanks to Marta Sobur for helping me gain access to the Zias 1995 article, and thanks to Sarah Bond for helping me track down the Justinian reference.

March 3, 2012

Roman Bioarchaeology Carnival XIV

This is a bit late, but here's your now monthly round-up of news in the world of Roman bioarchaeology (broadly defined, as usual)...

New Finds
  • The big story out last month was in the area of Montereggi, an Etruscan site.  There is plenty of information at La Repubblica, Nove da Firenze, and Archeorivista, as well as some brief English-language coverage (The Florentine).  Montereggi has been excavated for seven years, with the last phase ending in October of 2011.  This past year, excavators found a human skeleton in a well.  The skeleton was found on top of a number of waterproof jars that seem to have contained wine (although further testing will determine this for sure), then covered with other fragmented jars.  The excavators think it was a purposeful burial (not that, for example, someone fell into the well or was thrown in), but analysis of the skeleton is ongoing at the Archaeological Superintendency of Tuscany.
The Etruscan Skeleton in the Wine Well
(credit: La Repubblica)
  • Another big story was on the discovery of around 90 graves that may hold the bones of early Christian martyrs near Milan.  The skeletons were found near the Basilica of St. Ambrose and seem to date to the 4th-5th centuries AD, although it's uncertain because the graves are quite simple (meaning there are few artifacts that can date them).  There's a nice series of photographs with the Corriere della Sera piece, and the find was also covered at Archeorivista.  Sounds like some construction project is being held up for the excavation of the bodies, so I hope the archaeologists are able to recover as much as possible given the time constraints. (See also: The Bones of Martyrs?)
A Christian Martyr?
(credit: Corriere della Sera)
  • Archaeologists also found about 30 Lombard tombs in Cividale del Friuli (northeastern Italy, on the border with Austria).  They seem to date from around the Roman period (or at least are positioned near the Roman architecture that remains).  Work has been done at this site in the past, but many of these new Lombard graves were pretty intact and included a lot of interesting artifacts.  One of the graves:
Lombard Grave from Cividale del Friuli
(credit: Archeorivista)
  • Two cremated bodies were found in Cawston (near Norfolk, UK) dating to the Roman period.  Not a lot of additional information on them, though.
  • Did an Italian archaeologist find the tomb of St. Philip the Apostle, who was martyred in 80 AD, in Hierapolis (Turkey)?  He's certainly suggesting that the Roman-style tomb was indeed that of Philip, but this is the only coverage I saw.
  • Roman cemetery was discovered in Djerba, Tunisia.  There are apparently over 100 graves, but no additional information has been released yet.  Djerba may have been the island of the lotus-eaters referred to in the Odyssey and, in Roman times, produced a lot of murex dye.  This could be a very cool site, especially if they have skeletons from those graves.  I hope more information comes out soon.
Upcoming Excavations and Projects
  • And now for a bit of crowd-sourced archaeology... If you live in Kingsholm, Gloucester (UK), you might want to dig up your garden and see what you find - the area used to be a Roman military fort.
  • Excavations are resuming at the Etruscan site of Populonia this summer, including its necropolis.  Should be some interesting news coming out of this dig.
  • new archaeological project seeks to answer the question "What have the Romans ever done for us?" - with the "us" being the Irish.  The project will tackle Late Iron Age and Roman Ireland.  Previous work has already been done on human remains (including isotope analyses), but this project will find additional sites and try to figure out what it meant to be "Roman" in Ireland.  This could be quite interesting, as it's likely that Roman influence in Ireland was different than Roman influence in Britain and this difference hasn't been thoroughly researched yet.
New Analysis and New Media
Fun Stuff
  • Would you have survived the eruption of Mt. Vesuvius in 79 AD?  Take this quiz at and learn a little about volcanoes!  (I did survive - but only barely.)
  • Mike Henderson at the Museum of London laid out a skeleton in proper anatomical position and was stop-motion-captured.  The result is this awesome 40-second video.  (A friend asked me if I could lay out a skeleton that quickly.  I could do it a whole lot faster; it's just a matter of speeding up the video!)
Join me next month for more news from the world of Roman bioarchaeology!

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