Date Published: August 28, 2012
Publisher: Wiley Subscription Services, Inc., A Wiley Company
Author(s): Jonny Geber, Eileen Murphy.
Scurvy has increasingly been recognized in archaeological populations since the 1980s but this study represents the first examination of the paleopathological findings of scurvy in a known famine population. The Great Famine (1845–1852) was a watershed in Irish history and resulted in the death of one million people and the mass emigration of just as many. It was initiated by a blight which completely wiped out the potato—virtually the only source of food for the poor of Ireland. This led to mass starvation and a widespread occurrence of infectious and metabolic diseases. A recent discovery of 970 human skeletons from mass burials dating to the height of the famine in Kilkenny City (1847–1851) provided an opportunity to study the skeletal manifestations of scurvy—a disease that became widespread at this time due to the sudden lack of Vitamin C which had previously almost exclusively been provided by the potato. A three-scale diagnostic reliance approach has been employed as a statistical aid for diagnosing the disease in the population. A biocultural approach was adopted to enable the findings to be contextualized and the etiology and impact of the disease explored. The results indicate that scurvy indirectly influenced famine-induced mortality. A sex and stature bias is evident among adults in which males and taller individuals displayed statistically significantly higher levels of scorbutic lesions. The findings have also suggested that new bone formation at the foramen rotundum is a diagnostic criterion for the paleopathological identification of scurvy, particularly among juveniles. Am J Phys Anthropol, 148:512–524, 2012. © 2012 Wiley Periodicals, Inc.
Largely as a result of economic constraints, the diet of the Irish poor had become increasingly monotonous and was limited to potato and dairy products by the mid-19th century. It has been estimated that the poorest third of the population relied entirely on the potato crop for sustenance at the time (Clarkson and Crawford,2001; Ó Gráda,2006). A diet consisting mainly of potato and buttermilk was very nutritious, however, and provided more than enough of the required daily intake of protein and vitamins (Crawford,1988).
As a measure to deal with the seemingly chronic pauperism in Ireland, a Poor Law was introduced in July 1838. The Poor Law, which was designed to provide a “more effectual Relief of the Destitute Poor in Ireland” (O’Connor,1995: 68), was based on the ideological perception that people had a natural passion for idleness, and that disincentives were needed to enable the poor to evade poverty (see de Tocqueville,1835). The Poor Law introduced a new workhouse institution to Irish society which, throughout its existence, was genuinely hated. In-door relief in the workhouse was to become the only form of government poor aid for the truly deserving. It was believed that each applicant would have “weighed the ‘pleasures’ of staying outside the workhouse with the ‘pain’ of entering it’ (May,2003: 8); meaning that only the truly desperate and destitute would accept relief and the able-bodied would be encouraged to find work and improve their situations by themselves. As a consequence, these institutions were built to low standards and inmates were subjected to arduous and repetitive labor. Kilkenny Union Workhouse had an allocated space for 1,300 inmates and was to become the fifth largest workhouse in Ireland when it first opened in April 1842. During the famine it became critically overcrowded with starving people, who in desperation had sought help, and by June 1851 a massive 4,357 people were registered in its books. The gross overcrowding meant that the spread of infectious disease, and consequential mass deaths, resulted in further logistical and economic challenges to the workhouse institution.
Scurvy is the consequence of an inadequate intake of Vitamin C (ascorbic acid). The introduction of the Vitamin C-rich potato in the seventeenth century had allowed the population of Ireland to increase to around eight million, the majority of whom were landless peasants. The blight had a devastating impact on the availability of Vitamin C to the poorest members of Irish society who were dependent on the tuber for their survival (Clarkson and Crawford,2001). A potato-based diet has a very high Vitamin C content—freshly dug potatoes hold approximately 30 mg of Vitamin C per 100 g of edible matter, which decreases to 8 mg after 8–9 months of storage. Cooked potatoes lose between 20 and 40% of their vitamin content, while an additional 10% is lost in peeled potatoes. The richness of the potato as a source of Vitamin C becomes clear when these values are compared to other foodstuffs such as apples and pears, for example, which only contain 2–5 mg Vitamin C per 100 g edible matter. The levels of Vitamin C in potatoes are more similar to those of citrus fruits, with lemon juice containing approximately 40–50 mg per 100 g of edible matter (Crawford,1988). A sufficient intake of Vitamin C is essential for the formation of mature collagen, which in turn is an important protein component in connective tissues such as skin, cartilage, and bone (Stuart-Macadam,1989; Hirschmann and Raugi,1999). A joint report by the World Health Organization and the Food and Agricultural Organization of the United Nations (2004) recommends a daily intake of 45 mg in adults, although experiments have shown that an absolute minimum requirement is 10 mg or even less (Bartley et al.,1953). Males require a slightly higher intake of Vitamin C than females due to metabolic, and possibly hormonal, differences (Basu and Schorah,1982; Clarkson and Crawford,2001).
The osseous manifestations of scurvy have been comprehensively described in the paleopathological literature (e.g., Maat and Uytterschaut,1984; Stuart-Macadam,1989; Ortner and Ericksen,1997; Ortner et al.,1999, 2001; Ortner2003; Maat,1982, 2004; Salis et al.,2005; Brickley and Ives,2006, 2008; Mays,2007, 2008; Brown and Ortner,2011). The osseous changes predominantly involve vascular responses to hemorrhages, usually appearing as a result of minor trauma and mechanical strains, which results in porotic and hypertrophic bone formation at the affected areas. Many of these traits are nonspecific, however, and may occur in other metabolic disorders such as anemia and rickets. Other even less specific observable traits include fractures, due to a weakened bone structure, and transverse fractures and dislocations of the osteochondral junction of the ribs (see Brickley and Ives,2006). As Vitamin C is required for osteoid formation, skeletal evidence of scurvy is only evident once the vitamin has been re-introduced into the diet after a period of deficiency (Brickley and Ives,2008). The lesions are therefore a reflection of the disease during its convalescence stage or after it has been cured. This is an important factor to consider when interpreting its prevalence in skeletal populations since individuals with no osseous lesions may have been severe sufferers who died before any scorbutic lesions had manifested (see Wood et al.,1992).
The skeletal population from Kilkenny Union Workhouse comprised a minimum of 970 individuals. Two-fifths of the skeletons (N = 396) were virtually complete or complete, and more than 80% of the skeleton was present in 68% (N = 661) of all analyzed individuals. Neonates and infants represented the least well preserved skeletons.
When the results from Kilkenny are compared to frequencies obtained for other macroscopically analyzed skeletal populations, which have ranged from approximately 3–7% (see Brickley and Ives,2008: Table A1), it is clear that the prevalence of scurvy in the Kilkenny Workhouse Union population is exceptionally high.
The paleopathological evidence of scurvy in the Kilkenny Union Workhouse skeletal population has provided the first opportunity to study the nature of the disease in a known archaeological famine population. Scurvy occurred with an exceptionally high prevalence and it appears to have had a significant impact on the mortality profile of the population. This may have arisen indirectly through a suppression of the immune system which would have made sufferers more prone to the acquisition of infectious diseases which inevitably resulted in their death. A comparison of the paleopathological evidence with information contained within historical and archival sources for the Kilkenny Union Workhouse indicates that scurvy was very probably misdiagnosed by the workhouse physicians during the famine.