Variation in porotic hyperostosis in the Royal Cemetery complex at Abydos, Upper Egypt: a social interpretation.

Variation in porotic hyperostosis in the Royal Cemetery complex at Abydos, Upper Egypt: a social interpretation. Introduction This paper presents the results of a palaeopathological study ofskeletal remains from the high status cemetery of Abydos in Upper Egyptassociated with the rulers of the First Dynasty (Petrie 1900). Thecrania cra��ni��a?n.A plural of cranium. from two groups of spatially-distinct subsidiary burials wereexamined, associated with the First Dynasty kings Djer and Diet (Uadji),the second and third, or third and fourth kings of the dynasty,depending on who is regarded as the first ruler: Narmer or Aha(Wilkinson 1999). These burials are thought to have taken place near thetime of the kings' interments. The investigation focused on porousdefects, broadly called porotic hyperostosis, which were observed in thecrania of the buried individuals, and the variations in this lesion wereused to explore possible social differences. There is a relationshipbetween social status and health that is readily appreciated, since theformer determines access to nutrients, the overall environmentalquality, and the ability to provide and receive medical care (Crooks1995). The sample population All the rulers of Dynasty I (Kemp 1966, 1967) as well aspredynastic kings and elites were interred at Abydos, a holy placeperhaps regarded as an ancestral home, as opposed to the capital atMemphis, in northern Egypt (Spencer 1993; Wilkinson 1999). The main partof the cemetery, called the Umm El Qaab, contains the actual tombs ofthe rulers, although none of their physical remains have survived. Inthe same place, however, are subsidiary burials, frequently marked bystelae, which are regarded as those of court functionaries and membersof the rulers' personal entourage (Petrie 1900; Emery 1961; Kemp1966; Trigger 1983; Spencer 1993). The idea that they were simplyservants or slaves has been contested (Thomson & Randall-MacIver1905, Petrie 1925, Bestock 2002). Approximately one mile away in northAbydos are another set of subsidiary burials arranged roughly in squares(Petrie 1925) which outline the remains of structures variously called'funerary palaces' or funerary fu��ner��ar��y?adj.Of or suitable for a funeral or burial.[Latin fner enclosures (Kemp 1967;O'Connor 1989). These graves can be identified with the reigns ofparticular rulers by associated artefacts (Petrie 1925). The associatedgrave occupants were apparently a mixture of artisans and lower courtofficials such as a 'seal bearer'. Examples taken fromskeletal material of both these groups of burials formed the subject ofthis investigation. Cranial porosis 'Porotic hyperostosis' is generally used to describedefects in the outer table of the cranial vault of the skull, associatedwith a widened diploic dip��lo��e?n.The spongy, porous, bony tissue between the hard outer and inner bone layers of the cranium.[Greek diplo space, and has varying degrees of severity (Angel1964; Ortner & Putschar 1981; Goodman et al. 1984; Larsen 1997). Thestandard depictions of porotic hyperostosis show gross large bilateralvault porous defects sometimes associated with new bone formation innotably thickened parietal bones, and usually in children, but this isonly the most severe manifestation. Lesions in the orbital roof(s) areusually called cribra orbitalia. The classic defects, whether in vaultsor orbits, are hypothesised to be caused by a compensatory expansion ofthe bone marrow with resultant pressure induced alterations in the outerskull bones (Larsen 1997). Other bones can be affected. The expansion ofbone marrow reflects the increased production of red blood cells inresponse to physiological states that have caused either decreasedlongevity of red blood cells and/or altered iron metabolism anddeficiency. Clear examples of such states are thalassemia major andsickle cell anaemia anaemiasee anemia. where clinical data support the correlation of bonypathology with anaemia. The marrow response helps to counter the effectsof anaemia. Sickle cell anaemia has been firmly diagnosed bybio-molecular means in predynastic sub-adult Egyptians whose remainsexhibited skeletal changes known to be associated with haemolytic Adj. 1. haemolytic - relating to or involving or causing hemolysis; "hemolytic anemia"hemolytic anaemias (Marin et al. 1999; Cerutti pers. comm.). Unfortunately it israre to get this kind of laboratory confirmation of a skeletaldiagnosis. The cause of the lesions has usually been thought to be due todietary iron deficiency (Sanford et al. 1983; Stuart-MacAdam 1985, 1992;Larsen 1997). Experimental data provide evidence for a more importantrole for whole blood loss. Chronically bled rats show a much greatermarrow response than those given an iron-deficient diet (Burkhard et al.2001). Extrapolating to the human case, this suggests that the chronicblood loss frequently associated with parasitic diseases such asschistosomiasis schistosomiasis(shĭs`təsōmī`əsĭs), bilharziasis,or snail fever,parasitic disease caused by blood flukes, trematode worms of the genus Schistosoma. and hookworm hookworm,any of a number of bloodsucking nematodes in the phylum Nematoda, order Strongiloidae that live as parasites in humans and other mammals and attach themselves to the host's intestines by means of hooks. (Stephenson & Holland 1987; Tanaka1989), could cause compensatory marrow expansion and resultant porotichyperostosis. Theoretically, iron loss from diarrhoea, also foundassociated with various infectious diseases, could trigger a marrowresponse. Reflex mechanisms that reduce serum iron in some bacterialinfections could also be a factor (see Kent & Weinburg 1989;Stuart-MacAdam 1992). The clinical severity of anaemia has to beconsidered in the contexts of crowding, poor general nutrition, weaningstress and overall disease burden, including chronic infections (Kent1986; Palkovich 1987) and the handling of sanitation (see e.g. Dixon1972). Other defects and causes have to be considered in the evaluation ofvault porosis. Localised lesions confined to the periosteum periosteumDense membrane over bones. The outer layer contains nerve fibres and many blood vessels, which supply cells in the bone. The bone-producing cells of the inner layer are most prominent in fetal life and early childhood, when bone formation is at its peak. may indicateprimary periostitis periostitis/peri��os��ti��tis/ (-os-ti��tis) inflammation of the periosteum. per��i��os��ti��tisor per��i��os��te��i��tisn.Inflammation of the periosteum. , and are usually related to trauma or proximal scalpinfections. If symmetrically widespread and restricted to theperiosteum, lesions may indicate vitamin C deficiency vitamin C deficiencyScurvy A condition caused by inadequate intake of vitamin C, characterized by fatigue, bleeding gums, poor wound healing, ↓ resistance to infections, weight loss. See Rebound scurvy, Vitamin C. or secondaryperiostitis, the latter being understood to reflect a generalinflammatory response to a non-local process (Ortner & Putschar1981); however, poor vitamin C intake is less well documented as aprobable cause. In the Nile Valley, secondary periostitis could be apart of the response to parasitic infection, given the prevalence ofschistosomiasis and hookworm (Stephenson & Holland 1987; Tanaka1989), even if the infection is not severe enough to provoke grosslydetectable diploic expansion. Vault porosis thought to be related to iron deficiency includingblood loss is hypothesised to manifest only in childhood and not tooccur in individuals who first become anaemic a��nae��mic?adj.Variant of anemic.anaemicor US anemicAdjective1. having anaemia2. pale and sickly-looking3. lacking vitalityAdj. as adults (Stuart-MacAdam1985), based on cross-sectional studies. It is known that skeletallesions do not occur or are not severe in all anaemic children, eventhose with sickle cell disease sickle cell diseaseor sickle cell anemia,inherited disorder of the blood in which the oxygen-carrying hemoglobin pigment in erythrocytes (red blood cells) is abnormal. who have haemolytic crises. It is assumedthat quantitative and qualitative variations in adult skulls reflect therelative differences that would have been found in childhood; thesimplifying assumption is that there are no great differences inremodelling rates between surviving groups. However, there is a caveat:the percentage of skulls with lesions could also be affected by groupdifferences in pre-adult mortality, assuming that the samples underconsideration are from distinct and 'real' populations (orstrata). Such demographic information is not known for these crania,which in part are likely to consist of people from northern Egypt (seeKeita 1992). Lesions in early Egypt would most likely have been related toanaemia, either from parasitic, genetic and/or dietary related causes inthe context of a challenging socio-ecological environment with aconsequent biological challenge. The remains of adult individuals withclinically severe genetic anaemias are not likely to be recovered fromancient cemeteries in great numbers, because of general and specificmortality. Vitamin D deficiency Vitamin D DeficiencyDefinitionVitamin D deficiency exists when the concentration of 25-hydroxy-vitamin D (25-OH-D) in the blood serum occurs at 12 ng/ml (nanograms/milliliter), or less. can reasonably be excluded as a frequentcause because of the high solar radiation in the area, even if only tothe face and hands. It is likely that blood loss from schistosomiasisand hookworm are primarily responsible. Given the concern here forexamining the pattern of pathology in relationship to social position, achildhood aetiology aetiologysee etiology. of the lesions would be advantageous because it mayreflect aspects of social origins. Early childhood lifestyle andlife-history are more likely to reflect aspects of social life such asrank or status because of the vulnerability of children (Nestel 1990),and ties to their parents' social position. Social status inadulthood may not be the same as that held in early life, even inancient monarchical societies. This study thus offers the opportunity to examine lesions believedto reflect a health setback that occurred during childhood, in twogroups of adults with perhaps broadly different roles at the royalcourt. Material The material studied consists of all existing adult crania from theburials around the tomb of King Djer primarily, and from the lowercemeteries (funerary enclosure sites, Abydos north) of Kings Djer andDiet as far as can be ascertained. Djer's tomb was flanked by 318subsidiary graves, and his funerary enclosure by 269. King D jet'sretainer burials numbered 174 and 161 respectively. Sex was determinedby standard anatomical criteria (Brothwell 1981), and the considerationof the names of individuals when known; no pelves were available. It issuggested that the royal tomb sample has 27 males and 17 females (44total), and the funerary enclosure tombs have 38 males and 10 females(48 total). These are the only known extant remains available for studyand they represent only a fraction of court functionaries, the'populations' actually interred (see Petrie 1925). Analysis ofvariance (ANOVA anovasee analysis of variance.ANOVAAnalysis of variance, see there ) revealed no difference between the sexes. However, sexsub-samples would have been combined in any case to obtain a groupimpression, because the lesions do not connote con��note?tr.v. con��not��ed, con��not��ing, con��notes1. To suggest or imply in addition to literal meaning: "The term 'liberal arts' connotes a certain elevation above utilitarian concerns"diseases that aregenetically sex-linked. The royal tomb material is stored at the NaturalHistory Museum in London. Cambridge University houses the funeraryenclosure/palace sample. Due to various kinds of damage not all structures of interest werepresent or complete in each cranium cranium:see skull. . The sample sizes by structure areshown in Table 1. The second grouping of vaults refers to those havingall three bones complete or nearly so. Methods The standard method of approach is based on macroscopic macroscopic/mac��ro��scop��ic/ (mak?ro-skop��ik) gross (2). mac��ro��scop��icor mac��ro��scop��i��caladj.1. Large enough to be perceived or examined by the unaided eye.2. observationwith the naked eye. For this study poroses were assessed in two ways.Vault, but not orbital, poroses were graded from 0-6 following Hillson(1978) who used the term porosities to describe the defects. The gradeis used as a variable called the vault porosity or porosis score (VPS (1) (Vectors Per Second) The measurement of the speed of a vector or array processor. See vector, vector processor and array processor.(2) (Virtual Private Server) See OS virtualization. )and noted as below: 0--no porosis, 1--scattered fine porosis, 2--larger porosis, 3--some linked porosis, 4--'canal-like' linked porosis, 5--small trabecular outgrowths from outer table, 6--marked trabecular structure on the outer table. Lesions were mapped for each vault onto a scheme that included thecoronal cor��o��naladj.1. Of or relating to a corona, especially of the head.2. Of, relating to, or having the direction of the coronal suture or of the plane dividing the body into front and back portions. , sagittal sagittal/sag��it��tal/ (saj��i-t'l)1. shaped like an arrow.2. situated in the direction of the sagittal suture; said of an anteroposterior plane or section parallel to the median plane of the body. and bregma bregma/breg��ma/ (breg��mah) the point on the surface of the skull at the junction of the coronal and sagittal sutures.bregmat��ic breg��man. pl. sutures. VPS was recorded for the mostanatomically severe lesion wherever found, which was usually theparietals. The number of kinds of superior vault bones affected wasrecorded as the extent score (ES), range 0-3. (Parietal parietal/pa��ri��e��tal/ (pah-ri��e-t'l)1. of or pertaining to the walls of a cavity.2. pertaining to or located near the parietal bone.pa��ri��e��taladj.1. involvement wasonly counted once.) Two dichotomous variables were devised. The firstdesignates vaults with any lesion porosis scores of one or more and iscalled VPP VPP Voluntary Protection Program (OSHA)VPP Velocity Prediction Program (to predict sail boat performance)VPP Virtual Presence ProtocolVPP Volts Peak to PeakVPP Virtual Presence Post 1. The second enumerates vaults with lesions of porosis scoresof two and greater (VPP2), and is of more interest in this study,because previous experience has shown that this variable was more oftenassociated with some parietal thickening. VPP2 serves as a kind ofscreen and facilitates the recording of lesions indicative of more thanperiostitis. Cribra orbitalia lesions were scored as present or absent. Parametric ANOVA, Mann-Whitney and contingency table analyses werecarried out. The five per cent probability level was chosen forsignificance. Results A range of lesion quality was observed. Noticeable, although notnecessarily severe, parietal thickening was usually observed with thehigher grade lesions; thus the second variable (VPP2) tends to restrictthe count to those vaults having lesions closer to 'porotichyperostosis' as originally described (see Angel 1964; Ormer &Putschar 1981), although mild. Crania with the extreme classic lesionswere not found, an observation made about other Egyptian material byHillson (personal communication). Some crania had what might bedescribed as pitting, not porosis, perhaps representing remodelling orother tissue activity. The royal tomb and funerary palace samples havelesion frequencies above ten per cent in all dichotomous variablecategories (Table 2). Lesions with a porosis score of one were notgenerally associated with visible thickening and could be due toperiostitis. The level of porosis-defined lesions is noteworthy in thetwo samples. The frequency of individuals having any degree or kind ofvault lesion is greater than 45 per cent. Contingency table analyses indicate significant inter-groupfrequency differences (Table 2). The royal tomb group is observed tohave three times more affected individuals than the funerary palacesample for cribra and higher grade vault lesions (VPP2). Individualsrecovered from around the royal tombs have one and a half times theobserved lesions (VPP1), found in the funerary palace folk. Thepercentage of crania having a vault porosis score of one, obtained bysubtracting VPP2 from VPP1, is nearly the same for both groups,approximately 30 per cent. This suggests a general background ofbiological challenge resulting in lesions largely restricted to theperiosteum. The average porosis score and extent of porosis lesions perindividual for the royal tomb vaults, is twice that of the funerarypalaces (Table 3). Although the standard deviations indicate highwithin-sample variability, the central tendency differences arestatistically significant. Discussion The results of the analysis are consistent in suggesting that theindividuals recovered from around the funerary palaces--as opposed tothose from near the royal tombs--experienced less physiologicalchallenge in childhood. Fewer individuals were affected, and those whowere had less anatomically extensive lesions. Although both seriesevince e��vince?tr.v. e��vinced, e��vinc��ing, e��vinc��esTo show or demonstrate clearly; manifest: evince distaste by grimacing. noteworthy levels of pathology, the royal tomb sample has moresevere lesions and a higher frequency of affected individuals with avault porosis score of two or more. Strictly speaking it can only besaid that a group difference in vault porosis frequency and severityexists in the recovered material. Therefore any more interpretivescenarios are speculative. As a starting point, and tentatively acceptingStuart-MacAdam's (1985) and others' interpretation ofpre-adult genesis, it is worth noting that there is a difference in thetwo adult groups for a lesion hypothesised to occur in childhood. In ahypothetical society with high social mobility, one could reasonablyexpect no difference between adult groups for a childhood lesion. In onewithout such equality such differences might be expected to'cluster' in adulthood groups, assuming that the socialposition of children and adults was somehow connected. If porosesassociated with diploic expansion do represent a childhood lesion thenthey can be seen as an osteobiographical tool that allows the social'tracking' of individuals or groups in some selectedcircumstances. Does the inter-group difference itself imply that those from thetwo sub-sites are true samples from distinct 'populations'within which individuals are connected by a 'principle' likeclass, caste or ethnicity? Or is it the result of sampling accident?This is a relevant theoretical and statistical question, withimplications for other research in similar circumstances. Stated anotherway, do the recovered site-differentiated individuals represent truesamples, either random or non-random, of actually existing entities('populations'), or are they non-statistical fragments of thegeneral population? There is no evidence that the crania preserved bythe excavators represent a specially selected subset of the burials, sothe surviving groups can reasonably be treated as representative. The reason for the disparity between the 'groups' mayreflect institutionalised social structure, in which those buried in thefunerary enclosure had greater environmental advantages than thoseburied with the king. However, there is little corroboration of such amodel from current documentation. There seem to be no later Egyptianreferences to internal social ranking in this early period, or to thecustom of having current court functionaries buried at the time of therulers (Baines personal communication). The results of studies of laterdynastic Egyptian society are consistent with there being four broadstrata (Trigger 1983). By extrapolation the Early Dynastic individualsinterred around the royal tombs and funerary palaces would have rankedbelow the ruler and royal family, nobles and high officials, and justabove the 'peasants'. Grave goods and stelae have beeninterpreted as marking the royal tomb occupants as having primarily beenthe rulers' personal retinue, and largely of servile ser��vile?adj.1. Abjectly submissive; slavish.2. a. Of or suitable to a slave or servant.b. Of or relating to servitude or forced labor. status. Thefunerary enclosure group was composed apparently of minor officials andartisans as indicated by titles, and the presence of fine copper tools(Petrie 1925). However, the interpretation of social status fromfunerary remains is always difficult (Ucko 1969). Several biosocial bi��o��so��cial?adj.Of or having to do with the interaction of biological and social forces: the biosocial aspects of disease.bi models are consistent with the findings. If thefunerary enclosure group consists of individuals from a strata or'population' with higher ascribed status, then the results fitcurrent normative expectations, namely that better health correspondswith higher social status, all other things being equal. Theseindividuals in childhood would have theoretically been at less risk fromdisease, especially for chronic conditions related to nutrition. Bycontrast, the results from the royal tomb group correlate with theirinterpretation as servants, which would in turn imply that court'servants', companions of the king, were recruited from the'poor'. A 'class' explanation works no matter whenthe lesions or their aetiology(ies) appear in life, and only requiresthat the defects represent evidence of a pathological condition. Forexample if the lesions were acquired in adult life, then it wouldsuggest that those buried around the king did work, or were fed in amanner, which placed them at greater risk. If the origins of the royal tomb individuals were from a group ofascribed higher status then the results would require a more complexexplanation. One of these would be that the higher status permitted theparents to invest more in sick children; thus more of them survived toadulthood, if the diseases in question were life-threatening. A higherlesion frequency in an adult cohort in this instance would indicate ahigher survival of challenged individuals who are missing from the othergroup, in which 'better health' is actually an illusion. Thisis a version of what has been called the osteological paradox (Wood etal. 1992). The concept of status may need rethinking for Early Dynastic Egypt.For example, another interpretation would employ the concept of phylesdescribed from ancient Egypt (Roth 1991), and hereditary occupationalcastes linked to kings or elites, the latter even known from more recentsocieties (see Levtzion 1973, and Tamari ta��ma��ri?n.Soy sauce made without wheat.[Japanese.] 1991). The evidence suggeststhat phyles were clan-like hereditary-based work associations associatedwith kingship (but not exclusively), and may have developed frompredynastic totemic clans. Symbolically, in the Early Dynastic world itis conceivable that phyles or phyle-associated groups would have beenexpected to assist the king in the afterlife. The royal tomb andfunerary enclosure groups may be of the same social rank, buthorizontally differentiated by the professions of the households intowhich they were born or recruited as young children, therebyparticipating in the work associated with these domiciles or homesteads. Young artisans (and other non-farmers) would have been less exposedto parasitic infections and their nutritional sequellae thanagriculturalists or shore fishermen exposed to Nile alluvium al��lu��vi��um?n. pl. al��lu��vi��ums or al��lu��vi��aSediment deposited by flowing water, as in a riverbed, flood plain, or delta. Also called alluvion. . There ispositive evidence for childhood occupation differences; the footprintsof children approximately six years of age have been preserved inplaster at some elite Early Dynastic building sites (Baines personalcommunication), and children are seen in paintings of farmingactivities. An occupational model would explain the group difference ifthe royal tomb folk were drawn from farmers, and the funerary enclosuresample connoted artisans or at least non-farmers, both perhaps connectedto the kingship, assuming that the lesions are of childhood origin.Differences would stem from occupation irrespective of class status. Itis not unreasonable to postulate that there may have been 'royalfarmers' (as there were artisans), and that as children, some ofthe adults in the household helped in food production, thus sustaining ahigher exposure to parasites, than the children of non-farmers. Whilethere is no described direct evidence that the samples in this studywere from phyles, the individuals represented did perform broadlydifferent kinds of work. Although it is known that phyles in the OldKingdom rotated through different kinds of work, they may have beeninitially more confined to one occupation. Another possibility is that the royal tomb people comprised ahereditary companion servant caste, fed from infancy a rituallyprescribed, but nutritionally deficient diet, and perhaps secluded fromthe sun, in a kind of purdah purdahSeclusion of women from public observation by means of concealing clothing (including the veil) and walled enclosures as well as screens and curtains within the home. . However, there is no known documentaryevidence for such a practice, or reference to it in later texts (Baines& Roth personal communication). Also, as mentioned, there are nolong bones to assess for rickets ricketsor rachitis(rəkī`tĭs), bone disease caused by a deficiency of vitamin D or calcium. Essential in regulating calcium and phosphorus absorption by the body, vitamin D can be formed in the skin by ultraviolet . The occupational model receives additional but indirect supportfrom an analysis of linear hypoplasias on the first and second molars.One would expect markers of severe physiological stress to track witheach other. However, there is no statistical difference between theroyal tomb and funerary enclosure samples for this lesion at any level.The frequency of individuals having first molar defects was 35.0 and36.4 per cent respectively [n = 22 (RT) and 40 (FE); Chi square = 0.012;p = 0.914); and for the second molar 42.1 and 41.7 per cent [n = 24 (RT)and 38 (FE); Chi square = 0.001; p = 0.973]. The average number oflesions for each tooth in the two groups was also statisticallyinsignificant (p > 0.05). These findings would seem to show that thegroup contrast in porotic hyperostosis frequencies does not reflect adifference in overall (general) health. Otherwise it could reasonably beexpected that the royal tomb sample would have had more linearhypoplasias; in fact if true this would lend somewhat more support to anexplanation of a status difference in origins, since a general andspecific indicator of childhood stress would both have high values.Instead a difference is only seen for the variable that can most easilybe associated with a particular lifestyle/ecology and disease risk. The recovery of more data from predynastic and dynastic contextsmay provide information with which to make better social inferencesabout these findings. However, based on a synthesis of the availableevidence, some variant of the model incorporating horizontaloccupational differentiation, with or without the concept of hereditarycaste, would seem to be more convincing in explaining the differencesthan a simple hierarchical class model, accepting the hypothesis thatthe lesions are of childhood origin. Acknowledgements We thank Dr C. Stringer, Dr R. Foley and M. Bellati, for permissionto examine collections in their care. Professor J. Baines, Professor G.Armelagos, Dr A. Roth and Dr S. Hillson made comments in variousdiscussions useful to this research. This work was made possible in partby grants from the Griffiths and Boise funds of Oxford University. Thispiece is dedicated to John Baines, Professor of Egyptology, OxfordUniversity, and the late Mamdouh Sharara, University of Maryland University of Maryland can refer to: University of Maryland, College Park, a research-extensive and flagship university; when the term "University of Maryland" is used without any qualification, it generally refers to this school Statistical Laboratory. Received: 2 February 2004: Accepted: 10 November 2004: Revised: 11November 2004 References ANGEL, J.L. 1964. Osteoporosis: thalassemia ThalassemiaDefinitionThalassemia describes a group of inherited disorders characterized by reduced or absent amounts of hemoglobin, the oxygen-carrying protein inside the red blood cells. . American Journal ofPhysical Anthropology 22: 369-74. BESTOCK, L. 2002. The ideological significance and societalcomplexity of the subsidiary graves for royal and elite monuments of theEarly Dynastic period Early Dynastic Period may refer to a period of the 3rd millennium BC in either Egypt or Sumer: Early Dynastic Period of Egypt Early Dynastic Period of Sumer . Paper presented at the Annual Meeting of theAmerican Research Center in Egypt, April 26-28, John Hopkins University,Baltimore (MD). BROTHWELL, D.L. 1981. Digging up bones. Ithaca, NY: CornellUniversity Press. BURKHARD, M.J., D.E. BROWN, J.P. MCGRATH, V.P. MEADER, D.A. MAYLE,M.J. KEATON, W.P. HOFFMAN, J.L. ZIMMERMAN, D.L. ABBOTT & S. SUN.2001. Evaluation of erythroid erythroid/er��y��throid/ (er��i-throid)1. of a red color; reddish.2. pertaining to the cells of the erythrocytic series.er��y��throidadj.1. regenerative response in two differentmodels of experimentally induced iron deficiency anaemia Noun 1. iron deficiency anaemia - a form of anemia due to lack of iron in the diet or to iron loss as a result of chronic bleedingiron deficiency anemia . VeterinaryClinical Pathology 30 (2): 76-85. CROOKS, D. 1995. American children at risk: poverty and itsconsequences for children's health, growth and school achievement.Yearbook of Physical Anthropology 38: 57-86. DIXON, D.M. 1972. The disposal of certain personal, household andtown waste in ancient Egypt, in P.J. Ucko, R. Tringham & G.W.Dimbleby (cd.) Man, settlement and urbanism: 647-50. London: Duckworth. EMERY, W.B. 1961. Archaic Egypt. London: Penguin. GOODMAN, A., D.L. MARTIN, G. ARMELAGOS & G. CLARK. 1984.Indications of stress from bone and teeth, in G. Armelagos & R.Cohen cohenor kohen(Hebrew: “priest”) Jewish priest descended from Zadok (a descendant of Aaron), priest at the First Temple of Jerusalem. The biblical priesthood was hereditary and male. (cd.) Palaeopathology at the origins of agriculture. 13-50. NewYork: Academic. HILLSON, S. 1978. Human biological variation in the Nile valley, inrelation to environmental factors. PhD Thesis, University of London For most practical purposes, ranging from admission of students to negotiating funding from the government, the 19 constituent colleges are treated as individual universities. Within the university federation they are known as Recognised Bodies . KEITA, S.O.Y. 1992. Further studies of crania from ancient northernAfrica: an analysis of crania from first dynasty Egyptian tombs, usingdiscriminant dis��crim��i��nant?n.An expression used to distinguish or separate other expressions in a quantity or equation. functions. American Journal of Physical Anthropology 87:245-54. KEMP, B.J. 1966. Abydos and the royal tombs of the First Dynasty.Journal of Egyptian Archaeology 52: 13-22. --1967. The Egyptian 1st Dynasty royal cemetery. Antiquity 41:22-31. KENT, S. 1986. The influence of sedentism and aggregation onporotic hyperostosis and anemia. Man 21: 605-36. KENT, S. & E. WEINBURG. 1989. Hypoferraemia: adaptation todisease. New England Journal of Medicine The New England Journal of Medicine (New Engl J Med or NEJM) is an English-language peer-reviewed medical journal published by the Massachusetts Medical Society. It is one of the most popular and widely-read peer-reviewed general medical journals in the world. 320: 672. LARSEN, C.S. 1997. Bioarchaeology: interpreting behavior from thehuman skeleton. New York: Cambridge University Press Cambridge University Press (known colloquially as CUP) is a publisher given a Royal Charter by Henry VIII in 1534, and one of the two privileged presses (the other being Oxford University Press). . LEVTZION, N. 1973. Ancient Ghana and Mali. New York: Methuen. MARIN, A., N. CERUTTI & E.R. MASSA. 1999. Use of theamplification refractory mutation system (ARMS) in the study of HbS inpredynastic Egyptian remains. Bollettino della Societa Italiana diBiologia Sperimentale 75 (5-6): 27-30. NESTEL, P.S. 1990. Nutritional vulnerability of the child, in G.A.Harrison & J.C. Waterlow (cd.) Diet and disease in traditional anddeveloping societies: 185-208. Cambridge: Cambridge University Press. O'CONNOR, D. 1989. New funerary enclosures (Talbezirke) of theEarly Dynastic Period at Abydos. Journal of the American Research Centrein Egypt 25: 51-86. ORTNER, D. & W. PUTSCHAR. 1981. Identification of pathologicalconditions in human skeletal remains. Washington, DC: SmithsonianInstitute. PALKOVICH, A.M. 1987. Endemic disease patterns in palaeopathology:porotic hyperostosis. American Journal of Physical Anthropology 74:527-37. PETRIE, W.M.F. 1900. The royal tombs of the First Dynasty. Part I.Eighteenth Memoir. London: Egypt Exploration Fund. --1925. Tombs of the Courtiers and Oxyrhynkhos. London: EgyptExploration Fund. ROTH, A.M. 1991. Phyles in the Old Kingdom: the evolution of asystem of social organization. Chicago: Oriental Institute, Universityof Chicago. SANFORD, M.K., D.P. VAN GERVEN & R.R. MEGLEN. 1983. Elementalhair analysis: new evidence on the etiology of cribra orbitalia inSudanese Nubia. Human Biology 55: 831-44. SPENCER, A.M. 1993. Early Egypt. London: British Museum Press. STEPHENSON, L.S. & C. HOLLAND. 1987. The impact of Helminth helminth/hel��minth/ (hel��minth) a parasitic worm. hel��minthn.A worm, especially a parasitic roundworm or tapeworm.HelminthA type of parasitic worm. infections on human nutrition: 57-152. New York: Academic. STUART-MACADAM, P. 1985. Porotic hyperostosis: representative of achildhood condition. American Journal of Physical Anthropology 66:391-98. --1992. Porotic hyperostosis: a new perspective. American Journalof Physical Anthropology 87: 47. TAMARI, T. 1991. The development of caste systems in West Africa.Journal of African History 32: 221-50. TANAKA, H. 1989. Hookworm disease, in R. Goldsmith & D.Heyneman (ed.) Tropical medicine and parasitology ParasitologyThe scientific study of parasites and of parasitism. Parasitism is a subdivision of symbiosis and is defined as an intimate association between an organism (parasite) and another, larger species of organism (host) upon which the parasite is : 361-68 Norwalk:Appleton and Lange. THOMSON, A. & D. RANDALL-MACIVER. 1905. Ancient races of theThebaid. Oxford: Oxford University Press. TRIGGER, B. 1983. The rise of Egyptian civilization, in B. Triggeret al. (ed.) Ancient Egypt, a social history: 1-70. Cambridge: CambridgeUniversity Press. UCKO, P. 1969. Ethnography and archaeological interpretation offunerary remains. World Archaeology 1: 262-80. WILKINSON, T. 1999. Early Dynastic Egypt. New York: Routledge. WOOD, J.W., G.R. MILNER, H.C. HARPENDING & K.M. WEISS WEISS Workshop on Industrial Experience with Systems Software . 1992.The osteological paradox: problems of inferring prehistoric health fromskeletal samples. Current Anthropology 33 (4): 343-70. S.O.Y. Keita (1) & A.J. Boyce (2) (1) National Human Genome Center, Howard University and Departmentof Anthropology, Smithsonian Institution, USA (2) Institute of Biological Anthropology and St Johns College,University of Oxford, UKTable 1. Sample sizes by structure Royal tomb Funerary enclosure/ PalaceOrbits (roofs) 37 45Vaults (all) 44 48Vaults (most complete) 37 42Table 2. Dichotomous variables, comparisons Frequencies (%)Series N VPP1 VPP2 CribraRoyal tomb (44, 37) 77.3 47.7 35.1Funerary enclosure (48, 45) 45.8 14.6 11.1[chi square] 9.53 11.91 6.84[rho] 0.002 <0.001 0.008Table 3. Means and standard deviations, comparisons VpS ES N Mean SD N Mean SDRoyal tomb 44 1.74 1.18 37 1.97 0.93Funerary enclosure 48 0.74 0.76 42 0.98 0.92ComparisonsANOVA [rho] <0.001 (F = 23.64) <0.001 (F = 22.82)Mann Whitney [rho] <0.0001 (Z = -3.85) <0.0001 (Z = -4.20)