Scurvy is a disease resulting from a deficiency of vitamin C characterised by the interruption of collagen and osteoid formation and leading to clinical symptoms including hemorrhage, the elevation of the periosteum, hematoma formation, and the inhibition of bone growth. Until recently there has been a lack of palaeopathological evidence for the presence of scurvy in ancient Egypt, but the recent discovery of a 16-month-old skeleton of an infant at the Pre-Dynastic site of Nag Al-Qarmila in Aswan by the AswanKom Ombo Archaeological Project (AKAP) of Bologna University in Italy and Yale University in the US has detected the first ancient Egyptian case of scurvy. The infant was placed on its left side within the excavated settlement in a semi-flexed position with the talon of a raptor found nearby. All the skeletal elements were recovered, except for a few unfused epiphyses, and all were well preserved. The infant's gender is not yet known. “Studies have revealed that the bone remains of the child have changes in the shape of the skeletal structure, one of the clearest signs of the vitamin C deficiency that causes scurvy,” said Maria Carmella Gatto, an archaeologist at the University of Leicester in the UK who is directing the AKAP mission. Writing in the International Journal of Paleopathology, Gatto and bioarchaeologists Mindy Pitre from St. Lawrence University in Canton, New York, and Robert J. Stark from McMaster University in Ontario, Canada, said that microscopic examination of the remains had revealed abnormal porosity, something often seen in scurvy victims. The child's skull was virtually covered in patches of porous bone, including the jaw and the eye orbits, the authors said. New bone formation suggestive of bone inflammation was also seen on the upper leg and arm bones. “Although the cause of this infant's probable scorbutic state is unknown, various circumstances such as diet, cultural behavior, and unhealthy food may have contributed to the condition,” the researchers said. “Given the current lack of evidence of scurvy from ancient Egyptian contexts, this case informs us of the antiquity of ascorbic acid deficiency in the Old World.” They suggested that the child's social status may have played a role in its falling victim to the disease. “Although he would likely have still been breastfeeding at this age, as ancient Egyptians used to breastfeed their children until three years old, it is possible that his mother or wet nurse was also malnourished and so was unable to provide enough vitamin C for her child,” the researchers said, adding that there was some evidence showing that the child had suffered bleeding as a result of the disease. There was plenty of food in ancient Egypt that could have provided sufficient vitamin C, said Pitre, but there is also written evidence from Egyptian medical papyri for treatments for a disease that is almost certainly scurvy. “If the ancient Egyptians were eating primarily meat, dairy products, fish, and cooked or preserved plants, their diets would be quite low in vitamin C,” she said, adding that a secondary condition such as malaria could have factored into the child's health, making the child more prone to reduced absorption of vitamin C. There is no direct evidence of exactly what this ancient Egyptian child died from, Pitre and colleagues noted, though “complications from infection, cachexia [wasting syndrome], and or cardiac and myocardial impairment often seen in cases of scurvy may have contributed to the child's mortality.” Although it is just one infant skeleton among many others from Pre-Dynastic Egypt, the researchers have concluded that the child “contributes to our understanding of the antiquity of ascorbic acid deficiency in the Old World and suggests that regardless of the fertile nature of the area dietary insufficiencies such as scurvy were possible.” “This is perhaps the first differentially diagnosed bioarchaeological example of scurvy in Egypt,” Gatto said, adding that studies would continue on the child's skeleton in order to reveal more about the disease. “In around 3800-3600BCE, the small Pre-Dynastic rural village where the infant skeleton was found sat on the southern periphery of what would later become the Egyptian state. Although the area is now largely desert, it is thought to have been covered in rich farmland at that time,” Gatto told the Weekly in an email. She said that other discoveries in the area had provided evidence that the inhabitants had a varied diet. They would have lived on cereals, livestock and by gathering wild fruit and tubers. “However, there is some evidence that they may have struggled to get enough vitamin C from their diet, particularly as the emerging hierarchy in ancient Egypt saw much of the produce from farming being taken by the elite,” Gatto pointed out. She continued that archaeologists in the past have found evidence in the area that suggests a flowering plant called Colocasia, or Tarul, was added to bread, wheat and barley to increase vitamin C intake. “Our project, like others in the area, is adding much more detailed information,” Gattoo said, adding that the case of the infant skeleton highlighted a small village that has not been investigated in previous excavations, when tombs and cemeteries were preferred. Scurvy, Gatto said, was known in ancient Egypt as there are texts telling us about this disease, but up to now it has been difficult to find evidence of it on bones. “That is what makes the baby skeleton so special,” she said, along with the fact that the skeleton was found buried in the village and not in the nearby cemetery. She said that although researchers know from other Pre-Dynastic sites like Adaima (Esna) that sometimes children were buried in villages, the fact that this baby was seriously ill may have been a reason to bury him in a special location such as in the village. Nasr Salama, general manager of the Aswan Archaeological Area at the ministry of antiquities, said that the discovery shed light on a poorly understood period in the country's history. The AKAP has been at work since 2005 investigating the area stretching between Aswan and Kom Ombo in an attempt to preserve and document ancient archaeological finds that are not well known. Many archaeological discoveries have already been made in the region, and in the 1920s archaeologist Herman Junker worked on the west bank of the Nile at Aswan south of Kunnabiya and found cemeteries and a monastery, and Fred Wendorf and the Combined Prehistoric Expedition worked in the 1980s on Palaeolithic sites in Wadi Kubbaniya. AKAP archaeologists and research scientists from partnering academic institutions have been adopting advanced three-dimensional imaging technologies in order to build detailed records of rock art left behind thousands of years ago in its natural environmental setting. The project is part of an effort to quickly, efficiently, and cost-effectively build data profiles on the region before the rock art and other archaeological finds are destroyed or compromised. Gatto told the Weekly that under the AKAP concession was a section of the west bank north of Qubbet Al-Hawa, part of Wadi Kubbaniya on the west bank and Wadi Abu Subeira on the east bank, and an area of the eastern desert east of Kom Ombo. “These areas were selected because our main interest is to detect the nature of the interaction between Egypt and the Nubian pastoral nomadic groups at the time. So we wanted to investigate not only the sites along the Nile, but also those in the desert, because those were the areas where Nubian sites could also be found.” Gatto said that the mission has made a lot of discoveries over the past ten years, including of the remains of villages, cemeteries, temples, monasteries, towns and rock art dating from the Palaeolithic era to the Islamic period, though its main interest has been in the study of the prehistoric sites. Archeological investigation is now taking place at the Late Palaeolithic sites in Wadi Kubbaniya where the Combined Prehistoric Expedition worked in the 1980s and produced new insights on human occupation 13,000 years ago. “These are very important data to understand how the process towards food production and social complexity started in Egypt and Nubia and, as a matter of fact, in all of Africa,” Gatto said, adding that the mission was also focusing on the study of the Pre-Dynastic period, finding many villages and cemeteries along the Nile one of which was the place where the baby skeleton with scurvy had been found. Apart from the Pre-Dynastic site of Elephantine, where only a few cemeteries dating to the fourth millennium BCE have been found, she said much more detailed information on the human occupation of the First Cataract region during the period that marked the rise of Egyptian civilisation in dynastic times had now been found. “Rock art is another part of our work, and we use different digital methodologies to document it. The most important site found so far is in Nag Al-Hamdulab in Aswan, and it consists of a series of rock drawings from the late Pre-Dynastic and Early Dynastic periods with representations of boats, animals, people and most importantly the earliest known representation of an Egyptian king, probably Narmer,” Gatto said.
