The various medical conditions suffered by the Scottish Soldiers is one area that we have investigated in quite a lot of detail. We have already blogged about some of the dental problems the soldiers suffered from  and about the work being done in York looking at dental plaque. In today’s post we are going to look at scurvy, which is something we think some of the soldiers may have suffered from.

Bone Response to Disease and Injury

Bone is a living tissue, and as such it can respond to disease and injury. This is how broken bones can heal and join back together. However, the way that bone can respond to illness is fairly limited – it can put down new bone and it can take bone away – which means that while we may see traces of disease and poor nutrition in the bones, it can be difficult to interpret what caused the lesions. Also, it takes time for bone to respond, so a person has to live with a condition for enough time for bone changes to form. Acute diseases that only last for a short time before the person either recovers or dies (e.g. dysentery) will not leave any trace in the skeleton. This is why we are exploring the dental calculus to see if we can see traces of these acute conditions there. New bone formation can occur in response to an infection, but also as a result of inflammation due to injury, or as a result of metabolic disease.

The initial bone that is laid down in response to illness or injury is called ‘woven bone’. It is disorganised, appearing brown or grey and porous, and is often not firmly attached to the bone surface.

Sk4 MT
Woven bone plaque on a metatarsal (foot bone) from Sk 4

With time, the woven bone is remodelled and turns into ‘lamellar bone’. This is typically striated, and is incorporated into the bone surface, appearing the same colour as the rest of the bone. Therefore, the presence of woven bone indicates that whatever the person was suffering from was still active at the time they died, whereas lamellar bone indicates that the lesion had healed. The presence of a mix of woven and lamellar bone can indicate a condition that was long-standing and still active at the time of death.

Sk14 R Tib
Lamellar bone on a tibia (shin bone) from SK14

New Bone Formation in the Scottish Soldiers

Several of the Scottish soldiers had new bone formation on their skeletons. However, there were some interesting patterns in the type of new bone formation and its distribution in the skeleton:

  • New bone formation was seen much more frequently in the adolescents compared to the adults
  • New bone formation was seen on a greater variety of bones in the adolescents compared to the adults – in the adults the new bone formation was confined to the lower legs, while in the adolescents the bones affected included the lower jaw
  • In the adolescents most of the new bone formation took the form of woven bone, meaning the lesions were still active at the time they died, while in the adults the new bone formation was all lamellar bone, meaning the lesions had healed

Identifying a specific cause for these lesions is impossible based on just looking at the bones. This bone formation could have been caused by infections, minor injuries, or metabolic diseases. However, it is suspected that a particular metabolic disease – scurvy – may have been the cause of some of these lesions, particularly the active lesions seen in the adolescents. The presence of scurvy is something that we are hoping to explore further using biochemical markers of the disease.

Sk23
Woven bone on the jaw of Sk23
Sk1 Prox Ulna
Woven bone on the ulna (forearm) in Sk 1

Scurvy

Unlike most animals, humans are unable to make their own Vitamin C, and so they must get all the Vitamin C they need from the food they eat. Vitamin C is found in fresh fruits and vegetables, with small amounts present in milk, meat and fish, but cooking food will destroy a large percentage of the Vitamin C it contains. People who do not eat enough Vitamin C for prolonged periods will develop scurvy. This is a condition famously associated with historical long sea voyages, where the sailors relied on eating preserved foods and didn’t have access to fresh fruits and vegetables. At the time, the cause of their symptoms was unknown – it wasn’t until James Lind carried out his experiments in the mid eighteenth century that it was proved that scurvy could be cured with the juice of citrus fruits. Even then, it took a long time before his results were accepted.

Vitamin C is necessary for the body to make collagen, which is an essential part of many of the body’s tissues, including bones, skin, muscles, tendons, ligaments, cartilage, and blood vessels. Lack of Vitamin C is therefore a serious health problem. If the consumption of Vitamin C is stopped completely, then it will take one to three months for the first symptoms to appear. Because children and infants are still growing, they are more likely to develop scurvy than adults, they will develop symptoms more quickly, and the effect on their bones is more severe.

Early symptoms of scurvy include tiredness and lethargy, with pain and weakness in the muscles and bones. Weakened blood vessels are more easily damaged leading to haemorrhages, or bleeding into the surrounding tissues and joints. This causes pain and swelling, and people suffering from scurvy may limp or find it difficult to walk. Haemorrhages next to the bone surfaces can lead to new bone formation, and this is more likely to occur in children. The gums become red and swollen, then ulcerated, and the teeth become loose and fall out. Vitamin C is also important in maintaining the immune system, so people deficient in Vitamin C can be more vulnerable to developing infections. A person suffering from scurvy will eventually die, if they do not begin consuming food containing Vitamin C.

Historical evidence suggests that the Scottish soldiers were already suffering from poor nutrition before they were captured by Cromwell’s army. Following capture and imprisonment, it is unlikely they would have received enough fresh fruits and vegetables to provide them with enough Vitamin C. This would have been more critical for the adolescents, who would still have been growing and who would have developed the symptoms of scurvy earlier than the adults. Haemorrhages into the tissues surrounding the bones would have been more likely to occur in the adolescents, leading to the new bone formation seen. However, it is important to note that the diet must have contained some Vitamin C in order for the new bone formation to occur at all.

Next steps

Because we suspect that some of the individuals may have suffered from scurvy we are going to carry out some further investigations using biochemical markers. This is still a fairly experimental technique but we are hopeful it may provide us with further information about the living conditions and diets of the individuals. We’ll keep you posted about this work as it progresses.

Anwen Caffell

Author: Anwen Caffell

Anwen is an honorary research fellow and teaching fellow at Durham University, teaching on the MSc in Palaeopathology. She has also worked as a freelance osteoarchaeologist since 2005 carrying out a wide variety of commercial projects predominantly for York Osteoarchaeology Ltd, but also Archaeological Services Durham University, and others. She completed a BSc in Archaeology at the University of Bradford (graduating in 1997), followed by an MSc in Human Osteology, Palaeopathology and Funerary Archaeology at the Universities of Sheffield and Bradford in 1998-1999. She obtained her PhD from Durham University in 2005.

Palaeopathology and Scurvy