Documentos de Académico
Documentos de Profesional
Documentos de Cultura
Sarah Musselwhite
Christs College
This dissertation is submitted for the Degree of Master of
Philosophy
August 2011
University of Cambridge
PREFACE
This dissertation is the result of my own work and includes nothing which is the
outcome of work done in collaboration, except where specifically indicated in the
text.
The dissertation does not exceed the 15,000 word limit stipulated by the Degree
Committee for the Faculty of Archaeology and Anthropology.
Word count: 14,965
ABSTRACT
This study investigates variation in skeletal health among Predynastic and Early
Dynastic Egyptian populations in relation to state formation and social status. Health
has been shown to correlate with political, economic and social change in past
societies, but many studies utilising skeletal data fail to examine its archaeological
context in detail. Here, variation in the frequency and severity of three skeletal stress
markers that reflect population healthcribra orbitalia, porotic hyperostosis and
linear enamel hypoplasiawas measured. 179 individuals were sampled across 6
distinct Predynastic and Early Dynastic populations. The social context of each
population was investigated through examination of original excavation reports. The
results suggest that overall health improved after the initial transition to agriculture
due to dietary diversification, but then declined with increasing urbanisation
because of the negative effects of increasing population density. Investigation of
elites buried in Cemetery T at Nagada and individuals buried around the First
Dynasty royal funerary enclosures at Abydos revealed that high social status did not
always confer good health in early Egypt. The adoption of methods from both
Egyptology and Biological Anthropology has shown great promise in reconstructing
the health of the early Egyptians and relating it to their social context.
TABLE OF CONTENTS
1. INTRODUCTION
1.1.
Research context and questions
1.2.
What determines health?
1.3.
Health and cultural change
1.4.
Health and social status
1.5.
How do you measure skeletal health?
1.5.1. Skeletal stress markers
1.5.2. Linear enamel hypoplasias
1.5.3. Porotic hyperostosis and cribra orbitalia
1.5.4. Childhood health
1.5.5
The osteological paradox
1.6.
Previous studies of skeletal health in Egypt
1.7.
Research aims and contribution
1
1
2
3
3
4
5
6
7
9
10
11
13
15
15
18
19
21
22
23
24
25
25
25
28
29
29
30
32
3. RESULTS
3.1.
Inter-population differences in stress markers
3.1.1. Cribra orbitalia
3.1.2. Porotic hyperostosis
3.1.3. Linear enamel hypoplasias
3.2.
Intra-population variation in stress markers
3.2.1
Sex
3.2.2. Age
3.3.
Association between different stress markers
33
33
33
39
44
58
58
59
60
4. DISCUSSION
4.1.
Health and cultural changetemporal trends in the stress markers
4.1.1. The Badarian period
61
61
61
4.1.2.
4.1.3.
4.2.
4.2.1.
4.2.2.
4.2.3.
62
65
68
68
73
75
76
BIBLIOGRAPHY
APPENDICES (CD)
78
83
ACKNOWLEDGEMENTS
I would like to thank my supervisors Dr Kate Spence and Dr Jay Stock for their advice
throughout the year and for reading drafts of this dissertation. Thanks also goes to
the Directors of the Duckworth Laboratory and Ms. Maggie Bellatti for allowing me
access to the skeletal material.
I would also like to acknowledge Daniel Strange and Lucy Musselwhite for
proofreading and technical assistance.
LIST OF TABLES
Table 1 - Origins of the skeletal material used in this study ....................................... 16
Table 2 - The skeletal sample taken in this study ........................................................ 25
Table 3 - The age distribution of the individuals sampled .......................................... 27
Table 4 - The scoring system used for measuring cribra orbitalia and porotic
hyperostosis ................................................................................................................ 31
Table 5 - Percentages of the highest frequency molar, premolar, canine and incisor
with LEH, by population ............................................................................................... 55
Table 6 - Percentages of the two highest frequency molars with LEH, by
population .................................................................................................................... 56
Table 7 - Average age (years) of LEH formation per individual (averaged across all
LEH bands), by population ........................................................................................... 56
Table 8 - Average age (years) of LEH formation in left maxillary second molar, by
population .................................................................................................................... 57
Table 9 - Average age (years) of LEH formation in right maxillary second premolar,
by population ............................................................................................................... 57
Table 10 - Average age (years) of LEH formation in right maxillary canine, by
population .................................................................................................................... 58
Table 11 - Average age (years) of LEH formation in right maxillary second incisor,
by population ............................................................................................................... 58
LIST OF FIGURES
Figure 1 - Linear enamel hypoplasia bands .................................................................. 7
Figure 2 - Porotic hyperostosis ..................................................................................... 9
Figure 3 - Cribra orbitalia ............................................................................................... 9
Figure 4 - Map showing the locations of the populations sampled ........................... 17
Figure 5 - Timeline of the periods studied .................................................................. 17
Figure 6 - Sexually dimorphic cranial features ........................................................... 29
Figure 7 - Location of the cemento-enamel junction ................................................. 30
Figure 8 - Percentage of individuals with cribra orbitalia severity score 1 or above,
by population ............................................................................................................... 34
Figure 9 - Percentage of individuals with cribra orbitalia severity score 2 or above, by
population .................................................................................................................... 35
Figure 10 - Percentage of individuals with each severity score of cribra orbitalia, by
population .................................................................................................................... 36
Figure 11 - Average severity of cribra orbitalia in each population ............................ 37
Figure 12 - Percentage of individuals with severe cribra orbitalia (scores 3 & 4), by
population .................................................................................................................... 37
Figure 13 - Percentage of individuals with cribra orbitalia severity score 2 or above,
by time period .............................................................................................................. 38
Figure 14 - Percentage of individuals with porotic hyperostosis severity score 1 or
above, by population ................................................................................................... 40
Figure 15 - Percentage of individuals with porotic hyperostosis severity score 2 or
above, by population ................................................................................................... 40
Figure 16 - Percentage of individuals with each severity score of porotic
hyperostosis, by population......................................................................................... 41
Figure 17 - Average severity of porotic hyperostosis in each population ................... 42
Figure 18 - Percentage of individuals with severe porotic hyperostosis
(scores 3 & 4) by population ........................................................................................ 42
CHAPTER 1 INTRODUCTION
1.1. Research context and questions
This study uses skeletal data to investigate how health varied among Predynastic
and Early Dynastic Egyptian populations, as the Egyptian state formed and new social
classes emerged. These periods were characterised by profound economic, political
and social changes: agriculture was introduced into the Nile Valley from the Fertile
Crescent and allowed the production of surplus food to support craft specialisation;
foreign trade flourished and allowed exotic raw materials to be imported into Egypt
for the manufacture of elite prestige items; urban centres developed and acted as
important arenas of elite activity and social stratification became more pronounced.
These changes cumulated in the rise of several different proto-states, of which the
most significant were centred on the Upper Egyptian sites of Nagada, Hierakonpolis
and This (Kemp 2006), and ultimately provided the ideological foundations for later
Egyptian kingship. Cultural unification of Egypt was complete by the Nagada II
period, followed soon after by political unification in the Nagada III period (Wilkinson
2000) and the establishment of a new political capital at Memphis. However, little is
known about how all of these processes affected the physical wellbeing of people
and how their relationship with the physical environment changed over time.
Skeletal remains are a particularly important source of information in these early
periods because archaeological evidence is generally poor compared to later
periods. Much of our evidence so far has come from studies of material culture
associated with burials or changing cemetery patterns, but these are limited in what
they can tell us about societal change and are biased towards representation of the
1
deceased in the afterlife. Skeletal health can tell us about the key political, economic
and social factors that shaped peoples lives whilst they were living. Furthermore,
skeletal health can provide insight into whether the changes brought to society by
state formation had the same effects on everyone, regardless of the social group to
which they belonged.
This study will address two key questions. Firstly, did health change over time
from the beginning of the Predynastic Period to the Early Dynastic Period, and if so,
why? What factors were underlying such changes? Secondly, were social status and
health correlated in these early periods? Ultimately, this study will examine the link
between political, economic and social change, and the health of populations.
particularly that with high nutritional content, and other resources which can affect
health such as general environmental quality and healthcare (Keita & Boyce 2006).
The promotion of easy access to such resources among higher status individuals
results in a better biological response to the environment (Cucina & Ican 1997) and
the stresses it causes.
Some studies have revealed a link between high status and good health (Cook
1981). However, there are also studies which have shown no such health distinctions
between high and lower status individuals groups from the same society. Robb et al.
(2001) found no significant association between various skeletal indicators of health
and social status as defined by grave goods from the Italian Iron Age site of
Pontecagnano; Cucina and Iscan (1997) found that disruption in childhood growth
was common among a high status group from the Fort Center site in Florida, US,
dated to A.D.200-800. This variation indicates that the relationship between social
status and health depends very much on the particular social context from which the
studied groups originate and the mechanisms in place within that particular society
to control resource distribution. The present study ensures that the social context of
each skeletal population sampled is investigated in detail so that the relationship
between social status and health can be examined further.
different groups and are also biased towards the elite view of the world. The analysis
of stable isotope ratios from bone and teeth is very informative of past diet, which
has a strong influence on health, but is not a direct measure of an individuals health.
The analysis of skeletal health provides the most direct way of quantifying health
differences between populations and hence will be used in this study.
Figure 3 - Cribra orbitalia (Adapted from: (Aberdeen Art Gallery and Museums
Collections n.d.))
and/or malnutrition present within the general population (Keita & Boyce 2001). The
relationship between environmental stress and poor health is complex, especially
among children. Children, particularly those under five years of age, are highly
susceptible to bacterial, viral and parasitic infections. After weaning, these can often
occur from contact with contaminated food and water, the risk of which is increased
when general sanitation is poor (Kent 1986). Many infections can lead to chronic
diarrhoea which can cause severe dehydration and malnutrition by inhibiting the
absorption of nutrients from ingested food (Carlson et al. 1974; Facchini et al. 2004).
If the diet is already nutritionally inadequate, then the effects of this will be
enhanced.
10
environment in which a group lived and the likelihood of a member of that group
suffering from poor health.
improvement in health after the Badarian period, although this study was not
focused solely on Egypt. Studies using just one or two populations have also been
carried out, with the advantage that they often employ a multitude of different
skeletal stress markers to quantify health. One such study by Greene (2006)
compared both diet and dental health between two populations from Hierakonpolis
and Nagada, mostly dating to the Nagada II period, and found that children from
Hierakonpolis were healthier than those from Nagada. Another study by Kumar
(2009) used multiple stress markers to compare the health of individuals from a
Nagada II cemetery at Hierakonpolis with data from other populations dating from
the Upper Palaeolithic to the Old Kingdom, and concluded that there was an overall
decline in health with the introduction of agriculture and increasing socio-economic
disparities.
These existing studies of health in early Egypt are limited in their scope and the
approaches they employ. Firstly, the relationship between health and cultural
change only becomes apparent when populations from different contexts are
compared with one another, so studies involving just one or two populations are
limited in what they can reveal. Secondly, the most useful studies which have
compared several populations over the Predynastic and Early Dynastic periods have
not always used multiple stress markers to quantify health change; the study by
Keita (2003) above only looked at the change in porotic hyperostosis prevalence. The
use of multiple indicators is essential if reliable conclusions of overall health change
are to be made as each skeletal stress marker only tells us about one aspect of an
individuals or populations health. Furthermore, the use of more than one stress
12
marker reduces the number of potential interpretations that can be made from the
data.
Thirdly, many studies have failed to trace the skeletal material used back to their
original archaeological contexts; often original excavation reports are not even
referenced in studies, implying that they were not consulted. This has resulted in
interpretations of health changes and differences being made without fully
considering how a groups social context could have affected their observed health.
Finally, the relationship between social status and health has only been touched
upon, not just in the context of early Egypt, but for most periods of Egyptian history.
This is surprising considering that social status is such an important issue within
Egyptology.
period of Egyptian history for which we know comparatively less than later periods.
Beyond Egyptology, it has wider implications for investigating the effects that major
cultural changes such as agriculture, urbanisation and social stratification have on
the ability of a human group to adapt to its environment, as well as providing more
accurate models for state formation in other areas of the world.
14
15
Badarian period
Nagada cemetery B
Nagada cemetery T
Tarkhan
Petrie (1914)
Abydos - Tombs
of the Courtiers
First Dynasty
Petrie (1924)
16
Figure 4 - Map showing the locations of the populations sampled (Adapted from:
(Grajetzki & Quirke 2001))
Figure 5 - Timeline of the periods studied (Created by the author dates taken
from (Shaw 2002))
N.B. Nagada III and Protodynastic are just different names for the same time period.
17
18
tools, various ivory items such as bracelets and rings, bone and ivory combs,
siltstone palettes, ostrich egg shell vessels, shell and stone beads, and copper items
such as pins (Midant-Reynes 2000; Brunton & Caton-Thompson 1928). There has
been debate as to the level of social stratification that Badarian period graves
represent. Trigger (1983) suggests that although graves were differentiated in size,
there were no strong wealth distinctions in terms of burial goods because rich
burials of children were not found; certainly, the concept of inherited status had not
developed at this point. Anderson (1992) argues against this and suggests that there
were burial good differences and that this argues against the traditional view of
Badarian society being largely egalitarian in its structure. Regardless of this though,
social status differences in tombs become much more evident in the latter half of
the Predynastic Period, as the ideological foundations of Egyptian kingship were
developing amongst a powerful elite class.
2.1.2. Hierakonpolis
The Predynastic material from Hierakonpolis is the most difficult to assign a
detailed provenance to, as the Duckworth records are the sparsest for this collection
and little has been done to investigate the provenance in previous studies where the
material has been used. Most of the individuals sampled have different one, two or
three digit grave numbers written on the skulls. A few have 232 E written on them
instead and some have the same number, 318. An entry by an unknown author in
the records lists three archaeological excavations where the material could have
come from: Egypt Research 1898, Petrie 1898 and Green & Quibell 1899. The
Egyptian Research Account, formed by Petrie, dispatched Green and Quibell to
19
salvage the Predynastic site at Hierakonpolis in 1897 (The Friends of Nekhen n.d.),
from which two excavation reports, Hierakonpolis I (Quibell 1900) and Hierakonpolis
II (Quibell & Green 1902) were published. The next expedition to Hierakonpolis was
in the 1905-06 season by Garstang and Jones (The Friends of Nekhen n.d.).
Therefore, it seems likely that the material originated from Quibell and Greens
excavations. They investigated two main Predynastic burial areas: one within the
Fort region and one at the south of the desert site. The latter was a Nagada II
cemetery in which the Painted Tomb (tomb 100) was found (Wilkinson 2000),
which possibly belonged to an early king (Case & Crowfoot Payne 1962). This
represented the main Predynastic cemetery area, and so is the most likely place
from which the material sampled in this study originated. However, in their report,
Quibell and Green make little mention of graves other than the large, brick-lined
ones to which tomb 100 belonged. They are quoted as saying:
The rest of the graves were mere rough rectangular excavations in the hard desert
sand varying in depth from 2.0 m. to 0.5 m. The roofs had in many instances been
made out of wood as the remains of the ends of the beams were found in some
cases Nearly all had been robbed, and most of those that had escaped contained
little except pottery (Quibell & Green 1902, p.22).
It is not clear how many graves they were referring to, though Crowfoot Payne
(1973) mentions a series of 150 Predynastic graves in a manuscript register compiled
by Green and suggests that they are from the tomb 100 cemetery. The contents of
most of these graves seem to have been published in (Adams 1974). However,
20
hardly any of the grave numbers associated with the skeletal material sampled in
this study are mentioned.
As a result of the material not being recorded in any detail, it is not possible to
make any significant statements about the social status of the individuals
represented in the skeletal material sampled at Hierakonpolis. All that can be said is
that most were probably of lower status than tomb 100 and other similar graves
(although one skull labelled with the number 100 could possibly have belonged to
the person buried in this tomb). As it is not possible to be completely sure that all of
the skeletal material originates from this one cemetery, but it is fairly certain that it
all came from the excavations of Quibell and Green, the Hierakonpolis group has
been labelled as a general Mid Predynastic-Protodynastic group, which could include
Nagada I and III period material (the Fort cemetery was used over these periods
(Wilkinson 2000)) in addition to that from the Nagada II period.
different cemeteries at Nagada by Bard (1994) points towards Cemetery B being for
lower status individuals than Cemetery T and N West on account of the smaller
average grave size, greater density of graves and lower number of rich graves. Bard
suggests that the cemetery was for middle-class individuals living in a nearby farming
village.
22
23
poorer people. Given that the graves associated with the material sampled in this
study are from a variety of different locations within the cemetery, and contain a
variety of different types and numbers of grave goods, the sample is likely to contain
individuals of a range of different social classes.
24
resource investment represented by the burials suggests that these individuals were
accorded a special high status.
Total number
of individuals
sampled
Number of
individuals
observable for
porotic
hyperostosis
Number of
individuals
observable for
cribra
orbitalia
Number of
individuals
observable for
LEH (at least 1
scorable
tooth)
El-Badari
30
30
30
30
Hierakonpolis
39
39
39
29
Nagada B
24
24
20
24
Nagada T
24
24
23
15
Tarkhan
30
30
29
28
Abydos
32
32
30
31
TOTAL
179
179
171
157
subadults or undefined. For the purposes of this study, distinction between different
age categories within adults was not made, as aging an individual from only cranial
material is considered to be an inaccurate method (Dr J.T. Stock, personal
communication) and because of the time constraints of the study. Adult status was
assigned primarily on the basis of dental status. Dental status was assigned for each
tooth using and adapting the scoring system developed by Dr J.T. Stock (personal
communication):
O - In occlusion/fully erupted tooth present (adapted in this study to include cases
where only part of a tooth was present because of post-mortem damage)
E - Emerging
U - Unerupted
CO - Crypt open (i.e. tooth about to emerge)
P - Postmortem loss
A - Antemortem loss
M - Missing for unknown reason
An individual was considered an adult if at least one fully erupted third molar was
present, or in the case of postmortem tooth loss, where there was evidence of one
having been present; the third molar (wisdom tooth) emerges from the age of 18
years (White & Folkens 2005). However, this method is limited in that third molar
emergence can be delayed by several years into adulthood, with the timing varying
between individuals within a population. Evidence of extensive cranial suture fusion
was also occasionally used to assign adult status if either no evidence of fully
erupted third molars was present or if there was insufficient dental material.
Subadult status was assigned if it could be confirmed that no fully erupted third
26
molars were present. If for any reason age status could not be confirmed, the
individual was recorded as undefined.
Table 3 - The age distribution of the individuals sampled
Population
Number of adults
Number of
subadults
Number of
individuals of
undefined age
El-Badari
30
Hierakonpolis
39
Nagada B
24
Nagada T
11
10
Tarkhan
30
Abydos
31
TOTAL
165
11
As can be seen from Table 3, the age distribution of individuals sampled varied
between populations. This is a common challenge faced by palaeopathologists and is
important to be aware of because it can affect the prevalence of stress markers
observed in each group. In the case of cribra orbitalia and porotic hyperostosis, a
sample with an overall older age distribution could theoretically exhibit a lower
prevalence than a sample with a younger age distribution. This is because both are
thought to form in childhood, but can then remodel and heal later in life (StuartMacadam 1985). LEH does not suffer from the same bias, as tooth enamel does not
remodel after its initial formation (Goodman & Rose 1990), but it should be
remembered that a skeletal sample will only consist of the individuals who survived
periods of childhood stress. For the samples used in the present study it was not
possible to see whether the prevalence of any of the stress markers changed
27
significantly with age. However, the inclusion of mostly adults minimises any bias
that could have arisen from higher prevalences among subadults.
3.1.2. Sex
Each individual was assigned a sex to enable any differences in health between
males and females to be identified in data analysis. Sex was determined from each
cranium using the standard method of Buikstra and Ubelaker (1994), in which five
sexually dimorphic cranial features (Figure 6) are given a score of 1-5 based on their
robusticity, where 1 is hyperfeminine and 5 is hypermasculine:
The scores are then averaged to give an overall sex. An individual with an average
score of 1-2.5 was recorded as female and 3.5-5 as male. Those individuals with
scores of 2.6-3.4 were recorded as undefined (Starling 2005). Where preservation
of material was poor, an individual was required to have a minimum of three out of
the five (i.e. more than half) cranial markers present for sex to be assigned with
confidence. If not, they were recorded as undefined. Any pre-assigned sex written
by previous researchers on either the skulls or boxes was also noted, as well as those
recorded in the original excavation reports.
28
Figure 6 - Sexually dimorphic cranial features (Source: (Buikstra & Ubelaker 1994))
be considered scorable, it needed to have at least half of its enamel surface present
and visible (Starling 2005). The poor preservation of tooth enamel was a significant
problem in this study. A 10x magnifying glass was used to examine teeth for LEH, but
a tooth was only recorded as having LEH if the band was visible with the naked eye
too. The distance of the LEH band, or the most severe one in the case of multiple
bands, from the cemento-enamel junction (Figure 7) was measured using a pair of
digital callipers. This was so that the approximate age at which the growth disruption
had occurred could be calculated; tooth enamel formation begins from the top of
the tooth. This was done using the formulae presented by Goodman and Rose
(1990).
Figure 7 - Location of the cemento-enamel junction (Source: (Spiller 2000))
(Table 4). In cases where porotic hyperostosis of multiple severity levels was present
in the same individual, only the most severe was scored.
Any individual with at least one orbit present was scored for the presence and
severity of cribra orbitalia, using the same scoring system as for porotic hyperostosis
(Table 4). Again, only the most severe manifestation of the condition was scored if
multiple severity levels were present. Only one orbit was required to be able to
measure cribra orbitalia because of its noted bilateral distribution (Stuart-Macadam
1989). An incomplete orbit could still be scored for cribra orbitalia as long as the
orbital roof was present, where cribra orbitalia usually appears (White & Folkens
2005). If both orbits were present and of sufficient preservation, only the most
severe occurrence of cribra orbitalia was recorded, but it was also noted whether
cribra orbitalia appeared in one or both orbits.
Table 4 - The scoring system used for measuring cribra orbitalia and porotic
hyperostosis (Buikstra & Ubelaker 1994)
Score
Criteria
No porosity present
True porosity
31
32
CHAPTER 3 RESULTS
N.B. The raw data collected in this study can be found in Appendix B.
El-Badari had the highest percentage (30.00 %), though this was only slightly higher
than Hierakonpolis (28.21 %) and Tarkhan (27.59 %). There was also very little
difference between the two Nagada groups (20.00 % vs 21.74 %).
Figure 8 - Percentage of individuals with cribra orbitalia severity score 1 or above,
by population
34
3.1.1.2. Severity
There were also differences in the severity of cribra orbitalia between
populations; the overall severity distribution is presented in Figure 10. Both Tarkhan
and Hierakonpolis had the highest average severity (1.10) and Abydos had the
lowest (0.57) (Figure 11). Nagada T also had a lower average severity (0.78) than
Nagada B (0.95). It should be noted though that these differences in average severity
were quite small and not significant (Kruskal-Wallis test: X2=9.045, df=5, p=ns).
Interestingly, Abydos was the only population in which the most severe occurrence
of cribra orbitalia, severity scores 3 and 4, was not observed, whereas Nagada B had
the highest percentage of individuals with these scores (15.00 %) (Figure 12).
Furthermore, Nagada T (8.70 %) had a lower percentage of individuals with severe
35
cribra orbitalia than Nagada B. Again though, these differences were not significant
(Kruskal-Wallis test: X2=4.310, df=5, p=ns).
Figure 10 - Percentage of individuals with each severity score of cribra orbitalia, by
population
36
Figure 12 - Percentage of individuals with severe cribra orbitalia (scores 3 & 4), by
population
37
38
39
40
3.1.2.2. Severity
Similar to cribra orbitalia, the severity of porotic hyperostosis showed
differentiation between populations; the overall severity distribution is presented in
Figure 16. El-Badari had the highest average severity (1.50), and Nagada B (0.83),
Nagada T (0.83) and Abydos (0.84) had the lowest (Figure 17). Again, these
differences were fairly small, although highly significant (Kruskal Wallis test:
X2=17.779, df=5, p<0.005). El-Badari, Tarkhan and Hierakonpolis were the only
populations to have any individuals with the most severe porotic hyperostosis scores
(3 and 4), whereas Nagada B, Nagada T and Abydos all had no such individuals
(Figure 18). Overall though, these differences were not significant (Kruskal Wallis
test: X2=5.590, df=5, p=ns).
Figure 16 - Percentage of individuals with each severity score of porotic
hyperostosis, by population
41
42
43
44
45
46
a similar overall pattern to the initial graph for LEH prevalence (Figure 20),
suggesting that the likelihood of recording LEH in an individual was affected by the
number of scorable teeth that that individual had; the populations with the three
highest average numbers of scorable teeth per individual, El-Badari, Abydos and
Tarkhan, also had the highest percentage of individuals with LEH. This was confirmed
by the finding that individuals with LEH had a higher average number of scorable
teeth than individuals without LEH in all populations (Figure 24). Finally, there was a
highly significant association between the number of scorable teeth per individual
and the number of those teeth with LEH in the overall sample (excluding individuals
with no scorable teeth, who would always have no teeth with LEH) (Kendalls tau
correlation test: =0.516, p<0.001 (1-tailed)) (Figure 25). All of these tests together
suggest that LEH prevalence was affected by preservation bias.
Figure 23 - Average number of scorable teeth per individual in each population
47
Figure 24 - Average number of scorable teeth in individuals with LEH and without
LEH, by population
48
49
A more specific source of preservation bias was that the overall number of
posterior teeth, i.e. molars and premolars (see Figure 26 for tooth types) was much
higher than the number of anterior teeth, i.e. canines and incisors (Figure 27). It has
been shown that anterior teeth have a greater susceptibility to developing LEH than
posterior teeth (Goodman & Armelagos 1985), and indeed in this study anterior
teeth were preferentially affected by LEH over posterior teeth (Figure 28). This could
have resulted in the prevalence of LEH being overestimated in the populations
where more anterior teeth were preserved. Indeed, the three populations which
show the highest LEH prevalence, El-Badari, Abydos and Tarkhan (Figure 20), do
have the highest numbers of preserved anterior teeth.
Figure 26 - Diagram of tooth types (Adapted from: (White & Folkens 2005))
50
Figure 27 - Average number of posterior and anterior teeth per individual in each
population
51
52
53
54
posterior teeth should be viewed as most accurate and feasible way of comparing
LEH prevalence between populations (Figures 29 & 30).
Table 5 - Percentages of the highest frequency molar, premolar, canine and incisor
with LEH, by population
Population
Left maxillary
second molar
Right
maxillary
second
premolar
Right
maxillary
canine
Right
maxillary
second
incisor
El-Badari
8.70 % (2 of
23)
9.52 % (2 of
21)
31.58 % (6 of
19)
16.67 % (1
of 6)
Hierakonpolis
6.67 % (1 of
15)
0.00 % (0 of
10)
0.00 % (0 of
1)
0.00 % (0 of
1)
Nagada B
7.14 % (1 of
14)
0.00 % (0 of 5)
Nagada T
9.09 % (1 of
11)
25.00% (1 of
4)
0.00 % (0 of
1)
100.00 % (1
of 1)
Tarkhan
4.55 % (1 of
22)
12.50 % (2 of
16)
53.33% (8 of
15)
53.85 % (7
of 13)
Abydos
16.00 % (4 of
25)
0.00 % (0 of
21)
87.50 % (7 of
8)
50.00 % (3
of 6)
TOTAL
9.09 % (10 of
110)
6.49 % (5 of
77)
47.73 % (21
of 44)
44.44 % (12
of 27)
N.B. If a box has been left blank, no scorable teeth were present.
55
Table 6 - Percentages of the two highest frequency molars with LEH, by population
Population
El-Badari
8.70 % (2 of 23)
16.67 % (4 of 24)
Hierakonpolis
6.67 % (1 of 15)
10.53 % (2 of 19)
Nagada B
7.14 % (1 of 14)
8.33 % (1 of 12)
Nagada T
9.09 % (1 of 11)
28.57 % (2 of 7)
Tarkhan
4.55 % (1 of 22)
5.00 % (1 of 20)
Abydos
16.00 % (4 of 25)
7.41 % (2 of 27)
TOTAL
El-Badari
4.48
Hierakonpolis
4.98
Nagada B
5.00
Nagada T
4.83
Tarkhan
4.03
Abydos
4.45
TOTAL
4.50
56
Table 8 - Average age (years) of LEH formation in left maxillary second molar, by
population
Population
El-Badari
6.93
Hierakonpolis
7.03
Nagada B
6.71
Nagada T
6.04
Tarkhan
6.84
Abydos
5.87
TOTAL
6.40
Table 9 - Average age (years) of LEH formation in right maxillary second premolar,
by population
Population
El-Badari
4.59
Hierakonpolis
Nagada B
Nagada T
4.35
Tarkhan
4.76
Abydos
TOTAL
4.61
57
El-Badari
4.20
Hierakonpolis
Nagada B
Nagada T
Tarkhan
4.10
Abydos
3.49
TOTAL
3.93
Table 11 - Average age (years) of LEH formation in right maxillary second incisor, by
population
Population
El-Badari
3.35
Hierakonpolis
Nagada B
Nagada T
3.76
Tarkhan
3.36
Abydos
2.92
TOTAL
3.28
58
Overall, there was no significant difference between males and females in the
prevalence of cribra orbitalia (severity score 2 or above) (Fischers Exact test: p=ns),
the prevalence of porotic hyperostosis (severity score 2 or above) (Fischers Exact
test: p=ns), or the prevalence of LEH (posterior teeth) (Fischers Exact test, p=n). This
was consistent across populations as well as in the overall sample. Although this lack
of difference may be suggestive, these results must be treated with caution as the
sample size of individuals with assigned sex was very small for many of the
populations and it is difficult to assign sex accurately using just cranial remains. Thus,
the same statistical tests were also run using the pre-assigned sex values recorded in
the original excavation reports. Again there were no significant differences between
males and females in the prevalence of any of the stress markers.
3.2.2. Age
Although the variation in the stress markers by age was not assessed in this
study, the potential bias of including a small number of subadults in the sample was
measured. Apart from one individual in the Abydos group, it was only the Nagada T
group which contained any individuals that classified as either subadults or
undefined age. However, no significant differences were found between adults and
undefined individuals when the frequencies of the different stress markers were
compared within the Nagada T group (Mann-Whitney tests: U=50.000, Z=0.000,
p=ns; U=15.000, Z=-0.522, p=ns; U=11.000, Z=-0.264, p=ns) (it was not possible to
carry out adult to subadult comparisons because of the small subadult sample size).
This suggests that the effects of having a potentially younger age distribution (at
least in terms of subadults vs adults) than the other populations was probably small.
59
60
CHAPTER 4 DISCUSSION
4.1. Health and cultural changetemporal trends in the stress markers
4.1.1. The Badarian period
When viewed temporally, the results of this study show that health changed
substantially over the period of state formation in Egypt. The population from ElBadari, which represent the first predominantly agricultural society to inhabit Upper
Egypt, has the highest prevalence (severity score two or above) and among the
highest average severities of both cribra orbitalia and porotic hyperostosis, as well
one of the highest prevalences of LEH (just using posterior teeth) of all the
populations sampled. The high prevalence of all three skeletal stress markers in the
population strongly suggests that their overall health was poor. Although it is not
possible to say on the basis of this data how health changed from the period
preceding the Predynastic, the poor health among the Badarian population supports
the current thinking that the transition to agriculture in many regions of the world
resulted in an initial decline in overall health. Documented health problems that
arose with agriculture include increased prevalence of dental caries (cavities) due to
the increase of starch-based foods in the diet, the increased prevalence of infectious
disease as a result of increased population density and sedentism, and an increase in
nutritional disorders because of reduced diversity and nutritional content of some
agricultural products (Larsen 1995).
The high prevalence of all three stress markers suggests overall poor health
among the Badarian population, but in particular the high cribra orbitalia and porotic
hyperostosis prevalences could plausibly be linked to an increased prevalence of
61
62
these groups represent different social groups of Egyptian society, this suggests that
the overall improvement in health occurred regardless of social status.
This improvement is most likely nutritional in origin as the result of agricultural
diversification and a wider range of foods being incorporated into the diet. A review
by Greene (2006) of recent evidence, including that from archaeobotanical studies,
states that vegetables and fruits known to have first appeared during the
Predynastic Period include fig, watermelon, cucumber, turnip, lentil, chickling vetch,
grape, pea and date palm. Several of these, i.e. pea, lentil and watermelon are rich in
iron, and a greater bioavailability of iron may explain why the prevalence of porotic
hyperostosis and cribra orbitalia decreased after the Badarian period. Another
important addition to the diet in the Mid Predynastic was beer, made by fermenting
barley. The earliest evidence for beer production comes from locality HK-21A at
Hierakonpolis, dating to the transition between the Nagada I and Nagada II periods,
with the discovery of a brewery containing beer residues (Geller 1992). Beer was
nutritionally-rich, containing vitamins, protein, starch and calories, as well as having
a low alcoholic content that would have disinfected the water used to make it
(Samuel 1993; Greene 2006), and along with bread became a dietary staple for the
ancient Egyptians. Fragmentary evidence makes it difficult to document any change
in the level of animal protein consumed, but it is plausible that as agriculture became
better established within the Nile Valley meat was eaten on a more regular basis.
Furthermore, there is evidence for increasing dietary uniformity across Egypt after
the Badarian period: on the basis of archaeobotanical and archaeozoological remains
from various Upper and Lower Egyptian sites dating to the early fourth millennium
63
Wengrow (2006) has argued that a broadly similar diet was eaten, consisting of
cultivated cereals, flax, lentil and pea, wild root-foods, figs and berries, animal
products from cattle, sheep, goats and pigs, and a limited amount of acquatic fauna.
Certainly, there is an overall picture of the diet becoming more diverse as the
Predynastic Period progressed.
It is also likely that the increasing ability to produce agricultural surplus brought
greater nutritional security against food shortages resulting from unpredictable Nile
flooding, and therefore fewer episodes of nutritional stress. The large reduction in
LEH prevalence observed after the Badarian period signifies that fewer children were
suffering from severe growth disruptions which could have been caused by
nutritional stress. Undeniable evidence that agricultural surplus was being produced,
and in increasing quantities, is suggested by the growth of craft specialisation
throughout the Nagada I,II and III periods, as this indicates that segments of the
population no longer had to work as farmers (Bard 2008). This is apparent from the
appearance of specialised craft areas associated with settlements, such as locality
HK29A at Hierakonpolis (Nagada II) which is associated with debris from flint working
and drills for making beads and vessels (Wengrow 2006). There was also an
increasing focus on specialist, high-quality objects placed in elite burials (Bard 1989).
As mentioned before, the decrease in skeletal stress markers occurred regardless of
the social status of the groups sampled and so may suggest that the growing ability
of elites to control resources and divert agricultural surplus to producing specialist
prestige goods for their own benefit did not pose a significant threat to the health of
the general population.
64
66
the effect would be more severe at Memphis than Tarkhan because this was the new
political capital. Furthermore, during the time period in which the majority of the
individuals sampled from Tarkhan lived (Protodynastic/Nagada III period), political
power and thus probably settlement was focused on Upper rather than Lower Egypt
(Tarkhan is in Lower Egypt). One might therefore expect that urbanisation would
have a less severe effect on health at Tarkhan than at sites in Upper Egypt.
This decline in health has important implications for our understanding of the
process of urbanisation in early Egypt and the effects it had on society. This is a topic
for which we know relatively little compared to other aspects of state formation and
the growth of urbanisation in other early states such as Mesopotamia, largely due to
poor preservation of early settlements and the technical difficulties of accessing
them. Population aggregation undoubtedly brought many advantages to those
involved, including the increased security of living in a larger settlement and more
permanent and strategic positioning for trade (Bietak 1979). Urban centres also
provided strategic foci at which elites could materialize their power, a process that
was essential to state formation. However, the results of this study suggest that
these developments occurred at a cost to peoples physical wellbeing. Moreover, it
seems that there was a threshold at which urbanisation had a negative impact on
health, as although settlement growth was already evident by the Nagada II period
in Egypt, it is only from the Protodynastic (Nagada III) period that a health decline is
observed in this study.
The negative effects of urbanisation on health were probably exacerbated by
possible warfare that has been suggested in the lead up to political unification. There
67
4.2.1. Servants to the First Dynasty kingssubsidiary burials around the royal
funerary enclosures
The Abydos group is of great interest for the discussion of social status and health
as it represents a group of individuals with a relatively clearly defined social context
and unusual burial pattern. It is first worth pointing out that the picture of health
that is revealed for these individuals is for their childhood; this is obviously the case
68
for all of the populations studied, but in the case of Abydos the social context that
we have built up for them is based on their adulthood occupations. Therefore, it is
not possible to assess their health when they were working as artisans and officials
for the king. However, given that there is evidence that social status in the broadest
sense was inherited rather than acquired in early Egypt (for example, wealthy burials
of infants as well as adults have been found in several Predynastic elite cemeteries,
including at Abydos (Wilkinson 2000)), it would be reasonable to assume that
artisans and officials working for the royal court would have come from families
which had a similar relationship to the king and thus social status. We can also place
this in the context of what we know from later periods that the social standing of a
typical elite family would be largely based on the social standing of the male head of
household, most likely determined by his position within the administrative
hierarchy and thus relationship to the king (as most officials were male). Thus, we
can infer that the health of these individuals when they were children was related to
their social status as adults.
When compared to all of the other populations sampled, the Abydos group has
the lowest cribra orbitalia prevalence and average severity, the second lowest
porotic hyperostosis prevalence and the lowest porotic hyperostosis average
severity alongside the Nagada groups. These results are supported by the low values
of cribra orbitalia and porotic hyperostosis found by Keita and Boyce (2006) on the
same skeletal material. When considered in isolation, these results indicate that the
Abydos group had a good level of childhood health when compared to the other
populations. If both of these markers are indeed caused by iron-deficiency anaemia,
69
this could indicate that either the families in which these individuals grew up had
more nutritionally-rich food resources than the other groups sampled in this study
and/or that there were better social buffers within the group to protect against or
treat outbreaks of disease which lead to the loss of iron. The low average severity
scores for both stress markers indicate that even when individuals did suffer from
poor health, it tended to be of lower severity than other the populations sampled.
Moreover, the high status Abydos group appears healthier for cribra orbitalia and
porotic hyperostosis than the Tarkhan group, which most likely represents a mixture
of different social classes. Tarkhan is the closest group temporally to Abydos and so
such a comparison is particularly revealing as it minimises the effects of more
general changes in health through time. Thus, there is an argument for high status,
as defined by a close relationship with the king, correlating with good health.
Evidence from later Dynastic tomb scenes certainly indicates that high status
individuals would have eaten well and that the general diet suggested would have
provided adequate nutrients (including enough iron) to ensure good health (Duhig
2000). In Old Kingdom elite tombs, scenes commonly depict agricultural or food
production activities, which the owner is often portrayed as overseeing. Rich food
offerings are also displayed and although such scenes are usually considered as
being highly idealised they are presumably a reflection to some degree of what were
considered luxurious foods in life. Suggestion that high status individuals ate well is
also indicated by some relief and sculptural depictions of the tomb owner, in which
they are portrayed as being overweight (Darby et al. 1977). Thus, we might assume
70
that the high status individuals at Abydos would have had access to the best, and
most nutritional, food resources available during the First Dynasty.
However, in contrast LEH prevalence is very high. As the three stress markers do
not show the same trend, it is quite difficult to assess health accurately. The LEH
results need to be considered with caution as they were undoubtedly affected by the
high preservation level of teeth in comparison to other populationsAbydos had the
second highest average number of scorable posterior teeth per individualmeaning
that LEH had a higher chance of being recorded than several of the other
populations sampled.
If LEH prevalence was high in comparison to the other stress markers among the
Abydos group, this could suggest that the causes of LEH, and cribra orbitalia and
porotic hyperostosis were different and therefore that they represent different
aspects of childhood health. One possibility is that LEH was caused predominantly by
disease, but cribra orbitalia and porotic hyperostosis were predominantly nutritionbased. Such a scenario would be possible if the individuals were given better food
resources than the general population because of their enhanced family status, and
thus fewer individuals were vulnerable to cribra orbitalia and porotic hyperostosis,
and yet were still predisposed to high disease levels because they lived in a highdensity settlement. Given that the royal court was located in the capital Memphis
(Bard 2008) (Abydos was the mortuary capital at this time, not the political capital),
settlements with a large population density would be feasible, and even if the
Abydos individuals grew up in settlements other than Memphis before they took on
roles in the royal court, the general growth of urbanisation and population
71
aggregation within Egypt at the time discussed earlier would have increased the
chances of disease spread in many regions. Further investigation is needed before
any definite conclusions can be made and it is beyond the scope of this study to
examine the exact causes of poor health in detail. However, the picture gained so far
is that although these individuals might have gained some health benefits from their
high status, it was not enough to protect against the most severe stresses of the
physical environment that caused growth disruption (resulting in high LEH).
Another possible reason as to why the Abydos individuals did not have as good a
level of health as might have been expected is that they were still essentially
servants to the king. This is supported by the belief that the primary function of royal
subsidiary burials was provision for the afterlife (Kemp 1967; Bestock 2007;
OConnor 2009). The importance of having servants in the afterlife is supported by
the later appearance of servant statues within tombs. Furthermore, the subsidiary
burials represent a substantial matarialisation of power, a central theme in Egyptian
kingship to demonstrate the power of the king over the elite classes. However, in
ancient Egypt the role of kings servant was actually a very privileged position to
hold. This loyalty to the king is well demonstrated in the later Sixth Dynasty
autobiography of an official called Weni (Lichtheim 1975), who expresses great pride
in his various roles in service of three different kings. Thus, the earlier hypothesis
that the high LEH prevalence among the Abydos individuals could have been the
result of increased disease spread with urbanisation is strengthened.
72
74
75
lower status individuals from Cemetery B. Again, this may suggest that the health
risks associated with urbanisation had a negative impact on people regardless of
their social status.
The relationship between the health and the environment is complex and there
are obviously limitations in what skeletal data can reveal about cultural change.
Perhaps the biggest hindrance arises from the general neglect of the earliest
excavations in Egypt to record skeletal remains with the level of detail they require.
Multiple interpretations are also possible from the measurement of stress marker
frequencies and their exact causes are still debated, but by linking the data closely
with the archaeological evidence the most important causes of the observed
differences in health can be ascertained. This study has gone further than others in
relating the skeletal material back to its original context as much as possible.
The results of this study have raised several issues that need to be addressed in
more detail in future research, such as whether urbanisation had the same effects
on health across the whole of Egypt and whether or not there was a relationship
between health and social status in later periods. Where time allows, larger sample
sizes of the same skeletal populations examined in this study would increase the
reliability of the statistical analyses used. Future research should continue to focus
on investigating changes in skeletal health over relatively short periods of time. Only
by doing this can the most likely cultural factors underlying any changes be revealed.
Most importantly, by looking at social status a number of new questions have been
raised, demonstrating the promise of this approach.
77
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APPENDICES
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